A bidirectional alliance of COVID-19 and dibates mellitus

Based on the available literature; briefly explaining the general and clinical characteristics of the  novel coronavirus; inclusive of incubation period, mode of transmission, period of infectivity,  demography and diagnosis with a better understanding of its association in diabetic patients.  Specific criteria should be kept in mind for testing and observation of preliminary symptoms.  Underlying comorbidities, particularly CVDs, Diabetes mellitus (DM), Chronic lung and renal disease,  hypertension and cancer are greatly associated with most severe and fatal cases in old people.  Although, the mechanisms are still unknown and more study needs to be done, the role of  Angiotensin-converting enzyme 2 (ACE2) in the association between DM and COVID-19 is plausible.  ACE2/Ang (1-7) systems are important anti-inflammatory and anti-oxidant systems; protects the  lung against ARDS. ACE2 expression is reduced in patients with DM due to glycosylation.  Overexpression of ACE2 is also counterproductive in COVID-19. DM and COVID-19 share a bi directional path, affecting and complimenting each other. Further understanding the consequences  of COVID-19 on diabetes, it was noted that hyperglycemia can lead to DKA and Hyperosmolar coma,  vomiting, diarrhea and therefore, dehydration. Risks for contracting COVID-19 is even greater for  T1DM patients as compared to T2DM. Viral infections as well show deleterious effect and leads to  development of T1DM in susceptible patients. Because of the imposition of Lockdown, patients  faced a number of challenges, like restriction of outdoor physical activity, school/college related  stress, poor management and control of BG levels, poor diet and sleep patterns, and home-related  stress. Effects of Chloroquine and Hydroxychloroquine are also understood when used for  prophylaxis and treatment for diabetic patients. Lack of medical assistance due to major focus on  COVID-19 patients and fear of going to a hospital during a pandemic are additional problems faced  and it is ardently necessary to manage DM during the pandemic. People with DM should be extra  cautious and take all the precautions, ensuring strict social distancing, proper hand hygiene and  good glycemic control.