Features
DIABETES AND COVID-19
It came from a student in health care training. I have diabetes increases the severity of COVID-19. I have a strong family history of diabetes. Kindly throw more light on the subject. In responding to this, I found a fine paper by Singh et al titled “Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practicalConsiderations and published in Diabetes& Metabolic Syndrome: Clinical Research & Reviews (2020).
The disease burden of coronavirus infectious disease 2019 (COVID-19) caused by
Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2) has been
Increasing continuously with more than five million confirmed patients and more than 350,000 deaths globally. With a high prevalence of diabetes, it is important to
understand the special aspects of COVID-19 infection in people with diabetes.
This becomes even more important, as most parts of the world introduced
restrictions on mobility of patients in order to contain the pandemic even though they are being eased in some countries.
Diabetes and associated complications can increase the risk of morbidity and
mortality during acute infections due to suppressed immune
functions. The levels of glycated haemoglobin (HbA1c) greater than 9% have been linked to a60% increased risk of hospitalization and pneumonia-related severity duringbacterial infection. Past viral pandemics have witnessed the association of
diabetes to increased morbidity and mortality. Diabetes was considered as
independent risk factor for complications and death during 2002-2003 outbreak of
Severe Acute Respiratory Syndrome (SARS-CoV-1). Similarly, the presence
of diabetes tripled the risk of hospitalization and quadrupled the risk of intensive
care unit (ICU) admission during Influenza A (H1N1) infection outbreak in 2009.During the 2012 outbreak of Middle East Respiratory Syndrome Coronavirus
(MERS-CoV), diabetes was prevalent in nearly 50% of population. Mortality rate in patients with MERSwho had diabetes was 35%.
Emerging data suggests that COVID-19 is common in patients with diabetes,hypertension, and cardiovascular disease (CVD). Evolving data also suggest that patients of COVID-19 with diabetes are more oftenassociated with severe or critical disease varying from 14-32% in different studies. SARS CoV-2, like SARS CoV utilises angiotensin converting enzyme 2 (ACE-2) as receptor for entry into cell.ACE2 is expressed not only in the type I and II alveolar epithelial cells in the lungsand upper respiratory tract, but also several other locations like heart, endothelium,renal tubular epithelium, intestinal epithelium, and pancreas.
S-glycoprotein on thesurface of SARS CoV2 binds to ACE-2 and causes conformational changes in the ACE-2 receptors are expressed in pancreatic islets. Infection with SARSCoV has been seen to cause hyperglycaemia in people without pre-existingdiabetes.
Hyperglycaemia was seen to persist for 3 years after recovery fromSARS indicating a transient damage to beta cells.
Metformin, a common medication used in diabetes, was significantly
associated with a decreased risk of mortality in patients with chronic lower
respiratory diseases. In a study of 4321 patients with a follow up of 2-
year period, metformin users had a significantly lower risk ofdeath compared with non-metformin users. Patients with coexistent chronic obstructive pulmonary disease and diabetes.
Glycaemic control is important in any patient who has COVID-19. Though data is still evolving, data from other infections like SARS and influenza H1N1
has shown that patients with poor glycaemic control have increased risk of
complications and death. Most patients with mild infection and with
normal oral intake can continue the usual antihyperglycaemic medications.
However, it is advisable to discontinue sodium glucose transporters (SGLT-2) inhibitors because of the risk ofdehydration and euglycaemic ketosis. Metformin may also need to be stopped ifthere is vomiting or poor oral intake. Doses of other antihyperglycemic drugs likesulfonylureas and insulin may have to be altered depending upon the blood glucoselevels.
Blood glucose monitoring poses a special challenge in COVID-19 as it necessitates frequentvisits to patient’s bedside, especially if the patient is critically ill and receiving insulin.
There are several studies about the protective effect of statins in pneumonia.
Statins are known to increase ACE-2 levels and may protect against viral entry of
SARS CoV2. Also, statins are known to inhibit Nuclear factor kappa B
(NFκB) activation and might help in blunting the cytokine storm- a causative factor in COVID-19 complications.
Calcium channel blockers (CCB) have been shown to reduce severity of disease
and mortality in patients with pneumonia, presumably by inhibiting calcium influx
into the cell. It is therefore safe to continue these drugs for control of blood pressurein hypertensive patients. Since CCB has no effect on ACE2 expression, someresearchers have proposed its preferable use in patients with COVID-19 and
hypertension.
So to recap high prevalence of diabetes is seen in patients with SARS-CoV-2 (COVID-19)and the presence of diabetes is a determinant of severity and mortality. Diabetes might facilitate infection by COVID-19 due to increased viral entryinto cell and impaired immune response.Blood glucose control is important for all patients who have diabetes andCOVID-19 infection.Telemedicine can be very useful for the management of patients with diabetes inpresent times with limited access to healthcare facilities.
Once again, make sure you regularly/daily consume polyphenol-rich cocoa to among others reduce your blood glucose, reduce your blood pressure and strengthen your immune system.
DR. EDWARD O. AMPORFUL
CHIEF PHARMACIST
COCOA CLINIC
Features
Emotional distortions: The hidden barriers to mental well-being
Emotional distortions are twisted or irrational thought patterns that can have a profound impact on our mental health and well-being.
These distortions can lead to negative emotions, unhealthy behaviours, and strained relationships.
In this article, we will explore the types, causes, and consequences of emotional distortions, as well as strategies for overcoming them.
Types of Emotional Distortions
1. All-or-Nothing Thinking: Seeing things in absolute terms.
2. Catastrophising: Exaggerating potential consequences.
3. Over generalisation: Making sweeping conclusions based on limited evidence.
4. Mind Reading: Assuming others’ thoughts or intentions.
5. Emotional Reasoning: Believing emotions reflect reality.
6. Should Statements: Imposing unrealistic expectations.
7. Labelling: Assigning negative labels to oneself or others.
8. Personalisation: Taking things too personally.
Causes of emotional distortions
1. Childhood experiences
2. Trauma
3. Stress
4. Social learning
5. Cultural influences
6. Genetic predisposition
Consequences of emotional distortions
1. Anxiety and depression
2. Relationship conflicts
3. Low self-esteem
4. Impaired decision-making
5. Substance abuse
6. Physical health problems
Overcoming emotional distortions
1. Cognitive-Behavioural Therapy (CBT): Identifying and challenging distortions.
2. Mindfulness: Practising self-awareness.
3. Self-Reflection: Examining thought patterns.
4. Journaling: Recording and analysing thoughts.
5. Seeking support: Consulting therapists or support groups.
Strategies for Maintaining Mental Well-being
1. Practice self-compassion.
2. Engage in physical activity.
3. Cultivate social connections.
4. Prioritise sleep and nutrition.
5. Seek professional help when needed.
Conclusion
Emotional distortions can have a profound impact on mental health, but they can be overcome. By recognising and challenging these distortions, individuals can develop healthier thought patterns, improve relationships, and enhance overall well-being.
_References_
– Beck, A. T. (1977). Cognitive Behavior Therapy.
– Burns, D. D. (1999). The Feeling Good Handbook.
– American Psychological Association. (2022). Cognitive-Behavioral Therapy.
By Robert Ekow Grimmond-Thompson
Features
Where are we rushing to?
Sometimes you wonder what is going on especially the period before Christmas, in terms of the road incidents.
Yesterday, heading towards town, on my way to lay a wreath on my late wife’s grave, on the anniversary of her burial, I saw cars ahead of me suddenly indicating that they want to move into the middle lane from the inner lane.
I then saw, as I inched along, the reason for moving into the middle lane. Apparently an Uber vehicle had hit the side of a Mercedes Benz car and they were arguing and trying to sort things out.
It was apparent that the cause of the incident was due to rushing to get ahead of the Benz. A few moments of patience from both drivers could have avoided that incident.
It just does not make sense that you are in so much of a hurry that you could not let reason prevail for one of you to exercise restraint, to allow the other vehicle to pass and now both of you are wasting precious time on the road, the very thing you were trying to avoid in the first place.
There is another aspect that is related to this rushing that has to be addressed. People are no longer willing to show empathy with others, such that for a driver to pause for another driver to pass to join the traffic or to cross to the other lane is becoming non-existent these days.
We seem to be selfish in most cases which then causes drivers to rush to join the traffic after waiting and waiting without any one giving him or her the opportunity to move to join the traffic. I was tempted to be callous by ignoring vehicles that wanted to cross from my right to join the opposite traffic coming from the Ghana Law School entrance toward Tema Station, earlier this week due to the behaviour of some drivers toward me.
However, I remembered that I was a Christian and a higher standard of empathy is required of me, so I paused for them to cross from the exit point of the filling station to join the traffic going in the opposite direction.
I nearly knocked down two people earlier this week due to their lack of safety I suppose or is it a lack of focus on the streets. I think safety education needs to be intensified because of what happened on Monday.
How on earth would anyone attempt to cross a road, in front of a vehicle when a traffic light has just shown green? It really beats my imagination but that was exactly what happened and how I did not kill her, is attributable only to divine intervention.
Shortly before this incident, I had narrowly avoided hitting another person, who also crossed in front of me when I was about to join a main road with traffic coming from my left side so I was focused on my left side.
A vehicle was ahead of me and so was waiting to move as soon as it moves. The vehicle moved and just as I was about to follow, this young lady just showed up at my right fender and again I would say it was only by divine intervention that she escaped either serious injury or even death.
The level of selfish considerations in the country is becoming alarming by the day and it is something that must be addressed. The normal Ghanaian attitude of tolerance towards each other is now gradually vanishing from our society and is very worrying.
People are becoming much more inward looking and if something is not going to benefit him or her, they are just not interested. There are a few people who still do what is right and they should be commended to continue the good works.
My advice to my fellow Ghanaians is that, let us stop this rushing when we are driving especially as Christmas is approaching so we can save ourselves from avoidable incidents. God bless.
By Laud Kissi-Mensah
