Diabetic Ketoacidosis Lawsuit: Get the Right Lawyer

Free Confidential Lawsuit Evaluation: If you or a loved one was diagnosed with ketoacidosis after taking a diabetes medication, you should contact our law firm immediately. You may be entitled to compensation by filing a suit and our lawyers can help.

Update: Research Links SGLT2 Inhibitor Medications to Rare Ketoacidosis Risk Post-Surgery

May 12, 2025 – A recent study published in JAMA Surgery has identified a potential complication linked to SGLT2 inhibitors like Invokana, Farxiga, and Jardiance: a heightened risk of a rare condition called euglycemic diabetic ketoacidosis (eKA) following surgical procedures [4.].

SGLT2 inhibitors are commonly prescribed to patients with type 2 diabetes and have been associated with lower rates of acute kidney injury (AKI) and improved postoperative survival rates.

However, researchers from the University of California, San Francisco have found a concerning trade-off: an increased incidence of eKA, a form of ketoacidosis that develops without the elevated blood glucose levels typical of standard DKA cases.

Because eKA does not cause blood sugar to spike, it can evade early diagnosis, potentially delaying treatment and leading to serious or fatal outcomes.

The research team, led by Dr. Roberta Teixeira Tallarico, analyzed surgical data from nearly 500,000 patients over an eight-year span (2014–2022). Among these, they compared 7,439 individuals taking SGLT2 inhibitors to a control group of 33,489 non-users. The study found that patients on medications like Januvia or Farxiga faced an 11% higher likelihood of developing eKA following surgery.

At the same time, these medications were linked to a 30% reduction in acute kidney injury and a lower risk of death within 30 days post-surgery. Specifically, the mortality rate for SGLT2 inhibitor users was 1.1%, compared to 1.5% for non-users.

Hospital stays were also affected: those who developed eKA remained hospitalized for an average of six days, double the three-day stay for those who did not experience the complication.

While the drugs offered clear renal and survival benefits, the researchers cautioned that clinicians should remain vigilant for signs of eKA—particularly in postoperative settings—due to the subtle onset and potentially dangerous delays in diagnosis.

FDA Warns of Ketoacidosis Risk with SGLT2 Inhibitors

On May 15, 2015, the U.S. Food & Drug Administration (FDA) issued a warning [1] about an increased risk of diabetic ketoacidosis with the sodium–glucose cotransporter 2 (SGLT2) inhibitor class of type 2 diabetes medications. FDA’s Adverse Event Reporting System (FAERS) found at least 20 reports of the condition in patients treated with the drugs between March 2013 and June 6, 2014.

Diabetic ketoacidosis does not usually occur in type 2 diabetics, and the case presentations were “atypical in that glucose levels were only mildly elevated at less than 200 mg/dL in some reports, while patients with type 1 diabetes who have DKA typically have glucose levels greater than 250 mg/dL,” the agency said.

As a result of these problems, FDA in December 2015 updated the labeling of SGLT2 inhibitors [2] to include a warning about diabetic ketoacidosis.

Which Drugs are SGLT2 Inhibitors?

SGLT2 diabetes drugs that may increase the risk of diabetic ketoacidosis include:

• Invokamet
• Farxiga (dapagliflozin)
• Glyxambi (empagliflozin and linagliptin)
• Jardiance (empagliflozin)
• Xigduo XR (dapagliflozin and metformin hydrochloride extended-release)

DKA Symptoms

When cells don’t get the sugar (glucose) they need for energy, the body begins to break down fat. This process creates chemicals called “ketones” that make the blood acidic. The more acid in the blood the greater the risk that ketoacidosis will result.

DKA usually develops slowly; however, when vomiting occurs, the condition can develop within hours.

Early symptoms include:

• Thirst or a very dry mouth
• Frequent urination
• High blood glucose (blood sugar) levels
• High levels of ketones in the urine

Later symptoms may include:

• Fatigue
• Dry or flushed skin
• Nausea, vomiting, abdominal pain
• Difficulty breathing
• Fruity odor on breath
• Confusion / hard time paying attention

It is important to remember that DKA is a serious medical condition. If you or a loved one has any of the symptoms listed above, call a doctor immediately or go to the nearest hospital emergency room.

Invokana Lawsuits Consolidated in New Jersey

December 19, 2016 – The U.S. Judicial Panel on Multidistrict Litigation (JPML) has ordered that all federal lawsuits alleging kidney failure and diabetic ketoacidosis from Invokana and Invokamet will be transferred to the District of New Jersey for pretrial handling before Judge Brian R. Martinotti. J&J and Janssen currently face about 55 such complaints in courts across the U.S. However, it is expected that this number will grow into the hundreds or even thousands by the time the litigation process is complete.

How Do I Check for Ketones?

Ketones can be detected with a simple urine test strip, similar to a blood testing strip. Many experts advise to check your urine for ketones when blood glucose is over 240 mg/dl, according to the American Diabetes Association (ADA) [3]. Also, check for ketones when you have any symptoms of ketoacidosis.

Complications

If left untreated, ketosis can result in a number of serious health complications including:

• Cerebral edema (swelling and fluid buildup in the brain)
• Heart attack
• Blood clots
• Extremely low blood pressure
• Intestinal tissue damage due to lack of blood-flow
• Kidney failure
• Diabetic coma
• Death

FAQs

1. Who Can File a Lawsuit Related to Diabetic Ketoacidosis?

Individuals who suffered harm from diabetic ketoacidosis due to medical negligence or defective products can file a lawsuit, including patients or their families seeking compensation for damages.

2. What Types of Damages Can Be Pursued in a Diabetic Ketoacidosis Lawsuit?

Damages may include medical expenses, lost wages, pain and suffering, and potentially punitive damages if negligence or malpractice is proven in diabetic ketoacidosis cases.

3. How Can Negligence or Malpractice Be Proven in Cases of Diabetic Ketoacidosis?

Negligence or malpractice can be proven by demonstrating a failure to follow medical standards, inadequate treatment, or misdiagnosis that directly led to the diabetic ketoacidosis and resulting harm.

Do I Have a Diabetic Ketoacidosis Lawsuit?

The Pharmaceutical Litigation Group at Schmidt & Clark, LLP law firm is an experienced team of trial lawyers that focus on the representation of plaintiffs in diabetes drug diabetic ketoacidosis lawsuits. We are handling individual litigation nationwide and currently accepting new injury and death cases in all 50 states.

Free Confidential Case Evaluation: Again, if you got ketoacidosis from a diabetes drug, you should contact our law firm immediately. You may be entitled to a settlement by filing a suit and we can help.