Study links abnormally high blood sugar with higher risk of death in COVID-19 patients not previously diagnosed with diabetes

DIABETOLOGIA

New research from Wuhan, China shows that, in patients with COVID-19 but without a previous diagnosis of diabetes, abnormally high blood sugar is associated with more than double the risk of death and also an increased risk of severe complications. The study is by Dr Yang Jin, Union Hospital and Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China, and colleagues. The study is published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]).

Previous studies have established that hyperglycemia (abnormally high blood sugar) is associated with an elevated risk of mortality in community-acquired pneumonia, stroke, heart attacks, trauma and surgery, among other conditions. A number of studies have also shown links between diabetes and poor outcomes in COVID-19 patients. However, direct correlation between fasting blood glucose (FBG) level at admission to hospital and clinical outcomes of COVID-19 patients without diagnosed diabetes has not been well established. In this new study the authors examined the association between FBG on admission and the 28-day mortality of COVID-19 patients without previously diagnosed diabetes in two hospitals.

The retrospective study assessed all consecutive COVID-19 patients with a known outcome at 28-days and FBG measurement at admission from 24 January 2020 to 10 February 2020 in two hospitals based in Wuhan, China. Demographic and clinical data, 28-day outcomes, in-hospital complications and CRB-65 scores of COVID-19 patients in the two hospitals were analysed. The CRB-65 score is an effective measure for assessing the severity of pneumonia and is based on four indicators: level of confusion, respiratory rate (over 30 breaths per min), systolic blood pressure (90 mmHg or less) or diastolic blood pressure (60 mmHg or less), and age (65 years or over).

A total of 605 COVID-19 patients were enrolled, including 114 who died in hospital. The median age of participants was 59 years and 322 (53.2%) were men. A total of 208 (34%) had one or more underlying conditions (but not diagnosed diabetes), of which high blood pressure was the most common. Almost one third (29%) of patients fell into the highest category of FBG on admission (7.0 mmol/L) which if found consistently would result in a diagnosis of type 2 diabetes. A further 17% were in the range that would be considered pre-diabetic (6.1-6.9 mmol/L), while more than half (54%) were in the ‘normal’ FBG range of 6.0 mmol/L or below.

The results showed that patients in the highest FBG group were 2.3 times more likely to die than those in the lowest, a statistically significant result. Those in the middle (pre-diabetic) FBG group were 71% more likely to die than those in the lowest group, although this result only had borderline statistical significance. The data also showed that men were 75% more likely to die than women; and that patients with higher CRB65 scores (and thus worse pneumonia) were also at higher risk of death: those with a score of 3-4 were more than 5 times more likely to die than those with a score of 0, while for those with a score of 1-2 there was a 2.7 times increased risk.

When looking at FBG and CRB65 scores together, the patients in the highest FBG group had an increased risk of death compared to the lowest, regardless of whether or not the CRB65 score was zero or higher, further underlining that FBG independently increases the risk of death in COVID-19 patients. However, the increased risk of death for the highest FBG group was lower in patients with CRB65 scores of above zero compared with those with a CRB65 score of zero. The risk of complications was also found to be 4 times higher in the highest FBG group compared to the lowest, and 2.6 times higher in the middle (pre-diabetic) group compared to the lowest.

The authors say: “This study shows, for the first time, that elevated FBG (?7.0 mmol/l) at admission is independently associated with increased 28-day mortality and percentages of in-hospital complications in COVID-19 patients without previous diagnosis of diabetes… we have also shown that FBG of 7.0 mmol/l or higher is associated with increased mortality, regardless of whether the patient has pneumonia that is more or less severe.”

They add: “These results indicate that our study included both undiagnosed diabetic patients and non-diabetic patients with hyperglycaemia caused by an acute blood-glucose disorder, since the 29% found in the highest FBG group is much higher than the estimated prevalence of diabetes in the Chinese population at 12%. Similarly to what was found in a previous study, COVID-19 patients might suffer from high blood sugar brought about by other conditions, and critically ill patients may develop acute insulin resistance, manifested by high levels of blood sugar and insulin levels. Patients with conditions not related to diabetes, such as severe sepsis, systemic inflammatory response syndrome (SIRS) and traumatic brain injury tend to have abnormally high blood sugar.”

The authors note several limitations with their study. First, this was a retrospective study. Second, they did not analyse glycated haemoglobin (HbA1c), a long-term blood sugar control indicator that helps distinguish patients with poor long-term blood sugar control from those with stress hyperglycaemia. Also, they did not have sufficient data to study the effect of glucose-lowering treatment (e.g. insulin, metformin) on the outcome of the patients in their study. However, they believe that acute hyperglycaemia is more important than long-term glycaemic control in predicting the prognosis of hospitalised COVID-19 patients.

The authors suggest that possible mechanisms for this increased mortality include hyperglycaemia-induced changes in coagulation (clotting), worsening of endothelial function (the function of the walls of blood vessels), and overproduction of inflammatory cytokines produced by the immune system (the so-called cytokine storm).

The authors conclude: “In conclusion, a fasting blood glucose level of 7.0 mmol/l or higher at admission is an independent predictor for 28-day mortality in patients with COVID-19 without previous diagnosis of diabetes. Blood sugar testing and control should be recommended to all COVID-19 patients even if they do not have pre-existing diabetes, as most COVID-19 patients are prone to glucose metabolic disorders. During a pandemic of COVID-19, measuring fasting blood glucose can facilitate the assessment of prognosis and early intervention of hyperglycaemia to help improve the overall outcomes in treatment of COVID-19.”

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From EurekAlert!

76 thoughts on “Study links abnormally high blood sugar with higher risk of death in COVID-19 patients not previously diagnosed with diabetes

  1. We already knew T2 diabetes was a big co-mornidity. Now we know that those individuals prediabetes is also a co-morbidity.

    The previously known co-morbidities obesity, hypertension, and T2 diabetes are all cross correlated. As is now pre-diabetes, here.

    As commented previously, this alone explains the impossible ‘racial’ preference of Wuhan virus.

    • Sugar consumption per capita by country. link

      1 United States 126.40
      2 Germany 102.90
      3 Netherlands 102.50
      4 Ireland 96.70
      5 Australia 95.60
      6 Belgium 95.00
      7 United Kingdom 93.20
      8 Mexico 92.50
      9 Finland 91.50
      10 Canada 89.10

      I used to work with a guy who called sugar ‘white death’.

      • “commieBob July 11, 2020 at 7:49 pm

        I used to work with a guy who called sugar ‘white death’.”

        I could not have said it better myself. Also low fat foods are loaded with salt AND sugar. Sugar is a bigger killer than COVID-19. Sugar may not be infectious but it is in everything we eat and consume. Artificial sugars are even worse.

        • Corn syrup, very commonly used as a sweetener in food products in the west contains both glucose and fructose. Fructose is not a direct source of energy but is metabolised to fat by the liver. Fructose contributes to the pandemic of obesity.

          The two are confounded in the sugar content printed on food labelling.

          It is not immediately clear to me that unrefined sugar is a lot better than “white death” but calling it brown death is probably “offensive” or a hate crime these days, so let’s just attack white sugar.

          Making poor black people eat white sugar is just part of the oppression of the racist white tyrannical patriarchy.

          • If you knew what went into cane sugar, you’d want the whitest of white, pure refined sugar. It has a much lower rat content. The very thought of cane molasses makes me want to vomit.

            I’m not sure about beet sugar or corn syrup.

          • Corn/rice syrup made and added to “honey” made in China. THey are great at making fake stuff, even food. That’s why I only ever have very expensive NZ manuka honey.

          • “Zig Zag Wanderer July 11, 2020 at 9:31 pm”

            If you knew what really went in to most foods you would starve. Chicken does not taste like chicken because it’s chicken. And many cheese don’t taste the way they do without something “extra”.

          • We have the robust, multi-layered immune defensive system not because we could avoid filth and feces and rats as we evolved into modern Homo sapiens, but precisely because we evolved in a filth and feces and rat-infested environment. So a little rat poop in my boiled cane sugar doesn’t bother me.

          • Interesting… high fructose syrups (glucose with more than 50% fructose) whether from corn syrup, honey or agave, all act the same. For one, the glycemic index is lower than sugar since the liver needs time to turn the fructose into glucose. The other is that sugar satiation is slower so more consumption happens. The liver produces triglycerides as a result of too much of the fructose… and that is not good either!

            People saying honey is good, sugar [sucrose which is fructose weakly bonded to glucose] is bad do not understand that honey is sugar with a higher level of fructose.

          • All sweet sugars, from sugar cane, beets, honey, cactus fruit, etc. etc. becomes 50% dextrose, 50% fructose upon reaching the stomach. High fructose corn syrup is just a bit more than 50%, not intrinsically different.

          • You alarmist trolls need to drink wine with your various contaminated foods, it kills the nasty stuff. This alone explains why I am the Golf Club Super Senior Champion. Cheers!

          • “Making poor black people eat white sugar is just part of the oppression of the racist white tyrannical patriarchy.”

            You just made my morning. LOL Sugar is racist!

          • “Chicken does not taste like chicken because it’s chicken.”

            Wait…what?
            I am guessing I am not the only person who has eaten chicken and other poultry that was raised out back, and slaughtered an hour before being cooked for dinner.
            I can assure you…it tastes like chicken.
            And turkey tastes like turkey, and cow tastes like beef.

          • AndyHce July 11, 2020 at 11:19 pm

            I think you mean glucose and fructose, not dextrose. Sucrose/table sugar is 50/50 glucose fructose…

          • Dextrose is a synonym of glucose.
            Glucose is a chiral molecule.
            It has the property of “handedness”, IOW the same molecule can exist in a right handed and left handed form.
            Such molecules are one type of isomer: Molecules which have the same chemical formula but which are different in some way.
            Chiral isomers are called “enantiomers”.
            Many biomolecules have this property of chirality, or handedness.
            When polarized light is shone through a solution of a chiral molecule, the light can be rotated either to the left or to the right, if that solution consists of either one or the other enantiomer of the molecule.

            Glucose (or any molecule) that rotates light to the right is called the “dextrorotary” form of that molecule, as oppose to the isomer that rotates light to the left, called the “levorotary” entantiomer.
            Levo- and dextro- are the prefixes that denote left handedness or right handedness in chemistry, after the Latin words for left and right, respectively’
            Think of the word dexterous.
            It refers to the right hand as the one which is more capably agile in most people.

            Dextrose is glucose, specifically the right handed enantiomer of the molecule.
            This is the one that is important biologically.
            Left handed sugar is inert, metabolically.

            Dextrose is glucose.

            But you have to know a few things to know that.

          • BTW…glucose and fructose are also isomers, of a type called “structural isomers”.
            They have the same molecular formula, but the atoms are joined in a somewhat different configuration.
            Interestingly, both glucose and fructose, when in solution, exist as a mixture of isomers of a different structural type.

          • But what do I know…I am the stupid one who only pretends to know what the hell I am talking about.

          • As someone mentioned sugar is glucose and fructose at about 50/50.

            Someone else mentioned honey which does correctly have more frcutose than glucose, but the numbers are 40/30 so both fructose and glucose are lower than sugar per gram.

            Glucose increases the glycation in the body, a common test more accurate to determine metabolic state would be a fasting insulin (as Insulin resistance is the thing most metabolic issues tend to be derived from) test or a HBA1C test (which looks at how ‘glycated’ your haemoglobin is, this is a fairly accurate reading of how much glucose your blood is carrying for months at a time as the scale. There can be outlyers in that it is believed that keto/carnivore diets show longer lifespan of haemoglobin and thus turn up a slightly higher HBA1C result). Both will show pre-diabetic results well before your fasting glucose starts moving due to how hard your pancreas ends up working to try to fix the glucose in the blood.

            Fructose exchanged for glucose in diets has been linked to increased insulin resistance over glucose alone. This also changed where fat was deposited. While not advisable is it shown that you can live on a high starch low protien and low fat diet (protien and fat still animal sourced) and not suffer the chronic metabolic illnesses we suffer now but fructose added to such a diet would be catastrophic as would the preplacement of animal protiens with plant ones and animal fats with vegatable oils. Starches break down to glucose, but the body can produce its own glucose and need 0 glucose or carbohydrate ingested for this process.

        • full agreement on that
          I call sugar white death too;-)
          I find it hard to eat anything commercially made ie biscuitsand cakes as theyre so damned sweet
          Bought a pack of biscuits ate 2 because i was low sugar hadnt eaten, been busy
          friend I also bought a pack for?
          had eaten the entire packet in 2 sessions!
          I dont know how they do it- Id be sick
          as for diet drinks etc some of the fattst people you see are the no sugar fizzy drinkers
          yourmouth tastes sweet the body releases insulin and theres nothing for it to work on
          thats just stupid to expect there wouldnt be a follow on result from that happening repeatedly.
          damned hard to get a decent slab of meat WITH decent fat left on it for years
          almost…got the local butcher trained now after some yrs;-)

          • “…as for diet drinks etc some of the fattst people you see are the no sugar fizzy drinkers.”

            Their parents poured Metrecal on their ice cream instead of chocolate or butterscotch syrup.

          • Of course, fat people, knowing they are fat and deciding to avoid large amounts of sugar when alternatives exist, could not possibly be fat DESPITE drinking diet soda with no sugar.
            It must be that sugarless drinks makes people fat, eh?

          • People that wear glasses have bad vision.
            Therefore, glasses cause bad vision.
            Same logic.

        • Rud

          There are multiple studies which raise the possibility that the virus itself may be causing diabetes in a fraction of patients. That process may have already started by the time of hospital admission.

          • Considering the virus can attack many different organs then the pancreas would also be a target, lowering insulin production and elevating glucose in the blood by ding so.

      • commieBob, that is daily consumption of sugar in grams per day.

        The US super sugar consumers (sugary drinks and sugary coffees and sugary food) consume 180 lbs of sugar per super sugar consumer.

        The super sugar consumers are having the same liver and liver related health care problems as do alcoholics. Including liver failure.

        • From the link:

          On average, Americans consume 126.4 grams of sugar daily.

          If I did my arithmetic correctly, that’s about a hundred pounds per year for the average American. Based on that, my wild ass guess is that there are many tens of millions of super sugar consumers.

    • Hyperglycemia. The Hallmark of Metabolic Syndrome indicating insulin resistance. The primary cause of obesity, hypertenison, Type 2 diabetes, Type 3 diabetis, coronary artery disease along with many of the Western “chronic” illnesses. You can fix it yourself without medications. Type 2 diabetes can even be cured.

      If you are motivated. You can test for insulin resistance but you need to find a MD that is current on the biochemistry advances. You can read about the Kraft Pre-Diabetes testing here: https://wimbledonclinic.co.uk/kraft-prediabetes-testing/
      The test is described here as well: https://profgrant.com/2013/08/16/joseph-kraft-why-hyperinsulinemia-matters/
      And, since you have four blood draws to test your glucose level, you should have your insulin tested as well (it’s an inexpensive test).

      Hyperglycemia, diabetes in situ, insulin resistance, pre-diabetes… all pointing to the need for those having one of the diabetes in situ patterns from the Kraft Test to dramatically change your dietary lifestyle. If one wishes to avoid the misery of Western chronic diseases and a premature death whether by Covid or diabetes or CVD or Alzheimers or …

      Plus, for the science minded, there is literally an avalanche of recent studies, randomized clinical trials, books and articles on the subject. And note, again, the “cure” is free.

      • “Hyperglycemia. The Hallmark of Metabolic Syndrome indicating insulin resistance. The primary cause of obesity, hypertenison, Type 2 diabetes, Type 3 diabetis, coronary artery disease along with many of the Western “chronic” illnesses. You can fix it yourself without medications. Type 2 diabetes can even be cured.

        If you are motivated.”

        That is correct. It is a self-inflicted disease. A little self-discipline would go a long way.

  2. I’ve often said that bacon makes everything better and now know that high glucose levels make everything worse. Diabetes, insulin intolerance and metabolic disorder make so many illnesses worse. Diets now include food that is highly refined, carb rich and nutritionally bereft. Obesity is one easy to see result but reducing blood sugar with added insulin puts the sugar in all parts of the body hence the amputation of limbs, blindness, kidney failure and heart problems.

    Doctors that I follow for their work on insulin intolerance include Dr. Jason Fung, Dr. Dominic D’Agostino, Dr. Tim Noakes. The one source of great info among many is Dr. Ben Bikman who has been researching insulin’s effect on the body for many years. Lots of material found at his twitter channel.

    https://twitter.com/benbikmanphd?lang=en

    • Polski
      Everyone should look at your sources. Great knowledge.

      The fact is that 2/3 of the population over 45 are have insulin resistance, hyperinsulinemia, metabolic syndrome, pre diabetes or hyperglycemia, pick the title you want to use. They all amount about the same thing. Doctors don’t diagnose diabetes until it is a few decades too late. The standard of care is killing hundreds of millions.
      Covid is nothing compared to this.

      • With “hundreds of millions” being “killed”, one wonders how on Earth people are living longer than ever, and staying heathier at advanced age, and doing both in larger and larger proportions?

        Even more encouraging for those of us that are not kids anymore, are the trends in longevity for those who have reached a certain age, such as “average remaining years of life for those reaching age 60”.

        All food is protein, carbohydrate, and fat.
        There is nothing else.
        Many people consider fresh fruit to be an essential part of a healthy diet.
        Fruit has most of it’s calories in the form of carbohydrates, including sugars.

        Besides for that, countries do not eat sugar, people do.
        Is this girl unhealthy (?):

        https://www.youtube.com/watch?v=e4eYghHdl7Q&t=1213s

        I could barely believe my eyes the first time I saw her..
        It was that video, in which she scarfs down 18 donuts in minutes.
        But that is nothing for her.
        She has videos in which she eats 15,000 calories in a hour or two.
        And she appears to be one of the most fit and trim people I have ever seen.
        Extreme athletes burn a ton of calories.
        It is all about balance…input, output…

        • Dr Tim Noakes was renouned for writing about ‘carb loading’ before events (Lore or Running) some decades ago. He was an accomplished marathon runner and did try to keep up his exercise.

          His father had t2 diabetes and I believed passed away reasonably young, then in his early 60s he struggled to move much at all and when tested came up as diabetic. He turned that around by moving to a ketogenic diet which removed the carbs from it… he often says you can not outrun a bad diet.

          There are many reasons why , on average, we live longer. One of the major reasons is hygiene, many of the key diseases leading into the 20th century were already pretty much gone by the time vaccines were introduced for them. Workplace health and safety would be another extension of life expectancy as would that pharma industry being able to extend a person’s life, but in many cases the drugs are related to treating metabolic diseases which would not be needed if people had avoided the carbs and the seed oils.

  3. Lockdowns and forced closures by political leaders of course is billed as supposedly “following the science.”

    Some COVID-19 responses “following the science” from experts:
    – closing gyms, beaches, parks, and social sports activities and then by extension forcing people to sedentary isolation settings,
    – work at home in PJs all day and stay at home is the wrong public health policy.
    – Children and teens, the least at risk group for COVID-19 complications, having schools, and extracurricular sports activities cancelled and summer camp activities cancelled simply because some became infected and the resulting hysteria then losing those activities.

    When the history of these responses is finally written 20+ years from now, it will not be kind to these general quarantine measures of healthy un-infected populations for those reasons.

    “Science is a belief in the ignorance of the experts.
    – Richard Feynman

    • Spot on, Brian. Almost everything we are doing to deal with this pandemic is wrong-headed. The problem is, the wrong-headed will likely write the history.

  4. Is the reason for the connection blood sugar level versus mortality simply that sugar competes with vitamin C. The molecules are fairly similar and use the same channels to get into cells. The solution then would be to increase vitamin C through mega doses possibly IV and at the same time get the blood sugar level down. Mega doses of vitamin C seem to work fairly well in acute situations.

    Next a pure speculation. An obese person with COVID should probably start fasting because there is fat available for weeks. Burning fat should increase the vitamin D level because surplus vitamin D is stored in the body fat. Based on Chinese reports seriously ill COVID patients tend to have low vitamin D levels.

    My own experiences. I probably had COVID (muscle pain, lost smell and a slight fever), not tested. The first day I took a total of ca. 40 g vitamin C split over the dasy at 2 hours intervals. I combined this with with 100 ug vitamin D per day and an estimated 160 mg Quinine (Tonic Water morning/evening) + 30 mg Zink with the tonic water. The vitamin C level was lowered to 20 g per day during the next few days. It is interesting to notice that the first day’s mega dose of 40 g didn’t produce any side effect which to me would to indicate that the body needed large amounts of vitamin C at that stage.

    I almost belong to the central risk group being male and 67 years of age.

    • “My own experiences. I probably had COVID (muscle pain, lost smell and a slight fever)”

      I heard a claim the other day that said the loss of smell/taste signalled that the Wuhan virus disease would be mild in those people.

  5. Why is everyone talking about sucrose/dextrose/fructose

    The Blood Sugar is glucose -its what you get from eating cooked starch (wheat, corn, rice, potato etc)

    These are all nutrient free tasteless mush.
    Even worse, they often come mixed with ‘Fibre’ (fiber) – now in the modern vernacular = Prebiotic and it has the effect of clearing whatever nutrient *was* in your food right out through your backside.
    (It has epic affinity for water and so do *most* nutrients you need/eat)

    Thus a diet high in carbohydrate leaves you nutrient starved – most Vitamins (notably VitC and many B vitamins) plus, all proteins are water soluble and nearly all the trace elements you need also.
    (Zinc, copper, iodine, sodium, selenium, magnesium etc etc etc)

    It is thus No Surprise that folks who eat a carb-based diet are those that get and die of disease. Their bodies are massively starved of all the stuff that powers their immune systems – and every other system in their bodies

    Notably of course, their brain.
    Hence we see the current epidemics of Junk Science, Junk Politics, Junk Media, Junk Medicine, Junk Social Media, Junk Personal Relationships, Junk Lawyers

    They are even further starved of vital nutrients by Soil Erosion (Modern Farming of generally = Tillage)

    it is Tillage: the destruction of High Albedo perennial plants with Low Albedo bare soil to make way for the annuals – wheat, corn, rice, potato which is causing the thermometers to move, Also city building.

    It is Tillage that’s causing the rise in atmospheric CO2 – hence why the Mauna Loa readings haven’t flickered despite the Covid shutdown – the food production system is still working as normal and expanding. As we’re constantly reminding ourselves here. It MUST be because the population is rising so they MUST be eating something. ‘Something’ obtained via Tillage

    Hence why OCO2 seems to have gone quiet.
    NASA cannot reconcile the observed high levels of CO2 above (what’s left of) rainforests and ALSO claim that CO2 causes Global Greening

    Well they can of course BUT, it Completely Trashes the notion of fossil fuel burning AND the Greenhouse Gas Effect
    So we see yet another effect of the Low Nutrient Diet – Junk Morals = Mendacity.
    I might choose Neil Ferguson as the flag bearer – you will have your own favorite candidate

    It all fits together so perfectly

  6. This is old news and absolutely nothing to do with diabetes, but human physiology.

    Raised blood sugar is one of the signs of Systemic Inflammatory Response Syndrome (SIRS), CoViD19 is known to cause an inflammatory response, that can lead to a cytokine storm..

    Up until about 5 years ago SIRS was used in the U.K. as an early indicator of sepsis AND hence mortality.

    Therefore, a person requiring hospitalisation because they are very unwell and has SIRS then their mortality is going to be worse than someone who isn’t exhibiting SIRS.
    The blood glucose part of SIRS was abandoned here in the U.K. and the rest of SIRS was pretty much dropped by NICE in their sepsis stratification guidelines, including high temperature (a low temperature is more indicative of mortality).

    A cytokine storm is the viral equivalent of bacterial sepsis.

    A personal anecdote, I qualified as a registered nurse at the age of 50 in 2006. In the August of that year I had a phone call from my mother who was unwell and waiting for the out of hours GP. I was 20 miles away and just finished a long shift. My mum was diabetic and the only thing I could think of was getting her blood sugar measured, this came out at 16 mmol. I then told her to call an ambulance. She was admitted to the ED and subsequently transferred to ITU. The upshot is that on the Monday my mother died from sepsis.

    The characterisation of type 2 diabetes is too simple. Not everyone who is obese has diabetes and not everyone who has diabetes is obese. There’s a strong genetic factor as well as epigenetics. A 25 year old Southern Asian male has the same risk of diabetes as a 40 year old white male. There is a suggestion that insulin resistance causes weight gain, rather than vice versa.

    • Scanning down the comments here I am glad to see there is someone with some physiology. High fasting blood glucose could be ‘prediabetic’ or an indicator of physiological stress – ie how sick you are.

      Without HbA1c, this paper is meaningless. All it says is ‘If you are really sick or if you are diabetic, you are more likely to die of the virus’. However just the mention of blood glucose brings out a screed of comments the evils of various diets.

      • In a well person:
        3.5 < = Fasting BM 7 likely diabetes, needs HbA1C

        In an unwell person no diabetes red flags:

        BM > 7 is a concern, but not diabetes as unwell

        Unwell person diabetes red flags:
        BM > 16 cause for concern, check for ketones, if ketones raised then danger of DKA even in type 2
        BM > 30 in Hyperglycaemic Hyperosmolar Syndrome.

      • Somehow my reply has got mangled.
        In the U.K.:
        Well person:
        3.5 >BM > 6 normal range
        6>BM > 7 possible diabetes, needs further investigation including HbA1C
        BM> 7 diabetic

        Unwell person without diabetes
        BM >7 , not a definitive diagnosis of diabetes possible as person is unwell, needs testing once recovered.

        Unwell person with diabetes
        BM < 16, may be normal as patient is unwell.
        RED FLAGS
        16< BM < 30, check for ketones, if positive then may be DKA even in type 2
        30< BM Hyperglycaemia, Hyperosmolar Syndrome

      • Fran

        Yes I agree, with out a long term sugar panel this article is totally meaningless.

  7. Just so you all know the figures….Carbs = sugar and sugar = carbs. As a true diabetic we have to know how much “sugar” is in carb food. So, a banana , medium to large has around four teaspoons of sugar, so does a round of bread, white or brown no difference.. Certain vegatables are also high in sugar, peas, for example, are 11% sugar. Potatoes=sugar, rice=sugar, pasta=sugar, oats=sugar and, of course, most of the tropical fruits.

    Meat contains no sugar, nor eggs, nor cheese, nor butter, nor nuts….All cows Milk is 4% sugar(it appears low but people tend to use large amounts), double cream just 1.8% sugar….

    Certain vegetables are also low sugar, mainly those grown overground , like cabbage…

    • Most nuts are high in carbs.
      Many have most of their calories from carbs, like cashews and pistachios.
      Regardless, they are IMO one of the essential foods for good health.

      • “Most nuts are high in carbs.
        Many have most of their calories from carbs, like cashews and pistachios.”

        I think not even close, re: calories. Nuts are primarily a fat source, and don’t forget the energy from fat is 9kCal/gm. The next calorie source is from protein at 5kCal/gm. Although nuts have carbohydrates, they are not primarily a source of carbs.

        • Nuts are a source of balanced nutrition.
          And they are diverse.
          Everything I said is factual.
          Here is a table:
          http://www.stapleton-spence.com/images/nuts-nutrition-chart.png

          “The next calorie source is from protein at 5kCal/gm.”

          Wrong.
          Both carbs and protein have the same amount of calories per gram and it is not 5, it is 4.
          Overall.
          Proteins vary in the mix of amino acids they contain, but the average accepted value for Calories per gram of protein is 4.
          Large C. Kilocalories is denoted with a large C in nutrition.
          https://www.nal.usda.gov/fnic/how-many-calories-are-one-gram-fat-carbohydrate-or-protein

          • Greg: I am tired of your lies and posting that I said things I did not. Everyone knows what you wrote, (reposted below) and I tried to to ignore your near dozen posts about me, which were defamatory and inaccurate.

            When you make clear mistake errors about basic nutrition, you don’t need to lie and make pretend that Mario said something he did not. Just admit it and move on.

            The link to what you wrote where you said most of the calories from nuts are from carbs” is flat wrong.

            I also taught you the energy amounts of fat, protein and carbs, correctly because this seems confusing to you. That you fabricate that I said other things is par for you. I suggest people ignore you.

            Take a breath, and realize that my corrections of your misleading posts were polite and correct.

            Here’s the evidence:

            https://wattsupwiththat.com/2020/07/11/study-links-abnormally-high-blood-sugar-with-higher-risk-of-death-in-covid-19-patients-not-previously-diagnosed-with-diabetes/#comment-3033968

            The full text showing Nick does not understand what he’s talking about, as well as Mario’s clear correction. I requoted Nick’s nonsense using quote marks, and then explained how he was wrong. He know claims I originated the nonsense.

            Nicholas McGinley July 13, 2020 at 5:27 am
            Most nuts are high in carbs.
            Many have most of their calories from carbs, like cashews and pistachios.
            Regardless, they are IMO one of the essential foods for good health.

            Reply
            mario lento July 13, 2020 at 10:52 am
            “Most nuts are high in carbs.
            Many have most of their calories from carbs, like cashews and pistachios.”

            I think not even close, re: calories. Nuts are primarily a fat source, and don’t forget the energy from fat is 9kCal/gm. The next calorie source is from protein at 5kCal/gm. Although nuts have carbohydrates, they are not primarily a source of carbs.

      • I was responding to a specific assertion.
        The assertion contained the statement that carbs are equal to sugar.
        This is of course false.
        Carbs are carbs, sugar is sugar.
        Dietary fiber is carbs.
        But no one considers them sugar.

        If peas are high in sugar at 11%, it cannot also be true that nuts have “no” sugar.
        Yes, I should have said much instead of most, but in terms of grams, nuts have considerable carbohydrates.
        They have to…they are seeds.

  8. I’ve never heard one public official say if you are obese you have a high likelihood of dying of the disease. Somehow it is insulting? In fact there is no emphasis on telling the groups most a risk to basically stay home.. instead they are mandated to just wear a cloth mask that lets 95% of the virus in and out on every breath.

    The mask thing gives everyone a false feeling of security. Today’s tight buildings don’t allow the viruses to escape, they just keep it inside circulating and if you are in that environment with a mask that is basically worthless, you are breathing in lots of virus particles. At least the CostCo’s and similar big box stores are large buildings that are fairly well ventilated.

    There is a video circulating where a health care worker takes off a face shield, then three masks in order, turns to the camera and says if he has to do this, you can at least wear a mask in public. Well, if he has to do that to keep himself protected, just how is one cloth mask going to work?

    The disease will ultimately run its course. They always do. There is no way we can stop it so let’s keep the most at risk out of the mainstream, let it run through the population and hope we get good therapeutics and a vaccine or two in the next year.

    • Notice the virus was predominantly in the Northern cold areas during winter. Now with warm/hot weather people in the warm areas are heading into the A/C and being affected.
      Outside is the safest place to be.
      And remember that your mask absorbs and adsorbs so if you touch it you have touched everything it has filtered. I remove my mask by the ear strings and place it in sunlight when removed. Then wash my hands.

  9. The authors suggest that possible mechanisms for this increased mortality include hyperglycaemia-induced changes in coagulation (clotting), worsening of endothelial function (the function of the walls of blood vessels), and overproduction of inflammatory cytokines produced by the immune system (the so-called cytokine storm).

    High pre-diabetic blood sugar levels increase interleukin-32, basically putting the body into a constant pro-inflammatory state:

    https://diabetes.diabetesjournals.org/content/65/12/3636

    Interleukin-32 has a negative effect on endothelial cells and coagulation:

    https://www.pnas.org/content/106/10/3883

    and is implicated in cardiovascular diseases:

    https://www.sciencedirect.com/science/article/pii/S0021915017311802

    In summary, this puts a lot more people at risk as one would guess at first.

  10. Having just read a very good book on SUGAR called “Sugar Crush” by leading nerve surgeon Dr. Richard Jacoby these results are not a surprise ……. Sugar is an addictive poison and too much of it especially in the most common form of “High-fructose corn syrup” is killing Americans with obesity and diabetes.

  11. So how do they measure “Fasting Blood Glucose levels at admittance to hospital”. Do they say, “We know you’re real sick, but you can’t eat anything for 12 hours?” BTW, this was a timely article. My wife has diabetes and just had her annual lab tests. Her A1C has increased significantly. She is scheduled for a telephone consult with her provider on Tuesday.

    • Littlepeaks

      There are a number of clinics that are treating diabetes with nutritional changes. They often include some fasting which helps bring down glucose levels. The key is their 24hr help that all offer. Making a choice of changing your diet or being ok with dosing with meds that usually increase over time is yours. Visit some of the following sites if you are interested and also want some knowledge to prep you for your Tuesday consult.

      Virta Health have had great success with their patients, many insurance companies support their treatment.
      https://www.virtahealth.com/

      Jason Fung’s IDM. Intensive Dietary Management. He is a nephrologist that was dismayed that his diabetic patients ended up on dialysis and seeing them eventually deteriorate.
      https://https://idm.health/

      good luck

    • Do they say, “We know you’re real sick, but you can’t eat anything for 12 hours?”

      If you put the same amount of glucose solution directly into your blood it raises your insulin levels way less than if you drink it! Crazy, isn’t it?

  12. Makes sense.

    Every time the liver is overloaded with sugar, the human immune system is suppressed for two or three hours which is right on time for the next super sugary meal.

    Sugar causes short term and long-term damage to the liver in a similar way as alcohol.

    In the US, added sugar to our food, has increased by more than a factor of ten. In the US, in 1800 the average consumption of added sugar was 18 lbs per year compared to 180 pounds per year in 2009.

    http://www.sugarstacks.com/beverages.htm
    http://www.sugarstacks.com/candy.htm

    The following statistics are from the link below:

    Seventy-five per cent of all US health-care dollars are now spent on treating the set of disease the Medical Industry calls ‘Metabolic Syndrome’ ‘diseases’ and their resultant disabilities.

    Metabolic Syndrome is the set of ‘diseases’ which happen when the liver is forced to processes 10 times more fructose, than the liver was designed for and when the body is Vitamin D deficient.

    The set of disease which are the Medical Industry calls ….

    …‘Metabolic Syndrome’ ‘diseases’ are also related to the population’s Vitamin D deficiency. We know that because the incidence of type 2 diabetes was reduced by 50%…

    By increasing the blood serum level of active Vitamin D in the bloodstream, 25(OH)D from 22 ng/ml (Vitamin D severe deficiency) to 40 ng/ml (closer to Vitamin D Optimum. Optimum is assumed to be greater than 60 ng/ml based on the 80% reduction in breast cancer and Vitamin D dosage proportional response of prostate cancer that has been found.)

    This is a link to a summary of the science and the estimated sugar US healthcare costs.

    https://www.nature.com/articles/482027a.pdf

    “Importantly, sugar induces all of the diseases associated with metabolic syndrome.
    This includes:
    hypertension (fructose increases uric acid, which raises blood pressure);
    high triglycerides and insulin resistance through synthesis of fat in the liver; (William: You know fatty liver ‘disease’)
    diabetes from increased liver glucose production combined with insulin resistance;
    and the ageing process, caused by damage to lipids, proteins and DNA through nonenzymatic binding of fructose to these molecules.

    It can also be argued that fructose exerts toxic effects on the liver that are similar to those of alcohol. This is no surprise, because alcohol is derived from the fermentation of sugar. Some early studies have also linked sugar consumption to human cancer and cognitive decline.”

    Vitamin D is a protohormone that changes our body at microbiological level. The Vitamin D researchers found that patients after correcting their Vitamin D deficiency are losing 20 to 40 lbs without dieting and they have increased muscle mass and less fat. They also have less depression and better balance.

    https://www.sciencedirect.com/science/article/pii/S0960076015300091?via%3Dihub

    Incidence rate of type 2 diabetes is >50% lower in Grassroots Health cohort with median serum 25–hydroxyvitamin D of 41 ng/ml than in NHANES cohort with median of 22 ng/ml

    • So is eating fruit bad?
      Should people eschew eating fresh fruits as part of a healthy diet?

      Every molecule in the biosphere is “derived” from glucose.

      • The short answer: Yes

        The longer answer: Historically we gorged on fruits, in very short windows when they were seasonally available. We put on weight and then had limited access to carbs over the colder months where in many environments we at most had access to animal meat.

        Fruits were also not the hyperpalatable produuce we eat to this day. In fact many of the fruits are infertile due to the way we have hybridised them in recent times. Lastly it was used quite succesfully to treat diabetes before the invention of insulin that the treatment was to avoid all starches, sugars and especially fruits. The oldest medical text on this exact treatment found was from 1797.

    • Regardless of what may or may not be true about any particular food molecule, no one can eat their way to good health.
      Without exercise, physical activity, no one will be healthy, get healthy, or maintain good health.
      Someone who gets plenty of physical exercise can maintain good health while subsisting on a widely varied diet including just about anything which is “food”.
      Without physical activity, i.e. with a sedentary lifestyle, no amount of attention to diet will allow good health.

  13. Any medical problem lead to a statisticaly higher risk of death. The whole covid scare could be a result of false positives from a very sensitive test. BMJ Counts 95% accuracy as a reasonable average and that could explain all positive cases in most countries. Contamination e.g. from previous tests can only lead to false positives, and it seems reasonable that testing personnel make more errors when they are overworked. In good lab conditions there is up to 8% false positives in research. Anyway, we cannot know if the Pcr test is measuring anything relevant. None of the conditions for attributing causality to the Covid Rna séquence are fulfilled.

  14. I read this article and all I see is that the people that came in late with more symptoms were more likely to die then the ones who got treated earlier in the illness. Without a long term sugar panel there is now way to know what this data means, many illnesses affect blood sugar levels.

  15. For anyone who routinely checks all of their blood work data and retains copies of such, you will have noticed that the units used in this report are in mmol/L (millimoles per liter), while blood test report units of mg/dL (milligrams per deciliter).
    To convert your blood test results to the units used here, divide by 18, since the molecular weight of glucose is 180 and a deciliter is one tenth of a liter.

    In any case, one way to interpret the results reported here is to simply note that unhealthy people are very often unhealthy in numerous ways, and are often in exceedingly poor health, and that people in poor health are in a lot more danger than healthy people when they become sick with an infectious disease.

    The upshot is, stay healthy.
    Try to keep your blood sugar below 80.

    • This is America being out of step with the rest of the world again. Everywhere (not dominated by the USA) reports glucose concentration in mmol/L. Pretty much every glucose meter can be configured to report either.

      For a type 2 diabetic, trying to maintain 80 (mg/dl, 4.44 mmol/L) is close to impossible.
      Go much below that and you run into hypoglycemia, which can be fatal.
      Even if you can fine-tune your drugs and afternoon/evening intake of carbs to result in 80 the next morning, you can’t control what happens when you eat. You don’t have a properly working system to churn out insulin to maintain a fairly constant glucose level, it will spike. If you use insulin, you can maybe estimate well enough to dose yourself before the meal to flatten the spike, but get it wrong and its hypo time. On glipizide etc, you get what the drug gives.

      Chasing a “normal” glucose level is dangerous.
      The best you can do keep it as low as possible without going too far.

      • I used to live with a diabetic, and tested often. Regardless of what I ate, and when I ate it, my blood sugar level was pinned between 80 and 82. I am today measured at 82, at 55 y/o. Guess I am lucky.

        If I had to inject, I’d be scared of trying to keep sugars at 80 for the reasons you stated. Going too low is extremely dangerous, whereas being elevated causes long term problems…

        There are some things you can do, as a type II diabetic, one thing is look into chromium picolinate.

        • or stay away from the carbs is another. Keto diets result in most probably either going completely off their insulin or lowering the needed dose substantially in the first 6months.

  16. We went more ketogenic about two years ago, wildly ignoring medical dietary advice. A little like ignoring climate alarmism. LDL came down, HDL went up, triglycerides way, way down. For a family member, what a doctor called pre-diabetes of 5.9 came back into normal range of 5.6. The cost has been a lot of extra cooking from scratch since so many things have sugar and chemicals them. Also dropped starches, most bread products most of the time. We’ve also learned what sweetener subs are less likely to spike blood sugar. Worth it, though, since we came home from a wedding with Covid in March. It was not fun, but we count ourselves lucky that it was mild by comparison.

    My breakfast is coffee whipped with MCT oil, a dab of ghee, heavy cream, a small spoonful of a combo of: cacao powder, Ceylon cinnamon, collagen, and ashwagandha.

    • If 5.6 and 5.9 are classified as “different”, this has more to do with the somewhat arbitrary cut off points that are established as being important, but in fact this is a small difference.
      If 5.9 (106.2)is too much, 5.6(100.8) is very close to being too much.
      They are not very different values, even if one is on one side of some line and the other is just on the other side of that line.
      The labs tests that spit out those numbers are not that accurate, and neither is a one time measurement a very reliable indicator of the range of blood glucose levels we all have, which vary continuously over the day and even minute by minute.
      The same is true of blood pressure readings.
      One should be looking for a value closer to 80.
      100.8 is high.
      So is 106.2
      80 is much better.
      Besides, these are fasting values.
      More significant is likely what happens when you eat something.

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