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High blood sugar damages blood vessels over time, increasing the risk of heart attacks, strokes, kidney disease, vision loss, and nerve damage

Astragaloside II ameliorated podocyte injury and mitochondrial dysfunction in streptozotocin-induced diabetic rats

In susceptible patients, severe gastrointestinal symptoms can precipitate dehydration and acute kidney injury, which may further disrupt electrolyte balance

Hwang J, Kiick KL, Sullivan MO

Clinically, DR is defined as the inability to achieve negative sodium and fluid balance despite appropriate dosing ( Importantly, what is often interpreted as DR may represent insufficient drug delivery or underdosing rather than true pharmacologic resistance