Unmasking Euglycemic Diabetic Ketoacidosis: The Interplay of Pregnancy, Sepsis, and Glucagon-Like Peptide 1 Analog.

Huang A, Lu J, Pancotto N, Sekhon GS, Gossen IM, Reyes JM, Lazarescu R

Cureus29 Jan 2025Cited by 1 (Europe PMC)

PMID40026933PMCIDPMC11870146DOI10.7759/cureus.78193PepBankPUB-40026933

Summary

Euglycemic diabetic ketoacidosis (EDKA) is a life-threatening, yet under-recognized, complication of type 1 and type 2 diabetes. EDKA is characterized by metabolic acidosis and ketonemia in the absence of significant hyperglycemia. The absence of ketoacidosis-related complications may delay diagnosis, leading to severe consequences. Common precipitating factors include medication use (e.g., sodium-glucose cotransporter 2 inhibitors), acute illnesses (e.g., sepsis), trauma, and pregnancy. We report the case of a 35-year-old pregnant female with a history of type 2 diabetes, hypertension, and hyperlipidemia who presented with a two-day history of chills, shoulder pain, and reduced range of motion. The patient was compliant with dulaglutide, but not insulin. She had a history of chronic left shoulder pain managed with intraarticular corticosteroid injections, and imaging showed no evidence of fracture. The patient was admitted for septic arthritis of the left shoulder. During her hospital stay, she developed an elevated anion gap metabolic acidosis with a small elevation in her blood glucose. She tested positive for ketonuria and glucosuria. Upon admission, she deteriorated and was transferred to the intensive care unit for the management of EDKA. An insulin drip was initiated, leading to the resolution of her anion gap and resolving the ketoacidosis. This case underscores the importance of recognizing EDKA, particularly in the context of rising glucagon-like peptide 1 receptor agonist use for diabetes and weight management. EDKA remains a rare but serious condition, and timely identification and management are critical in preventing morbidity. This report also emphasizes the need for heightened clinical suspicion of EDKA in pregnant or septic patients with diabetes, even when blood glucose levels do not suggest diabetic ketoacidosis.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study1

1 result from studies that gave the peptide. 1 result from people.

01HumanCase report or seriesSafety outcome
A pregnant patient taking dulaglutide with sepsis and insulin nonadherence developed euglycemic diabetic ketoacidosis requiring intensive care.
In plain wordsA pregnant patient taking dulaglutide developed ketoacidosis requiring intensive care, with sepsis and insulin nonadherence also present.
Peptide
Dulaglutide (Trulicity)
Outcome
Not applicableEuglycemic diabetic ketoacidosis requiring intensive care
Study
n = 1
Outcome group
Adverse events · Metabolic and weight
Studied dose
Dose not stated
Source sentences
Summary
Upon admission, she deteriorated and was transferred to the intensive care unit for the management of EDKA.
3 context sentences(design, population, supporting numbers)
Summary · context
The patient was admitted for septic arthritis of the left shoulder.
Summary · context
We report the case of a 35-year-old pregnant female with a history of type 2 diabetes, hypertension, and hyperlipidemia who presented with a two-day history of chills, shoulder pain, and reduced range of motion.
Summary · context
The patient was compliant with dulaglutide, but not insulin.
Show in the study text Report a problemFND-4002693301

AI wrote and checked these results. AI can make mistakes, so check important results against the source.

Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 2Current
22 Oct 2026, 02:25 UTC
Study results updated
Version 1
21 Oct 2026, 18:59 UTC
First added · source update from Europe PMC

Subjects

Terms as the source lists them.

Publication types

Keywords

PepBank is a research reference. Talk to a doctor before you use any peptide.