When it comes to type 2 diabetes, it's hard to know where to start, but maybe worth starting

with the practicality of how these patients present. And unlike type 1 diabetes, which frequently

presents with polydipsia, polyurea, so a lot of thirst and urination. Type 2 diabetes often does not present that way.

Particularly people will present either on screening tests and labs or much more common if you're

in a hospital setting with some sort of complication, a cardiovascular

complication, kidney disease, maybe an infection like cellulitis, or plenty of other infections.

It turns out bacteria love the source of high sugar as a fuel and also neutrophils get inhibited when you start

getting significant hyperglycemia.

But unlike type 1 diabetics that often present with DCA, with diabetic ketoacidosis,

in type 2 diabetes, usually, particularly in the early stages,

there's enough residual insulin production from the beta cells and the pancreas that make

insulin that you don't have lipolysis as an early problem. And what I mean by lipolysis is the breakdown of fats and other lipids to release fatty acids.

However, it should be noted that a lot of type 2 diabetics, particularly with an acute illness,

they can suddenly present with a lot of metabolic stress and become

ketone producers and be having liposis. And therefore some type 2 diabetics either can

present with DCA or develop DCA at a point in their disease.

Now, of course, the fatty acids and glycerol molecules liberated by lipolysis in normal

metabolism, in normal everyday life, are important because they generate energy needs that your body can utilize.

But too much acid in your blood can be a bad thing. And so we see that a lot in presentations

to hospitals and emergency rooms, but it's not the main thing we see with type 2 diabetes, as opposed

to we frequently see. It's not maybe the main thing we see with type 1 diabetes, but it's a very

frequent presentation. So insulin, it inhibits lipolysis. It slows down that breakdown of adipose tissue of fat and so one of the

...