A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 milligrams per deciliter (high), urine glucose and ketones 4+ (high), and arteri-al pH 7.20 (low)
Her parents state that she has been sick with the "flu" for a week. Which of the following state-ments best explains her acidotic state?
a. Increased insulin levels promote protein breakdown and ketone formation.
b. Her uncontrolled diabetes has led to renal failure.
c. Low serum insulin promotes lipid storage and a corresponding release of ketones.
d. Insulin deficiency promotes lipid metabo-lism and ketone formation.
ANS: D
With insulin deficiency, lipolysis is enhanced, and there is an increase in the amount of nonesteri-fied fatty acids delivered to the liver. The consequence is increased glyconeogenesis contributing to hyperglycemia and production of ketone bodies (acetoacetate, hydroxybutyrate, and acetone) by the mitochondria of the liver at a rate that exceeds peripheral use. Insulin levels are decreased. There is no evidence that the patient is in renal failure. Insulin is low, but the ketones are the re-sult of fatty acid breakdown due to lack of insulin, not because of lipid storage.
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