Tirzepatide Alone Caused Diabetic Ketoacidosis Despite Normal Blood Sugar | Research

The takeaway

A patient developed euglycemic diabetic ketoacidosis on tirzepatide monotherapy without SGLT-2 inhibitor use — a rare but serious adverse event.

Normal sugar, dangerous acid
EDKA on tirzepatide monotherapy — blood sugar appeared fine while blood became dangerously acidic

What the researchers found

EDKA occurred in a patient on tirzepatide monotherapy without concurrent SGLT-2 inhibitor use, suggesting GLP-1/GIP agonists may independently precipitate this rare condition.

Why it matters

EDKA is life-threatening and easily missed because blood sugar appears normal. Clinicians need to know it can occur with tirzepatide even without SGLT-2 inhibitors.

How the study worked

Single case report of euglycemic DKA in a patient on tirzepatide monotherapy.

What this study cannot tell us

Single case report — cannot establish incidence rate. Individual patient factors (fasting, illness, dehydration) may have contributed.

How to read the evidence

Single case report — important safety signal but cannot establish incidence or causation.

When this study was published

Published in 2026; emerging safety signal for an increasingly prescribed drug.

The bigger picture

As dual and triple agonist drugs become widely prescribed, monitoring for rare but serious metabolic complications must keep pace.

Questions still open

Should all patients on tirzepatide be monitored for ketones during illness or fasting?
Is this risk class-wide for GLP-1/GIP agonists or specific to tirzepatide?

Common questions

What is euglycemic DKA?

EDKA is a dangerous condition where blood becomes acidic from high ketone levels, but blood sugar stays normal. It's easily missed because doctors typically look for high blood sugar as a warning sign.

Should I worry about this on tirzepatide?

This is extremely rare. However, if you experience persistent nausea, vomiting, abdominal pain, or fatigue on tirzepatide, seek medical attention — especially during illness or fasting when EDKA risk may increase.

Read the original research

Tirzepatide-Associated Euglycemic Diabetic Ketoacidosis in the Absence of Sodium-Glucose Cotransporter-2 Inhibitor Use: A Case Report.

The Journal of emergency medicine, 83, 57-60

View on PubMed ↗Publisher’s paper ↗

Citation

Campana, Christina; Heaney, Ashley; Ceraolo, Negin; Srinivas, Surbhi; Simon, Erin L. (2026). Tirzepatide-Associated Euglycemic Diabetic Ketoacidosis in the Absence of Sodium-Glucose Cotransporter-2 Inhibitor Use: A Case Report.. The Journal of emergency medicine, 83, 57-60. https://doi.org/10.1016/j.jemermed.2026.01.002