The use of sodium glucose cotransporter (SGLT) inhibitors increases the risk of ketosis and diabetic ketoacidosis (DKA) in type 1 and type 2 diabetes (T1D and T2D, respectively).2–9 In patients with T1D treated with the SGLT inhibitor dapagliflozin, insulin dose reductions >20% were associated with increases in BHB as well as an increased incidence of DKA.6 Here, INS is linked to type 1 diabetes mellitus.