TUESDAY, Jan 12, 2021 (HealthDay News) – People with diabetes infected with COVID-19 should stop using a class of common diabetes drugs known as sodium-glucose co-transporter-2 inhibitors (SGLT2i) , to adjust.
People taking these drugs for diabetes are at risk of a potentially fatal complication called diabetic ketoacidosis (DKA), and it seems that the risk increases even further when they develop COVID-19, lead researcher Dr. Naomi Fisher, director of the Hypertension Service and Specialty Hypertension Clinic at Brigham and Women’s Hospital in Boston.
Diabetic ketoacidosis occurs when there isn’t enough insulin to allow cells to absorb glucose from the bloodstream, Fisher said.
“Because the body can’t use glucose for energy, it begins to break down fat for fuel instead,” Fisher said. “This process leads to high acids in the blood, the so-called ketones, as well as very high sugar concentrations in the typical DKA.”
High levels of ketones poison the body, causing headaches, nausea, vomiting, difficulty breathing and confusion. A person’s breath can also begin to smell fruity.
If left untreated, diabetic ketoacidosis can kill a person.
Five unusual cases of DKA were treated at Brigham’s diabetes clinic within two months at the height of the 2020 pandemic, including three within a week, Fisher and her team recently reported in AACE Clinical Case Reports.
The five cases all involved euglycemic DKA (euDKA), a type of diabetic ketoacidosis that is harder to diagnose because it occurs even though people don’t have severely high blood sugar levels.
SGLT2i drugs include Jardiance (empagliflozin) and Invokana (canagliflozin). They help treat diabetes by making patients urinate glucose, said Dr. Cecilia Lansang, director of endocrinology at the Cleveland Clinic.
“It’s supposed to prevent the kidneys from absorbing the glucose,” said Lansang, who was not part of the study.
But the drugs also make people dehydrated from urination, and the combined glucose decrease and water loss “are likely both major factors in causing euDKA,” Fisher said.
All five of Brigham’s euDKA cases were observed in COVID-19 patients with type 2 diabetes and were taking the drug. Three patients were treated in rehab, one was released to their home and one died, a 52-year-old man who developed severe breathing problems.
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