DM type 1 Has Ketoacidocis, Type 2 Not?

by Ahmed
(Aden)

QUESTION: Why in DM type 1 there is ketoacidocis but not in type 2?



ANSWER: Hi Ahmed,

As you probably know, there are a lot of hormones taking part in the glucose metabolism, the two major ones include insulin and glucagon.

Insulin is the only hormone that reduces the sugar in plasma by helping it to enter in the cells.

Glucagon is one of the contra-insulin hormones, i.e. glucagon is increasing the amount of sugar in blood.

Beside lowering blood glucose, insulin is also suppressing the secretion of glucagon. When you have high insulin secretion (during high blood glucose level), you have low glucagon secretion.

During low blood glucose level you have high glucagon secretion and low insulin secretion.

Glucagon as hormone is reducing the secretion of insulin and increases the hydrolysis of glycogen (polymer of glucose stored in the liver and in the muscles).

Besides this, glucagon stimulates the ketogenesis (process during which the ketobodies are formed and cause ketoacidosis). Ketoacidosis is a very dangerous condition, which is supposed to be treated immediately.

  • For your information, there are several types of diabetes. When we are talking about diabetes mellitus, there are only two types - one and two.

    Diabetes type one is caused by beta-cell destruction which leads to stop in the insulin secretion. That means that in patients in diabetes type 1, there is no insulin secretion at all. The only way to replaces the lack of insulin is by injections.

    Diabetes type 2 is caused by reduced insulin secretion and insulin resistance. That means that normally, in patients with diabetes type 2, insulin is still secreted, which at the same time, prevents the development of ketoacidosis.

    The mechanism is simple: when the beta cells do still produce insulin, the glucagon secretion is stopped; therefore, the ketogenesis and ketoacidosis caused by Glucagon is also prevented while controlling blood sugar.

    When there is no insulin which can stop the synthesis and secretion of glucagon, the amount of this hormone is elevated. That explains why type 1 diabetics (who have no insulin secreted) are prone to ketoacidosis than type 2 diabetics.

    Therefore, they are constrained to inject insulin in order to reduce the secretion of glucagon, preventing the condition of ketoacidosis from developing.

    Hope it was all clear!

    Dr.Alba

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