Original title: Do new crown antiviral drugs conflict with diabetes hypoglycemic drugs?Endocrinologist Answers
Chen Sisi, Chief Reporter of The Paper
At present, the prevention and control of the new crown pneumonia epidemic is in a severe situation. For those patients who may develop severe or critical illness after infection, the drug Neimatevir/ritonavir (Paxlovid) can reduce the risk of hospitalization and mortality, and has attracted much attention.
But it should be noted that the best time to use this medicine is within 5 days after the onset of symptoms. At the same time, due to the certain interaction between this drug and various drugs, many diabetic patients will worry: Will there be any conflict or interaction between it and the hypoglycemic drugs used daily?
In this regard, Yu Haoyong, deputy chairman of the 8th Youth Committee of the Diabetes Branch of Shanghai Medical Association and chief physician of the Department of Endocrinology and Metabolism of Shanghai Sixth People’s Hospital, said that Paxlovid drugs and hypoglycemic drugs currently used in clinical practice include oral drugs. There is no conflict with insulin, insulin analogs, glucagon-like peptide-1 (GLP-1) receptor agonists, etc., that is to say, the daily hypoglycemic treatment will not be affected during the anti-new coronavirus drug. Similarly, there is no conflict between other antiviral drugs such as azvudine and monogravir and hypoglycemic drugs.
Yu Haoyong further stated that it should be noted that for severe or critically ill patients, as well as non-severely ill patients, systemic hormones have been used before infection with the new coronavirus for other reasons (such as chronic obstructive pulmonary disease, chronic autoimmune disease) , or aggravated clinical symptoms, etc. At this time, glucocorticoids (such as prednisone, dexamethasone, etc.) should be considered for treatment. This type of drug will cause blood sugar to rise during use. There may be a sharp increase in blood sugar, and even induce diabetic ketosis (DK) or ketoacidosis (DKA). At this time, insulin-based hypoglycemic therapy should be considered. If diabetic patients have symptoms such as markedly elevated blood sugar, nausea, vomiting, or even disturbance of consciousness, they need to be alert to acute complications such as DKA and hyperosmolar syndrome. Electrolyte supplementation and other measures should be taken, and immediate referral to an endocrinologist for further diagnosis and treatment is required. Usually, the course of hormone use is generally more than 5 days. During this period and within a few days of hormone withdrawal, blood sugar changes must be closely monitored.
Yu Haoyong pointed out that poor control of diabetes is usually a risk factor for new crown infection, and poor blood sugar control is associated with poorer outcomes of new crowns. If a diabetic patient is infected with the new coronavirus and has poor appetite and reduced food intake, the dose or frequency of hypoglycemic drugs or insulin should be appropriately reduced, and the frequency of blood sugar monitoring should be increased. Blood sugar, not only to prevent hypoglycemia, but also to prevent complications such as severe hyperglycemia and DKA.