October 2025

ENDOCRINOLOGY

PROTOCOL FOR MANAGING EUGLYCEMIC DIABETIC KETOACIDOSIS

Featuring:  Grazia Aleppo, MD, Jared G. Friedman, MD,  Emily D. Szmuilowicz, MD,  Amisha Wallia, MD
Northwestern Medicine Endocrinologists — including Grazia Aleppo, MD, Jared G. Friedman, MD,  Emily D. Szmuilowicz, MD, and Amisha Wallia, MD — collaborated to develop a standardized protocol for the management of euglycemic diabetic ketoacidosis (euDKA), a growing clinical challenge linked to the increased use of SGLT2 inhibitors.
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Published in Current Diabetes Reports, the review outlines the limitations of traditional DKA protocols, which rely on elevated glucose levels to guide insulin therapy. In euDKA, patients present with normal or mildly elevated glucose, complicating diagnosis and treatment. The team’s protocol introduces a fixed-rate insulin infusion paired with titrated dextrose-containing fluids, designed to safely resolve ketoacidosis while maintaining euglycemia. This approach has been approved by hospital regulatory committees and is currently in use within intensive care units at Northwestern Medicine.
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Grazia Aleppo, MD, Professor of Endocrinology at Northwestern Medicine
Jared G. Friedman, MD, Assistant Professor of Endocrinology at Northwestern Medicine
Amisha Wallia, MD, MS, associate professor of Medicine (Endocrinology) and Preventative Medicine (Epidemiology)
Emily D. Szmuilowicz, MD, associate professor of Medicine in the Divisio

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