Ketosis-Prone Type 2 Diabetes Clinical Presentation

Updated: Jan 20, 2023
  • Author: Richard S Krause, MD; Chief Editor: George T Griffing, MD  more...
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At first diagnosis of diabetes, approximately half of affected patients have "unprovoked' ketosis-prone diabetes (KPD) and present with diabetic ketoacidosis (DKA) without a precipitating factor. These individuals have a low frequency of human leukocyte antigen (HLA) class II susceptibility alleles for type 1 diabetes (T1D), lack T-cell reactivity to islet autoantigens, [9] and they demonstrate sustained preservation of β-cell function following recovery from DKA with the ability to discontinue insulin treatment while maintaining excellent glycemic control.

Patients with “provoked” A-β+ ketosis-prone ketoacidosis develop DKA in association with a precipitating factor such as an acute illness; have long-standing diabetes with high frequencies of HLA class II T1D susceptibility alleles and T cell reactivity to islet autoantigens; and demonstrate progressive loss of β-cell function and inability to achieve glycemic control without insulin treatment following recovery from DKA. [9]

The presentation of DKA does not differ markedly according to the Aβ phenotype. Typical features of polydipsia, polyuria, and fatigue are seen. In patients who already require insulin, the onset of DKA can be rapid when, for example, insulin is abruptly discontinued or a major stressor such as an acute myocardial infarction occurs.

Patients with previously undiagnosed ketosis-prone type 2 diabetes may have a less abrupt onset of symptoms. Symptoms related to an underlying precipitating event, such as myocardial infarction or infection (eg, pneumonia, urinary tract infection), may be noted. Abdominal pain is also a common complaint associated with DKA, especially in children. The cause of abdominal pain in DKA is not well understood but appears to relate to the severity of the acidosis. Failure of abdominal pain to resolve with treatment of DKA or marked abdominal tenderness should lead to consideration of other causes. Shortness of breath in spite of normal pulse oximetry and clear lungs is common.


Physical Examination

Physical signs in diabetic ketoacidosis are associated with the severity of the metabolic derangement and dehydration, and they may include the following:

  • Tachypnea/hyperpnea

  • Tachycardia

  • Dry mucous membranes

  • Poor skin turgor

  • Altered mental status

  • Nausea, vomiting

  • Hypotension

  • Signs related to a precipitating illness