True about Type 1 diabetes mellitus

* Patients may become hyperglycemic in poorly controlled type 1 diabetes mellitus . The reason being - due to lack of insulin to stimulate uptake and utilization of glucose and also because in the absence of insulin which antagonize the actions of glucagon, there is increase in gluconeogenesis from amino acids in liver. * Lack of insulin (which antagonize the actions of glucagon) results in increased lipolysis in adipose tissue , and the resultant NEFAs become substrates for ketogenesis in the liver. There is defect in the utilization of ketone bodies in muscle because of lack of oxaloacetate . * In uncontrolled diabetes, ketosis is severe enough to cause pronounced acidosis (ketoacidosis). * Coma results from both the acidosis and also the considerably increased osmolality of extracellular fluid (mainly as a result of the hyperglycemia, and diuresis resulting from the excretion of glucose and ketone bodies in the urine). Ref:- Harper 30/e; pg num:- 149