PMID- 38022370
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231201
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 10
DP  - 2023 Oct
TI  - Insulin Requirements During Severe COVID-19 Were Relatively Low in Japanese 
      Patients With Type 2 Diabetes: Two Case Reports.
PG  - e47654
LID - 10.7759/cureus.47654 [doi]
LID - e47654
AB  - The global coronavirus disease 2019 (COVID-19) pandemic has caused myriad adverse 
      effects on the pathology of other diseases. Numerous studies on COVID-19 have 
      reported that, in patients with type 2 diabetes mellitus (T2DM) who have 
      contracted severe COVID-19, glucose metabolism is exacerbated by multiple 
      factors, such as severe inflammation, beta-cell dysfunction caused by the 
      SARS-CoV-2 infection itself, corticosteroid therapy, vasopressor administration, 
      and enteral or parenteral nutrition. Very high doses of insulin are often 
      required in the acute phase of such patients; however, the factors that affect 
      insulin requirements and to what extent remain unclear. A 50-year-old Japanese 
      woman and a 67-year-old Japanese man, both with T2DM and obesity, were admitted 
      to our hospital with severe COVID-19. Both patients required mechanical 
      ventilation and were treated with dexamethasone and tocilizumab, an interleukin-6 
      (IL-6) receptor monoclonal antibody. Subcutaneous insulin injections failed to 
      control the patients' hyperglycemia, requiring up to 1.83 and 1.81 units/kg/day 
      of intravenous insulin, respectively. Insulin requirements were rapidly decreased 
      with improvement of the respiratory condition, termination of dexamethasone, and 
      discontinuation of tube feeding. Both patients were discharged with oral 
      antidiabetic agents alone. We experienced two Japanese patients who achieved 
      satisfactory glycemic control with a lower intravenous insulin dose than previous 
      reports. Comparing the clinical factors with the previous literature, ethnic 
      differences in insulin sensitivity and the administration of IL-6 receptor 
      antibodies may have been related to the relatively low insulin requirements.
CI  - Copyright (c) 2023, Yamamoto et al.
FAU - Yamamoto, Junpei
AU  - Yamamoto J
AD  - Division of Metabolism and Diabetes, Osaki Citizen Hospital, Osaki, JPN.
FAU - Takahashi, Hironobu
AU  - Takahashi H
AD  - Division of Metabolism and Diabetes, Osaki Citizen Hospital, Osaki, JPN.
FAU - Saito, Takaharu
AU  - Saito T
AD  - Division of Metabolism and Diabetes, Osaki Citizen Hospital, Osaki, JPN.
FAU - Yamamoto, Yuri
AU  - Yamamoto Y
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Takahashi, Koudai
AU  - Takahashi K
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Itakura, Koji
AU  - Itakura K
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Kobayashi, Makoto
AU  - Kobayashi M
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Igusa, Ryotaro
AU  - Igusa R
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Kobayashi, Takafumi
AU  - Kobayashi T
AD  - Division of Anesthesiology, Osaki Citizen Hospital, Osaki, JPN.
FAU - Ichinose, Masakazu
AU  - Ichinose M
AD  - Division of Respiratory Medicine, Osaki Citizen Hospital, Osaki, JPN.
FAU - Usui, Masahiro
AU  - Usui M
AD  - Division of Metabolism and Diabetes, Osaki Citizen Hospital, Osaki, JPN.
LA  - eng
PT  - Case Reports
DEP - 20231025
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10668887
OTO - NOTNLM
OT  - covid-19
OT  - ethnic differences
OT  - il-6 receptor antibody
OT  - insulin requirements
OT  - type 2 diabetes
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/11/29 18:42
MHDA- 2023/11/29 18:43
PMCR- 2023/10/25
CRDT- 2023/11/29 15:21
PHST- 2023/10/25 00:00 [accepted]
PHST- 2023/11/29 18:43 [medline]
PHST- 2023/11/29 18:42 [pubmed]
PHST- 2023/11/29 15:21 [entrez]
PHST- 2023/10/25 00:00 [pmc-release]
AID - 10.7759/cureus.47654 [doi]
PST - epublish
SO  - Cureus. 2023 Oct 25;15(10):e47654. doi: 10.7759/cureus.47654. eCollection 2023 
      Oct.