A 34-year-old woman with type 1 diabetes on an SGLT2 inhibitor presents with nausea, vomiting, and malaise. Blood glucose is 198 mg/dL, pH 7.18, bicarbonate 9 mEq/L, anion gap 24, serum ketones strongly positive, and urine ketones 4+. Which of the following best explains this presentation?

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