Challenges in hyperglycemia management in critically ill patients with COVID-19

Abstract

Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the corona virus disease 2019 (COVID-19) pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality. The proposed hypothesis for hyperglycemia in COVID-19 include insulin resistance, critical illness hyperglycemia (stress- induced hyperglycemia) secondary to high levels of hormones like cortisol and catecholamines that counteract insulin action, acute cytokine storm and pancreatic cell dysfunction. Diabetic patients are more likely to have severe hyperglycemic complications including diabetic ketoacidosis and hyperosmolar hyperglycemic state. Management of hyperglycemia in COVID-19 is often complicated by use of steroids, prolonged total parenteral or enteral nutrition, frequent acute hyperglycemic events, and restrictions with fluid management due to acute respiratory distress syndrome. While managing hyperglycemia special attention should be paid to mode of insulin delivery, frequency of glucose monitoring based on patient and caregiver safety thereby minimizing exposure and conserving personal protective equipment. In this article we describe the pathophysiology of hyperglycemia, challenges encountered in managing hyperglycemia, and review some potential solutions to address them.

UTI COVID-19: Perfil dos pacientes internados e possíveis interações medicamentosas descritas para os medicamentos mais prescritos

“…A insulina, por sua vez, ao ser identificada em 50% (11) dos prontuários, evidencia a hiperglicemia como um desfecho adverso em pacientes com COVID-19, mesmo na ausência de diagnóstico prévio de diabetes, visto que o percentual de pacientes com diabetes preexistentes era inferior (27,3%). A hiperglicemia pode ser fruto de fatores mediados por infecção como: resistência à insulina associada ao excesso de liberação de hormônios do estresse, tempestade inflamatória e alterações morfológicas e funcionais causadas pelo vírus CO-VID-19 ao infectar as células do pâncreas 28 . Nas prescrições dos pacientes que participaram do presente estudo, a insulina estava prescrita na forma de SOS (uso quando necessário), já que esse distúrbio na glicemia pode ser transitório.…”

Impact of COVID-19 on Short- and Medium-Term Prescription of Enteral Nutrition in the General Population vs. Older People in the Community of Madrid, Spain

“…Hyperglycemia is commonly associated with adverse outcomes especially in patients requiring intensive care unit stay. Data from the COVID-19 pandemic indicates that individuals with diabetes appear to be at similar risk for COVID-19 infection to those without diabetes but are more likely to experience increased morbidity and mortality [ 13 ].…”