In diabetic ketoacidosis, lack of insulin leads to production of ketones causing which metabolic disturbance?

• A. Hyperosmolar state without ketosis
• B. Hypoglycemia
• C. Ketone production with metabolic acidosis
• D. Lactic acidosis

Answer: (C)

In diabetic ketoacidosis, insulin deficiency with raised counterregulatory hormones triggers rapid lipolysis. The liver converts the liberated fatty acids into ketone bodies (acetoacetate and beta-hydroxybutyrate), which are acids themselves. Their accumulation lowers blood pH and bicarbonate, causing a high anion gap metabolic acidosis. This is the hallmark disturbance—ketone production leading to metabolic acidosis. Hyperglycemia and dehydration come from osmotic diuresis, but the key issue described here is ketosis with acidosis. Lactic acidosis or a nonketotic hyperosmolar state aren’t the central features of classic DKA.