Abstract
BackgroundSevere insulin resistance is an uncommon finding in patients with type 2 diabetes but is often associated with difficult to managing blood glucose. While severe insulin resistance is most frequently seen in the setting of medication side effects or rare genetic conditions, this report of two cases highlights the presence of severe insulin resistance in the setting of severe COVID-19 and explores how this may contribute to the poor prognosis of patients with diabetes who become infected with SARS-CoV-2.Case presentationHere we present the cases of two African-American women with pre-existing type 2 diabetes who developed severe COVID-19 requiring mechanical ventilation and concurrent severe insulin resistance with total daily insulin dose requirements of greater than 5 unit/kg. Both patients received aggressive insulin infusion and subcutaneous insulin therapy to obtain adequate glucose management. As their COVID-19 clinical course improved, their severe insulin resistance improved as well.ConclusionsThe association between critical illness and hyperglycemia is well documented in the literature, however severe insulin resistance is not commonly identified and may represent a unique clinical feature of the interaction between SARS-CoV-2 infection and type 2 diabetes.
Highlights
The association between critical illness and hyperglycemia is well documented in the literature, severe insulin resistance is not commonly identified and may represent a unique clinical feature of the interaction between SARS-CoV-2 infection and type 2 diabetes
SARS-CoV-2 infection is associated with severe hyperglycemia, which has been associated with poor patient outcomes [1,2,3,4]
While hyperglycemia is a feature of many severe infections, severe insulin resistance is less frequently documented
Summary
Based on our review of the literature and exemplified by the cases presented here, it is likely that hyperglycemia in patients with COVID-19 infection worsens the dramatic inflammation and cytokine storm that accompanies severe infection.
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