JCEM case reportsJan 30, 2026

A case of diabetic ketoacidosis without high blood sugar linked to tirzepatide use and very low calorie intake

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Jun 27, 2026

Abstract

Essence

use combined with intermittent fasting and a low-carbohydrate diet may be linked to during unsupervised weight loss.

Evidence

This single case report describes EDKA in a 30-year-old man with no known diabetes who was taking tirzepatide while practicing intermittent fasting and a low-carbohydrate diet.

Caveat

The report cannot separate the contribution of tirzepatide from severe calorie restriction and ketosis-inducing dietary changes.

Simplified

We describe a case of (EDKA) in a 30-year-old man with no known diabetes on , intermittent fasting (IF), and a low-carbohydrate diet for weight loss. While glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combined GLP-1/glucose-dependent insulinotropic polypeptide receptor agonists (GLP-1/GIP RAs), like tirzepatide, are effective for weight loss and diabetes management, their unsupervised use, especially alongside ketosis-inducing diets, may lead to serious risks such as EDKA. This report emphasizes the need for medical supervision in weight management, particularly when combining medications such as tirzepatide with dietary interventions, like IF and low-carbohydrate diets.

Key numbers

24.4 mEq/L to 14.5 mEq/L

Bicarbonate Level Decrease

Initial and 12-hour post-admission bicarbonate levels

7.5 mmol/L

β-Hydroxybutyrate Level

β-Hydroxybutyrate level on admission

15 pounds (∼7 kg)

Weight Loss

Weight loss attributed to and dietary changes

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A case of diabetic ketoacidosis without high blood sugar linked to tirzepatide use and very low calorie intake

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