A complete understanding of all of these factors is essential to ensure the health and safety of athletes with diabetes during prolonged/high-intensity exercise, or activity in the heat. As ketoacidosis has several symptoms in common with heat stroke, it is important for athletes with diabetes as well as their coaches and trainers to be able to differentiate between these two. Athletes with type 1 diabetes will thus often enter competition with elevated blood glucose levels and therefore an elevated requirement for fluid intake to prevent dehydration. In such cases, and where medication has been prescribed for hypertension, athletes with type 2 diabetes should be aware of possible sodium deficits related to sweating for long periods of time during training and participation in athletic events. Chronic hyperglycemia, however, will increase the activation of sodium/glucose cotrans-porters in the proximal tubule and thereby promote sodium retention.