DKA is normally seen in states of prolonged fasting or starvation. The body shifts metabolism from primarily using glucose to using an alternate fuel pathway, ketones, derived from fatty acids. A key signal for this shift is very low insulin levels. However, in T1D this shift can happen within a few hours when too little insulin is administered, often in the setting of another illness such as an infection or flu (the basal insulin in a basal/bolus insulin regimen typically blocks the production of ketones).
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