DKA occurs when there is either a decrease in insulin or when there is an excess of counter-regulatory hormones both of which causes hyperglycemia.

What is hyperglycemic ketoacidosis?

If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn’t have enough insulin. Without insulin, your body can’t use glucose for fuel, so your body breaks down fats to use for energy.

How does SGLT2 inhibitors cause euglycemic ketoacidosis?

The proposed mechanism of SGLT2 inhibitor–associated euglycemic diabetic ketoacidosis implicates glucosuria leading to decreased plasma glucose levels and decreased insulin release (Fig 1). Carbohydrate deficit, insulinopenia, and increased glucagon release lead to upregulation of lipolysis and ketogenesis.