COVID-19 and Diabetes: Insulin Requirements Parallel Illness Severity in Critically Unwell Patients

Insulin Requirements Parallel Illness Severity in Critically Unwell Patients

Linda Wu; Christian M. Girgis; Ngai Wah Cheung


Clin Endocrinol. 2020;93(4):390-393. 

In This Article

Abstract and Introduction


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.


As the world grapples with the crisis of covid-19, diabetologists are faced with 2 critical questions: what is the nature of the association between covid-19 and diabetes and what are the direct clinical implications to our patients? Early data raised alarm that diabetes diagnosis and hyperglycaemia are independent predictors for death and morbidity in patients with SARS-CoV-2.[1,2]