Normal Blood Glucose and High Blood Ketones in a Critically Unwell Patient with T1DM Post-Bariatric Surgery: a Case of Euglycemic Diabetic Ketoacidosis

Abstract

Obesity is a global epidemic. Obesity in those with type I diabetes (T1DM) contributes to poor glycemic control and complications. Bariatric surgery as management for obesity is increasing in those with T1DM. However, there is limited data pertaining to these patients and their potential post-operative complications. These complications include severe hyperglycemia and diabetic ketoacidosis (DKA). This case study describes a 43-year-old woman with T1DM whose post-operative period following her bariatric surgery was complicated by euglycemic DKA. Post-bariatric surgery the incidence of those with T1DM experiencing DKA can be up to 1 in 4. Clinicians should be vigilant of this atypical presentation of DKA to avoid misdiagnosis potentially resulting in delays in treatment. Close monitoring in the post-operative period is warranted.

Keywords: Bariatric surgery; Euglycemic diabetic ketoacidosis; Obesity; Post-operative complications; Type 1 diabetes.