DKA without high blood sugar: What it is, why it happens, and what to do

When your body starts burning fat for fuel instead of sugar, it produces ketones. Normally, that’s a red flag for diabetic ketoacidosis, a life-threatening condition where high blood sugar and ketones build up together. Also known as euglycemic DKA, it’s a version of this crisis that happens without the usual spike in glucose. This isn’t rare—it’s underdiagnosed, especially in people with type 1 diabetes, those on SGLT2 inhibitors, or even pregnant women with gestational diabetes.

Most people assume DKA means blood sugar over 250 mg/dL. But in euglycemic DKA, blood sugar stays normal or only mildly elevated, often between 100 and 250 mg/dL, making it easy to miss. You might feel nauseous, fatigued, or breathe fast—but your glucometer shows nothing alarming. That’s the trap. The real danger? Your body is still in metabolic chaos: ketones are high, blood is acidic, and insulin is critically low. This form is especially common in people using newer diabetes drugs like Farxiga, Jardiance, or Invokana. It’s also seen in those who’ve skipped insulin, are sick, or are fasting for long periods.

Why does this happen? It’s not about eating too much sugar. It’s about insulin not working properly—even if sugar levels look fine. Your liver keeps making glucose, but your muscles can’t use it. So your body turns to fat, floods your blood with ketones, and your pH drops. insulin deficiency, the core driver of all DKA forms is still the culprit. But now, the sugar isn’t screaming for help—the ketones are. That’s why labs matter more than fingersticks. If you’re feeling off and have diabetes, don’t wait for your sugar to climb. Check your ketones with a urine strip or blood meter. If they’re high, even with normal glucose, call your doctor. This isn’t a glitch in your meter. It’s a medical emergency hiding in plain sight.

What you’ll find below are real, practical posts that break down how this condition shows up, who’s most at risk, and what medications or lifestyle choices can trigger it. You’ll see how drugs like SGLT2 inhibitors connect to this silent form of DKA, how pregnancy changes the risk, and why skipping insulin—even for one day—can lead to disaster without the usual warning signs. These aren’t theory pieces. They’re written by people who’ve seen this happen, treated it, and want you to recognize it before it’s too late.