Ketogenic Diet as a Trigger for Diabetic Ketoacidosis in a Misdiagnosis of Diabetes: A Case Report
Open accessAbstract
A 30-year-old Caucasian man with a 2-month history of type 2 diabetes presented to the emergency department with abdominal pain, emesis with occasional coffee-ground content, and constipation of 6 days’ duration. The day before, he had presented to an urgent care center for similar complaints and was told he had a high stool burden and was prescribed an oral laxative, which he was unable to tolerate. He was taking metformin 1,000 mg twice daily for type 2 diabetes and had also initiated lifestyle modifications, which included an intensive low-carbohydrate ketogenic diet. He had restricted his carbohydrate intake to no more than 20 g/day. His family history included type 2 diabetes in his father and type 1 diabetes in a grandparent. He reported having lost 60 lb during the past 2 months, and his current weight was 263 lb (BMI 33.5 kg/m2). Previous lipid panels were only significant for low HDL cholesterol of 33 mg/dL. Since his diabetes diagnosis, home monitoring had revealed blood glucose fluctuations between 90 and 400 mg/dL despite changes in activity and diet and initiation of medication. His vital signs included blood pressure 159/100 mmHg, pulse 98 bpm, respiration rate 26/minutes with noted Kussmaul breathing, oxygen saturation 99%, and temperature 98.1°F. Physical examination revealed diffuse abdominal tenderness, dry mucous membranes, and an acetone-like scent on his breath. Further testing revealed the results shown in Table 1, which included positive urine ketones and glucose, elevated serum ketones, a pH of 6.97, an elevated anion gap, and a blood glucose of 424 mg/dL. A diagnosis of diabetic ketoacidosis (DKA) was established, and the patient was admitted to the intensive care unit and started on treatment with intravenous fluids, insulin, potassium, and pantoprazole. View this table: TABLE 1 Patient’s Laboratory Test Results at Initial Presentation Surgery was consulted to rule out a possible …
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Metabolic ketoacidosis with ketogenic diets is a hazard, particularly with sodium−glucose cotransporter 2 (SGLT2) inhibitors.
“Metabolic ketoacidosis with ketogenic diets is a hazard, particularly with sodium−glucose cotransporter 2 (SGLT2) inhibitors [82–87].”
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Cites
(2019) · Diabetes Care · doi:10.2337/dc20-s005 · Cited by 346 · see citing works
Ketogenic diet in endocrine disorders
Gupta, L., Khandelwal, D., Kalra, S., Gupta, P. K., Dutta, D., & Aggarwal, S. (2017) · Journal of Postgraduate Medicine · doi:10.4103/jpgm.jpgm_16_17 · Cited by 112 · see citing works
Latent Autoimmune Diabetes in Adults: A Review on Clinical Implications and Management
Pieralice, S., & Pozzilli, P. (2018) · Diabetes & Metabolism Journal · doi:10.4093/dmj.2018.0190 · Cited by 105 · see citing works
Umpierrez, G. E. (2006) · Diabetes Care · doi:10.2337/dc06-1870 · Cited by 94 · see citing works
Ketoacidosis associated with low-carbohydrate diet in a non-diabetic lactating woman: a case report
von Geijer, L., & Ekelund, M. (2015) · Journal of Medical Case Reports · doi:10.1186/s13256-015-0709-2 · Cited by 74 · see citing works
Recognizing and Appropriately Treating Latent Autoimmune Diabetes in Adults
O’Neal, K. S., Johnson, J. L., & Panak, R. L. (2016) · Diabetes Spectrum · doi:10.2337/ds15-0047 · Cited by 71 · see citing works
Ketogenic diet versus ketoacidosis: what determines the influence of ketone bodies on neurons?
Fedorovich, S. V., Voronina, P., & Waseem, T. (2018) · Neural Regeneration Research · doi:10.4103/1673-5374.241442 · Cited by 56 · see citing works
Sodium-glucose cotransporter 2 inhibition and health benefits: The Robin Hood effect
Kalra, S., Jain, A., Ved, J., & Unnikrishnan, A. (2016) · Indian Journal of Endocrinology and Metabolism · doi:10.4103/2230-8210.183826 · Cited by 42 · see citing works
Another “D” in MUDPILES? A Review of Diet-Associated Nondiabetic Ketoacidosis
Ullah, W., Hamid, M., Abdullah, H. M. A., Rashid, M. U., & Inayat, F. (2018) · Journal of Investigative Medicine High Impact Case Reports · doi:10.1177/2324709618796261 · Cited by 12 · see citing works
Nubiola, A., Ternianov, A., & Remolins, I. (2019) · Hipertensión y Riesgo Vascular · doi:10.1016/j.hipert.2019.09.003 · Cited by 8 · see citing works
Laffel (1999) · doi:10.1002/(sici)1520-7560(199911/12)15:6
Flagged first, then by citations
Research works printed but not linked: 1
- [8]Nubiola A, Ternianov A, Remolins I. [Ketogenic diet as a trigger for diabetic euglycaemic ketoacidosis in a patient under treatment with iSGLT2]. Hipertens Riesgo Vasc 2020;37:39–41 [in Spanish] [DOI] [PubMed] [Google Scholar]
Cited by
Sorted by citations
Evidence-based European recommendations for the dietary management of diabetes
The Diabetes and Nutrition Study Group (DNSG) of the European Association for the Study of Diabetes (EASD), Aas, A.-M., Axelsen, M., Churuangsuk, C., Hermansen, K., Kendall, C. W. C., Kahleova, H., Khan, T., Lean, M. E. J., Mann, J. I., et al. (2023) · Diabetologia · doi:10.1007/s00125-023-05894-8 · Cited by 262 · see citing works
Churuangsuk, C., Hall, J., Reynolds, A., Griffin, S. J., Combet, E., & Lean, M. E. J. (2022) · Diabetologia · doi:10.1007/s00125-021-05577-2 · Cited by 204 · see citing works
IgG glycans in health and disease: Prediction, intervention, prognosis, and therapy
Shkunnikova, S., Mijakovac, A., Sironić, L., Hanić, M., Lauc, G., & Kavur, M. M. (2023) · Biotechnology Advances · doi:10.1016/j.biotechadv.2023.108169 · Cited by 84 · see citing works
Common and divergent molecular mechanisms of fasting and ketogenic diets
Paoli, A., Tinsley, G. M., Mattson, M. P., Vivo, I. D., Dhawan, R., & Moro, T. (2023) · Trends in Endocrinology and Metabolism · doi:10.1016/j.tem.2023.10.001 · Cited by 60 · see citing works
Sripongpun, P., Churuangsuk, C., & Bunchorntavakul, C. (2022) · Journal of Clinical and Translational Hepatology · doi:10.14218/jcth.2021.00494 · Cited by 28 · see citing works
The Ketogenic Effect of SGLT-2 Inhibitors—Beneficial or Harmful?
Koutentakis, M., Kuciński, J., Świeczkowski, D., Surma, S., Filipiak, K. J., & Gąsecka, A. (2023) · Journal of Cardiovascular Development and Disease · doi:10.3390/jcdd10110465 · Cited by 28 · see citing works
Kapila, V., & Topf, J. M. (2021) · Cureus · doi:10.7759/cureus.17093 · Cited by 20 · see citing works
Banerjee, R., Zhu, Y. G., Brownrigg, G. P., Moravcova, R., Rogalski, J. C., Foster, L. J., Johnson, J. D., & Kolic, J. (2024) · Endocrinology · doi:10.1210/endocr/bqae079 · Cited by 18 · see citing works
Acute esophageal necrosis as a complication of diabetic ketoacidosis: A case report
Moss, K., Mahmood, T., & Spaziani, R. (2021) · World Journal of Clinical Cases · doi:10.12998/wjcc.v9.i31.9571 · Cited by 9 · see citing works
Use of technology in prediabetes and precision prevention
He, J., Chu, N. H. S., Wan, H., Ling, J., Xue, Y., Leung, K. H. T., Yang, A., Shen, J., & Chow, E. (2025) · Journal of Diabetes Investigation · doi:10.1111/jdi.70057 · Cited by 10 · see citing works
Ketogenic diet in clinical populations—a narrative review
Zemer, A., Samaei, S., Yoel, U., Biderman, A., & Pincu, Y. (2024) · Frontiers in Medicine · doi:10.3389/fmed.2024.1432717 · Cited by 9 · see citing works
Wu, Z., Wang, Z., Ng, S. Q., Lidster, J. A., Schwerd‐Kleine, P., Phua, Z. J. C., Peh, K. L. E., Ho, Y. Y., Yuan, J. X., Shathishwaran, S., et al. (2025) · Cell Metabolism · doi:10.1016/j.cmet.2025.10.001 · Cited by 7 · see citing works
Ruddiman, K. R., Bartfield, J. K., & Hirsch, I. B. (2025) · Obesity · doi:10.1002/oby.70033 · Cited by 6 · see citing works
Emerging roles of ketone bodies in cardiac fibrosis
Maduray, K., & Zhong, J. (2024) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00241.2024 · Cited by 5 · see citing works
Family Support Toward Adherence and Glycemic Control of Type 2 Diabetes Patient: A Systematic Review
Yusra, A., & Waluyo, A. D. (2022) · PROBLEMS OF ENDOCRINE PATHOLOGY · doi:10.21856/j-pep.2022.1.14 · Cited by 5 · see citing works
Geometry design for a fully insertable glucose biosensor with multimodal optical readout
Fine, J. N., Coté, G. L., & McShane, M. J. (2022) · Journal of Biomedical Optics · doi:10.1117/1.jbo.27.11.117001 · Cited by 4 · see citing works
Cielecka, J., Szkamruk, Z., Walędziak, M., & Różańska-Walędziak, A. (2025) · Diseases · doi:10.3390/diseases13100347 · Cited by 4 · see citing works
Effectiveness of ketogenic therapy in patients with obesity and diabetes: a narrative review
Pellegrini, P., Lemasson, P., Rastrelli, L., & D’Elia, M. (2024) · Exploration of Foods and Foodomics · doi:10.37349/eff.2024.00039 · Cited by 3 · see citing works
Lada or Type 2 Diabetes Mellitus - A Challenging Diagnosis in Clinical Approach
Custură, L. M., Deteșan, O., Tilinca, R. M., Schmiedt, R. A., Bacso, B. I., & Tilinca, M. C. (2021) · Acta Medica Transilvanica · doi:10.2478/amtsb-2021-0052 · Cited by 1 · see citing works
Popüler Diyete Bağlı Gelişen Diyabetik Ketoasidoz: Olgu Sunumu
Özcan, A., Çelik, Z. M., & Yıldız, E. (2024) · Bandırma Onyedi Eylül Üniversitesi Sağlık Bilimleri ve Araştırmaları Dergisi · doi:10.46413/boneyusbad.1441464
The application of seaweed-based food products for ketogenic diet: Opportunities and prospects
Phang, S. M., Lee, Y. Z., Tham, C. L., Ho, Y.-C., & Lee, M. T. (2025) · Future Foods · doi:10.1016/j.fufo.2025.100833
- Authors
- White-Cotsmire, A. J., & Healy, A. M.
- Affiliations
- Ohio University (US)
- OhioHealth (US)
- Corresponding author
- White-Cotsmire, Alexander J.
- Venue
- Clinical Diabetes
- Publisher
- American Diabetes Association
- Published
- 2020-07-01
- Volume
- 38
- Issue
- 3
- Pages
- 318-321
- ISSN
- 0891-8929 (ISSN-L)
- 1945-4953
- PMC
- PMC7364458
- OpenAlex
- W3024511918
- Cited by
- 22
- References
- 11
- Citations by year
- 2025: 6 · 2024: 5 · 2023: 4 · 2022: 3 · 2021: 4
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Clinical Diabetes (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Diet and metabolism studies
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology › Dietary Effects on Health
- Keywords
- diabetic ketoacidosis, ketogenic diet, type 2 diabetes, misdiagnosis, low-carbohydrate diet, metformin, ketosis, anion gap, hypokalemia, pantoprazole, insulin therapy, abdominal pain, weight loss
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