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What are Comorbidities?

Dr. Joanne Paul- MBBS (UWI), FRCPCH (UK), FRCP (Edin)

Before the covid pandemic, the word comorbidities was not such a well-known word. Now it is repeated maybe at least 10 times a day and definitely on the nightly news when detailing the update from Ministry of Health as to the covid numbers. Comorbidities means the presence of two or more diseases or medical conditions. The common ones are diabetes, hypertension, kidney failure, heart disease, cancer.

 

As the pandemic evolved, the information changed, expanded, refuted, and sometimes flipped 180 degrees. From an academic point of view, one had to be constantly updating since things were even changing on a weekly basis. We migrated from the usual definition of comorbidities to appreciating that Obesity was also classified as a significant comorbidity with the covid virus. Soon after it was realised that Obesity was probably one of the more significant comorbidities if not the most significant with regards to covid 19.

 

And when one thinks about it, it makes sense. Obesity is pro inflammatory which means that it keeps your entire system in a heightened or increased inflammatory state. The covid 19 virus also causes our immune system and our general system to be more inflamed. Thus, when covid is added to obesity, it causes the general system to be double or triple inflamed with all the effects on the organ systems ramped up and exacerbated.

 

Obesity itself also can have the person in a high blood sugar state. With its high levels of fatty acids and inflammation, it causes insulin resistance and type 2 diabetes. Generally, Insulin works by pushing the glucose into cells and into the liver where it is stored. Thus, the glucose levels in the blood reduces and is controlled. With obesity the abdominal fat causes the fat cells to release proinflammatory chemicals which are anti the effects of insulin and cause the cells to not respond to insulin and not allow the glucose to enter, keeping a higher glucose level in the blood. Thus, the abdominal fat would cause your sugar levels to be poorly controlled. With Obesity, the liver is packed with fat and there is less room to store the glucose and thus again, more glucose is kept in the blood, causing again your sugar levels to be poorly controlled.

 

Not only does Obesity cause diabetes, it can also exacerbate existing diabetes. It causes the insulin resistance which causes the pancreas to work harder to produce more and more insulin which wears out the pancreas and thus it starts to produce less insulin, which then causes the diabetes to worsen. One of the terms now bandied about is Diabesity, when you are obese and have diabetes. When you have Diabesity, they make each other worse and there is a slippery slope of deterioration.

 

Obesity as we know can also cause hypertension or make hypertension worse. Just to add to the fun, obesity can worsen heart disease and kidney disease. So, if diabetes, hypertension, heart disease and kidney disease are major comorbidities which cause one to be more at risk for covid, and Obesity causes all of them, it makes sense that obesity is the super comorbidity. It is like a special combo with all the sides. And as an extra drink, it causes increased inflammation similar to what covid does. So, with Obesity we have a superpower comorbidity and double or triple inflammation.

But that is not all. The covid 19 virus damages the beta cells in the pancreas. These are the cells that produce insulin. The virus can also damage the cells around the beta cells. These cells around the beta cells organise for insulin release. So, the virus can reduce insulin production and also reduce insulin release, causing diabetes with high glucose levels in the blood. So sometimes persons can become diabetic with covid 19 infection, even if they were not diabetic before. So, Obesity is the superpower comorbidity and covid 19 also causes the same said Diabetic comorbidity that makes it a more severe disease

 

What about those persons who are healthy without comorbidities or at least think they are? An invisible comorbidity though is prediabetes or borderline diabetes. This is where your blood glucose is higher than normal but not yet high enough to be classified as diabetes. It can easily lead to type 2 diabetes. Most people who have prediabetes are not aware of it. They only know when the signs of type 2 diabetes start to appear. You are at high risk of prediabetes if you have a close family member who is diabetic, if you are obese, if you have hypertension, above 40 years old or given birth to a baby that weighed over 9 pounds. Of course, genetics are also a big deal. If you are Indo Trinidadian, Afro Caribbean, Native American or South Asian, you are also at risk.

 

So essentially, obesity is the superpower comorbidity with covid infection and puts you at severe risk. Covid 19 infection can make you become diabetic. You may think you are healthy, but you may be prediabetic or prehypertensive and very much at risk of having severe covid

 

It is like everything begat each other. Diabesity is the new cuss word. If we can learn one thing from this pandemic; time to make a change with our health

 

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