Ketoacidosis in type 2 DiabetesWatch
Why does ketoacidosis usually not occur in a patient suffering from type 2 diabetes?
Thanks in advance
In type 2 DM it's usually an insulin resistance picture, i.e. the pancreas is still OK - at least in the beginning, in the long-term it will begin to fail - at producing insulin but the cells do not respond to it appropriately. The cells do not take up the glucose. However, ketogenesis is a different mechanism that is also regulated by insulin and even the smallest amount of insulin in the blood is good enough to stop it from happening. So, the insulin produced in DM2 is not enough to regulate sugar balance (either due to cellular resistance, or in late DM2 because there's not enough of it PLUS the resistance) but it's good enough to halt ketogenesis. In type 1 DM, there's an absolute deficiency of insulin so ketogenesis is allowed to occur and the patient can present in DKA. The "equivalent" in DM2 is a hyperosmolar hyperglycaemic state.