Which medication class is most associated with euglycemic diabetic ketoacidosis?

• A. Insulin
• B. SGLT2 inhibitors
• C. Sulfonylureas
• D. Metformin

Answer: (B)

Euglycemic diabetic ketoacidosis occurs when the body develops ketoacidosis with normal or only mildly elevated blood glucose. This pattern is most associated with SGLT2 inhibitors. These meds block glucose reabsorption in the kidneys, causing glucose to spill into the urine and lowering plasma glucose levels. At the same time, insufficient insulin action or increased counterregulatory hormones during illness or stress promote lipolysis and hepatic ketogenesis, so ketones accumulate and metabolic acidosis develops even though glucose isn’t markedly high. That combination—DKA physiology with glycosuria keeping glucose near normal—defines the euglycemic form. Clinically, you’ll see an anion-gap metabolic acidosis with elevated ketones but only modest hyperglycemia or normoglycemia, and management includes stopping the SGLT2 inhibitor and treating as you would DKA with fluids, electrolyte correction, and insulin if indicated. Other diabetes medications do not typically cause this euglycemic presentation, which is why this drug class is the best answer.