Abstract
Introduction: A bidirectional relationship exist between the COVID -19 diagnosed & recovered patient and Type 2 Diabetes Mellitus. As per the various article available in public domain it has been proved that entry of COVID – 19 virus can lead to a series of pathological changes into a patient’s body which may lead to the development of insulin resistance and damage to the pancreas.
 The patient in our case was a COVID – 19 survivor which was diagnosed with type 2 DM during the treatment. The patient was started with the Glargine insulin when she was undergoing her treatment in the hospital for COVID – 19 Symptoms. Her fasting and postprandial blood sugar level was controlled with the insulin. After her discharged she was started with the Metformin 500 mg twice a day but her blood sugar was not controlled with the Metformin monotherapy, so we started with the triple drug combination Metformin + Glimepiride + Pioglitazone. After 1 month of follow-up, it was seen that the blood sugar level was not controlled, so the Pioglitazone was replaced with the DPP-4 inhibitor drug Vildagliptin and again the patient was asked to come for follow-up after 15 days, it was seen in this follow-up that the patients’ blood sugar was dramatically controlled.
 Conclusion: COVID – 19 triggered Type 2 DM is the result of cytokine storm develop during the disease. Metformin and DPP – 4 inhibitors reduce the insulin resistance in type 2 diabetes patients and helps to achieve the euglycemic goal of the patient.
Highlights
A bidirectional relationship exist between the COVID -19 diagnosed & recovered patient and Type 2 Diabetes Mellitus
COVID – 19 triggered Type 2 DM is the result of cytokine storm develop during the disease
COVID-19-associated diabetes isn't the result of a single occasion but is a combination of illness vulnerability related with persistent ailment and COVID-19-specific cause affecting the body metabolism.It is not yet clear that a post COVID – 19 diabetes is associated with long lasting β-cell damage and responsible for uncontrolled diabetes.A two-way relationship exists between Covid-19 and diabetes,on the one side, diabetes is related with an expanded chance of serious Covid-19, while on the flip side, new-onset diabetes and serious metabolic complications of pre-existing diabetes, counting diabetic ketoacidosis and hyperosmolarity for which outstandingly excessive dosages of insulin are justified, have been noticed in patients with Covid-19 [2,3,4]
Summary
A bidirectional relationship exist between the COVID -19 diagnosed & recovered patient and Type 2 Diabetes Mellitus. The patient was started with the Glargine insulin when she was undergoing her treatment in the hospital for COVID – 19 Symptoms. Her fasting and postprandial blood sugar level was controlled with the insulin. After her discharged she was started with the Metformin 500 mg twice a day but her blood sugar was not controlled with the Metformin monotherapy, so we started with the triple drug combination Metformin + Glimepiride + Pioglitazone. The increased in the levels of Tumour necrosis factor and Interleukin 6 are the result of COVID -19 inflammation and cytokine storm [5]
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