Fisher and her team suspect that COVID-19 might exacerbate the risk of developing euDKA.
The coronavirus can bind to cells on the pancreas that produce insulin, and it may have a toxic effect on them. Studies have shown that COVID patients can suffer from increased blood sugar.
The severe inflammation caused by COVID-19 also might contribute to diabetic ketoacidosis, the researchers added.
The symptoms of COVID also could predispose someone to DKA, Fisher said.
“Underlying nearly all cases of euDKA is a state of starvation that can be triggered by vomiting, diarrhea or loss of appetite with COVID-19 infection,” Fisher said. “Unfortunately, poor food and fluid intake can worsen the effect of SGLT2 inhibitors, which cause glucose and fluid loss via the kidneys.”
The researchers recommend that diabetics suspend their SGLT2i use until their COVID infection clears.
“Many people will be able to hold their SGLT2i [meds] while they are acutely ill without serious consequence, especially if they are taking other medications to control diabetes,” Fisher said. “Sometimes an increase in insulin dosing will be needed.”
However, Lansang thinks it’s too early to recommend completely halting the use of the diabetes drugs if you’ve contracted COVID.
Diabetic ketoacidosis is easily treated once it’s recognized, by providing the person fluids and insulin as needed, Lansang said.
“I think the key here is not stopping this medication to prevent the onset of DKA, but more trying to educate the providers of what euglycemic DKA is,” Lansang said. “If it is recognized by the physician in the hospital, then they can treat patients for diabetic ketoacidosis.”
The U.S. National Institutes of Health has more about diabetic ketoacidosis.
SOURCES: Naomi Fisher, MD, director, Hypertension Service and Hypertension Specialty Clinic, Brigham and Women’s Hospital, Boston; Cecilia Lansang, MD, MPH, director, endocrinology, Cleveland Clinic, Ohio; AACE Clinical Case Reports, Nov. 27, 2020