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For type 1 diabetes patients with inadequate glycemic control, one treatment option is to increase the insulin dose (scenario 1), which should not give rise to a “metabolic imbalance.” A second option is additional treatment with a  sodium–glucose cotransporter 2  inhibitor, which might lead to a “metabolic imbalance” (scenario 2). A reduction in insulin dose in addition to administration of a  sodium–glucose cotransporter 2  inhibitor might further increase the “metabolic imbalance” (scenario 3).

journal of diabetes investigation

Sodium–glucose cotransporter 2 inhibitor‐associated diabetic ketoacidosis in patients with type 1 diabetes: Metabolic imbalance as an underlying mechanism