Infection with the virus itself leads to oxidative stress, resulting in hypoxia and inflammation, which aggravates glucose homeostasis.4,7 Another underlying mechanism appears to be insulin resistance due to the high levels of interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-a) in subjects with severe COVID-19 infection.21-23 Additionally, damage to key organs involved in glucose metabolisms, such as the kidney and the liver, resulting in abnormal blood glucose levels have been observed in cases of COVID-19 infection. Here, TNF is linked to Insulin resistance.