<prompt> A 74-year-old woman is admitted to the hospital in an obtunded condition. Her temperature is 37deg C, pulse is 95 min, respirations are 22min, and blood pressure is 9060 mm Hg. She appears dehydrated and has poor skin turgor. Her serum glucose level is 872 mgdL. Urinalysis shows 4 glucosuria, but no ketones, protein, or blood. Which of the following factors is most important in the pathogenesis of this patients condition?Autoimmune insulitisGlucokinase gene mutationHLA-DR3HLA-DR4 genotypePeripheral insulin resistance  <response>: A complication of type 2 diabetes mellitus is hyperosmolar, nonketotic coma. In type 2 diabetes mellitus, the fundamental defect is insulin resistance, leading to an eventual decrease in plasma insulin or a relative lack of insulin, but there is still enough insulin to prevent ketosis. The resulting hyperglycemia tends to produce polyuria, leading to dehydration, which increases the serum glucose level further. If not enough fluids are ingested, dehydration drives the serum glucose to very high levels. Glucokinase gene mutations can be present with maturity-onset diabetes of the young MODY. The HLA-DR3HLA-DR4 genotype is a predisposing factor for type 1 diabetes mellitus. Severe loss of beta cells with insulitis, which may be triggered by a viral infection, is a feature of autoimmune, or type 1, diabetes mellitus. 