In type 1 vs type 2 diabetes, which type is more prone to DKA and what is a key metabolic feature?

In type 1 vs type 2 diabetes, which type is more prone to DKA and what is a key metabolic feature?

• A. Type 1; ketoacidosis with anion gap metabolic acidosis and positive ketones.
• B. Type 2; ketoacidosis with normal ketones.
• C. Both types equally; no ketones.
• D. Type 2; lactic acidosis.

Answer: (A)

DKA crops up most often when there’s little to no insulin, which is typical in type 1 diabetes. Without insulin, counterregulatory hormones drive unlimited lipolysis; the liver turns those free fatty acids into ketone bodies. The accumulation of these ketones—acetoacetate and beta-hydroxybutyrate—produces a ketoacidosis that shows up as an anion gap metabolic acidosis, with positive ketones in the blood or urine. That combination—type 1 diabetes plus ketone-driven anion gap acidosis—is what defines the classic DKA picture. Type 2 can rarely present with DKA, especially under stress or dehydration, but it isn’t the usual scenario, and the hallmark ketosis with anion gap acidosis is not as typical as in type 1. Lactic acidosis isn’t the defining feature of DKA.

DKA crops up most often when there’s little to no insulin, which is typical in type 1 diabetes. Without insulin, counterregulatory hormones drive unlimited lipolysis; the liver turns those free fatty acids into ketone bodies. The accumulation of these ketones—acetoacetate and beta-hydroxybutyrate—produces a ketoacidosis that shows up as an anion gap metabolic acidosis, with positive ketones in the blood or urine. That combination—type 1 diabetes plus ketone-driven anion gap acidosis—is what defines the classic DKA picture.

Type 2 can rarely present with DKA, especially under stress or dehydration, but it isn’t the usual scenario, and the hallmark ketosis with anion gap acidosis is not as typical as in type 1. Lactic acidosis isn’t the defining feature of DKA.