Severe hyperglycemia and insulin resistance in patients with SARS-CoV-2 infection: a report of two cases

Abstract

Background Severe insulin resistance is an uncommon finding in patients with type 2 diabetes but is often associated with difficult to managing blood glucose. While severe insulin resistance is most frequently seen in the setting of medication side effects or rare genetic conditions, this report of two cases highlights the presence of severe insulin resistance in the setting of severe COVID-19 and explores how this may contribute to the poor prognosis of patients with diabetes who become infected with SARS-CoV-2. Case presentation Here we present the cases of two African-American women with pre-existing type 2 diabetes who developed severe COVID-19 requiring mechanical ventilation and concurrent severe insulin resistance with total daily insulin dose requirements of greater than 5 unit/kg. Both patients received aggressive insulin infusion and subcutaneous insulin therapy to obtain adequate glucose management. As their COVID-19 clinical course improved, their severe insulin resistance improved as well. Conclusions The association between critical illness and hyperglycemia is well documented in the literature, however severe insulin resistance is not commonly identified and may represent a unique clinical feature of the interaction between SARS-CoV-2 infection and type 2 diabetes.

Epidemiology and Pathophysiology of COVID-19-Associated Mucormycosis: India Versus the Rest of the World

“…The ACE2 protein allows entry of SARS-CoV-2 into pancreatic islet cells and may injure the beta cells [76,77]. Also, severe COVID-19 increases insulin resistance through enhanced secretion of stress hormones (cortisol and others) and cytokines [78].…”

COVID-19 and the Vasculature: Current Aspects and Long-Term Consequences

“…Pancreas : In post-mortem material of COVID-19 patients, the viral N protein was detected in β-cells located in islets of the pancreas, which have been proposed as potential site of viral replication ( Müller et al, 2021 ; Qadir et al, 2021 ). This resulted in an impaired production of insulin upon stimulation with glucose in vitro and could be the reason for the hyperglycemia observed in COVID-19 patients ( Zhu L. et al, 2020 ; Affinati et al, 2021 ; Montefusco et al, 2021 ; Müller et al, 2021 ).…”

Importance of Insulin Resistance in the COVID-19 Era: A Retrospective Analysis of a Single Center in Mexico

“…T2DM is characterized by an inflammatory state with endothelial damage that, it is thought, could favor a fatal outcome in patients with COVID-19 [8,9]; however, this state is already present before the clinical and biochemical diagnosis of T2DM in a context known as insulin resistance (IR) [10]. IR favors overexpression of angiotensin-converting enzyme 2 (ACE2) receptors, an enzyme necessary for the entry of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) into the host cell [7,11,12]; as a result, people with IR are expected to have a higher viral load. On the other hand, SARS-CoV-2 can cause direct pancreatic damage in up to 17% of COVID-19 patients [13].…”