What Is Lactic Acidosis In Diabetes – Signs, Causes & Treatments!

Lactic acidosis may develop in people with type 1 and type 2 diabetes, especially if their diabetes is not well controlled.

So What Is Lactic Acidosis In Diabetes

Lactic acidosis is a medical condition characterized by the buildup of lactate (especially L-lactate) in the body, with formation of an excessively low pH in the bloodstream. It is a form of metabolic acidosis, in which excessive acid accumulates due to a problem with the body’s oxidative metabolism.

Lactic acidosis is typically the result of a medical condition, medication, or poisoning. The symptoms may include nausea, vomiting, Kussmaul breathing (laboured and deep), and generalised weakness.

There have been reports of lactic acidosis in people who take metformin, which is a medication for treating type 2 diabetes. However,the incidence is low, with equal to or less than 10 cases per 100,000 patient-years of using the drug, according to a 2014 report in the journal Metabolism. Some diabetics should not take Metformin unless specifically advised to do so by their GP or diabetes healthcare team.

Diabetics with kidney problems, liver problems, and heart problems are often advised to avoid Metformin. So too are patients who dehydrated, drink a lot of alcohol, due to have an x-ray or surgery

For some pregnant diabetics, Metformin may not be the best choice, but in all instances this should be discussed with your doctor.

Symptoms Of Lactic Acidosis In Diabetes

Symptoms in humans include all those of typical metabolic acidosis (nausea, vomiting, generalized muscle weakness, and rapid breathing).1

The onset of lactic acidosis might be rapid and occur within minutes or hours, or gradual, happening over a period of days. The best way to treat lactic acidosis is to find out what has caused it.

Untreated lactic acidosis can result in severe and life-threatening complications. In some instances, these can escalate rapidly.

Typically, symptoms of lactic acidosis do not stand out on their own but can be indicative of a variety of health issues.
However, some symptoms known to occur in lactic acidosis indicate a medical emergency.

These include:

  • disorientation
  • yellow skin or eyes, known as jaundice
  • shallow, rapid, or other breathing problems
  • rapid heart rate

Other symptoms include:

  • muscle pains or cramping
  • overall body discomfort
  • abdominal pain and discomfort
  • body weakness
  • fatigue, lethargy, and unusual sleepiness
  • reduced appetite problems
  • diarrhea
  • nausea and vomiting
  • headaches

Anyone who experiences one or more should call emergency services or go to hospital.

Causes Of Lactic Acidosis In Diabetes

Lactic acidosis occurring from associated, underlying diseases, known as type B1 lactic acidosis, has been identified with diabetes mellitus, bowel ischemia, severe iron-deficiency anemia, liver disease, alcoholic ketoacidosis, pancreatitis, malignancy (leukemia, lymphoma, lung cancer), infection, renal failure, seizures, heat stroke, pheochromocytoma, thiamine deficiency, short gut syndrome, and other carbohydrate malabsorption syndromes.

The Cohen-Woods classification categorizes causes of lactic acidosis as:[1]

  • Type A: Decreased tissue oxygenation (e.g. from decreased blood flow)
  • Type B
    • B1: Underlying diseases (sometimes causing type A)
    • B2: Medication or intoxication
    • B3: Inborn error of metabolism

Lactic acidosis has a wide range of underlying causes, including carbon monoxide poisoning, cholera, malaria, and asphyxiation. Some common causes include:

  • Heart disease
  • Severe Infection (sepsis)
  • HIV Medications
  • Cancer
  • Short bowel syndrome
  • Alcoholism
  • Intense exercise
  • Biguanides (metformin)

When found in a patient with long term uncontrolled Type-1 Diabetes Mellitus, there is a unique condition we can

consider. Lactic Acidosis is commonly seen in Diabetic ketoacidosis, however it can be seen in well controlled diabetics• with Glycogenic Hepatopathy.

Glycogenic Hepatopathy (GH) is a rare condition that develops due to excessive accumulation of glycogen in the hepatocytes, leading to hepatomegaly and elevated transaminases levels in patients with uncontrolled type 1 DM

Preventing Lactic Acidosis


Don’t go from being a couch potato to trying to run a marathon in a week. Start with an aerobic exercise like running or fast walking. This will increase your “lactate threshold,” making it less likely you’ll get lactic acidosis. Drink lots of water. It helps get rid of any excess acid. Eat a balanced diet that includes lots of fruits, vegetables, whole grains, and lean meats. Get plenty of sleep at night and give yourself time to recover between bouts of exercise.

If your lactic acidosis is caused by a disease or medication, talk to your doctor. You may be able to make changes that will help you avoid the problem. And talk to your doctor before starting a new exercise routine.


In people with lactic acidosis due to medication or other health problems, the condition usually goes away once the underlying cause is addressed. However, lactic acidosis can be very dangerous if you ignore it or if you have certain health problems. In critically ill people (for example, people in septic shock or people who just had a heart attack), lactic acidosis makes death more likely.

Please leave any comments or questions below, I will try to respond within 24 hours


Garry (type 1)


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