Causes And Treatment Of Insulin Deficiency
Hepatic gluconeogenesis, glycogenolysis secondary to insulin deficiency, and counter-regulatory hormone excess result in severe hyperglycemia, while lipolysis increases serum free fatty acids. Hepatic metabolism of free fatty acids as an alternative energy source (ie, ketogenesis) results in accumulation of acidic intermediate and end metabolites (ie, ketones, ketoacids).
Meanwhile, increased proteolysis and decreased protein synthesis as result of insulin deficiency add more gluconeogenic substrates to the gluconeogenesis process. In addition, the decreased glucose uptake by peripheral tissues due to insulin deficiency and increased counter regulatory hormones increases hyperglycemia.
The underlying or concomitant infection might be reason as WBC 's as increased, which would further add up the stress and also the poor compliance with insulin through the omission of insulin injections, due to illness, vomiting or as a result of psychological stress, particularly in adolescents can lead to DKA.
Progressive rise of blood concentration of these acidic organic substances initially leads to a state of ketonemia, although extracellular and intracellular body buffers can limit