A case report describes euglycemic diabetic ketoacidosis developing after re-initiating dulaglutide at a higher dose, presenting with non-specific GI symptoms and resolving with insulin and IV fluids.
Normal glucose, dangerous DKAEuglycemic DKA from dulaglutide presented with non-specific symptoms and normal blood sugar—easy to miss but potentially life-threatening
What the researchers found
Dulaglutide re-initiation at a higher dose triggered euglycemic DKA presenting with GI symptoms and weakness. Normal blood glucose levels made diagnosis challenging. Resolved with insulin drip and IV fluids.
Why it matters
As GLP-1 drug prescriptions surge, clinicians must be aware that euglycemic DKA—though rare—can occur with these medications, not just with SGLT2 inhibitors. The non-specific symptoms and normal glucose levels make this easy to miss, potentially life-threatening if untreated.
The numbers in context
Single patient with T2DM. Euglycemic DKA after re-initiation of dulaglutide at higher dose. Presented with GI symptoms and weakness. Resolved with insulin drip and IV fluids.
How the study worked
Single case report with clinical presentation, laboratory findings, and treatment outcome documentation.
Who was studied
One adult with type 2 diabetes on dulaglutide
What this study cannot tell us
Single case report cannot establish causation or frequency. Other contributing factors may have been present. No rechallenge was attempted. Rare adverse event reporting may be subject to publication bias.
How to read the evidence
Single case report—lowest level of clinical evidence. Valuable for safety awareness but cannot establish incidence or causation.
When this study was published
Published in 2025; adds to post-marketing safety data for GLP-1 receptor agonists.
The bigger picture
This case contributes to safety surveillance of the rapidly expanding GLP-1 drug class. As these medications are used by millions, rare adverse events become important to document and recognize, especially those that present atypically like euglycemic DKA.
Questions still open
- What is the true incidence of euglycemic DKA with GLP-1 agonists?
- Should patients restarting GLP-1 drugs be monitored for ketoacidosis, especially at higher doses?
- Are certain patient populations more susceptible to GLP-1-associated euglycemic DKA?
Common questions
What is euglycemic DKA?
Should I worry about this if I take a GLP-1 drug?
Read the original research
Euglycemic Diabetic Ketoacidosis in the Setting of Dulaglutide Use.
Cureus, 17(4), e82143
Citation
Patel, Niyati; Reddy, Anvit; Romero, Kaitlyn N; Reddy, Pramod. (2025). Euglycemic Diabetic Ketoacidosis in the Setting of Dulaglutide Use.. Cureus, 17(4), e82143. https://doi.org/10.7759/cureus.82143