Covid Ketoacidosis: How The Coronavirus Is Turning Metformin Into A Life-Threatening Drug


Diabetic ketoacidosis (DK) can be fatal if left untreated. With DK, the cells are unable to use glucose for energy and instead burn fatty acids for fuel. 

Ketogenic diets, one of the latest health trends, has shown that by severely restricting carbohydrates in the diet, your body can then burn fatty acids for energy. Following a keto diet is one of the best ways to lose unwanted body fat. 

However, keto diets are not always safe for those who have diabetes. That’s because by having very low levels of blood glucose, “the body thinks that it is starving and starts breaking down fats and proteins too quickly,” describes This condition is known as ketoacidosis. 

Ketoacidosis also occurs in people with type 1 diabetes or insulin-dependent type 2 diabetes when there is insufficient insulin, which is required to transport blood glucose into the cells. If glucose cannot be moved into the cells, dangerously high levels of both glucose and ketones can accumulate in the blood, explains. 

Because of the Covid-19 pandemic, a new type of diabetic ketoacidosis is emerging, according to Medical and Life Sciences News. The condition is called euDKA. 

EuDKA is a subset of diabetic ketoacidosis (DKA), and researchers believe that diabetes patients on glucose-lowering drugs may be at increased risk for euDKA when they contract COVID-19. Cases of euDKA were observed at Brigham and Women’s Hospital, and documented in an observational study published in The American Association of Clinical Endocrinologists Clinical Case Reports

EuDKA is more difficult to diagnose than DKA because lower blood sugar levels are present. This makes euDKA more difficult to diagnose.

The class of drugs that may increase the risk of DKA or euDKA in Covid patients with diabetes are SGLT2i’s, of which metformin is the most-widely prescribed.

According to, the following medications are some of the most popular SGLT2i drugs:

  • canagliflozin (Invokana)
  • canagliflozin/metformin (Invokamet)
  • canagliflozin/metformin extended release (Invokamet XR)
  • dapagliflozin (Farxiga)
  • dapagliflozin/metformin extended release (Xigduo XR)
  • dapagliflozin/saxagliptin (Qtern)
  • empagliflozin (Jardiance)
  • empagliflozin/linagliptin (Glyxambi)

SGLT2i drugs function by releasing excess glucose through urine. Because these drugs act as a diuretic, euDKA can further trick the body into thinking it’s starving. Symptoms of the condition include vomiting, diarrhea, and loss of appetite; these symptoms are often exacerbated by the diuretic effect of SGLT2i drugs.

Researchers at Brigham hospital studied five unusual euDKA cases, three of which occurred in one week, coinciding with the one of the biggest uptick in coronavirus cases in Boston (spring of 2020). Considering that in the previous two years prior to the pandemic, there were fewer than 10 euDKA cases, the researchers speculate that Covid contributed to the unusually high number of euDKA cases in a relatively short time span. 

Unfortunately, one of the five euDKA cases resulted in fatality. He was a 52-year old male with acute respiratory distress syndrome. (Three patients were discharged to rehab facilities and the other one was discharged home.) 

Why Does Covid Cause Ketoacidosis?

The authors of the study believe that the SARS-COV-2 virus which causes the disease known as COVID-19 binds to insulin-producing cells on the pancreas. Perhaps because viruses seek out sugar that resides on the trillions of cells in the human body, the virus is intentionally destroying beta cells, the specific type of cells in the pancreas that produce insulin. 

And by destroying the beta cells, blood sugar levels will be higher, which supplies the virus the food it needs to survive and multiply. 

Furthermore, in patients with severe Covid-19 symptoms, there is a noticeable increase in the number of cytokines. Cytokines are proteins that are vital to a healthy, balanced immune response. However, in severe cases of Covid, the immune response is out of control, leading to a cytokine storm. A cytokine storm can cause organ damage, which has proved fatal in deaths caused by the novel coronavirus. 

Other hospitals and institutions besides Bingham have observed an uptick in euDKA cases. The authors of the study suggest physicians that they stop administering an SGLT2i drug to patients who develop Covid-19 symptoms or have been diagnosed with DKA. This is already standard practice with metformin which unfortunately, may be contaminated with the carcinogenic compound, NDMA.

What To Do If You Have Covid And Take Metformin

Covid patients with diabetes are urged to vigorously monitor their blood sugar, especially if it is very high. You can speak to your doctor and inquire about other forms of diabetes management should you go off your SGLT2i medication for a brief spell. Assume your doctor is unaware of the link between SGLT2i drugs and euDKA and DKA. Point your physician to this study.

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