| Sumario: | With the introduction of sodium-glucose cotransporter inhibitors, the incidence and awareness of euglycemic DKA have been increasing. This condition is a distinct subset of DKA without marked hyperglycemia. It can arise in various clinical settings, present with non-specific symptoms, and is thus prone to underdiagnosis. A set of circumstances (SGLT2i users during major stress, pregnancy with diabetes), clinical findings (non-specific GI symptoms, lassitude), and biochemical changes (ketonemia and metabolic acidosis) are consistent findings in the majority of cases of euglycemic DKA. Awareness that diabetic ketoacidosis can occur with normoglycemia, and leveraging the use of blood ketone tests, including meter kits, will significantly improve the diagnosis of euglycemic DKA. Plain Language Summary: Diabetic Ketoacidosis Without High Blood Glucose. A Review Diabetic ketoacidosis (DKA) is a serious and life-threatening complication of diabetes. It usually happens when the body does not have enough insulin, causing high blood sugar levels and a buildup of dangerous acids called "ketones" in the blood. Because DKA is traditionally known for causing very high blood sugar, doctors and patients often rely on high glucose readings to suspect it. However, there is a specific type of DKA called "euglycemic DKA" where patients have dangerous acid buildup but normal or near-normal blood sugar levels. This review explains that relying solely on blood sugar tests can lead to missed or delayed diagnoses, which can be fatal. This condition is becoming more common due to the widespread use of certain diabetes medications (known as SGLT2 inhibitors) and can also occur during pregnancy, major surgery, or severe illness. In these situations, patients may feel nauseous, tired, or short of breath, but because their blood sugar looks normal, the seriousness of their condition is often overlooked. This article highlights the importance of checking for ketones using a simple blood test or urine strip in any patient with diabetes who feels unwell, even if their blood sugar is not high. We recommend that patients taking SGLT2 inhibitors and pregnant women with diabetes be extra vigilant. Raising awareness that "normal blood sugar does not mean no DKA" can help ensure patients get the life-saving treatment they need faster.
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