What is the biochemical basis of diabetic ketoacidosis?

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What is the biochemical basis of diabetic ketoacidosis?

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In diabetic ketoacidosis, there is a shift in the balance in favor of the counter-regulatory hormones over insulin. Thus, plasma levels of glucagon, epinephrine, growth hormone, and cortisol are increased, often due to some form of stress. Insulin levels are insufficient, either due to the patient not taking insulin or due to the increased requirements for insulin. This sets the scene for hyperglycemia and for increased production of ketone bodies. The hyperglycemia is due to decreased glucose uptake by tissues, and increased gluconeogenesis and glycogenolysis. The increased ketogenesis is due to increased lipolysis triggered by the counter-regulatory hormones. The free fatty acids that are released can be converted in the liver to ketone bodies, and increased ketone bodies result in a metabolic acidosis. This manifests as a low pH and a low bicarbonate, which is consumed in buffering the keto acids. In response to the metabolic acidosis, the respiratory center is stimulated to reduce

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