What is the primary trigger for diabetic ketoacidosis (DKA)?

The primary trigger for diabetic ketoacidosis (DKA) is insulin deficiency. In individuals with diabetes, particularly those with Type 1 diabetes, inadequate insulin levels lead to a state where the body cannot properly utilize glucose for energy. As a result, the body begins to break down fat as an alternative fuel source. This process produces ketones, which are acidic byproducts that accumulate in the bloodstream.

When insulin is insufficient, glucose remains in the bloodstream, leading to hyperglycemia. Without enough insulin, the body cannot transport glucose into the cells for energy, prompting increased fat metabolism. The combination of high blood sugar and elevated ketone levels results in the metabolic state known as DKA, which is characterized by acidosis and can be life-threatening if not treated promptly.

This understanding highlights why insulin deficiency is critical in the pathophysiology of DKA, distinguishing it from factors like high carbohydrate intake, excessive physical activity, or dehydration, which can contribute to DKA but are not the primary cause.