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Although our knowledge of the SARS-CoV-2 coronavirus (and COVID-19, the disease that causes it) is still uncertain in many areas, the link between diabetes mellitus and severe COVID-19 infection is one of the strongest associations that have occurred so far.

Some have suggested that the COVID-19 pandemic provides an opportunity to improve care for diabetic patients. Here we review what is known about the relationship between diabetes and COVID-19, and what individuals with a non-pharmaceutical approach can do to improve their diabetes management.

Diabetes – in a nutshell

Diabetes mellitus is a condition characterized by high blood sugar and impaired insulin secretion or function. It has been called “the epidemic of the 21st century”.

Type 2 diabetes Often referred to as adult diabetes, it involves decreased insulin secretion and insulin resistance, which means that cells are less responsive to the effects of insulin.

Type 1 diabetes is an autoimmune disease that typically begins in childhood, when the beta cells in the pancreas that are responsible for producing insulin are destroyed. As a result, the patient can no longer produce his own insulin and has to inject insulin.

The Diabetes-COVID Relationship

There have now been many reports showing that patients with diabetes are prone to a more severe course of COVID-19. The underlying metabolic disorders (disorders) in diabetes have been thought to cause an impaired immune response and exaggerated inflammation when infected with the coronavirus.

An early study found that “Patients with diabetes have higher levels of serum inflammatory markers, including lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin, D-dimer, lower lymphocyte counts, and more pronounced computed tomography (CT) pathologies that indicate an overall more serious and in particular indicate lung involvement. “

In particular, an increased D-dimer indicates a state of increased coagulation hypercoagulability and is particularly associated with the risk of death from COVID-19.

A large Chinese study of 1,099 COVID patients found that diabetics with COVID-19 were more likely to need intensive care compared to non-diabetic COVID patients. A total of 22 percent of COVID patients in the intensive care unit were diabetic, compared with just 10 percent of COVID patients outside the intensive care unit.

In addition, there was a 3.6 times higher rate of diabetes in COVID patients who needed intensive care and mechanical ventilation or who died.

In analyzes of 2,003 deaths in China and Italy, the prevalence of diabetes in deceased COVID patients was twice that of surviving COVID patients.

Another Italian study of 3,988 intensive care patients found that type 2 diabetes was linked to an 18 percent increased risk of dying from COVID.

A study in Wuhan, China found that in 605 non-diabetic COVID patients, elevated fasting blood sugar (≥ 7.0 mmol / L) at hospitalization within 28 days was significantly linked to the risk of death.

A fasting glucose of 7.0 mmol / L or more is diagnostic of diabetes, while 6.1 mmol / L or more is defined as pre-diabetes (<5.6 mmol / L is considered normal). In this study, a fasting glucose of 7.0 or more was associated with a 2.3-fold increased risk of death within 28 days, while a fasting glucose of 6.0 or higher was associated with a higher rate of complications during the hospital stay.

This study suggests that optimal glucose control can be important for everyone, including those without a diagnosis of diabetes, when it comes to reducing COVID risk and / or severity.

Animal studies of viral infection suggest why this is so: Elevated blood sugar levels facilitate local virus replication in the lungs and inhibit the antiviral immune response.

There is currently no good data distinguishing the effects of type 1 diabetes versus type 2 diabetes on morbidity and mortality from COVID, although a publication indicated that there was no evidence of increased COVID in Belgium in the first year – Hospitalization rate in type 1 diabetics gave three months of the pandemic.

Improve diabetes

Based on the data so far, it seems reasonable that better blood sugar control can lead to a reduction in the morbidity and mortality of COVID. It should be noted that more research is needed in this area and that diabetes management is not a substitute for following public health measures for COVID prevention. With this in mind, weight loss, diet, and exercise are the most important lifestyle factors for managing diabetes.


A diet high in green and colored vegetables and less refined carbohydrates with moderate amounts of lean protein and healthy fats like nuts, olive oil, and fish mimics the Mediterranean diet that has consistently benefited diabetes and heart disease.


Regular exercise five times a week for up to an hour improves insulin sensitivity and promotes weight loss.

coping with stress

Managing stress is also an important consideration, especially given that many of our unhealthy behaviors are an adaptation to life stress and contribute to a vicious circle. Stress hormones like cortisol and adrenaline raise blood sugar and cortisol inhibits weight loss.

The vitamin D compound

In addition to better diabetes management, there is also evidence of a connection between vitamin D deficiency (<50 nmol / l serum 25 (OH) D level) and COVID infection.

One study reported a higher rate of vitamin D deficiency in COVID patients in the intensive care unit compared to COVID patients in the intensive care unit: Only 19 percent of patients in the intensive care unit had serum 25 (OH) D levels greater than that than 50 nmol / L compared to 39 percent in intensive care patients.

In another study of 499 patients, the predicted COVID-19 rate in the vitamin D deficient group was 21.6 percent versus 12.2 percent in the vitamin D deficient group. Since diabetics have higher levels of vitamin D deficiency, optimizing vitamin D levels is another strategy that could help reduce the risk in those with diabetes. The vitamin D level should be at least 75 nmol / l.

Natural health products (NHPs) can help

Include NHPs with evidence of blood sugar regulation in patients with diabetes

  • Vitamin D
  • Berberine
  • Alpha lipoic acid
  • chrome
  • Inositol
  • Curcumin

Other NHPs with additional benefits for secondary goals like cardiovascular health and inflammation include

  • Fish-derived omega-3 fatty acids eicosapentanoic acid (EPA) and docosahexanoic acid (DHA)
  • Probiotics

Consult a licensed naturopathic doctor to determine which NHPs are best for you.

Diabetes and Stress Management

How stress affects diabetes
  • The stress hormones cortisol and adrenaline increase blood sugar levels and worsen insulin resistance.
  • “Stress eating” is characterized by poor eating habits and leads to a deterioration in blood sugar control.
  • High stress conditions tend to pull us back into old (bad) habits.
Healthy stress management
    • Go outside in nature: go for a walk outside, hike, work in the garden.
    • Avoid or limit caffeine, sweets, and alcohol, which can alter stress hormones, sleep patterns, and cause anxiety.
    • Take part in creative activities such as painting, drawing, playing instruments, or other artistic activities.
    • Practice prayer and meditation regularly.
    • Maintain regular sleeping habits.
    • As much as possible, avoid having negative or “toxic” people in your life, or limit their psychological influence on you.
    • Consider natural health products that can help regulate your stress response, including adaptogenic herbs (like ashwagandha, rhodiola, and schisandra), B vitamins, omega-3 fatty acids, and others.

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