Acute uncontrolled hyperglycemia, a non-specific presentation and predictor of covid-19 severity- a report of three cases

Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory coronavirus 2 (SARS Cov-2) which currently has caused over 76 million cases with over 1.6 million people dead worldwide. COVID-19 can manifest with several non-specific clinical presentations, posing a diagnostic challenge. Several studies have shown an increased COVID-19 severity in patients with Diabetes mellitus.  However, some patients with COVID-19 severity may present with new-onset Diabetes mellitus or worsening blood glucose control in a known diabetic. There are various mechanisms by which the SARS Cov-2 causes hyperglycemia in infected patients. This can lead to hyperglycemia as a presentation of COVID-19 in the absence of specific signs and symptoms. We present three cases: two of them initially presented with acute onset hyperglycemia and were diagnosed with Diabetes mellitus but shortly developed clinical manifestations that led to the suspicion of COVID-19 and a positive COVID-19 RT-PCR test. The third was a diabetic with previously good glycaemic control which suddenly worsened for no reason and shortly after, also developed clinical manifestations that led to the suspicion of COVID-19 which was later confirmed.

We recommend that patients with acute hyperglycemia state and/or worsening blood glucose control in patients with previously well controlled Diabetes mellitus should be evaluated for COVID-19 in order to reduce morbidity and mortality as hyperglycemia confers an increased disease severity.