Aim Sodium-glucose co-transporter 2 inhibitors (SGLT-2I) are oral anti-diabetic drugs. We aimed to raise awareness by presenting a difficult and long-lasting DKA case that developed after the addition of dapagliflozin to the treatment. Case presentation We report a case of a 40-year-old woman who developed diabetic ketoacidosis (DKA) after 2 weeks use of dapagliflozin, a sodium-glucose co-transporter 2 inhibitor (SGLT-2I). She had complaints of nausea, vomiting, loss of consciousness, fever, and shortness of breath. DKA was detected in her laboratory results despite the absence of marked hyperglycemia. The patient had metabolic acidosis episodes accompanied by ketonuria on the 5th (mild) and 9th (severe) day despite discontinuation of dapagliflozin. Sudden fluctuations in blood glucose levels of the patient lasted for 10 days and made it difficult to switch to routine basal-bolus insulin treatment. Conclusion Prolonged DKA may be a result of SGLT-2 inhibition and individualized treatment and follow-up should be performed instead of standard DKA treatment. Also, we suggest that we need to evaluate endogenous insulin reserves of the patients before starting a SGLT-2I treatment. We believe that in order to raise awareness, these cases should be reported.

中文翻译：

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与达格列净相关的长期糖尿病酮症酸中毒和血糖波动：病例报告

目的 钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT-2I) 是口服抗糖尿病药物。我们旨在通过介绍在治疗中加入达格列净后出现的一个困难且持续时间长的 DKA 病例来提高认识。病例介绍 我们报告了一例 40 岁女性在使用达格列净（一种钠-葡萄糖协同转运蛋白 2 抑制剂（SGLT-2I））2 周后出现糖尿病酮症酸中毒（DKA）的病例。她主诉恶心、呕吐、意识丧失、发烧和呼吸急促。尽管没有明显的高血糖症，但在她的实验室结果中检测到了 DKA。尽管停用达格列净，患者在第 5 天（轻度）和第 9 天（重度）出现代谢性酸中毒并伴有酮尿。患者血糖水平的突然波动持续了 10 天，因此难以转为常规基础胰岛素治疗。结论 DKA延长可能是SGLT-2抑制的结果，应进行个体化治疗和随访，而不是标准的DKA治疗。此外，我们建议在开始 SGLT-2I 治疗之前，我们需要评估患者的内源性胰岛素储备。我们认为，为了提高认识，应该报告这些案例。