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That does not make the symptom more or less serious by itself, but it does add context when clinicians are deciding whether ketones may be involved

Participants were evaluated using imaging techniques, food-behavior questionnaires, blood tests, and fecal microbiome analysis

Diabetes Care 39(6):861877

We show that the cardioprotective actions of GLP-1(2836) do not depend on a functional transmembrane GLP-1R but rather are mediated intracellularly through type 10 soluble adenylyl cyclase (sAC), accompanied by increased cAMP levels, protein kinase A (PKA) activation, and endothelial nitric oxide synthase (eNOS) phosphorylation

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And without that signal, especially when calories are low, the body becomes much more willing to break down muscle tissue along with fat tissue