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While GLP-1 and GIP agonists primarily reduce caloric intake through appetite suppression, the glucagon component increases caloric output

The total dose remains the same, but the pharmacokinetic profile changes

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Why Blood Sugar May Not Be Very High In classic DKA: Insulin deficiency severe hyperglycemia In euglycemic DKA: Some insulin is still being administered Blood glucose may appear only mildly elevated But insulin is insufficient to prevent ketogenesis This can delay recognition because: Patients and clinicians may not suspect DKA with glucose under 250 mg/dL Symptoms may initially resemble dehydration or GI illness Additional Contributing Factors GLP-1 use in Type 1 diabetes may also increase DKA risk due to: Vomiting dehydration stress hormones ketone rise Intentional insulin reduction due to fear of hypoglycemia Reduced basal insulin during weight loss Increased glycemic variability from delayed gastric emptying Hypoglycemia and the Insulin Reduction Trap Another issue is the cycle that can develop: Appetite decreases Insulin dose is reduced Hypoglycemia occurs intermittently Insulin is reduced further Ketone production increases Over time, this can push the patient into metabolic instability

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Even after adjusting for age and BMI, this lipid profile remains associated with an increased cardiovascular risk (53)