Ketoacidosis with SGLT-2 Inhibitor and Ketogenic Diet: A Case Study


  • Mercedez Bernard, D.O. Comanche County Memorial Hospital
  • Karen Schafer, D.O. Comanche County Memorial Hospital


SGLT2 Inhibitors, ketoacidosis, ketogenic diets, low carbohydrate diets, diabetic ketoacidosis


This case study illustrates the importance of obtaining dietary history and supplying dietary education for patients on sodium-glucose cotransporter 2 (SGLT2) inhibitors. In this case, the presumed diagnosis of pure diabetic ketoacidosis is confounded by the persistence of anion gap metabolic acidosis despite correction of glucose and electrolyte abnormalities. Only after obtaining the dietary history could the etiology for the patient’s persistent ketoacidosis be elicited. Frank discussion with the patient regarding his dietary intake and additional diabetic education allowed shared decision making for the physician and patient regarding medication regime. The patient had successful weight loss and improved glucose control while on a low–carbohydrate diet. Due to his reluctance to discontinue the low-carbohydrate diet, SGLT2 inhibitors were discontinued. SGLT2 inhibitors have many benefits for diabetic patients and have been a successful adjunct to the treatment of diabetes; however, patient selection and dietary education when initiating these medications is imperative.


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