For some people, Covid-19 can trigger symptoms that last weeks or months after recovery from infection. This is sometimes called post-Covid-19 syndrome or "long Covid."
Although most people with Covid-19 get better within weeks of illness, some people experience post-Covid conditions – a wide range of new, returning, or ongoing health problems that last four or more weeks after first being infected with the virus. And now some Covid-19 survivors are reporting a severe spike in their sugar levels and an onset of diabetes.
Local medical experts are working to learn more about short- and long-term health effects associated with Covid-19, who gets them, and why.
On June 15, Eunice Nakintu walked into a medical clinic and received a positive Covid-19 diagnosis days after enduring constant mild headaches, colds, and fever. She gobbled up gallons of concoctions to ease the symptoms. On June 18, she developed severe illness, which required hospitalization.
On top of a severe headache and fever, she was unable to speak properly. She also developed breathing complications. She spent another two weeks on and off oxygen.
Luckily for her, the symptoms wore off and by the third week she was able to breathe on her own. But something new came up. Throughout her three weeks' stay in hospital, her toilet visits shot up from one to an average of four times. She was always thirsty and hungry. Her doctor was puzzled. He ordered a random blood test [RBS]. The results showed a spike in sugar levels; 19.7mmol/L [millimole per liter of blood] way above 7mmmol/L considered the upper limit of normal levels.
The spike was dangerously high for the 67-year-old Nakintu. Before she was discharged, the doctor urged her to monitor her sugar levels daily. His prediction was that after full recovery, the sugar levels will drop and normalise. It's now over a month since she left hospital but her sugar levels haven't dropped to the normal 7mmol/L. In the meantime, she is enrolled on anti-diabetic drugs to manage her condition.
Nakintu's story is a not an isolated one. Rogers Katumba, another Covid-19 survivor, has a similar tale to tell. Dr Monica Musenero, the minister of Science, Technology and Innovation and head of the Presidential Scientific Initiative on Epidemics [PRESIDE], said they have received a number of new diabetes cases brought on by Covid-19.
"It's a known phenomenon but what we are yet to find out is what exactly causes it. Sometimes, the treatment given to arrest inflammation caused by Covid causes diabetes. But we are still carrying out research to know exactly what causes it," Musenero said.
Interviewed for this story, Dr Emmanuel Onyait, who works at Kibuli hospital and treats diabetes patients, said steroid tablets given to deal with severe illness have aftershocks.
"Dexamethasone that is used in Covid-19 management causes intolerance and very high blood sugar levels. But its benefits in severe management of Covid-19 outweigh the risks," Onyait said.
Dr Xavier Kasujja, a researcher at Makerere University School of Public Health, who has written extensively about diabetes, said the drugs used to manage Covid-19 could be a trigger to the development of diabetes.
"Like most things about Covid-19, we really don't know why that is the case but it's an association we have noticed and people are trying to study it to get a clear understanding of it," Kasujja said.
He added, however, that some people's sugar levels normalize after a few months but for others their sugar levels stay high and must be handled just like any other diabetic case.
"People who have developed diabetes after Covid should see a physician because management is the same irrespective of how it came. If they don't do that, they risk damaging the blood vessels to all the vital organs of the body. So, irrespective of the cause, we really need to take control of that sugar," Kasujja said.
Asked whether the body doesn't get hooked to the anti-diabetic drugs if a person starts using them, Kasujja said there is no evidence to suggest that.
"The reason we know this is that in some people, diabetes goes away and they need less and less of the drugs. For the lucky ones, they eventually don't need any drugs at all. If they highly manage their diet and also do physical exercises, it will take the pressure off the pancreas, meaning it's able to regain control of the blood sugar," Kasujja said.
Dr Musenero said those who have the condition need to first visit Mulago hospital's Post-Covid facility and consult specialists before they start on anti-diabetic drugs.
"I know there are some doctors who are working to reverse this… For us in the management of Covid-19, such conditions have informed us about the changes in the treatment regimen. Therefore, people who develop such conditions before they enroll on diabetes treatment drugs, they should first seek advice," Musenero said.
According to an analysis published by the journal, Diabetes, Obesity and Metabolism, at least 14.4 percent of people hospitalized with severe Covid-19 developed diabetes. However, researchers are yet to find the connection between Covid-19 and diabetes.
"While newly diagnosed diabetes in Covid-19 patients could be attributed to the stress response associated with severe illness or treatment with glucocorticoids, the diabetogenic effect of Covid-19 should also be considered. This is supported by reports showing exceptionally high insulin requirements in severely or critically ill Covid-19 patients with diabetes. These appear disproportionate when compared with critical illness caused by other conditions," the analysis reads in part. It adds that in addition to defective insulin secretion, Covid-19 patients also present with a high degree of insulin resistance, particularly those with severe illness.
"It is not known whether this is because of the insulin receptor defects in the key metabolic organs associated with glucose metabolism or interference with the insulin receptor signaling by the virus," the report adds.
Like in Uganda, doctors elsewhere are still scrambling to find a definite answer to what is the relationship between Covid-19 and diabetes. However, what is no longer in disrepute is the fact that people with diabetes have more chances of developing severe illness after contracting Covid-19 and actually there is also a higher chance that they die from the disease.
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