In type 2 diabetes, higher baseline lactate levels can be due to PDH seeing higher glucose and shunting it to lactate, and also due to poorly functioning mitochondria.

“The first is PDH because their PDH is seeing higher glucose than the non-diabetic. So that's the first thing it's doing is, as you say, I like that analogy of the fuse. It's just triggering the fuse and shunting more glucose down the pyruvate to lactate pathway. And then of course, there's everything we spent the first hour talking about, which is in addition to that, their mitochondria are just tap out very early. They're not working well. So those two things that are related but quite distinct would both push up lactate.”