Starvation and diabetes mellitus can lead on to ketoacidosis which of the following features is in our of ketoacidosis due to diabetes mellitus?
Ketoacidosis is a high anion gap metabolic acidosis due to an excessive blood concentration of ketone bodies. Ketone bodies (acetoacetate, beta-hydroxybutyrate, acetone) are released into the blood from the liver when hepatic lipid metabolism has changed to a state of increased ketogenesis. The three major types of ketosis are: Starvation ketosis Alcoholic ketoacidosis Diabetic ketoacidosis Starvation Ketoacidosis: Occurs secondary to starvation, is due to a diminished insulin secretion, that leads to an increase in lipolysis and ketogenesis. The acidosis even with prolonged fasting is only mild to moderate. Diabetic ketoacidosis (DKA) is a state of absolute or relative insulin deficiency and is defined by the American Diabetes Association's (ADA) diagnostic criteria of Hyperglycemia , Acidosis (aerial pH Ketosis (moderate ketonuria or ketonemia) The metabolic differences between diabetes and starvation include- Insulin levels: The level of insulin is decreased in both diabetes and starvation. It is more decreased in case of diabetes (viually absent in type I diabetes). There is relative excess of glucagon in both the cases. Glucagon acts through elevation in CAMP level. Blood glucose levels: Diabetics exhibit a characteristic hyperglycemia where as in starvation the individual maintain a blood glucose level that is near to normal Ketosis: The mobilization of fatty acids from adipose tissue and hepatic ketogencsis are greater in diabetes than in starvation. As a result the ketoacidosis observed in diabetes in much more severe than that observed during starvation. Factors DKA Starvation pH | normal Plasma glucose | normal Glycosuria + + ---- Total plasma ketones || Mild | Anion gap | Mild | Osmolality | normal Ref: Lippincott's illustrated reviews Biochemistry, 2nd Edition, Page 297.
Increase in glucagon/insulin ratio, increased CAMP and increased blood glucose
Decreased insulin, increased free fatty acid which is equivalent to blood glucose
Decreased insulin, increased free fatty acid which is not equivalent to blood glucose
Elevated insulin and free fatty acid, equivalent to blood glucose