ACIDO CETOSE DIABETIQUE. ASPECTS PHYSIOPATHOLOGIQUES ET THERAPEUTIQUES RECENTS

TL;DRAbstract

Diabetic hyperketonemia results primarily from an excessive production of ketone bodies by the liver. Two factors ought to be present in order to induce hyperketogenesis: increased amounts of free fatty acids should be delivered to the liver from adipose tissue; and the liver should be in a ketogenic state. These two conditions are present in diabetic ketoacidosis owing to the simultaneous existence of insulinopenia and hyperglucagonemia. Under the influence of a low insulin/glucagon ratio, adipose tissue lipolysis is enhanced and intrahepatic fatty acid metabolism is switched towards β oxidation and ketogenesis, away from triglyceride synthesis. Thus, the bi hormonal insulin glucagon system is implicated in the regulation of ketone metabolism as it is in glucose homeostasis. Another recent step in our knowledge on ketone metabolism is the in vitro and in vivo demonstration of a reduced capacity of certain extrahepatic tissues to utilize ketones in diabetic ketosis. This defect probabl

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