Euglycemic DKA?


I’m a 70yo stable T2 taking Jardiance, MDI, and other odds and ends.

For a few hours, I’ve been having massive urination, dizziness, and BG which is hardly responding at all to large doses of Novorapid. Was about 250 this morning, about 150 after impressive doses of Novorapid. (Toujeo in background.) No fruity odor, and I know it.

Taking the Jardiance into account, am I right in thinking that this is probably almost-euglycemic KA?

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I don’t know the answer, but as a type 2 who has only been on Faxiga about a month - this is an issue of some concern for me. If these symptoms are still active it might be good to go to the ER, urgent care or at least contact the prescribing doctor’s office. Get some ketone test strips to test urine on hand.

I did read this paper on Euglycemic DKA and SGLT 2 Inhibitors. It’s pretty rare but does happen.
Euglycemic Diabetic Ketoacidosis - StatPearls - NCBI Bookshelf.

You don’t understand the place I live in western Asia. I am more likely to get the pope on the telephone than the prescribing doctor; the newly hatched resident who will see me in the ER will not listen to a word I say, because it wasn’t in the textbook.

I recently had to take my unconscious wife to the ER, and it turned out that I diagnosed right, but the young resident didn’t even think that the medication she accidentally took even existed, and wouldn’t check.

I recently had something extremely painful in my leg, probably some kind of inflammation of connective tissue, related to trigger finger, etc. It went untreated even after the ER. There was finally an enormous improvement when an orthopedist friend of the family came to my house and injected me with a local steroid.

If you have medical professionals who will even listen to the words coming out of your mouth, count your blessings.

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The ketone test strips are a good idea, but I doubt they even have them in the tiny village where I live. You wouldn’t believe the things that sometimes happen here. You should have seen what was going on during the run on Ozempic.

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Maybe time to get more creative. Find someone with access to a PX (Post Exchange), diplomatic pouch, depending on your in-country status, talk to the staff doctor at your nearest embassy, or consulate, and ask for options. If your country does not have representation, representation is done through a third-party consulate. Talk to directors that have programs in your country, USAID, Peace Corps, WHO, UN-supported programs, etc. I have worked in some pretty unstable countries over the decades, but have always managed to get what I need, oftentimes in some pretty unconventional ways. When there is a strong enough will, there is always a way. You can always send me a PM if you are looking for ideas.


@CJ114 , I have also done things like that once or twice, but rarely succeeded.

Things have greatly improved, maybe stabilized.

One of my sons who’s an OB/GYN called yesterday. He said he knows something about it because euglycemic KA is not rare among ladies with gestational diabetes. It was even on the material for a test he took!

He said that even though a BG of 250 isn’t that high, he orders blood gases for any lady over 200. He also said that what I did for myself is exactly what they would have done under those circumstances: plenty of water and repeated ultra-short-acting insulin analog until the thing stops.

He doesn’t believe in ketone dipsticks, but he’s worked very little in ambulatory medicine.

Thanks, everyone.


I have ketone test strips (Freestyle) that test just like a finger-stick glucose test.

Good to know if you are in a ketoacidodic state with especially when you might not know normal blood sugar.


You should be able to get them online then and have them delivered. They are a vital managment tool. I carry a vial in my purse and one in each bathroom at home. The only way to know if you had euglycemic DKA is by testing to see if you were throwing ketones while your blood glucose levels were in the normal range.


What is difficult to figure out, is whether you are in ketosis or ketoacidosis. And ketone tests don’t tell you that.
I do intermittent fasting on weekends and I fast 24 hours. My body breaks down fats and begins to make ketones. My sugars remain stable. Much more stable than when I eat.
I exercise while fasting. It has been a very positive experience for me. My ketones get to the moderate level in my urine. And then return to normal when I eat a meal.
I had only one instance where I think I felt symptoms of DKA while fasting. I was kayaking and my sugar dipped low to 65. So I decided I needed to kayak another hour to get back in, so I ate half of a power bar, and I kept going. My sugar jumped to 200 and resisted coming down even with insulin and at the end, I felt acidotic. I drank a lot of water and took a large injection of insulin and I felt better after an hour.
I never went over 200, and I’ve been at 200 before. I’m sure it was the combination of ketones and then quickly switching it up by eating sugar. Ketones reduce insulin sensetivity, so I think I just hit the perfect storm.
The reason for this post was to explain that ketosis and ketoacidosis are very complex processes and urine ketone tests and blood ketone tests can’t tell the difference.
I’m fortunate that I know how it feels and I was able to react quickly. Back before cgm I went into DKA because my pump cannula pulled out and I didn’t know.
That’s not going to happen to me now with cgm, but it’s still a risk.