Euglycemic Ketoacidosis Induced by SGLT2 Inhibitor in Latent Autoimmune Diabetes in Adults: A Case Report

Abstract

Background: Euglycemic ketoacidosis (EKA) is a medical condition characterized by the presence of ketoacidosis without significant hyperglycemia. It is particularly challenging to diagnose due to normal or near-normal blood glucose levels. SGLT2 inhibitors, used in managing type 2 diabetes mellitus, are known to cause EKA. This risk is increased in patients with latent autoimmune diabetes in adults (LADA), a type of Type 1diabetes presented in adult (Hybrid form of diabetes) Case Report: A 64-year-old male with a history of diabetes mellitus and hypothyroidism presented with shortness of breath, nausea, and dizziness. Despite taking Metformin, Glimepride, Thyroxin, and Empagliflozin, he had poor glycemic control (HbA1c 9%) Physical examination showed generalized vitiligo and tachycardia. Initial laboratory results revealed high anion gap metabolic acidosis with normal blood glucose, consistent with EKA. Extensive diagnostic workup confirmed the presence of LADA and SGLT2 inhibitor induced EKA. Result: The patient was diagnosed with type 1 diabetes mellitus (LADA) and EKA induced by SGLT2 inhibitors. Management included discontinuation of the SGLT2 inhibitor, initiation of insulin therapy, and monitoring of metabolic parameters. Conclusion: Euglycemic ketoacidosis induced by SGLT2 inhibitors in patients with LADA is a serious condition requiring prompt recognition and treatment. Clinicians should be vigilant in monitoring adult patients with diabetes and other autoimmune conditions who are on SGLT2 inhibitors for symptoms of ketoacidosis even when blood glucose levels are normal. Recommendations: Regular monitoring of blood ketone levels in patients on SGLT2 inhibitors. Consideration of alternative glucose-lowering therapies in patients with LADA. Education for patients and healthcare providers on the risks of EKA. Keywords: Euglycemic ketoacidosis, SGLT2 inhibitors, Latent autoimmune diabetes in adults, Diabetes management, Metabolic acidosis.