Prolonged diabetic ketoacidosis and glycemic fluctuations associated with dapagliflozin: a case report

Abstract

Sodium-glucose co-transporter 2 inhibitors (SGLT-2I) are oral anti-diabetic drugs. We aimed to raise awareness by presenting a difficult and long-lasting DKA case that developed after the addition of dapagliflozin to the treatment. We report a case of a 40-year-old woman who developed diabetic ketoacidosis (DKA) after 2 weeks use of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT-2I). She had complaints of nausea, vomiting, loss of consciousness, fever, and shortness of breath. DKA was detected in her laboratory results despite the absence of marked hyperglycemia. The patient had metabolic acidosis episodes accompanied by ketonuria on the 5th (mild) and 9th (severe) day despite discontinuation of dapagliflozin. Sudden fluctuations in blood glucose levels of the patient lasted for 10 days and made it difficult to switch to routine basal-bolus insulin treatment. Prolonged DKA may be a result of SGLT-2 inhibition and individualized treatment and follow-up should be performed instead of standard DKA treatment. Also, we suggest that we need to evaluate endogenous insulin reserves of the patients before starting a SGLT-2I treatment. We believe that in order to raise awareness, these cases should be reported.