Sodium-glucose cotransporter 2 inhibitor-associated diabetic ketoacidosis in patients with type 1 diabetes: Metabolic imbalance as an underlying mechanism

For type 1 diabetes patients with inadequate glycemic control, one treatment option is to increase the insulin dose (scenario 1), which should not give rise to a "metabolic imbalance." A second option is additional treatment with a sodium-glucose cotransporter 2 inhibitor, which might lead to a "metabolic imbalance" (scenario 2). A reduction in insulin dose in addition to administration of a sodium-glucose cotransporter 2 inhibitor might further increase the "metabolic imbalance" (scenario 3).