It may develop before diabetes has been diagnosed in with advanced metabolic alterations. Or, it can occur in times of acute stress or illness in people with diabetes treated with insulin. Insulin is not present or is in short supply relative to an excess of counter regulatory hormones driven by significant stress or illness. Glucose levels rise in blood, but cell are unable to access it as fuel. Liver cells break down protein and glycogen, converting both into glucose.
More glucose is released into the blood.
Fat cells release fats into blood as alternative fuel. Muscle cells utilize fat as their primary fuel source, creating an abundance of its waste product, ketones. Ketone levels rise in the blood. They are acidic and change the acid- base chemical balance of the blood. Lungs try to neutralize acid by changing respiration rate and gas exchange.