New Profiles of Diabetic Ketoacidosis

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Abstract
THERE IS a strong perception among physicians that "ketoacidosis is rare in true NIDDM [non–insulin-dependent diabetes mellitus]"1 and that it occurs in adult patients with type 2 diabetes only in unusual circumstances in association with severe stress.2 The biochemical basis for this belief is that patients with type 2 diabetes are rarely completely deficient in circulating insulin and are therefore able to avoid exuberant lipolysis and ketogenesis.1 In recent years, however, diabetic ketoacidosis (DKA) has been reported to occur in patients with type 2 diabetes of different ethnic groups.3-9 These reports underscore the phenotypic complexity of type 2 diabetes and invite further debate into the utility of traditional,2,10 and even more recent,11 clinical classification schemes for diabetes.