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A Caucasian woman aged 54 years presented, acutely unwell, to a regional hospital emergency department. She had a progressive three-week history of increasing nausea, abdominal pain, lethargy and shortness of breath. On presentation she was noted to have mottled skin and Kussmaul breathing. Her vital signs on presentation are shown in Table 1. She had a past medical history of latent autoimmune diabetes in adults (LADA) diagnosed at age 42 years on the basis of a positive test for glutamic acid decarboxylase (GAD) antibodies (GAD titre 63 U/mL) and C-peptide <0.05 nmol/L. Three weeks prior to presentation the patient had been switched from her basal-bolus insulin regimen to oral hypoglycaemic therapy consisting of dapagliflozin and metformin, with a reduced nocte long-acting insulin dose. In the days prior to presentation, the patient had limited oral intake and reported her blood glucose levels (BGLs) had been stable at 7-10 mmoL

Sodium–glucose co-transporter 2 inhibitors: Think twice about diabetic ketoacidosis