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Obesity, diabetes mellitus (mostly type 2), and COVID-19 show mutual interactions because they are not only risk factors for both acute and chronic COVID-19 manifestations, but also because COVID-19 alters energy metabolism. Such metabolic alterations can lead to dysglycemia and long-lasting effects. Thus, the COVID-19 pandemic has the potential for a further rise of the diabetes pandemic. This review outlines how preexisting metabolic alterations spanning from excess visceral adipose tissue to hyperglycemia and overt diabetes may exacerbate COVID-19 severity. We also summarize the different effects of SARS-CoV-2 infection on the key organs and tissues orchestrating energy metabolism, including adipose tissue, liver, skeletal muscle, and pancreas. Last, we provide an integrative view of the metabolic derangements that occur during COVID-19. Altogether, this review allows for better understanding of the metabolic derangements occurring when a fire starts from a small flame, and thereby help reducing the impact of the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Correction of early signs of neuroglycopenia preceding the insurgence of severe hypoglycaemia may help to prevent the subsequent intake of sugar in excessive amount which can cause rebound hyperglycaemia. A practical and easy tool to control progression towards hypoglycaemia is missing. The aim of this study was to evaluate the effect of the administration of small amounts of glucose through the Glucose RapidSpray device in controlling the early symptoms associated with neuroglycopenia which precede the insurgence of hypoglycaemia. This device consists of a 10 ml bottle containing 10g glucose solution with the addition of artificial flavours and excipients to facilitate buccal absorption delivering by spray puffing regular amount of glucose in quantifies as small as 0.5 grams. We tested 10 normal individuals, mean age 25 years ± 3, both males and females with body mass index (BMI) ranging between 18 and 26. All subjects were fasting for more than 4 hours and experiencing slight signs of neuroglycopenia when glucose puffs were administered. The continuous glucose monitoring system was applied to fine recording changes in glucose levels following the administration of glucose. Different amounts of oral puffs ranging between n=5 and n=15 were taken by the subjects, as well as 3 grams of sugar by mouth as control. In subjects with lean BMI, 5-15 puffs were able to increase within 5 minutes glucose levels from 71.2 mg ± 4.3 to 80.5±5.1 (p<0.01). Glucose levels remain unchanged up to 15 minutes after. The increase of glucose following administration of 3 gr. sugar by mouth occurred only after 15 minutes. In subjects with BMI comprised between 24 and 26 no hyperglycaemic effect was observed following puffs or sugar administration as one can expect to occur in subjects with insulin resistance. The results of this study suggest that the absorption of glucose by oral spray puffs in quantities ranging between 0.5 and 2 gr. in lean subjects is able to raise rapidly blood glucose levels; thus controlling potential fall of glucose levels in a more physiological way. [ABSTRACT FROM AUTHOR]