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Clinical Management of Diabetes in Hospitalized COVID Patient

Published on Jul 01, 2021 and last reviewed on Jan 27, 2022   -  5 min read


A high blood sugar level is becoming common in COVID-19 patients under-recovery. Let this be a way to inform doctors and the general public to manage it. To learn more, read the article.

Clinical Management of Diabetes in Hospitalized COVID Patient


With this raging third wave of COVID-19, high blood sugar level is becoming common in COVID patients under-recovery. Hence, the following clinical guidance on the diagnosis and management of diabetes among patients with COVID-19 has been established.

What Precautions Have to Be Taken in Regards to the Admission of Patients in the COVID Care Facility?

Every patient has to be screened for hyperglycemia with at least two capillary blood glucose values, one before food and one after food, by using a glucometer. And every patient with diabetes should be put on a diabetic diet. And the patient has to be monitored regularly and strictly if they adhere to the timing and quantity advised in the diet chart.

What Is a Diabetic Diet?

A diabetic diet is an eating plan which is healthy, naturally rich in nutrients, and that is low in fat and calories. It is basically eating the healthiest food in balanced amounts and sticking to regular meal times.

A good meal plan includes:

How to Screen for Hyperglycemia in Patients Admitted to a COVID Care Facility?

hyperglycemia values

What Is the Outcome in COVID-19 Patients With High Random Blood Glucose?

How to Monitor Blood Glucose for Individuals With No Evidence of Stress Hyperglycemia or Undiagnosed Diabetes at the Initial Screen?

How to Treat Patients With Known Diabetes Who Are on Oral Antihyperglycemic Drugs (OAD)?

Patients can continue the existing oral antihyperglycemic drugs if

If the patient does not fulfill the above criteria, then the patient must be referred to an Endocrinologist to change the treatment regimen.

How to Initiate Oral Antihyperglycemic Drugs in Patients Newly Diagnosed With Diabetes?

The patient has to be consulted by an Endocrinologist or general physician. Initially, the patient can be put on tablet Metformin either immediate or sustained release 500 mg two times a day, and tablet Gliptin, provided the patient fulfills the following criteria:

When to Use Oral Glucose-Lowering Agents?

Patients can be prescribed oral glucose-lowering agents when:

Pre-meal < 180 mg/dL

Post-meal < 250 mg/dL.

Which Are the Safer Oral Glucose-Lowering Drugs?

The safe drugs are:

1) Vildagliptin or Teneligliptin.

2) Sitagliptin or Linagliptin.

Which Are the Drugs That Should Be Given With Caution?

1) Metformin- As there is a risk of lactic acidosis if the patient is moderate to severely ill with hypoxia (low oxygen level).

2) Sulfonylureas- As there is a risk of hypoglycemia if there is poor oral intake or with concomitant use of insulin therapy.

And these drugs need to be stopped if the severity of the disease increases and should not be initiated in patients who are not on these drugs.

1) SGLT-2 Inhibitors- It can increase the risk of dehydration.

2) Pioglitazone- It increases the risk of fluid retention and edema (inflammation). It is contraindicated in patients with cardiac or hepatic dysfunction.

How to Initiate Insulin for Patients Newly Detected With Diabetes?

Insulin can be given in patients with the following blood glucose levels:

The total daily dose that can be given in patients above the age of 65 years and with nephropathy or any other liver disease is 0.2 units/kg/day. The total daily dose should be divided into four doses:

How to Give Insulin for Patients on Oral Antihyperglycemic Drugs and Still the Blood Glucose Levels Are Not Under Control?

Injection of Regular Insulin is not required to be given for all three meals but can be added to any individual meal that requires prandial coverage.

How to Decide the Initial Doses of Insulin for Steroid Induced Worsening of Blood Glucose in People With or Without Diabetes?

Blood Glucose


In patients with diabetes, preventing a COVID-19 infection in the first place is the most preferred to avoid complications. Diabetic patients should take vaccinations to keep their immune levels high to fight against the virus. Also, following adequate precautionary guidelines is essential. When experiencing symptoms, reaching out to a healthcare provider at the earliest is needed to prevent the disease progression and further associated complications.

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Last reviewed at:
27 Jan 2022  -  5 min read




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