Question of Week | What explains JR’s sudden DKA?

JR, a 67-year-old with type 2 diabetes for seven years and an A1C of 9.7% was started on empagliflozin 10mg two weeks ago. Other labs include a GFR of 49 and a UACR of 34 mg/g. Other diabetes medications include glucotrol 10mg twice daily and sitagliptin 100mg daily. JR sometimes has a few shot’s of whiskey before bed, especially if they had a stressful day. JR’s partner calls you in a panic and says JR is admitted to the hospital in DKA.  

What is the most likely explanation?

  1. Excess alcohol intake leading to starvation ketosis
  2. Potential side effect of SGLT-2 Inhibitors
  3. Low GFR and elevated UACR increase hyperglycemic risk
  4. JR is misdiagnosed and likely has type 1 diabetes

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