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Patients must have the ability to understand and perform these protocol steps. They should seek medical attention if they are unable to maintain hydration or clear ketones despite additional insulin.

The section Cases presents brief case reports that convey clear, sport science journal lessons. Preference is given to common presentations of important rare conditions, and important unusual presentations of common problems. Articles start with a case presentation (500 words maximum), and a discussion of the underlying condition follows (1000 words maximum).

Consent from patients for publication of their story is a necessity. See information for authors at www. Competing interests: Manpreet Doulla has received travel funding from Novo Nordisk, unrelated to this work.

Mary Jetha is the local principal investigator for a clinical sport science journal of teplizumab, which is sponsored by Provention Bio Inc. She is also the local principal investigator for a surveillance study of youth with type 2 diabetes, sponsored by the Canadian Institutes of Health Research, with funding provided to the University of Alberta, unrelated to this work.

No sport science journal competing interests were declared. Contributors: All of molecular liquids journal authors contributed equally to the writing and editing of this manuscript, reviewed it critically for intellectual content, gave final approval of the version sport science journal be published and agreed to be accountable for all aspects of the work.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution sport science journal BY-NC-ND 4.

DiscussionHealth Canada has not approved the use of SGLT-2 inhibitors sport science journal patients under 18 years of age. Pathophysiology of ketosis with sodium-glucose co-transporter 2 inhibitorsThe mechanism by which SGLT-2 inhibitors increase the risk of DKA is shown in Figure 2.

Sodium-glucose co-transporter 2 inhibitors and diabetic ketoacidosisFew reports of DKA associated with SGLT-2 inhibitors in sport science journal exist. Risk factors for diabetic ketoacidosisOur patient was at high risk of DKA because he had an elevated HbA1c level, did not follow diabetes self-management routines and did not monitor his blood glucose and ketone levels when he was sick.

Patient educationBy presenting this case, we aimed to highlight that treatment with a SGLT-2 inhibitor increases the risk of DKA in situations of illness, decreased carbohydrate intake or reduced insulin doses.

FootnotesCompeting interests: Manpreet Doulla has received travel funding from Novo Nordisk, unrelated to this work. This sport science journal has been peer reviewed. The authors have obtained patient consent.

Diabetes Canada 2018 clinical practice guidelines for the prevention and management of diabetes in Canada. Children and adolescents: standards apologize to medical care in diabetes 2020. ISPAD clinical practice consensus guidelines 2018: type 2 diabetes in youth.

OpenUrlPubMedTang H, Aging and nursing homes W, how to deal with stress D, et al. Sodium-glucose co-transporter 2 inhibitors in addition to insulin therapy for management of type 2 diabetes mellitus: a meta-analysis of randomized controlled trials.

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Sodium-glucose co-transporter-2 inhibitors as add-on therapy to insulin for type 1 diabetes mellitus: systematic review and meta-analysis of randomized controlled trials. OpenUrlCrossRefPubMedQiu H, Novikov A, Vallon V. Ketosis and diabetic ketoacidosis in response to SGLT2 inhibitors: basic mechanisms and therapeutic perspectives. OpenUrlPubMedGoldenberg RM, Berard LD, Cheng AYY, et al.

SGLT2 inhibitor-associated diabetic ketoacidosis: clinical review and recommendations for prevention and diagnosis. OpenUrlPubMedAmed S, Dean HJ, Panagiotopoulos C, et al. Type 2 diabetes, medication-induced diabetes, and monogenic diabetes in Canadian children: a prospective national surveillance study. Euglycemic diabetic ketoacidosis: a predictable, detectable, and preventable safety concern with SGLT2 inhibitors.

OpenUrlFREE Full TextPeters AL, Buschur EO, Buse JB, et al. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Ottawa: Government of Canada. FDA Adverse Event Reporting System (FAERS) Public Dashboard.

Goldenberg RM, Gilbert JD, Hramiak IM, et al. Sodium-glucose co-transporter inhibitors, their role in type 1 diabetes treatment and a risk mitigation strategy for preventing diabetic ketoacidosis: the STOP DKA protocol.

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