# Can a GLP-1 Cause Ketoacidosis? 470 Reports, Most of Them Hospitalized | This GLP Can a GLP-1 cause ketoacidosis? Reporting ratios of 3.15 and 1.22 across 470 cases in people without diabetes, over 70% hospitalized, and why none of it is a rate. Publisher: This GLP Editorial Team Canonical: https://thisglp.com/research/can-a-glp1-cause-ketoacidosis Updated: 2026-09-17 Published: 2026-09-17 [← Research](https://thisglp.com/research) Safety # Can a GLP-1 Cause Ketoacidosis? 470 Reports, Most of Them Hospitalized Two drugs, 470 reported cases, and hospitalization in roughly three quarters of them. The database cannot say how often it happens. [This GLP Editorial Team](https://thisglp.com/about)September 20269 min read Ketoacidosis reports, people without diabetes · semaglutide · 261 cases · 3.15 · tirzepatide · 209 cases · 1.22 · Hospitalization required: 74.3% and 71.3% of cases. · No denominator. This measures reporting, not risk. **Research, not medical advice.** This GLP is independent and educational. Nothing here is a substitute for individualized care from a licensed clinician, and reading it creates no doctor–patient relationship. Talk to your own provider before starting, stopping, or changing any medication, peptide, or therapy. See our [methodology](https://thisglp.com/methodology) and [terms](https://thisglp.com/terms). It has been reported, including in people who do not have diabetes. A disproportionality analysis covered 7,349,591 FDA reports [\[1\]](https://thisglp.com/research/can-a-glp1-cause-ketoacidosis#ref-1). Semaglutide gave a reporting odds ratio of 3.15, 95% CI 2.78 to 3.56, from 261 cases. Tirzepatide gave 1.22, 95% CI 1.06 to 1.39, from 209 cases. Hospitalization was required in 74.3% and 71.3% of them. A reporting ratio is not a rate. Nothing in that database counts how many people took the drug. In a supervised type 1 diabetes trial, two episodes of euglycemic ketosis were recorded [\[2\]](https://thisglp.com/research/can-a-glp1-cause-ketoacidosis#ref-2). ## Key takeaways - A disproportionality analysis of 7,349,591 FDA adverse event reports looked at ketoacidosis in people using these drugs for obesity, without diabetes. - Semaglutide showed a reporting odds ratio of 3.15 (95% CI 2.78-3.56) from 261 cases; tirzepatide 1.22 (95% CI 1.06-1.39) from 209 cases. - Hospitalization was required in 74.3% and 71.3% of those cases respectively. - Tirzepatide reports rose from 1-2 per quarter in 2022 to 28-34 by 2025 — over the period its use expanded enormously. Ketoacidosis is a metabolic emergency normally associated with type 1 diabetes. It is not something expected in a person without diabetes at all. That makes it an unusual thing to find in the adverse event database for a weight drug. This analysis asks how often it is being reported [\[1\]](https://thisglp.com/research/can-a-glp1-cause-ketoacidosis#ref-1). The wider safety profile these drugs carry in people without diabetes is surveyed in [the network meta-analysis of nineteen drugs](https://thisglp.com/research/the-best-losers-are-the-worst-tolerated). Both drugs produced a signal among non-diabetic users. Semaglutide had a reporting odds ratio of 3.15 (95% CI 2.78–3.56) across 261 cases, and tirzepatide 1.22 (95% CI 1.06–1.39) across 209. Roughly three quarters of the cases in each group required hospitalization. A reporting ratio is not a risk These figures describe how often a term appears among reports relative to other terms. There is no count of how many people took the drug, so no incidence can be calculated and no individual can be told their chance of this happening. Two hundred and sixty-one cases across a drug taken by millions is, on any plausible denominator, rare — and the database cannot say how rare. What lifts this above the usual pharmacovigilance caveats is the population and the severity. Ketoacidosis in someone without diabetes cannot be explained away by the underlying condition. In a diabetes cohort, most adverse events can be. And the hospitalization rate, above 70% in both groups, is a severity marker. Disproportionality analysis does not usually supply one, and these are not minor coded events. The rising trend is the part most likely to be misread. Tirzepatide reports went from one or two a quarter in 2022 to 28 to 34 a quarter by 2025. That sounds like a worsening problem. It spans precisely the period in which tirzepatide went from newly launched to one of the most prescribed drugs in the country. More users generate more reports. Nothing in this design separates a rising rate from a rising denominator, the same trap set out in [the reflux reporting study](https://thisglp.com/research/do-glp1-drugs-cause-acid-reflux). ## Where it sits in the wider report pile These reports are a small part of a large file. A multi-source pharmacovigilance mapping took 243,114 GLP-1 records where the drug was the primary suspect, covering 2021 to 2026 [\[3\]](https://thisglp.com/research/can-a-glp1-cause-ketoacidosis#ref-3). Tirzepatide accounted for 133,100 of them, semaglutide 55,619 and dulaglutide 38,406. Frequently reported terms included incorrect dose administered, off-label use and extra dose administered. The authors call those use-process issues rather than adverse drug reactions. They also state that no source in the study estimates incidence, comparative risk or causality. That is the same limit that applies here, and it is counted in [the dose error records](https://thisglp.com/research/glp1-dose-errors-in-adverse-reports). ## The one setting where it was measured inside a trial Type 1 diabetes is the population where ketoacidosis is expected, and it is not an approved indication for any of these drugs. A crossover trial added semaglutide to automated insulin delivery [\[2\]](https://thisglp.com/research/can-a-glp1-cause-ketoacidosis#ref-2). Time in range rose 4.8 percentage points without more hypoglycemia, and two episodes of euglycemic ketosis were recorded. Two events is a count, not a rate, but it came from supervised randomized follow-up rather than a spontaneous report. The rest of that evidence is in [the type 1 diabetes trials](https://thisglp.com/research/semaglutide-in-type-1-diabetes). The practical content is a symptom list rather than a probability. Persistent vomiting, abdominal pain, rapid breathing and confusion during a period of very low food intake are reasons to seek urgent care. Waiting is worse, particularly during dose escalation when intake falls fastest. That is the same window in which the nutritional problems in [the thiamine cases](https://thisglp.com/research/can-a-glp1-cause-thiamine-deficiency) arose. It is described from the tolerability side in [titration and nausea](https://thisglp.com/research/how-long-does-nausea-last-on-a-glp1). ## Frequently asked Can a GLP-1 cause ketoacidosis? It has been reported in people without diabetes, at a reporting odds ratio of 3.15 for semaglutide across 261 cases and 1.22 for tirzepatide across 209. Roughly three quarters of those cases required hospitalization. A reporting ratio cannot produce a probability for any individual. How likely is ketoacidosis on one of these drugs? This analysis cannot say. Reporting ratios have no denominator of people taking the drug, so they produce no incidence figure. The case counts are small relative to how many people take these medicines. Why does it matter that these people did not have diabetes? Ketoacidosis in someone without diabetes cannot be attributed to the underlying condition, which is the usual explanation when it appears in diabetes cohorts. Are tirzepatide reports rising because it is more dangerous? Not demonstrably. Reports rose from 1-2 to 28-34 per quarter between 2022 and 2025, over exactly the period its use expanded enormously. More users produce more reports. ## Sources 1. \[1\] Makhmutov A, Qureshi F (2026). Ketoacidosis Risk in Non-diabetic Patients Using Semaglutide Versus Tirzepatide for Obesity: A Disproportionality Analysis of the FDA Adverse Event Reporting System Cureus. [PMID 42299163](https://pubmed.ncbi.nlm.nih.gov/42299163/) 2. \[2\] Karakus KE, Akturk HK, Kruger D, Ahmann A, Bharvaga A, Langel CR (2026). Effect of Semaglutide on Insulin Dose Reduction in Adults With Type 1 Diabetes and Obesity Using Automated Insulin Delivery Systems: ADJUST-T1D Post Hoc Analysis Diabetes Care. [PMID 41429002](https://pubmed.ncbi.nlm.nih.gov/41429002/) 3. \[3\] Ren L, et al. (2026). Postmarketing Safety Signals and Medication-Use Risks of GLP-1-Based Therapies in Diabetes and Obesity: A Multi-Source Pharmacovigilance and Regulatory Evidence-Mapping Study Diabetes, Obesity and Metabolism. [PMID 42687799](https://pubmed.ncbi.nlm.nih.gov/42687799/) ## More in Safety - [ Medication list · Check combinations · Fluid loss · Changes kidney risk · Pharmacist · Choose a safe option ### Can You Take Ibuprofen With Ozempic? Check Kidney and Stomach Risks ](https://thisglp.com/research/can-you-take-ibuprofen-with-ozempic) - [ 1.9% · Placebo · 8.5% · Ozempic 0.5 mg · 8.8% · Ozempic 1 mg ### Does Ozempic Cause Diarrhea? 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