AACS and diabetes mellitus: An important point recently made by Aguilo et al. (8) is that AACS is a high-affinity enzyme with a low micromolar Km for AcAc, and there is plenty of AcAc available to supply the process of KB utilization for denovo lipid synthesis in virtually any metabolic state including the fed animal and not just in states when KBs are elevated such as in diabetes or fasting.