While most patients with diabetic ketoacidosis have normal or high blood glucose levels, rarely the patient may show hypoglycemia.
Conditions associated with diabetic ketoacidosis with hypoglycemia:
(1) starvation
(2) alcohol abuse
(3) drug-induced: SGLT2 inhibitors, Dapagliflozin, aspirin, others
(4) excessive insulin dosing or sudden reversal of extreme insulin resistance
(5) pancreatitis
Differential diagnosis:
(1) nondiabetic ketoacidosis with hypoglycemia, especially alcoholic ketoacidosis
Clinical importance:
(1) the presence of hypoglycemia may delay or interfere with the diagnosis of ketoacidosis
(2) measurement of serum insulin may be indicated if a cause is not apparent
(3) the cause should be identified so that it can be addressed if necessary
