In the absence of insulin, protein metabolism is negatively impacted, leading to muscle breakdown.

“and then so taking the other extreme of that which is when someone is fasting or starving which is effectively what's happening in type 1 diabetes at the cellular level they don't have insulin how does the lack of insulin promote the breakdown of actual muscle so this negative nitrogen balance could because I'm assuming that well a lot of that muscle that breaks down is used for gluconeogenesis wouldn't that patient if you're measuring urinary nitrogen levels also be in a profound negative nitrogen balance”