Many Americans suffer from type-2 diabetes and many take medication to help control the disease. However, the possible side effect of diabetic ketoacidosis, or DKA from Invokana, has been a legitimate concern among patients and the medical community.

Invokana is a drug that was approved by the U.S. Food and Drug Administration in 2013 for use in patients with type-2 diabetes. It works by preventing a protein in the kidney called SGLT2 from allowing the kidney to reabsorb glucose.

The kidneys, instead, dispose of glucose in the urine. This reduces the sugar in the blood and helps with diabetes symptoms.

Diabetic ketoacidosis, or DKA, is a condition that has been linked to Invokana. Its symptoms include, according to Medscape, “difficulty breathing, nausea, vomiting, abdominal pain, confusion, and unusual fatigue and sleepiness.” Other symptoms of DKA from Invokana include excessive thirst, frequent urination, weakness, shortness of breath and fruity-scented breath. These symptoms can come on suddenly, within 24 hours or less.

If a physician tests for DKA from Invokana, it can show up as high ketone levels in the urine and high blood sugar, also known as hyperglycemia.

When a patient experiences DKA from Invokana, his or her body produces too many blood acids, or ketones. When the body cannot produce enough insulin, it begins to use the fat in the body as fuel. Ketones begin to build up in the blood during this process. Too many ketones create a condition known as diabetic ketoacidosis.

Diabetic ketoaciosis is more commonly associated with type-1 diabetes, not type-2. Invokana patients typically suffer from type-2 diabetes. So when they develop ketoacidosis, they may be at risk of being misdiagnosed by physicians who aren’t expecting to see that complication.

If DKA from Invokana is not properly treated, the condition can become life threatening and the patient may die.

In 2015, the U.S. Food and Drug Administration warned that certain SGLT2 inhibitors like Invokana may in fact increase the risk of DKA, or diabetic ketoacidosis. This condition is serious and may lead to hospitalization. The FDA said it received reports of 20 people who took SGLT2 inhibitors for their type-2 diabetes, then later developed diabetic ketoacidosis.

DKA from Invokana is not the only possible serious side effect from the type-2 diabetes medication. Along with diabetic ketoacidosis, Invokana patients risk developing lactic acidosis, kidney stones and urinary tract infections. They also may experience heart attack, stroke, kidney failure, coma and even death.

The FDA has added a black box warning for leg and foot amputations in Invokana users. Those who take Invokana needed leg, foot or toe amputations two times more often than those who did not take Invokana.

Additionally, acute kidney injury is also a risk for those who take Invokana. Acute kidney injury happens when the kidneys do not work any longer and waste builds up in the body. Invokana has also been linked to acute pancreatitis, which can lead to death if not medically treated.

If you or someone you love has suffered any severe side effects such as DKA from Invokana, you may be eligible to file a lawsuit against the manufacturers of the drug.