Although a mild increase in circulating ketones during gliflozin therapy is common, relevant euglycemic ketosis induced by gliflozins, and even more so ketoacidosis, is rare and usually occurs in the presence of further factors such as concomitant insulin therapy, type 1 diabetes mellitus, low carbohydrate intake, acute intercurrent illness, pregnancy, or acute ethanol ingestion [45]. Here, INS is linked to diabetes mellitus.