What are the three main causes of DKA?

• A. Hypoglycemia, dehydration, and kidney failure.
• B. Missed insulin dose, illness or infection, and undiagnosed/untreated type 1 diabetes.
• C. Overhydration, excessive exercise, and high-fat diet.
• D. Excessive insulin in the presence of infection.

Answer: (B)

DKA happens when there isn’t enough insulin to counter the rise of stress hormones, so the body shifts to breaking down fat and producing ketones, leading to high glucose, dehydration, and acidity. The three main triggers are: missing an insulin dose, which creates a sudden drop in insulin levels and lets ketogenesis surge; an illness or infection, which raises stress hormones like glucagon, cortisol, and adrenaline that drive glucose production and fat breakdown; and undiagnosed or untreated type 1 diabetes, where the body isn’t producing enough insulin from the start.

Other options don’t fit as triggers for DKA. Hypoglycemia isn’t a trigger for DKA and actually reflects too much insulin or too little glucose. Dehydration occurs as a consequence of DKA—not as the primary cause. Kidney failure is a complication that can worsen DKA but isn’t what initiates it. Excessive insulin in the setting of infection would more likely cause low blood glucose, not the ketone-driven crisis seen in DKA.