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Diabetic ketoacidosis with sodium–glucose cotransporter type 2 inhibitors: a case series

Gina McLachlan, Claire Keith and Albert Frauman
Med J Aust 2019; 211 (5): . || doi: 10.5694/mja2.50302
Published online: 2 September 2019

To the Editor: Sodium–glucose cotransporter type 2 (SGLT2) inhibitors — dapagliflozin, empagliflozin and now ertugliflozin — have become established second line options for type 2 diabetes, with favourable potential for weight loss and cardiovascular protection.1 However, it soon became clear post‐marketing that they had potential for several pronounced side effects, including euglycaemic ketoacidosis — an unusual form of diabetic ketoacidosis where blood sugar levels remained relatively normal.2


  • 1 Austin Health, Melbourne, VIC
  • 2 University of Melbourne, Melbourne, VIC



Competing interests:

No relevant disclosures.

  • 1. eTG Complete. Choice of antihyperglycaemic treatment for adults with type 2 diabetes [website]. Melbourne: Therapeutic Guidelines, 2019.
  • 2. Peters AL, Buschur EO, Buse JB, et al. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium‐glucose cotransporter 2 inhibition. Diabetes Care 2015; 38: 1687–1693.
  • 3. Sodium glucose co‐transporter 2 inhibitor: safety advisory — diabetic ketoacidosis and surgical procedures. Therapeutic Goods Administration, 2018. https://www.tga.gov.au/alert/sodium-glucose-co-transporter-2-inhibitors (viewed July 2019).
  • 4. Australian Diabetes Society. Severe euglycaemic ketoacidosis with SGLT2 inhibitor use in the perioperative period. ADS, 2018. https://diabetessociety.com.au/documents/2018_ALERT-ADS_SGLT2i_PerioperativeKetoacidosis_v3__final2018_02_14.pdf (viewed July 2019).
  • 5. eTG Complete. Sick day management for adults with diabetes [website]. Melbourne: Therapeutic Guidelines, 2019.

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