Successful Reimplementation Of A Very Low Carbohydrate Ketogenic Diet After SGLT2 Inhibitor Associated Euglycemic Diabetic Ketoacidosis

This case study reports on a patient with type 2 diabetes who experienced a serious but rare side effect called euglycemic diabetic ketoacidosis (euDKA) while following a very low-carb ketogenic diet and taking an SGLT2 inhibitor medication. SGLT2 inhibitors are newer diabetes drugs that help the kidneys remove excess glucose through urine and provide heart and kidney protection benefits. However, when combined with a ketogenic diet (which restricts carbohydrates to less than 50 grams daily), this medication can sometimes trigger a dangerous condition where the blood becomes too acidic, even when blood sugar levels appear normal.

After the patient recovered from this episode, her medical team carefully developed a plan to help her safely return to a ketogenic diet while monitoring her closely. They started by allowing 75 grams of carbohydrates daily, then gradually reduced this to 25 grams over two months. The patient was required to check her urine for ketones daily and communicate with her healthcare team through a patient portal system. During this process, she was able to dramatically reduce her insulin requirements and eventually stopped insulin entirely while maintaining good blood sugar control with metformin alone.

Over two years of follow-up, the patient achieved remarkable results: she lost 72 pounds total and maintained excellent diabetes control without any further episodes of ketoacidosis. Her success demonstrates that with careful medical supervision and gradual implementation, patients may be able to safely follow ketogenic diets even after experiencing complications.

This case highlights the importance of close medical supervision when combining ketogenic diets with certain diabetes medications, particularly SGLT2 inhibitors. It shows that personalized monitoring protocols and gradual dietary changes can help patients safely achieve their metabolic health goals while minimizing risks.