Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve glycemic control by a 
reversible inhibition of the sodium-glucose cotransporters in the renal proximal 
tubules resulting in increased urinary glucose. This unique mechanism, 
independent of insulin secretion and beta cell function, has made this class of 
medication desirable in patients with type 2 diabetes. However in May 2015, the 
US Food and Drug Administration issued a safety warning pertaining to the 
development of diabetic ketoacidosis (DKA) with the use of SGLT2 inhibitors. DKA 
associated with SGLT2 inhibitors frequently develops in the absence of 
hyperglycemia, which makes the diagnosis more challenging. Due to the reversible 
inhibition of SGLT2 by this class of medication, a quick recovery of glucosuria 
after cessation of medication is expected. In this article, we present a case of 
a 50-year-old woman with type 2 diabetes who developed euglycemic DKA after 
initiating therapy with canagliflozin. This case of DKA associated with SGLT2 
inhibitor use was unique due to her hypoglycemic presentation and persistent 
glucosuria. SGLT2 inhibitors such as canagliflozin may predispose patients not 
only to diabetic ketoacidosis but also to prolonged glucosuria.