Diabetes Risk Increases After Covid 19 Diagnosis

Overview

Some research suggests that people who have had COVID-19 may be a little more likely to be diagnosed with diabetes in the weeks and months afterwards. This is not about catching diabetes from someone else. It is about the body's blood sugar control being affected after an infection. Diabetes happens when the body cannot keep the level of sugar in the blood in a healthy range. Either the body stops making enough insulin (a hormone that moves sugar from the blood into your cells for energy), or the body's cells stop responding well to insulin, or both. Most people who have COVID-19 do not go on to develop diabetes. The rise in risk is small for most people, and it matters most for people who already had a higher chance of diabetes before they became ill.

New diabetes after COVID-19 is not common. Even in the largest studies, only a small number of people who had COVID-19 went on to be diagnosed with diabetes. For most people, the chance stays low. Doctors are still learning how much of the rise is caused by the virus itself and how much is down to other things, such as steroid treatment during illness, weight changes, or health checks that would not otherwise have happened.

Anyone who has had COVID-19 can be affected, but the risk is higher for people who were already at risk of type 2 diabetes. That includes people who are living with overweight or obesity, people over 40 (or over 25 for some South Asian, African and Caribbean backgrounds), people with a parent or sibling with diabetes, women who had diabetes in pregnancy, people with polycystic ovary syndrome, and people who needed hospital treatment or steroid medicines for COVID-19. Children can develop diabetes after illnesses too, but this is usually type 1 diabetes and is rare.

Symptoms

Common symptoms

• Feeling very thirsty, even after drinking
• Needing to pee more often, especially at night
• Feeling tired or lacking energy
• Blurred vision
• Cuts and sores that heal slowly
• Losing weight without trying
• Tingling, numbness or pain in the feet or hands
• Getting repeated infections, such as thrush or skin infections

Symptoms in children

• Losing weight quickly while still eating
• Being very thirsty and needing to pee a lot, sometimes wetting the bed again after being dry
• Tummy pain, feeling sick or being sick
• Feeling very tired, sleepy or grumpy
• Breathing fast or deeply, which needs urgent medical help

Symptoms in older adults

• Confusion, memory problems or a change in usual behaviour
• Feeling unusually weak, unsteady or having falls
• Losing weight without trying
• Feeling very tired with no clear reason
• Repeated urine or skin infections

Causes

Main causes

• The virus that causes COVID-19 can attach to cells in the pancreas, the organ that makes insulin. Inflammation during infection may temporarily or, in some people, lastingly affect how well insulin works.
• Serious infection puts the body under stress. Stress hormones raise blood sugar, and this can be hard for the body to bring back to normal afterwards.
• Steroid medicines, which are used to treat some people with severe COVID-19, are known to raise blood sugar. This usually settles after the medicine stops, but not always.
• Illness often brings weight gain, less physical activity and poorer sleep, all of which make type 2 diabetes more likely.
• Some people already had diabetes or pre-diabetes before COVID-19 and only found out because they had blood tests during or after their illness.

Risk factors

• Living with overweight or obesity, especially around the waist
• Being older, or being from a South Asian, African, Caribbean or Middle Eastern background, where risk starts at a younger age
• A parent, brother or sister with type 2 diabetes
• Having had diabetes in pregnancy (gestational diabetes)
• Polycystic ovary syndrome
• High blood pressure or high cholesterol
• Taking steroid medicines now or in the past
• Having had severe COVID-19, especially if you were in hospital
• Smoking and drinking a lot of alcohol
• Poor sleep and long-term stress

When to see a doctor

See a doctor urgently if:

• You have the classic signs of high blood sugar: strong thirst, peeing much more than usual, weight loss without trying, and blurred vision
• You feel very drowsy, confused, or are breathing fast and deeply
• You have vomiting with tummy pain and cannot keep fluids down
• You have a wound or infection that is getting worse quickly

Book a routine appointment if:

• You had COVID-19 recently and have been feeling more tired or thirsty than usual
• You have one or more risk factors for type 2 diabetes and have not had a blood sugar check in the last year
• You were treated with steroid medicines and want to check how your blood sugar is doing
• You are living with extra weight and would like support to make healthy changes

Diagnosis

Diabetes is diagnosed with a blood test, not by how you feel. Your doctor will ask about your symptoms, your health history and your family, then arrange a blood test. If the first result is borderline, you may have a second test on a different day to confirm. If you are unwell with clear symptoms, one clearly high result may be enough.

Tests that may be done

• HbA1c: a single blood test that shows your average blood sugar over the past two to three months
• Fasting blood glucose: a blood test taken after not eating for around eight hours
• Random blood glucose: a blood test taken at any time, usually when you have symptoms
• Oral glucose tolerance test: a sugary drink followed by blood tests over about two hours; often used in pregnancy
• Urine test: to check for sugar or ketones, which are made when the body burns fat instead of sugar
• Blood pressure, cholesterol and kidney checks, offered alongside the blood sugar test

What to expect at your appointment

The whole thing is usually quick. You may be asked to avoid food for a few hours before a fasting test, so bring a drink and a snack for afterwards. Results normally come back within a few days. Your doctor will explain what the numbers mean and whether you need a repeat test, a check for pre-diabetes, or a referral to a diabetes team. Nothing about this is a judgement on you. Diabetes is common and very treatable.

Treatment

If diabetes is found, the aim of treatment is simple: keep your blood sugar in a healthy range so you feel well and lower your chance of long-term problems. Treatment is planned around you. Many people start with changes to food, activity and sleep, and some also need medicine. If your blood sugar is high because of recent steroid treatment or a recent illness, your doctor may want to repeat the test in a few weeks to see whether it settles on its own.

Self-care at home

• Eat regular meals and build them around vegetables, beans, lentils, wholegrains and lean proteins
• Cut back on sugary drinks and fruit juice, which push blood sugar up quickly
• Aim for some movement most days, building up gradually to around 150 minutes a week of brisk activity
• Try to lose a modest amount of weight if you are carrying extra, even a small amount can make a real difference
• Get enough sleep and find ways to manage stress
• Attend your check-ups even when you feel fine, and ask your pharmacist or local health service if you are unsure about anything
• Learn the warning signs of very high and very low blood sugar, and keep them where family members can see them

Medical treatments

Treatment is matched to the type of diabetes you have and to your other health conditions. Most people with type 2 diabetes are offered a combination of lifestyle support and tablets that help lower blood sugar; some later need insulin or other injectable medicines. People with type 1 diabetes need insulin from the start. Your doctor may also suggest treatment for blood pressure and cholesterol, because protecting the heart, eyes, kidneys and feet is part of good diabetes care. Your care team will choose medicines that suit your kidneys, heart and daily routine, and will review them regularly. Never start or stop a medicine on your own; talk to your doctor or pharmacist first.

When is surgery considered?

Surgery is not used to treat diabetes itself. Some people with obesity and type 2 diabetes are offered weight-loss surgery (bariatric surgery) through specialist services when other approaches have not worked and their health would benefit. This is a decision made with a specialist team, not something you need to think about at the start.

Living with this condition

Living with diabetes is mostly about small, steady routines rather than big dramatic changes. Checking your sugar if your team asks you to, taking medicines as prescribed, eating regular meals and staying active become part of normal life. Expect good days and less good days. A single high reading after a birthday party is not a failure; what matters is the pattern over weeks and months.

Lifestyle tips

• Keep a simple routine for meals, sleep and movement, and build from there
• Carry water and a healthy snack with you, especially if you use medicines that can lower blood sugar
• Look after your feet: check them daily, keep nails tidy and wear well-fitting shoes
• Look after your teeth and gums with regular brushing and dental check-ups
• If you smoke, ask your local health service for stop-smoking support; it is one of the biggest things you can do for your health
• Keep alcohol within low-risk limits and never on an empty stomach if you use insulin or certain tablets
• Have a sick-day plan from your care team, because illness and dehydration can raise blood sugar

Diet and exercise

You do not need a special diet or to give up foods you love. Build meals around vegetables, beans, lentils, wholegrains, nuts, eggs, fish and lean meat, and choose water or unsweetened drinks instead of sugary ones. Eating at regular times helps keep blood sugar steady. For movement, anything counts: walking, gardening, swimming, cycling, dancing or chair-based exercise. Aim for a little more each week and add some strength work twice a week if you can. If you use insulin or medicines that can cause low blood sugar, check with your team about eating and exercise timing. A dietitian or a local healthy-lifestyle service can help you build a plan that fits your life and your budget.

Mental health and emotional wellbeing

Being told you have diabetes, or worrying about it after an illness, can bring up a lot of feelings: shock, worry, guilt, or feeling overwhelmed by information. That is very common and it is not a sign of weakness. Some people find their mood dips or they feel anxious about food and numbers. Talking helps, whether that is with a friend, your doctor, or a trained counsellor. If you ever have thoughts of harming yourself, please reach out right away to your local emergency number or a crisis line in your area, or speak to someone you trust who can stay with you. You deserve support, and good support is available.

Prevention

You cannot fully control whether you develop diabetes, but you can lower your risk. Staying up to date with COVID-19 vaccination reduces your chance of severe illness, which is the situation most linked with blood sugar problems afterwards. Looking after your weight, staying active, eating well, sleeping enough and not smoking all lower your risk of type 2 diabetes, whether or not you have had COVID-19. If you had steroid treatment or a severe infection, ask your doctor whether a follow-up blood sugar check would be sensible.

Vaccines

Vaccination against COVID-19 is still recommended in many countries, especially for people with diabetes or other long-term conditions, because it lowers the risk of severe illness. People with diabetes are usually advised to have flu and pneumonia vaccines too. Ask your doctor or pharmacist which vaccines are right for you and when.

Screening programmes

Many health systems offer a free or low-cost blood sugar check to adults in certain age groups or with risk factors, even if they feel completely well. If you have had COVID-19 and you have any risk factors, it is reasonable to ask your doctor whether you should be checked. A single blood test is all it usually takes, and finding a high blood sugar early gives you the best chance of staying well.

Complications

If left untreated

• Blood sugar that stays high can damage the small blood vessels and nerves over years
• Damage to the eyes that can affect sight if not found and treated
• Kidney damage, which is why kidney checks are part of routine diabetes care
• Numbness, ulcers and, rarely, serious foot problems
• A higher chance of heart attack and stroke
• Sexual difficulties and bladder problems
• Gum disease and slower healing of wounds
• Very high blood sugar can, rarely, lead to a medical emergency needing hospital care

Long-term outlook

The outlook is genuinely encouraging. Early diabetes and pre-diabetes can often be improved a lot, and sometimes brought back into the normal range, through weight loss, activity and healthy eating. Modern care means most people with diabetes live full, active lives with no serious problems. Regular check-ups catch small issues before they become big ones. If you have had COVID-19 and are worried, the most useful thing you can do is ask for a simple blood test. Whatever the result, there is a clear next step and people ready to help you take it.

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