Euglycemic diabetic ketoacidosis due to a strict low‐carbohydrate diet during treatment with sodium‐glucose cotransporter 2 inhibitors

BACKGROUND: Euglycemic diabetic ketoacidosis is a critical clinical presentation that can occur during treatment with sodium‐glucose cotransporter 2 inhibitors. However, little is known regarding how a low‐carbohydrate diet in combination with this treatment can increase the risk for this condition. Here, we report a case of euglycemic diabetic ketoacidosis in a patient treated with sodium‐glucose cotransporter 2 inhibitors after initiation of a low‐carbohydrate diet. CASE PRESENTATION: A 54‐year‐old woman who was taking canagliflozin was transferred to our hospital with severe dyspnea. She had been started on a strict low‐carbohydrate diet for 6 days before admission. Laboratory evaluation revealed severe ketoacidosis and a blood glucose level of 196 mg/dL. After her symptoms improved, she was diagnosed with type 1 diabetes mellitus. CONCLUSION: Although low‐carbohydrate diets are recommended for patients with diabetes mellitus, physicians should exercise great caution in recommending low‐carbohydrate diets to patients undergoing treatment with sodium‐glucose cotransporter 2 inhibitors.