TLR4 and myocarditis: Regarding the relationship of the SIR and the possible pathogenesis of myocarditis [99], it is important to note that two metabolites of poorly controlled diabetes-hyperglycemia [100] and free fatty acids (FFA) [101] amplify toll-like receptors (TLR) in monocytes and results in the potential for: TLR-4-mediated myocardial apoptosis and DCM [102]; and the enhancement of the expression of anaphylatoxin C5a [103] and other complement peptides that are increased systemically during DKA and its treatment [28].