Euglycemic DKA: What It Is, Why It Happens, and How to Stay Safe

When you think of diabetic ketoacidosis, or euglycemic DKA, a life-threatening condition where the body burns fat for fuel instead of glucose, even when blood sugar levels aren’t high. Also known as euglycemic diabetic ketoacidosis, it’s not the classic high-sugar DKA you’ve heard about—it’s sneakier, harder to catch, and just as dangerous. This isn’t just a theory. It’s a real, documented risk for people taking SGLT2 inhibitors like Farxiga, Jardiance, or Invokana—drugs designed to lower blood sugar by flushing glucose out through urine.

Here’s the twist: your blood sugar might read 150 or even 120 mg/dL, which seems fine. But your body is still making ketones—acidic fuel from fat breakdown—because insulin isn’t doing its job properly. That’s euglycemic DKA, a form of diabetic ketoacidosis that occurs with normal or only mildly elevated blood glucose levels. It often hits people with type 1 or type 2 diabetes who are stressed, sick, cutting carbs too hard, or recently stopped eating. The danger? Doctors and patients alike assume everything’s okay because the glucose meter doesn’t scream alarm. But ketones are building up, your blood is turning acidic, and you could slip into coma before you realize something’s wrong.

This isn’t just about SGLT2 inhibitors. insulin resistance, a condition where the body’s cells don’t respond well to insulin, forcing the pancreas to overproduce it plays a big role. Even if you’re on insulin, if your dose is too low or your body is fighting infection, ketones can rise without glucose following. And SGLT2 inhibitors, a class of diabetes drugs that increase glucose excretion in urine make this worse by lowering blood sugar artificially, masking the real problem: your body is in starvation mode.

You won’t always feel dizzy or thirsty. Nausea, fatigue, abdominal pain, or rapid breathing might be your only clues. If you’re on one of these drugs and feel off—even if your sugar is normal—test for ketones. Urine strips or a blood ketone meter can catch it early. Don’t wait for your glucose to spike. That’s when it’s often too late.

The posts below give you real, practical advice: how to monitor for hidden ketoacidosis, what medications raise your risk, how to talk to your doctor about switching treatments, and what to do if you’re sick and on SGLT2 inhibitors. No fluff. No jargon. Just what you need to stay safe.