A case of sodium-glucose cotransporter-2 inhibitor-associated euglycemic diabetic ketoacidosis complicated by concurrent subacute thyroiditis

Sodium-glucose cotransporter-2 (SGLT2) inhibitors for the treatment of type 2 diabetes mellitus are gaining popularity due to their cardioprotective and renoprotective effects, yet SGLT2 inhibitors are increasingly associated with euglycemic diabetic ketoacidosis, which could be life-threatening if missed due to pseudo-normoglycemia. We herein report a 55-year-old male with poorly controlled type 2 diabetes mellitus on Alogliptin, Pioglitazone, Canagliflozin and Repaglinide presented with 3 weeks of low-grade fever, generalized weakness, anorexia, cough, feeling of discomfort in the jaw and dysphonia. The patient was found to have euglycemic diabetic ketoacidosis complicated by subacute thyroiditis. After saline infusion with IV glucose and insulin, he recovered quickly and was discharged on the 8th day of admission. This is the first reported case of simultaneous development of euglycemic DKA and subacute thyroiditis and highlights the importance of identifying the rare combination of disease as soon as possible and treating them promptly.