Unmasking Type – 1 Diabetes Mellitus Following an Episode of Euglycemic Diabetic Ketoacidosis with SGLT-2 Inhibitor Use: A Case Report

We describe here the case of a patient with Euglycemic DKA in the setting of SGLT-2 inhibitor use, further evaluation of which led to unmasking of Type-1 Diabetes Mellitus. There have been previous case reports where SGLT-2 inhibitor use has led to unmasking of diabetes mellitus type-1 in patients previously diagnosed with diabetes mellitus type-2.

We had a 57-year-old female with history of type 2 DM since last 10-12 years on Empagliflozin, Liraglutide, Metformin, Glimepiride and Pioglitazone presented with 5-hour history of shortness of breath which was acute in onset and was not associated with any other complaints. On initial evaluation, random blood sugar was 182 mg/dl. ABG showed high anion gap severe metabolic acidosis and Serum ketones levels were high. She was treated with IV fluids in the form of normal saline and was later switched to dextroseinfusion when her random blood sugar levels fell below 250 mg/dl, Insulin infusion and Potassium correction along with other supportive measures. her symptoms resolved with treatment over 3-4 days.

We did a literature review on the topic and present here the pathophysiology, Diagnosis, Management and Prevention of SGLT-2 inhibitor induced Euglycemic DKA.