Importance of diabetes control for prevention of black fungus

With the ongoing Covid-19 surge, mucormycosis, commonly known as the black fungus is posing a serious threat to Covid-19 recovered patients and is seen to have affected people with the impaired immune systems, or with damaged tissue. Compared to the other countries the incidence of mucormycosis was 70 times higher in India even before the COVID pandemic, these numbers have increased several-fold during the pandemic.  Some of the most common risk factors being attributed to a high incidence of mucormycosis in post-COVID cases are hyperglycemia arising due to various factors like diabetes (new-onset or not) or steroid induced hyperglycemia. The poor immune state seen in COVID patients and the indiscriminate use of steroids have also contributed to the sudden rise, prolonged hospitalization with or without mechanical ventilators may also be a causative factor. According to a recent study ‘Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India,’ diabetes mellitus is the single most important risk factor in COVID patients developing mucormycosis, hence it is very critical to control diabetes.

Poorly controlled diabetes puts people at a higher risk of certain fungal infections. The problem lies with the fact that the majority of diabetes cases are discovered through other health complications and hence remain untreated. The best way to control diabetes is through insulin as it helps in balancing blood glucose levels. When there is excess glucose in the bloodstream, it helps the body to store excess glucose in the liver. The stored glucose is only released when the blood glucose level decreases.

Insulin helps in treating both type 1 and type 2 diabetes. Injectable insulin acts as a replacement for the body’s insulin. People with type 1 diabetes face difficulty in producing insulin and hence depend on insulin to control blood glucose levels. The closer insulin therapy gets to the body’s natural response, the better it is at balancing blood glucose levels. People with type 2 diabetes can manage their blood glucose levels with oral medication and lifestyle changes. However, when the treatment doesn’t work, people with this condition have to depend on insulin to control their blood glucose levels. Insulin treatment has evolved significantly, and with each advancement, we are getting closer to achieving a natural insulin response. Most importantly, these advancements helped people living with type 1 diabetes overcome some of the inconveniences that come with treating and living with the disease.

The black fungus may be observed in some Covid-19 patients with uncontrolled high blood glucose levels. According to a recent research paper reviewing COVID-19-associated mucormycosis (black fungus) cases globally, it was noted that among patients recovering from Covid-19, 94% who had black fungus also suffered from diabetes. Quick diagnosis through the high degree of clinical suspicion and confirmation with culture followed by immediate medical management with surgical debridement offers the best therapeutic outcome for patients.

People with diabetes who have poor immune systems are particularly vulnerable to black fungus., It is of utmost importance to keep sugar levels under control in such high-risk individuals. Additionally, maintaining high immunity post recovering from Covid-19 is also very crucial since low immunity can increase the risk of contracting such fungal and other infections.

(Written by Dr. Mohan Y Badgandi, Consultant Diabetes & Endocrinology, Manipal Hospitals Bangalore.)