A known risk factor for COVID-19 is diabetes. People with diabetes may suffer from rare but life-threatening complications like diabetic ketoacidosis (DKA). Euglycemic DKA differs from DKA in that it is characterized by lower blood sugar levels, making it more difficult to diagnose. The US FDA has warned that the risk of DKA and euDKA may be increased for individuals who use sodium-glucose cotransporter 2 inhibitors (SGLT2i), which function by releasing excess glucose in the urine. Brigham researchers studied five unusual euDKA cases.
These cases represented a markedly heightened incidence of euDKA. All five of the recent euDKA cases were observed in COVID-19 patients who were taking SGLT2 inhibitors. Amongst the five patients, one patient with acute respiratory died, three patients were discharged to rehabilitation facilities, and one patient was discharged home. The researchers hypothesize that COVID-19 may exacerbate euDKA risks. The virus might bind to the cells on the pancreas that produce insulin and may exert a toxic effect on them.
The inflammatory response associated with COVID-19 produces high levels of immune-response-related proteins called cytokines, which may further increase the risk of DKA.
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