Unmasking the risk: euglycemic diabetic ketoacidosis induced by GLP-1 agonist in type 2 diabetes.

Euglycemic diabetic ketoacidosis (EDKA) is a rare but serious complication of type 2 diabetes, traditionally linked to SGLT-2 inhibitors. We report a 59-year-old woman with type 2 diabetes and gastroparesis who discontinued SGLT-2 inhibitors 1 month earlier and developed EDKA shortly after initiating dulaglutide. She presented with nausea, vomiting, abdominal pain, and a modestly elevated glucose level. Laboratory findings confirmed EDKA, and she was successfully treated with intravenous insulin and fluids. Dulaglutide was discontinued, with no recurrence on follow-up. This case underscores the potential for GLP-1 receptor agonists to trigger EDKA in susceptible patients and the need for heightened clinical awareness.