What is the most common precipitating factor for diabetic ketoacidosis?

• A. overeating
• B. not taking enough insulin
• C. drinking alcohol
• D. taking too much insulin

Answer: (B)

Diabetic ketoacidosis occurs when there is a severe lack of insulin, allowing ongoing glucose production and fat breakdown to produce high glucose and ketones with metabolic acidosis. The most common precipitating factor is not taking enough insulin or missing doses, which removes the insulin signal that normally suppresses liver glucose output and ketone formation. Without adequate insulin, glucose rises, lipolysis increases, ketones accumulate, and acidosis develops, often brought on by stress or illness but fundamentally due to insufficient insulin delivery. Other options—overeating, drinking alcohol, or taking too much insulin—can affect glucose control in different ways, but they are not the typical trigger for DKA in the way inadequate insulin is.