Urolithiasis is a systemic metabolic disease whose prevalence increases with type 2 diabetes mellitus. type 2 diabetic patients have lower urinary pH and low citrateuria due to insulin resistance and resulting defective renal processing of ammonium. Insulin stimulates ammonium synthesis and sodium-hydrogen exchange in the renal tubules and regulates urinary ammonium excretion. Many patients with type 2 diabetes are obese, and obesity itself can cause insulin resistance and lower urinary pH. In addition, the compensatory hyperinsulinemia associated with insulin resistance can also cause increased urinary calcium excretion. Patients with insulin resistance can be combined with uric acid stones due to a defect in urinary acidification, i.e., impairment of the L-glutamate system in the proximal tubule and a decrease in Na+-K+ transport. Defects in the Na+-K+ transport system can also be accompanied by a decrease in citric acid excretion, which is a risk factor for the formation of calcium-containing stones. In addition, insulin can also affect renal processing of calcium and acid, which favors the formation of calcium-containing stones. Urinary oxalic acid excretion is significantly increased and urinary pH is decreased in patients with urolithiasis with diabetes mellitus, which is important for the diagnosis, management and prevention of urolithiasis.