Euglycemic DKA: What It Is, Why It Happens, and How It's Managed

When you think of diabetic ketoacidosis, you probably imagine high blood sugar, fruity breath, and confusion. But euglycemic DKA, a dangerous form of diabetic ketoacidosis that occurs with normal or only mildly elevated blood glucose levels. Also known as normoglycemic DKA, it’s a silent threat that can catch even doctors off guard. Unlike classic DKA, where blood sugar soars above 250 mg/dL, euglycemic DKA hides in plain sight—blood sugar might be 150 or even 120, and you’d never suspect trouble until it’s too late.

This isn’t just a rare oddity. It’s increasingly common in people taking SGLT2 inhibitors, a class of diabetes drugs that help the kidneys flush out extra sugar. Also known as gliflozins, these include drugs like canagliflozin, dapagliflozin, and empagliflozin. They work by pulling glucose out through urine, which sounds great—until your body starts burning fat for fuel instead, and ketones build up without the usual red flag of high blood sugar. It’s like a smoke alarm that only goes off when the fire is already huge.

Who’s most at risk? People with type 1 diabetes, but also type 2 patients on SGLT2 inhibitors, especially if they’re sick, fasting, cutting carbs too hard, or drinking alcohol. Even a minor infection or skipping insulin for a day can trigger it. And because the numbers look okay, it’s often missed until the person is vomiting, breathing hard, or in shock.

Here’s the catch: treating it isn’t just about giving insulin. You have to fix the fluid loss, replace electrolytes, and keep giving insulin—even if blood sugar drops fast. Stopping insulin because glucose is normal? That’s how people crash. Doctors now know to check ketones in anyone on SGLT2 inhibitors who feels off, no matter what the glucometer says.

And it’s not just about the drugs. Euglycemic DKA can also show up in pregnancy, after bariatric surgery, or during extreme stress—even in people who’ve never had diabetes before. That’s why it’s not just a diabetes problem. It’s a metabolic emergency that demands quick thinking.

In the posts below, you’ll find real-world insights into how medications like SGLT2 inhibitors affect your body’s balance, what happens when insulin and glucose don’t talk to each other properly, and how to spot trouble before it turns critical. You’ll see how kidney function, diet changes, and drug interactions all play a role in this hidden danger. Whether you’re managing your own health, caring for someone on these meds, or just trying to understand why normal blood sugar doesn’t always mean safe—this collection gives you the facts you need to act fast.