GLP-1 Drug Dulaglutide Triggered Rare Diabetic Emergency Despite Normal Blood Sugar

This is a single case report describing the clinical presentation, laboratory findings, treatment, and outcome of a patient who developed euglycemic DKA after initiating dulaglutide therapy.

As millions of people start GLP-1 drugs for diabetes and weight loss, awareness of rare but serious complications is essential. EDKA is particularly dangerous because standard blood sugar monitoring won't catch it — glucose levels are only modestly elevated. The combination of gastroparesis (which can reduce food intake and cause vomiting) with a GLP-1 drug (which further suppresses appetite) may create metabolic conditions favoring ketone production. Clinicians need to be alert to this possibility.

EDKA has been a well-known risk with SGLT-2 inhibitors, leading to FDA warnings and clinical guidelines. This case report extends the concern to GLP-1 receptor agonists. As more patients use GLP-1 drugs — especially in combination with fasting, low-carbohydrate diets, or conditions like gastroparesis — the risk of metabolic ketoacidosis may be higher than previously recognized. This is particularly relevant as GLP-1 drugs are prescribed to increasingly diverse patient populations for weight loss.

This is a single case report, which is the weakest level of clinical evidence. The patient had recently discontinued SGLT-2 inhibitors, raising the possibility that residual effects of the prior medication contributed to the EDKA. The temporal association with dulaglutide initiation does not definitively prove causation. Gastroparesis itself can cause nausea and reduced food intake, which could independently contribute to ketosis. No mechanistic explanation for how dulaglutide specifically triggered EDKA is provided.