Which of the following are listed as common triggers for diabetic ketoacidosis?

• A. Missed insulin dose, illness or infection, and undiagnosed/untreated type 1 diabetes.
• B. Regular physical activity.
• C. Overhydration and excessive sleep.
• D. Consistent carbohydrate intake.

Answer: (A)

The main concept here is what commonly triggers diabetic ketoacidosis (DKA). DKA typically arises when insulin is severely lacking or its action is overwhelmed, so the body switches to breaking down fat for energy and producing ketones. A missed insulin dose or disruption in insulin delivery lowers insulin levels, tipping the balance toward lipolysis and ketogenesis that drive acidosis. Illness or infection adds stress hormones like cortisol, adrenaline, and glucagon, which raise glucose production and worsen insulin resistance, pushing someone with insufficient insulin toward DKA. If someone has undiagnosed or untreated type 1 diabetes, there is little to no insulin activity from the outset, making them especially susceptible to DKA when a precipitating stressor occurs. In contrast, regular physical activity is generally beneficial and not a trigger for DKA; overhydration and excessive sleep are not typical precipitating factors; and consistent carbohydrate intake supports stability rather than precipitating DKA.