COVID-19 and diabetes: Insulin requirements parallel illness severity in critically unwell patients

Objective In the light of increased adverse outcomes for people with diabetes affected by COVID-19, we have described the clinical course of a cohort of critically ill patients with COVID-19 and diabetes. Methods We retrospectively analysed characteristics, glucometrics and inflammatory markers of patients with diabetes mellitus admitted to intensive care unit (ICU) with COVID-19. Results Eight patients with diabetes were admitted to ICU with COVID-19. All had type 2 diabetes, with three being newly diagnosed that admission. Mean HbA1c was 9.2%. Glucometric analysis indicated that extremely high insulin doses were required during peak inflammatory response to maintain glycaemic control with a mean peak insulin requirement of 201 units per day (2.2 units/kg/day). Conclusions Critically unwell patients with diabetes mellitus and COVID-19 had high insulin requirements and poorer time in target range at the time of peak inflammatory response, and this improved as their illness resolved.