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359,360 In the diabetic state, abnormalities in cellular energy metabolism affect macrovascular and microvascular lesions, 361,362,363 including abnormalities in substrate delivery to vascular EC or target organ cells (e.g., cardiac myocytes, thylakoid cells in glomeruli, and neurons and Schwann cells in peripheral nerves), conversion of the ratio of cell-specific fuel sources between glucose intermediates, fatty acids, and amino acids, changes in respiratory chain protein function, and uncoupling of respiratory chains

These complications are serious and life threatening