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This early pathological change can further activate a series of cascade reactions, including metabolic disorders, hemodynamic abnormalities, ERS, inflammatory responses and fibrotic processes, leading DKD to progress from early functional impairment to irreversible organic lesions (91)

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59 Patients with T2DM treated with SGLT2-I who experience gastrointestinal upset and malaise or develop metabolic acidosis should be promptly evaluated for the presence of ketones, even in the absence of severely elevated blood glucose

doi: 10.1016/j.cbi.2010.09.006 303 SteigerovJRrovLOkletkovJKovKLevkovMvchovMet al