How does Invokana Cause Ketoacidosis?

To put it simply, Invokana (canagliflozin) doesn’t let the body dispose of ketones (acid chemicals produced by the liver) the way it normally should. As a result, it increases the risk of developing diabetic ketoacidosis (DKA). This is not the only SGLT-2 inhibitor with such side effects. Studies show that all of them increase the risk of DKA.

The risk of DKA is higher among Invokana users if:

  • their glucose levels suddenly drop lower than expected.
  • their beta cell function reserve is too low.
  • they drink too much alcohol.
  • they stick to to a low carb diet.

Which type of diabetes type are we talking about?

Both, but it’s not that simple. 

DKA is normally associated with type 1 diabetes, which is understandable. The pancreas of those who suffer from this type of diabetes doesn’t produce enough insulin. What happens when they:

  • forget about their next insulin shot
  • oversleep and miss the injection time
  • don’t have their insulin kit with them
  • ran out of insulin and it’s not available?

The body activates the mechanism of burning fat for energy to compensate for insufficient amounts of insulin. As soon as fatty acids get transformed into energy, ketones start to accumulate in the bloodstream. When there are too many of them, the blood’s Ph gets too low. Without a timely treatment, the patient runs the risk of falling into a diabetic coma. 

What about type 2 diabetes? Patients diagnosed with this disease produce enough insulin and have no risk of developing diabetic ketoacidosis unless they use SGLT-2 inhibitors like Invokana. 

Invokana was approved for type 2 diabetes, but in fact, it was also prescribed to type 1 diabetics by some doctors because the manufacturer (Johnson & Johnson) initially didn’t include diabetic ketoacidosis into the list of potential side effects of Invokana. Numerous lawsuits have been filed by patients who suffered because they and/or their doctors were not informed by Invokana makers about the possible risks of ketoacidosis.

The FDA Warning

Even though Invokana was approved by the FDA in 2013, it had taken two years to discover the link between its use and the increased risk of diabetic ketoacidosis.

When 20 cases of DKA brought about by Invokana were reported, the FDA issued a warning that this medication could induce ketoacidosis.

Major symptoms of Invokana-induced DKA:

  • acetone breath
  • feeling chronically tired and/or sleepy
  • rapid breathing
  • nausea and/or vomiting
  • decreased alertness
  • feeling confused
  • unusual thirst
  • dehydration
  • abdominal pain

Other SGLT2 inhibitors

Please be aware that the following medications also belong to the class of SGLT2 inhibitors and therefore can cause diabetic ketoacidosis just like Invokana does:

  • Empagliflozin (also known as Jardiance)
  • Dapagliflozin ( aka Farxiga)
  • Ertugliflozin (aka Steglatro)

Medically speaking, they affect the reabsorption of renal glucose, which make blood glucose levels drop because too much glucose gets excreted with urine. As a result, even users with blood glucose levels that are considered to be near-normal might develop diabetic ketoacidosis.

The danger

Since blood glucose levels of patients with diabetic ketoacidosis induced by SGLT2 inhibitors are often only slightly increased, it is atypical for a regular case of DKA. As a result, patients who develop this condition because of Invokana use might be misdiagnosed and the treatment might be delayed. Such situations should be avoided at all costs since DKA can be fatal if nothing is done about it.

Should I discontinue Invokana due to the risk of ketoacidosis?

No. The FDA wouldn’t have approved this medication if it wasn’t effective. One can find a great number of positive Invokana reviews where people claim no other diabetes medication could help them control their blood glucose levels as easily as this one. Besides, Invokana does wonders for those who want to lose weight fast.

To make sure you’ll be fine while taking Invokana, you should do the following:

  • Talk to your doctor about the potential risk of developing ketoacidosis and make sure you don’t have other health issues that might increase it. If the risk is higher than average, don’t take Invokana.
  • Be informed about all the symptoms common for Invokana-induced diabetic ketoacidosis to be able to take measures in a timely manner.
  • Know how to deal with ketoacidosis and what should be done in the first place when you have reasons to think you’ve got it.
  • Develop body awareness to notice even the slightest changes in your well-being. The sooner you diagnose ketoacidosis, the better. If the process has only started, it won’t be a big deal to stop it.

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