Diabetic ketoacidosis (DKA) in type 1 diabetes mellitus (T1DM) temporally related to COVID-19 vaccination

Abstract

SARS-CoV-2 pandemic has claimed millions of lives since its first identification in December 2019. Patients with diabetes are at a high risk of adverse outcomes after COVID-19 infection, whereas infection itself can be associated with severe hyperglycemia, including hyperglycemic emergencies. While the accelerated vaccine development and rollout have considerably decreased morbidity and mortality with reasonable safety, there are emerging reports of worsening of hyperglycemia in response to vaccination, with possible shared pathophysiology with COVID-19 infection-related hyperglycemia. We hereby report two young patients with type 1 diabetes (T1DM) who presented with severe diabetic ketoacidosis (DKA) after receiving second doses of COVISHIELD (ChAdOx1 nCoV-19) and COVAXIN (BBV152- inactivated whole virion) vaccines. Though a causal link cannot be established, post-vaccination immune response can potentially explain this transient worsening of hyperglycemia and hyperglycemic emergencies. We, hence report diabetic ketoacidosis (DKA) following COVID-19 vaccination in T1DM. We suggest that people with diabetes, particularly patients with T1DM with inadequate glycemic control should ideally be closely monitored for hyperglycemia and ketonemia for at least 2 weeks after receiving vaccination for COVID 19.

Endocrine system after 2 years of COVID-19 vaccines: A narrative review of the literature

“…Diabetic ketoacidosis (DKA) in patients with known T1DM was reported in two case series ( 73 , 74 ) and one case report ( 75 ), including five patients (four women and one man; median age was 25 years). In one case, DKA occurred less than 12h after the first dose of Pfizer/BioNTech BNT162b2 ( 73 ) in a patient who had consumed approximately 20 g of alcohol on the night before vaccination.…”

“…In one case, DKA occurred less than 12h after the first dose of Pfizer/BioNTech BNT162b2 ( 73 ) in a patient who had consumed approximately 20 g of alcohol on the night before vaccination. The other four cases occurred, with a variable latency between 12h and 6 days, after the second dose of Moderna mRNA-1273 ( 75 ), Pfizer/BioNTech BNT162b2 ( 73 ), Vaxzevria ChAdOx1 ( 74 ) and Covaxin (BBV152-inactivated whole virion) ( 74 ). All patients were successfully treated with intravenous fluids and insulin.…”

BNT162b2 mRNA COVID-19 Vaccine Does Not Impact the Honeymoon Phase in Type 1 Diabetes: A Case Report

“…Another (non-mutually exclusive) explanation of ViHG relies on the fact that the stimulation of the immune system following COVID-19 vaccination may cause a stress response associated with a rise in circulating levels of counterregulatory hormones such as growth hormone, adrenaline, cortisol, and/or glucagon [ 50 , 51 ]. Accordingly, there are reports of DKA development after administration of different COVID-19 vaccines, such as ChAdOx1 nCoV-19 vaccine and BBV152-whole virion inactivated vaccine [ 52 ], mRNA-1273 Moderna vaccine [ 53 ], and BNT162b2 (Pfizer-BioNTech) mRNA vaccine [ 54 ], in the absence of other precipitating factors for DKA. The activation of systemic inflammatory pathways and the rise in circulating levels of counterregulatory hormones after COVID-19 vaccine administration may substantially contribute to hyperglycemic emergencies such as DKA and/or HHS as a likely consequence of increased insulin resistance and hepatic glucose production [ 45 , 46 , 47 , 55 ].…”

An update on the interaction between COVID-19, vaccines, and diabetic kidney disease

“…The rapid rollout of vaccines has significantly reduced morbidity and mortality associated with COVID-19 ( 80 ). However, associated adverse reactions have been reported; we summarize the cases of hyperglycemia and related complications following COVID-19 vaccination in people with or without diabetes ( Table 2 ) ( 81 – 97 ). The majority of cases occur with nausea, polydipsia, and polyuria after 1–4 weeks of COVID-19 vaccination and diagnosed as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic syndrome, or new-onset diabetes.…”