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Sugar-sweetened beverages and acute metabolic crises in type 2 diabetes mellitus: a report of two cases

European Journal of Clinical Nutrition (2026)Cite this article

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Abstract

Diabetic ketoacidosis (DKA) is an uncommon but serious complication in patients with type 2 diabetes mellitus (T2DM). Excessive intake of sugar-sweetened beverages (SSBs) may represent an underrecognized trigger for DKA in individuals with T2DM. We present two male patients with T2DM who developed ketosis following excessive consumption of SSBs (aerated drinks). The first patient, aged 33 years, reported consuming 2.5 litre/day of SSBs and developed ketosis without acidosis. The second, aged 18 years, reported daily intake of 4 litre/day of SSBs and presented with frank DKA. Both patients were managed with insulin therapy, which was successfully tapered off post-discharge. At follow-up, glycemic control was maintained with oral antidiabetic therapy or lifestyle modification alone. Both patients exhibited clinical signs of insulin resistance and were negative for anti-glutamic acid decarboxylase antibodies. These cases underscore the potential role of SSBs in precipitating ketosis in T2DM patients.

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Data availability

The datasets in the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank the patients for their consent and cooperation.

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Authors and Affiliations

  1. Department of Endocrinology, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi, India

    Abhinay Jain

  2. Department of Endocrinology, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India

    Ankitesh Kumar, Pragya Mangla, Nishant Raizada & S. V. Madhu

  3. Department of Internal Medicine, Yashoda Super Speciality Hospital, Ghaziabad, Uttar Pradesh, India

    Pooja Alipuria

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  1. Abhinay Jain
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  2. Ankitesh Kumar
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  3. Pooja Alipuria
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  4. Pragya Mangla
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  5. Nishant Raizada
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  6. S. V. Madhu
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Contributions

SVM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. AJ, AK, PA, PM, NR, SVM were involved in the management of patients. Initial draft of the manuscript was prepared by AJ. AK, PA, PM, NR, SVM were involved in critical revision of the manuscript. All authors approved the final version of the manuscript and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to S. V. Madhu.

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Competing interests

The authors declare no competing interests.

Ethics approval

The study was conducted in accordance with the ethical standards of the institutional ethics committee and the Declaration of Helsinki. As this is a retrospective case series based on anonymized clinical records, formal ethics committee approval was not required. Written informed consent was obtained from both patients for participation and for publication of their clinical details.

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Jain, A., Kumar, A., Alipuria, P. et al. Sugar-sweetened beverages and acute metabolic crises in type 2 diabetes mellitus: a report of two cases. Eur J Clin Nutr (2026). https://doi.org/10.1038/s41430-026-01738-x

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