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To mitigate the well-established risk of DKA, patients were required to have a total daily insulin requirement of 0.5 U/kg, undergo frequent home ketone monitoring and receive structured education [28]

Possible environmental risk factors and causes include: Heavy metal toxicity Head and neck trauma Low levels of magnesium and calcium Glutamate toxicity Antioxidant deficiency including SOD and glutathione Trouble digesting protein properly Low levels of vitamin E and vitamin B12 Exposure to toxins including pesticides Immune system dysfunction Smoking Mitochondrial and Metabolic Dysfunction with ALS Growing evidence shows that there are metabolic defects in people with ALS (2)