A Case Series of Ketoacidosis After Coronavirus Disease 2019 Vaccination in Patients With Type 1 Diabetes

Front Endocrinol (Lausanne). 2022 Mar 18:13:840580. doi: 10.3389/fendo.2022.840580. eCollection 2022.


Introduction: We report a case series of severe ketoacidosis after COVID-19 vaccination in a type 1 diabetes patients treated with insulin and an SGLT-2 inhibitor.

Case report: We present two cases of type 1 diabetes mellitus. One patient was treated with insulin therapy and an SGLT-2 inhibitor, and the other patient was treated with insulin therapy alone. Both patients became ill after coronavirus disease-2019 vaccination, making it difficult to continue their diet or insulin injections. On admission, they developed severe diabetic ketoacidosis. This is the first report of ketoacidosis after coronavirus disease-2019 vaccination.

Conclusion: The vaccine should be carefully administered to type 1 diabetes patients receiving intensive insulin therapy and a sodium-glucose transporter due to the high risk ketoacidosis. It is important to instruct patients to drink sufficient fluids and to continue insulin injections when they become sick.

Keywords: clinical diabetes; coronavirus disease 2019 vaccination; ketoacidosis; latent autoimmune diabetes in adults; sodium-glucose cotransporter 2 inhibitor; type 1 diabetes.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 Vaccines / adverse effects
  • COVID-19* / complications
  • Diabetes Mellitus, Type 1* / complications
  • Diabetes Mellitus, Type 2*
  • Humans
  • Hypoglycemic Agents / adverse effects
  • Ketosis*
  • Vaccination / adverse effects


  • COVID-19 Vaccines
  • Hypoglycemic Agents