T. Hayami, Y. Kato, H. Kamiya, M. Kondo, E. Naito, Y. Sugiura, C. Kojima, S. Sato, Y. Yamada, R. Kasagi, T. Ando, S. Noda, H. Nakai, E. Takada, E. Asano, M. Motegi, A. Watarai, K. Kato, et al. (2015). Case of ketoacidosis by a sodium-glucose cotransporter 2 inhibitor in a diabetic patient with a low-carbohydrate diet. Journal of diabetes investigation, 6(5), 587-90. https://doi.org/10.1111/jdi.12330

PubMed 26417418

[Abstract]
We present a case of a 32-year-old diabetic woman with Prader-Willi syndrome who developed severe ketoacidosis caused by a sodium-glucose cotransporter 2 (SGLT2) inhibitor, a novel class of antihyperglycemic agents, during a strict low-carbohydrate diet. At admission, a serum glucose level of 191 mg/dL was relatively low, though laboratory evaluations showed severe ketoacidosis. This is the first report of ketoacidosis caused by a SGLT2 inhibitor. It is necessary to not only pay attention when using a SGLT2 inhibitor in patients following a low-carbohydrate diet, but also to start a low-carbohydrate diet in patients treated with a SGLT2 inhibitor because of a high risk for developing ketoacidosis.