 The proteolysis is going to result in a decrease in protein. There's going to be breaking down of muscle and increase in your plasma amino acids. Those amino acids that have been broken down, that have been made available from the breakdown of protein are going to feed back into and act as substrate in the liver for gluconeogenesis. So, the proteolysis is one of the factors in the diabetic that is responsible for weight loss. There is also going to be lipolysis. The lipolysis or the breaking down of fat is also going to contribute to the weight loss. The lipolysis is going to result in an increase in plasma-free fatty acids. The increase in plasma-free fatty acids is going to result in ketone genesis. So, there will be ketoemia and ketoyuria. Increase number of ketones in the blood. Increase number of ketones in the urine. And you know that the ketones that we're talking about are beta-hydroxybutyrate, acetylacetate, and acetone. Now, this will result in an anion gap metabolic acidosis. Because ketones are acidic, there will be an anion gap metabolic acidosis. And so, this is known as diabetic ketoacidosis. Diabetic ketoacidosis is one of the acute complications of diabetes mellitus. It can occur in individuals who have type 2 diabetes and it can occur in individuals who have type 1 diabetes. However, it is most common in individuals that have type 1 diabetes mellitus. The contrasting acute complication in the individual with type 2 diabetes mellitus is known as, I'll use this space here, hyperosmolar hyperglycemic syndrome or we can call it hyperosmolar hyperglycemic non-ketotic syndrome. So, let me compare and contrast the two in the individual that has anion gap metabolic acidosis that is in diabetic ketoacidosis, which is more common in type 1 diabetes mellitus. There is going to be a compensatory hyperventilation and Kuhls-Molls respirations. Kuhls-Molls respirations are deep labored respirations. They can be at a normal rate or they can be at an increased rate. The individual with hyperosmolar hyperglycemic syndrome or HHS will not have Kuhls-Molls respirations. They will not have hyperventilation. They will not have as low a pH and bicarbonate when compared to the DKA individual. There is a difference in the plasma glucose levels. In the individual that has DKA, you typically have blood sugars that are anywhere from 300 to 600 milligrams per deciliter. Contrastly, in the individual with HHS, you have plasma glucose levels anywhere from 600 to 1000 milligrams per deciliter. Because you in the individual with HHS do not have the hyperventilation and the Kuhls-Moll respirations, there is not infrequently a delay in these individuals presenting to the hospital for treatment. In addition to the fact, because they have a higher plasma glucose, they will have a more profound osmotic diuresis so that they are more frequently than not more dehydrated than the individual with DKA because of the higher plasma glucose as well in the delay in going to the hospital. So for that reason, the mortality for individuals that have HHS is greater than that of individuals that have DKA. And we said that this was the most typical acute complication of those with type 2 diabetes, malitis. The other thing that is taking place with the lipolysis is it's going to result in hyperlipidemia. There's going to be an increase in your plasma LDL, a decrease in HDL, and an increase in your triglycerides. This hyperlipidemia therefore in the diabetic can result in cholesterol gallstones but also cardiovascular disease. In fact, cardiovascular disease is the number one cause of death in diabetics that cardiovascular disease can include coronary artery disease, peripheral vascular disease, strokes. There is renal damage or nephropathy as a result of vascular damage, small vessels damage, resulting in retinopathy. And there is a decrease in the amount of nutrients and energy that is available to neurons when you're not taking sugar into the cell. In addition to that decrease in the amount of neuron nutrients, there is also going to be the formation of sorbitol which has an osmotic force that is capable of damaging small vessels that are in these neurons. And this results in all types of neuropathies, sensory motor neuropathies as well as autonomic neuropathies. So this is a brief summary of the pathophysiology of diabetes malitis. If you have any questions or comments, please leave them below. Thank you very much for watching the video and if you would like to take advantage of our USMLE courses, please use the promo code below.