Diabetic ketoacidosis

What it is

The name is the definition: Diabetes with hyperglycemia, Ketosis with ketonemia and ketonuria, and Acidosis with an anion gap. Insulin is absent and ketones are present. That pair is what tells it apart from the hyperosmolar hyperglycemic state, where some insulin is still present and ketones are absent. It is more common in type 1 diabetes mellitus: with no insulin to suppress lipolysis, ketones form and acidosis follows. Absolute insulin deficiency leads to rapid symptomatic acidosis and an early presentation, over hours, with only moderate hyperglycemia above 250 mg/dL. Mortality is relatively lower than in the hyperosmolar state, which comes on over days.

It is put as a triad: diabetic ketoacidosis is characterized by the triad of hyperglycemia, high anion gap metabolic acidosis and the presence of ketone bodies. It is common in type-1 DM, although it may also occur in type-2 DM during stressful situations - so type 2 does not rule it out. Ketoacidosis is a potentially lethal condition and should be suspected and treated promptly.