Predisposing and precipitating factors of diabetic ketoacidosis during SGLT2 inhibitor therapy are still incompletely understood but several precipitating factors are now well identified such as: surgical stress, limited perioperative withholding of SGLT2 inhibitor, insufficient pre- and postoperative or reduced dose of insulin, reduced perioperative oral intake, preoperative low carbohydrate diets, concurrent illness (infection, malignancy, dehydration and decreased oral intake), alcohol use and recent initiation of SGLT2 inhibitor therapy [14]. Here, INS is linked to diabetic ketoacidosis.