Euglycemic Diabetic Ketoacidosis in the Setting of Dulaglutide Use

Dulaglutide is a glucagon-like peptide (GLP-1) receptor agonist approved by the Food and Drug Administration in patients with type 2 diabetes mellitus (T2DM) with noted cardiovascular and renal benefits along with weight loss. Dulaglutide's most common adverse effects include fatigue, poor appetite, abdominal pain, nausea, vomiting, and diarrhea. Although typically associated with the use of sodium-glucose cotransporter-2 (SGLT2) inhibitors, there have been case reports of GLP-1 receptor agonists leading to euglycemic diabetic ketoacidosis (DKA). We present a case of dulaglutide use leading to euglycemic DKA, a rare but life-threatening adverse effect after re-initiation of the medication at a higher dose. Our patient presented with non-specific gastrointestinal symptoms and weakness, which both resolved after the initiation of an insulin drip and intravenous fluids.