INS and hyperinsulinemic hypoglycemia, familial, 4: In contrast, for subjects with IAs-related hyperinsulinemia, who often have worse beta-cell function and a high risk of hypoglycemia, a combination with SGLT2i should be monitored frequently, since diabetic ketoacidosis (DKA) tends to occur in patients with insulin-deficient diabetes, and SGLT2 inhibitors-associated DKA was reported previously (24).