2020 Volume 63 Issue 1 Pages 26-34
We herein report a 44-year-old man who presented with so-called euglycemic diabetic ketoacidosis. He was diagnosed with type 2 diabetes and administered canagliflozin 100 mg and metformin 500 mg at 4 days before admission. In addition, on the same day (4 days before admission), an extremely-low-carbohydrate diet was started of his own volition. Four days later, he visited our hospital complaining of strong physical weariness. His blood glucose level was 183 mg/dL, HbA1c was 12.1 %, and urinary ketone was 3+, and metabolic acidosis was observed. He was diagnosed with euglycemic diabetic ketoacidosis (euDKA) and admitted immediately. After hospitalization, continuous intravenous infusions of insulin and glucose was started. Insulin administration was changed to a subcutaneous injection on the second day. He was discharged from our hospital 10 days after admission. We suggest that the extremely-low-carbohydrate diet, in addition to the administration of an SGLT2 inhibitor, triggered euDKA. There have been several reports of euDKA in patients taking SGLT2 inhibitors. Approximately 60 % of cases had a reduction in their carbohydrate intake as a cause. When prescribing an SGLT2 inhibitor, attention should be paid to the patient's diet, such as encouraging the avoidance of extreme carbohydrate restriction.
