HIGH BLOOD KETONE-BODY CONCENTRATION IN TYPE-2 NON-INSULIN-DEPENDENT DIABETIC-PATIENTS

To assess the metabolic disturbances, and, in particular, the occurren ce of high blood ketone body concentration in post-absorptive Type 2 ( non-insulin-dependent) diabetic patients as compared to a matched norm al population, a study was carried out in a group of 78 Type 2 diabeti c outpatients matched for age and sex and in 78 normal individuals. In all subjects we measured HbA(1c), and fasting levels of glucose, FFA, lactate, pyruvate, glycerol, alanine, 3-hydroxybutyrate, acetoacetate , uric acid, total cholesterol, triglycerides, creatinine, growth horm one, cortisol, glucagon, free insulin, and C-peptide. Multistix strips were used for urine ketone determination. As expected HbA(1c), and pl asma glucose were higher in Type 2 diabetics. This was associated with multiple metabolic disturbances as shown by higher circulating concen trations of FFA, glycerol and gluconeogenic precursors. Similarly, blo od levels of ketones (351+/-29 vs 159+/-15 umol/l; p<0.0001) were incr eased, in spite of higher plasma free-insulin (77+/-7 vs, 49+/-14 pmol /l; p<0.0001) and C-peptide concentration (0.63+/-0.03 vs. 0.46+/-0.07 nmol/l; p<0.05) and no differences in plasma levels of cortisol, and growth hormone. Plasma glucagon levels were higher in Type 2 diabetics . Blood ketone body levels were directly correlated with both plasma g lucose and FFA concentrations. These observations clearly show that Ty pe 2 diabetes is a pathologic condition characterised by multiple meta bolic disturbances which are fully apparent in the basal state. Furthe rmore, we emphasise that Type 2 diabetic patients, though not insulin deficient, may present a significant increase in their fasting levels of ketone bodies.