Intermittent Fasting as a Trigger of Ketoacidosis in a Patient With Stable, Long-term Type 1 Diabetes

Diabetic ketoacidosis (DKA) is an acute complication of type 1 diabetes (T1DM) with a high morbidity and mortality. Diabetic ketoacidosis is usually triggered by metabolic stressors that increase insulin requirements like infection, trauma, surgery, or some medications. Ketogenic diets are nutritional regimes that drastically reduce the intake of carbohydrates in order to increase circulating ketones and reduce appetite. Intermittent fasting diets similarly aim to impact appetite and body weight, but through the restriction of feeding to specific periods of time or days. A 58-year-old woman with T1DM and no prior episodes of DKA since her diagnosis 16 years ago was admitted to the emergency room with severe metabolic acidosis, ketosis, dehydration, and back pain after 9 days of practicing a ketogenic, intermittent fasting diet on the advice of a friend. The standard management of DKA led to the resolution of the symptoms and metabolic alterations, but this might not be the case in other patients. This case highlights the relevance of close professional monitoring of dietary and insulin schemes in patients with T1DM, and of the adequate nutritional education of patients in order to avoid having them follow fashionable dietary trends without knowledge of their implications.