The presence of ketoacidosis in a patient with diabetes, but without significant hyperglycaemia (<11 mmol/L).
Associated causes include: pregnancy, starvation, high alcohol consumption, insulin use, sepsis and liver disease.
Another cause is the use of sodium-glucose transporter 2 inhibitors such as canagliflozin, dapagliflozin, empagliflozin and ertugliflozin.
Of those developing DKA who take a SGLT2-inhibitor, 60% will present with euglycaemia.
This medication class prevents reabsorption of glucose in the proximal convoluted tubule, promoting glycosuria and causing polyuria. They stimulate glucagon release and suppress insulin production leading to lipolysis and ketogenesis.
