Euglycemic Diabetic Ketoacidosis Triggered by Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitor Use in a Patient With Type 2 Diabetes Mellitus

Euglycemic diabetic ketoacidosis (EuDKA) is a potentially life-threatening complication associated with sodium-glucose co-transporter 2 (SGLT2) inhibitors. Its subtle presentation, often lacking the hallmark of marked hyperglycemia, can lead to delayed recognition and treatment. We present the case of a 53-year-old female with type 2 diabetes mellitus who developed EuDKA following the abrupt discontinuation of long-term insulin therapy and transition to an SGLT2 inhibitor. Her vague symptoms and near-normal glucose levels concealed the severity of her condition, delaying the diagnosis. Once identified, she was managed with intravenous insulin, dextrose-containing fluids, and potassium replacement, resulting in resolution of acidosis and normalization of serum ketones. This case focuses on the diagnostic challenges posed by euglycemic DKA and highlights the importance of considering it in patients with SGLT2 inhibitors, even without significant hyperglycemia. It also emphasizes the need for careful clinical judgment when adjusting diabetic regimens and calls for more structured prescribing guidelines as these agents gain broader use.