Living with COVID-19 and type 2 diabetes risk: a perspective from Nepal

COVID-19 has posed an unprecedented threat to global health, affecting over 55 million people across the world and causing more than 1.3 million deaths. Like many developing countries, Nepal has been greatly affected. As of 11 November, there were close to 200,000 confirmed cases and more than 1100 deaths in the country and the total number continues to increase dramatically. The impact of COVID-19 is exacerbated by the growing prevalence of health risk factors such as chronic conditions and their associated complications and malnutrition; and systemic factors such as access to medication, care and treatment. Research has shown that people at high risk of type 2 diabetes (ie. diagnosed with impaired glucose tolerance, IGT, also known as pre-diabetes) are more likely to experience poor treatment outcomes. However, a large number of people at high risk who have been infected with the virus have made a healthy recovery. Prof. Krishna Gopal Adhikari, Vice-Principle of the Nepal Model School, is one of them. Diagnosed with IGT in 2019, he shares his experience of infection and recovery from COVID-19.

How were you diagnosed with COVID-19?

I live with my wife and two daughters in a rented house in Kathmandu. After the government enforced lockdown measures in March, we restricted our movement and worked from home until August. When the government began to ease the restrictions, I went back to school to interact with parents and students, facilitate the enrollment process and discuss online classes. I also went outside to buy groceries and other daily necessities. I always took the recommended safety measures, wearing a mask and gloves, washing my hands, using hand sanitizers and maintaining social distance. After a few days, I started having a dry cough for a few hours in the morning. I dismissed this as just being a sign of the flu. However, the symptoms got worse and I ended up with a high fever. I realised that I might have COVID-19 and went to get tested at the nearest governmental hospital. After two days, I received a text message and phone call confirming that I had been infected with the virus. My family members also tested positive a few days later.

How long did you have COVID-19, what symptoms did you experience, and did they impact on your blood glucose management?

I lived with the virus for 16 days. Initial symptoms included dry cough, fever, headache, weakness, diarrhea and loss of taste and smell. Towards the end, my symptoms were limited to weakness and loss of smell.  Since I felt weak, I exercised less and also ate more foods with a high glycaemic index. This made me experience symptoms of high blood glucose such as frequent urination and excessive thirst and reduced my energy levels even further. Being confined at home meant that I was not able to do any clinical examinations. Throughout the period I had the virus, I regularly consumed medicinal herbs which I believe helped my recovery.

Did you receive support from a health professional and sufficient information to manage your risk of type 2 diabetes while you had the virus?

The assistance I received from the Tokha municipality and hospital exceeded all my expectations. They reacted quickly to deal with my infection and initiate contact tracing and also provided valuable psychological support and guidance to help me manage the symptoms of the virus. I did not however receive extra information and advice to help manage my blood glucose levels. It would have been beneficial to have had received this as part of counselling and follow-up calls.

What was your biggest fear while you had the virus?

I was optimistic that I would recover soon and so my greatest concern was the recovery of my wife and children. I was afraid that in case of emergency they would not be able to access hospital care as there was a scarcity of beds in the city. Happily, they recovered earlier than me, perhaps as a result of their stronger immunity or the absence of underlying conditions.

How did COVID-19 affect your daily life, apart from needing to stay home?

In general, COVID-19 helped me realise the importance of finding time for myself and my family. On a daily basis, the pandemic prevented me from doing regular outdoor activities and made buying necessities more difficult, also due to higher prices and shortages of supplies. Having to self-isolate for two weeks also made me feel bored. To counter this, I spent a lot of time planning activities for my school, reading and getting in touch with colleagues and close relatives to facilitate contact tracing. I also used the time to inform my friends, families and colleagues about the symptoms of the virus and how to manage and prevent it.