A patient with insufficient insulin (or resistance to the effect of insulin) may not be able to transport enough glucose into cells to meet metabolic needs despite hyperglycemia in the peripheral blood. The cell may shift to lipid oxidation with metabolic acidosis and release of ketone bodies. Prompt recognition and management are important to prevent serious sequelae.


Early symptoms may include:

(1) a fruity odor on the breath

(2) facial flushing

(3) anorexia

(4) thirst

(5) drowsiness


If uncorrected, the symptoms may progress with:

(1) heavy breathing

(2) tachycardia

(3) nausea and vomiting

(4) dehydration secondary to osmotic diuresis

(5) loss of consciousness, progressing to coma


Laboratory testing will show:

(1) hyperglycemia

(2) large amounts of glucose and acetone in the urine

(3) metabolic acidosis

(4) sodium and potassium depletion

(5) ketone bodies (acetoacetic acid and beta-hydroxybutyrate) in blood and urine


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