# Euglycemic Diabetic Ketoacidosis Presenting as Hypoglycemia in a Patient With Type 2 Diabetes and Von Gierke’s Disease

## TL;DR

A patient with Von Gierke’s disease and type 2 diabetes presented with hypoglycemia during diabetic ketoacidosis, requiring glucose-containing fluids before insulin treatment.

## Contribution

This case highlights a rare presentation of DKA with hypoglycemia in a patient with Von Gierke’s disease and type 2 diabetes.

## Key findings

- The patient required glucose-containing fluids before insulin for DKA treatment.
- This case demonstrates hypoglycemia in the context of DKA in a patient with Von Gierke’s disease.
- Use of empagliflozin may have contributed to the hypoglycemic presentation.

## Abstract

Von Gierke’s disease (VGD) is rarely associated with type 2 diabetes mellitus (DM2). We present a case of VGD with DM2 that presented with hypoglycemia in the setting of diabetic ketoacidosis (DKA) in a young male with VGD using the sodium-glucose co-transporter 2 (SGLT2) inhibitor empagliflozin. The patient required resuscitation with fluids containing glucose prior to the administration of insulin for DKA protocol with significant clinical improvement. This case demonstrates a rare presentation of DKA with hypoglycemia.