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If you have a history of prediabetes, insulin resistance, or are taking other metabolic medications, your primary care provider will evaluate your specific need for monitoring

The metabolic derangements incorporate PDHC and TCA cycle defects: increased blood lactate and pyruvate, elevated plasma alanine, BCAA, presence of allo-isoleucine in plasma, and increased urinary lactic, pyruvic, 2-ketoglutaric, and branched-chain 2-hydroxy- and 2-ketoacid [143,144]