Diabetic ketoacidosis threatens hospitalized patients with COVID-19

Diabetic ketoacidosis is a common and potentially fatal complication in hospitalized patients with COVID-19, according to a new clinical perspective published in the Endocrine Society's Journal of Clinical Endocrinology & Metabolism.

Diabetic ketoacidosis almost always requires special care in the hospital which usually takes place in the intensive care unit (ICU). It is caused by insufficient insulin circulating in the bloodstream, which is more likely to occur during a serious infection like COVID-19. Diabetic ketoacidosis causes a buildup of acids in the blood, leading to serious illness characterized by dehydration and sometimes difficulty breathing.

"People with diabetes who are infected with COVID-19 are at increased risk of severe disease, which in some cases is accompanied by diabetic ketoacidosis," said the paper's corresponding author Marie McDonnell, M.D., of Brigham and Women's Hospital and Harvard Medical School in Boston, Mass. "Hospitals and clinicians need to be able to quickly identify and manage diabetic ketoacidosis in COVID patients to save lives. This involves determining the options for management (including when less intensive subcutaneous insulin is indicated) and understanding how to guide patients on avoiding this serious complication."

The authors outline simpler methods of diabetic ketoacidosis management with the goal of keeping ICU beds available for severe COVID-19 cases. They advocate, in select cases, for diabetic ketoacidosis protocols that use subcutaneous insulin therapy outside of the ICU instead of IV insulin therapy in the ICU to protect nurses from having to deliver frequent bedside care to COVID-infected patients.

Other topics include the importance of recognizing euglycemic ketoacidosis in those taking SGLT2-inhibitor agents and the recognition that unique approaches, including telemedicine, may be needed to help the highest risk patients avoid ketoacidosis.