Glycemic Control in an Undiagnosed Diabetes Mellitus Patient with Coronavirus Disease 2019

Abstract

Diabetes mellitus in coronavirus disease 2019 (COVID‑19) patients is associated with poor outcomes due to poorly understood reasons inclusive of blood sugar patterns. Hence, we report a case of a 52‑year‑old Nigerian man known hypertensive heart disease patient, previously undiagnosed diabetes mellitus patient with difficulty in blood sugar control, heart failure, and persistent severe acute respiratory syndrome coronavirus 2 8 weeks after he tested positive. A 52‑year‑old male civil servant obese, known hypertensive heart disease patient presented with complaints of fever, cough, difficulty with breathing, headache, and generalized body weakness. At presentation, he had respiratory distress with low oxygen saturation of 78% and hyperglycemia (blood sugar of 40 mmol/l). His body mass index was 35.9 kg/m² . Chest radiography showed ground‑glass appearance with cardiomegaly. Over the next 10 days on  admission, his blood sugar fluctuated between hyperglycemia and an episode of hypoglycemia with occasional euglycemia and had glycated hemoglobin of 10.8%. The full blood count was normal, electrolyte, urea and creatinine showed mild elevation of the urea and creatinine, other parameters were normal, while the lipid profile showed hypercholesterolemia. He received multiple doses of insulin, anti‑hypertensive, lopinavir/ ritonavir, methylprednisolone, and azithromycin. The patient was weaned off oxygen after 10 days and discharged home 15 days after admission. This case report highlighted the challenges that may face a patient with undiagnosed diabetes mellitus and COVID‑19. It also brings forth the need to expand research options in COVID‑19 and risk factors associated with the disease as the world strives to control the global pandemic.

Keywords: Coronavirus disease 2019, glycemic control, undiagnosed diabetes mellitus