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High blood ketone body concentration in Type 2 non-insulin dependent diabetic patients

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Abstract

To assess the metabolic disturbances, and, in particular, the occurrence of high blood ketone body concentration in post-absorptive Type 2 (non-insulin-dependent) diabetic patients as compared to a matched normal population, a study was carried out in a group of 78 Type 2 diabetic outpatients matched for age and sex and in 78 normal individuals. In all subjects we measured HbA1c, and fasting levels of glucose, FFA, lactate, pyruvate, glycerol, alanine, 3-hydroxybutyrate, acetoacetate, uric acid, total cholesterol, triglycerides, creatinine, growth hormone, Cortisol, glucagon, free insulin, and C-peptide. Multistix strips were used for urine ketone determination. As expected HbA1c, and plasma glucose were higher in Type 2 diabetics. This was associated with multiple metabolic disturbances as shown by higher circulating concentrations of FFA, glycerol and gluconeogenic precursors. Similarly, blood levels of ketones (351 ± 29 vs 159 ± 15 umol/I; p<0.0001) were increased, in spite of higher plasma free-insulin (77 ± 7 vs. 49 ± 14 pmol/I; p<0.0001) and C-peptide concentration (0.63 ± 0.03 vs. 0.46 ± 0.07 nmol/I; p<0.05) and no differences in plasma levels of Cortisol, and growth hormone. Plasma glucagon levels were higher in Type 2 diabetics. Blood ketone body levels were directly correlated with both plasma glucose and FFA concentrations. These observations clearly show that Type 2 diabetes is a pathologic condition characterised by multiple metabolic disturbances which are fully apparent in the basal state. Furthermore, we emphasise that Type 2 diabetic patients, though not insulin deficient, may present a significant increase in their fasting levels of ketone bodies.

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Authors and Affiliations

  1. Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi di Padova, Azienda Ospedaliera di Padova, Italy

    Angelo Avogaro M.D., C. Crepaldi, M. Miola, A. Maran, V. Pengo, A. Tiengo & S. Del Prato

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  1. Angelo Avogaro M.D.
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  2. C. Crepaldi
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  3. M. Miola
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  4. A. Maran
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  5. V. Pengo
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  6. A. Tiengo
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  7. S. Del Prato
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Avogaro, A., Crepaldi, C., Miola, M. et al. High blood ketone body concentration in Type 2 non-insulin dependent diabetic patients. J Endocrinol Invest 19, 99–105 (1996). https://doi.org/10.1007/BF03349844

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