Why Ketoacidosis is more common in Type 1 diabetics?

Insulin causes preferred brekadown of Glucose over Ketone bodies for energy.

Insulin actually prevents the formation of Ketone bodies.

Without Insulin there will be lots of Glucose in the blood as they will not be utilised and formation of Ketoacids will also occur.

In Type 2 there is insulin so Ketoacids are not formed but Glucose is high in the blood nonetheless.

In type 1 diabetics, insulin is not there, so Ketoacids are present and Glucose concentration is also high - That is why Ketoacidosis occurs in Type 1 and not in type 2(atleast not commonly) - probably the reason why type is considered more dangerous.

So insulin must be given in Diabetic Ketoacidosis not only to lower Glucose but also to prevent formation of Ketone bodies so as to subside Ketoacidosis. Oral Hypoglycemics are not so good.

There is one issue though Insulins causes Pottasium to enter the cells along with Glucose so Diabetic induced Diuresis has already caused Pottasium depletion and entry of Pottasium into the cells may exacerbate Hypokalemia or Concentration of Pottasium in the blood.

Going a bit further -

Insulin causes increased Fatty acid synthesis in cells of lower redox and decreased fatty acid synthesis in cells of higher redox, so in diabetic state the former is applicable but let us not complicate it for it suffices to say that insulin causes breakdown of Glucose over Fatty acids.

So, insulin causes accumulation of Fats instead of breakdown so much that insulin injections causes accumulation of Fats on the place where needle was inserted. Also because of this Type 1 diabetic patients are skinny(less fats and more ketoacids) while Type 2 diabetic patients can be overweight.

-Syed Moris

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