Euglycemic Diabetic Ketoacidosis in a Patient with Type 2 Diabetes and Preserved Insulin Secretion on Empagliflozin

Abstract

As the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors has become widespread, euglycemic diabetic ketoacidosis (EDKA), a rare but notable complication associated with SGLT2 inhibitor use, is gaining attention, although the underlying mechanisms of SGLT2 inhibitor-associated EDKA remain unclear. This report describes the case of a 77-year-old male with type 2 diabetes mellitus on an SGLT2 inhibitor who developed EDKA just after undergoing percutaneous coronary intervention following acute myocardial infarction, with only one day of fasting, despite sufficient insulin secretion. Our case report provides valuable insights into the mechanism and management of SGLT2 inhibitor-associated EDKA in urgent clinical settings.