Preventing Diabetic Ketoacidosis: Clinical Decisions in Action (On-Demand)-2. DKA- MODULE 2

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The speaker explains SGLT2 inhibitor–associated euglycemic DKA, defining it as DKA with glucose usually under 250 mg/dL, but with elevated beta-hydroxybutyrate, metabolic acidosis, and often a high anion gap. He reviews risk factors: type 1 diabetes, fasting, major surgery, severe illness, sepsis, alcohol use, and insulin dose reduction. SGLT2 inhibitors lower glucose via glycosuria, which can mask DKA and promote ketogenesis. Management is the same as standard DKA: stop the SGLT2 inhibitor, give IV fluids, insulin, and potassium, but add dextrose early and use lower-dose insulin to avoid hypoglycemia. He emphasizes beta-hydroxybutyrate testing over urine ketones or anion gap for diagnosis and resolution. Prevention includes holding SGLT2 inhibitors during illness or surgery, ketone monitoring, and using CGM or emerging glucose-ketone monitoring systems to reduce DKA risk.

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Concept Euglycemic Diabetic Ketoacidosis

Concept Sodium-Glucose Cotransporter 2 Inhibitor

Concept Insulin

Concept Diabetic Ketoacidosis

Concept Type 1 Diabetes

Keywords

SGLT2 inhibitor

euglycemic DKA

beta-hydroxybutyrate

ketone monitoring

insulin therapy

Euglycemic Diabetic Ketoacidosis

Sodium-Glucose Cotransporter 2 Inhibitor

Insulin

Diabetic Ketoacidosis

Type 1 Diabetes