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The second hit refers to the occurrence of lipid peroxidation and oxidative stress in hepatocytes with excessive lipid deposition, leading to mitochondrial dysfunction, production of inflammatory mediators, and activation of hepatic stellate cells, thereby resulting in NASH and fibrosis (James and Day, 1998)

The problem with lowering the dose of insulin in combination with having a SGLT-2 inhibitor on board is that the levels of ketones start to rise and push some people to DKA, a life-threatening complication, Mathieu said, adding that DKA primarily occurred in people who had a lower body weight, were on insulin pumps, or had a pump catheter obstruction

Consult your doctor First and foremost, before setting off, it's a good idea to book appointment with your GP