GLP-1 Drug Dulaglutide Triggered Severe Diabetic Ketoacidosis in Patient With Undiagnosed LADA | Research

The takeaway

A 50-year-old woman diagnosed with type 2 diabetes developed severe diabetic ketoacidosis within a day of starting dulaglutide — revealing she actually had latent autoimmune diabetes in adults (LADA).

DKA in 24 hours
after first dulaglutide injection and insulin discontinuation in a patient with undiagnosed LADA

What the researchers found

A patient misdiagnosed as type 2 diabetes developed severe DKA within 24 hours of starting dulaglutide and discontinuing insulin, leading to her correct diagnosis of LADA.

Why it matters

As GLP-1 drugs are prescribed to millions for diabetes and weight loss, cases like this highlight the importance of correctly identifying diabetes type before prescribing. LADA is frequently misdiagnosed as type 2 diabetes, and GLP-1 drugs cannot replace insulin in autoimmune diabetes.

The numbers in context

One documented case of DKA in a T2D patient on dulaglutide — rare but clinically significant.

How the study worked

Single case report documenting clinical presentation, diagnostic workup, emergency treatment, and outcome of GLP-1 agonist-induced DKA in a patient subsequently diagnosed with LADA.

Who was studied

Single type 2 diabetes patient who developed DKA on dulaglutide

What this study cannot tell us

Single case report — the weakest form of clinical evidence. The patient had multiple risk factors (12-year disease duration, insulin discontinuation, potential LADA). DKA could have been triggered primarily by stopping insulin rather than by dulaglutide itself. Cannot generalize to all GLP-1 drug users.

How to read the evidence

Preliminary evidence: single case report. While clinically instructive, one case cannot establish causation or risk frequency.

When this study was published

Published in 2024. Relevant to current GLP-1 prescribing practices.

The bigger picture

Up to 10% of people diagnosed with type 2 diabetes may actually have LADA. As GLP-1 prescriptions surge for both diabetes and obesity, correctly identifying which patients have autoimmune beta-cell destruction becomes critical for safety. This case serves as a warning that GLP-1 drugs are not suitable replacements for insulin in LADA or type 1 diabetes.

Questions still open

Should LADA screening (anti-GAD antibodies, C-peptide) be routine before starting GLP-1 drugs in diabetes patients?
How many cases of GLP-1-associated DKA involve undiagnosed LADA or late-onset type 1 diabetes?
Are there warning signs that could help clinicians identify LADA patients before prescribing GLP-1 drugs?

Common questions

Can GLP-1 drugs cause diabetic ketoacidosis?

DKA with GLP-1 drugs is extremely rare but has been reported, particularly in patients who actually have LADA or type 1 diabetes rather than true type 2 diabetes. GLP-1 drugs do not produce insulin and cannot replace it in patients whose insulin-producing cells are destroyed.

What is LADA and why does it matter for GLP-1 drugs?

LADA (Latent Autoimmune Diabetes in Adults) is a slow-onset autoimmune diabetes often misdiagnosed as type 2. Unlike T2D, LADA patients eventually lose all insulin production. GLP-1 drugs work by boosting existing insulin release — if there are no functioning beta cells, the drugs cannot work and stopping insulin can be dangerous.

Read the original research

GLP-1 receptor agonist-induced diabetic ketoacidosis: A case report.

Medicine, 103(39), e39799

View on PubMed ↗Publisher’s paper ↗

Citation

Zhang, Jiaming; Ma, Ying; Zu, Qianhe; Wang, Xiaohui; Zhang, Yao. (2024). GLP-1 receptor agonist-induced diabetic ketoacidosis: A case report.. Medicine, 103(39), e39799. https://doi.org/10.1097/MD.0000000000039799