Studies have reported that risk factors for the development of EKA include organic pancreatic insufficiency, pancreatic cancer, a low-carbohydrate diet, prolonged starvation, carbohydrate restriction, and the discontinuation of insulin or insulinotropic hormones at the time of initiation of treatment with SGLT2i, which are associated with a keto metabolic state induced by reduced circulating insulin levels. Here, INS is linked to familial pancreatic carcinoma.