A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

Patel, Latika; Ayad, Sarah; Rayad, Mohammad Nabil; Gergis, Kirolos; Ejikeme, Chidinma; Talpur, Afrah; Abdelazeem, Basel; Eckman, Ari

doi:10.7759/cureus.16923

Cited by 4 publications

(4 citation statements)

References 11 publications

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“…Diabetic ketoacidosis is a serious and potentially life-threatening condition that occurs when an insulin deficit causes lipolysis and the formation of ketone bodies and acidosis in the blood [43]. Diabetic ketoacidosis is more common in T1DM but may also occur in T2DM, particularly if extreme stress is involved [43,44]. For some COVID-19 patients, diabetic ketoacidosis may be a presenting symptom rather than the conventional COVID-19 symptoms [43].…”

Section: Diabetic Ketoacidosismentioning

confidence: 99%

“…Diabetic ketoacidosis is more common in T1DM but may also occur in T2DM, particularly if extreme stress is involved [43,44]. For some COVID-19 patients, diabetic ketoacidosis may be a presenting symptom rather than the conventional COVID-19 symptoms [43]. The exact pathogenesis of diabetic ketoacidosis in COVID-19 patients is not known [43].…”

Section: Diabetic Ketoacidosismentioning

confidence: 99%

“…For some COVID-19 patients, diabetic ketoacidosis may be a presenting symptom rather than the conventional COVID-19 symptoms [43]. The exact pathogenesis of diabetic ketoacidosis in COVID-19 patients is not known [43].…”

Section: Diabetic Ketoacidosismentioning

confidence: 99%

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Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Pergolizzi¹,

LeQuang²,

Breve³

et al. 2023

Cureus

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Post-viral new-onset diabetes has been an important feature of the COVID-19 pandemic. It is not always clear if new-onset diabetes is the unmasking of a previously undiagnosed condition, the acceleration of prediabetes, or new-onset diabetes that would not have otherwise occurred. Even asymptomatic cases of COVID-19 have been associated with new-onset diabetes. Diabetes that emerges during acute COVID-19 infection tends to have an atypical presentation, characterized by hyperglycemia and potentially lifethreatening diabetic ketoacidosis. It is not always clear if new-onset diabetes is type 1 or type 2 diabetes mellitus. Many cases of COVID-associated diabetes appear to be type 1 diabetes, which is actually an autoimmune disorder. The clinical course varies temporally and with respect to outcomes; in some cases, diabetes resolves completely or improves incrementally after recovery from COVID-19. Disruptions in macrophagy caused by COVID-19 infection along with an exaggerated inflammatory response that can occur in COVID-19 also play a role. Those who survive COVID-19 remain at a 40% elevated risk for diabetes in the first year, even if their case of COVID-19 was not particularly severe. A subsequent post-pandemic wave of new diabetes patients may be expected.

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Section: Diabetic Ketoacidosismentioning

confidence: 99%

Section: Diabetic Ketoacidosismentioning

confidence: 99%

See 1 more Smart Citation

Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Pergolizzi¹,

LeQuang²,

Breve³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Therefore, the EMA and the FDA Adverse Event Reporting System do not suggest SGLT-2 inhibitors for patients with type-1 diabetes (FAERS). Aside from their negative side effects, this family of medicines has acquired appeal due to their glucose-lowering properties, as well as their ability to lower blood pressure (3-5 mmHg) and weight loss (1.5-3.5 kg) 30 Dapagliflozin, canagliflozin, and empagliflozin operate by inhibiting sodium-glucose cotransporter channels in PCT, decreasing glucose levels by preventing reabsorption, and limiting glucose availability in plasma 31 . This causes a lack of insulin and an increase in glucagon secretion, resulting in a metabolic shift toward free fatty acid breakdown (lipolysis) and ketoacidosis.…”

Section: Discussionmentioning

confidence: 99%

Diabetes Ketoacidosis Is a Cause of Concern in Sodium-Glucose Co-Transporter-2 Inhibitors Medication

Bhasin

Sharma

YADAV

et al. 2022

Int J Life Sci Pharm Res

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Diabetic ketoacidosis (DKA) is a dangerous complication that can afflict persons with Type 1 and Type 2 diabetes and is caused by a lack of glucose utilization and insulin generation. DKA is diagnosed by observing the anion gap values, blood glucose level, pH, serum bicarbonate level, and so on. DKA is associated with an elevated blood glucose of > 250 mg/dl (16.7 mmol/l) and is diagnosed by observing the values of anion gap, blood glucose level, pH, serum bicarbonate level, and so on. It occurs more frequently in type 1 diabetics with low insulin levels. Sodium-glucose Co-transporter-2 (SGLT-2) inhibitors are a novel family of anti-diabetic medications that lower blood glucose levels and produce glucosuria. The US Food and Drug Administration (USFDA) has issued a drug safety warning about the increased risk of DKA when using SGLT-2 inhibitors. Following the USFDA's warning, the European Medicine Agency reported 101 more cases of ketoacidosis caused by SGLT-2 inhibitors in people with Type 2 Diabetes Mellitus (EMA). According to the American Association of Clinical Endocrinologists, all SGLT-2 inhibitors should be stopped 3-4 days before major surgery and 24 hours before elective surgery. This review article focuses on the metabolism of ketone bodies and many pathophysiologic mechanisms of SGLT-2 inhibitors, which lower insulin/glucagon ratios, promote glucagon secretion from alpha cells, and increase ketones levels by stimulating lipolysis and resulting in ketogenesis. The primary goal of this study is to improve our understanding of a significant consequence of DKA caused by sodium-glucose cotransporter-2 inhibitors in patients with Type 1 and Type 2 diabetes. Psychosocial factors linked to diabetic ketoacidosis in adults with type 1 diabetes, as well as the prevalence of DKA in COVID-19 patients, have been linked to higher severity of mortality and duration of stay in these patients, according to recent research.

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Incidence, characteristics, risk factors, and outcomes of diabetic ketoacidosis in COVID-19 patients without prior insulin dependence: comparison with influenza

Dell’Aquila

Lee

Alamuri

et al. 2022

Preprint

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Whether SARS-CoV-2 infection triggers diabetic ketoacidosis (DKA) is unclear. This study characterized incidence, patient profiles, risk factors, and outcomes of in-hospital DKA in COVID-19 patients without prior insulin dependence and compared with influenza. This cohort consisted of 13,383 hospitalized COVID-19 patients (March 2020 to July 2022) and 19,165 hospitalized influenza patients (January 2018 to July 2022) in Bronx, NY. Patients with prior DKA and prior insulin use were excluded. Primary outcomes were in-hospital mortality and new-insulin use 3-month post-infection. The incidence of DKA in hospitalized COVID-19 patients was significantly higher than hospitalized influenza patients (1.4% vs. 0.8%, p < 0.05). COVID-19 patients with DKA were more likely to be intubated, receive steroid treatment, and die (mortality OR = 6.178, p < 0.05) than those without DKA. DKA patients without pre-existing diabetes were more likely to die than DKA patients with pre-existing diabetes (OR = 7.56, p < 0.05). Steroid use, pre-existing type-2 diabetes, and male sex were risk factors for DKA. Patients with DKA had a higher rate of insulin use 3 months post SARS-CoV-2 infection compared to those without DKA (8.2% vs. 1.6%, p < 0.05), suggesting SARS-CoV-2 infection could trigger new insulin dependence. Identification of risk factors for DKA and new insulin-dependency could enable careful monitoring and timely intervention.

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A Case of New Onset Diabetes and Severe Diabetes Ketoacidosis in a Patient With COVID-19

Cited by 4 publications

References 11 publications

Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Exploring the Implications of New-Onset Diabetes in COVID-19: A Narrative Review

Diabetes Ketoacidosis Is a Cause of Concern in Sodium-Glucose Co-Transporter-2 Inhibitors Medication

Incidence, characteristics, risk factors, and outcomes of diabetic ketoacidosis in COVID-19 patients without prior insulin dependence: comparison with influenza

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