ImmunoNutrition Series : Diabetes & Covid19

Author: Dr. Akshay Alawani, INFS Faculty Head

In this series, we so far grasped, who are more susceptible to Covid-19 and why, how a general population should diet; by reviewing the World Health Organisation’s (WHO) recommendations during Covid-19 crisis. We also understood the rationale behind those recommendations. However, those with chronic disease are at a higher risk. We learned that controlling such conditions will reduce the Covid-19 associated risk in such patients. Today, we will address what additional improvements can be considered by 463 million diabetes patients across the globe, of which, 1/6th patients are in India.

First and foremost, if you have not checked your blood glucose levels recently, you should get them checked. Especially if they are out of control, controlling them should be your priority. Higher blood glucose is a well-recognised contributor to inflammation as it takes part in the development of diabetes-related macrovascular (like coronary heart disease) and microvascular complications (like diabetic nephropathy and retinopathy) (1–3).

As small as five-per cent weight loss has shown to be potent in controlling blood glucose levels (4). In any disease related to insulin resistance, where the affected is overweight, gradually losing this weight should be a priority aim. In a study by Lean (5), optimal weight loss in people with diabetes (~10kg) with hypertension showed reduction not only in blood glucose levels but also a decline in hypertension. Hence, being in a moderate calorie deficit should be the priority. If you have very high blood glucose and you are being supervised by a clinical nutrition specialist, trying lower carbohydrate diet may provide additional benefits as shown by studies like Sato (6) and Hussain (7) in the short term. However, the long-term adherence issues are common, and that can lead to a reversal of achieved benefits. This can be seen in a study (8) which followed diabetic subjects for more almost four years.

In addition to this, aerobic (cardio) and anaerobic (weight training) exercise addition may prove beneficial as that has shown to affect blood glucose levels favourably (9). This is because blood glucose is used by exercise and insulin-resistant tissues get more sensitive because of the physical activity (9). Moreover, depression is widespread in type two diabetes patients (10), and the lockdown situation may contribute to additional mental challenges. Hence, making sure that you are mentally healthy is essential. In the case of mental issues, reaching psychologists should be the preference. Diabetes often coexists with various co-morbidities and hence, cause and manifestations of those conditions should be attended to as well.

We have previously discussed weight management and exercise implementations through various posts and blogs. We encourage you to go through them and revise WHO guidelines. Implement our two cents with proper support as needed, and let us know if this post was helpful.

Stay safe!


1.        Forbes JM, Cooper ME. Mechanisms of diabetic complications. Vol. 93, Physiological Reviews. 2013. p. 137–88.

2.        Chawla A, Chawla R, Jaggi S. Microvasular and macrovascular complications in diabetes mellitus: Distinct or continuum? Vol. 20, Indian Journal of Endocrinology and Metabolism. Medknow Publications; 2016. p. 546–53.

3.        Cade WT. Diabetes-Related Microvascular and Macrovascular Diseases in the Physical Therapy Setting. Phys Ther. 2008 Nov 1;88(11):1322–35.

4.        Wing RR, Lang W, Wadden TA, Safford M, Knowler WC, Bertoni AG, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011 Jul;34(7):1481–6.

5.        Lean ME, Leslie WS, Barnes AC, Brosnahan N, Thom G, McCombie L, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet [Internet]. 2018;391(10120):541–51. Available from:

6.        Sato J, Kanazawa A, Makita S, Hatae C, Komiya K, Shimizu T, et al. A randomized controlled trial of 130 g/day low-carbohydrate diet in type 2 diabetes with poor glycemic control. Clin Nutr [Internet]. 2017 [cited 2019 Nov 19];36(4):992–1000. Available from:

7.        Hussain TA, Mathew TC, Dashti AA, Asfar S, Al-Zaid N, Dashti HM. Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes. Nutrition. 2012 Oct;28(10):1016–21.

8.        Nielsen J V, Joensson EA. Low-carbohydrate diet in type 2 diabetes: stable improvement of bodyweight and glycemic control during 44 months follow-up. Nutr Metab (Lond) [Internet]. 2008 Dec 22 [cited 2019 Nov 21];5(1):14. Available from:

9.        Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, et al. Exercise and type 2 diabetes: The American College of Sports Medicine and the American Diabetes Association: Joint position statement. Vol. 33, Diabetes Care. American Diabetes Association; 2010. p. e147.

10.      Unwin N at al. IDF Diabetes Atlas Fourth Edition. International Diabetes Federation. 2009. 1–527 p.

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