A Rose by Any Other Name: Ketoacidosis Due to SGLT2 Inhibitors Reveals Latent Autoimmune Diabetes

Published:October 02, 2017DOI:
      A 69-year-old woman who had been living with diabetes for more than 40 years presented to the emergency room (ER) with polyuria, polydipsia, malaise, and hyperglycemia. Her other medical history included a cerebrovascular accident in 2009, dyslipidemia, and hypothyroidism. For her diabetes she took a combination of long- and rapid-acting insulins for more than 30 years and had been started on a sodium glucose transport protein 2 inhibitor (SGLT2i) approximately 6 months prior. Her other medications included atorvastatin, pantoprazole, levothyroxine, and gabapentin. Her symptoms began during an upper respiratory tract infection, which was resolving. There was no clinical or radiographic evidence of pneumonia. She was rehydrated and received subcutaneous insulin overnight. By the morning she had improved enough to be discharged home on increased doses of insulin to follow up with her usual doctors. Before her outpatient follow-up and within the month she returned to the ER because of ongoing symptoms and several capillary glucose readings above 20 mmol/L, despite her increased doses of insulin.
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