Euglycemic diabetic ketoacidosis in type 2 diabetes treated with a sodium-glucose cotransporter-2 inhibitor

More than 10 million Canadians are currently living with diabetes. 1 Of those, 90% have type 2 diabetes mellitus (T2DM). (1) Recently launched oral medications known as sodium-glucose cotransporter-2 (SGLT2) inhibitors were approved by the US Food and Drug Administration (FDA) in 2013 for treating T2DM. (2) Approval by Health Canada was granted in 2014.(3) Treatment with SGLT2 inhibitors (canagliflozin, dapagliflozin, or empagliflozin) has been shown to improve weight loss and glycemic control and to provide cardiovascular protection. (4) Given the favourable clinical profile of SGLT2 inhibitors, health care providers are increasingly prescribing these antihyperglycemic agents. However, recent FDA and Health Canada warnings have cautioned about the possibility of patients developing ketoacidosis with their use. (5,6) More important, most cases of ketoacidosis occurred in settings of mildly elevated or normal blood glucose levels (ie, euglycemic diabetic ketoacidosis [DKA]). (6) We report a case of ketoacidosis in a patient with T2DM, taking canagliflozin, presenting with a serum glucose level of 11.9 mmol/L.