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In DKD, upregulation of local angiotensin II in the renal tubule, activation of vascular endothelial growth factor (VEGF), and reduction of nitric oxide (NO) ( Activation of RAAS also leads to the release of aldosterone, a mineralocorticoid hormone, from the adrenal glands

But that is what we know today, that you have these pathways that end up in these appetite-regulating centers and the reward regulation as well

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Document symptom timing, check blood glucose during episodes, and discuss whether dose adjustment, symptomatic treatment, or mental health referral is appropriate

Whether high estrogen levels are problematic depends on a persons overall health and the specific reason behind the elevated levels