QuestionSBA
QuestionChoice
No, this is not the correct answer. Whilst this statement is true, it is not the inhibition of HMG-CoA reductase which directly results in the increased production of ketone bodies. This patient has diabetic ketoacidosis (DKA) secondary to type 1 diabetes mellitus (T1DM). They have a lower insulin/glucagon ratio, resulting in increased activation of the lyase enzyme and thus urinary ketones.
10007842
c
A lower insulin/glucagon ratio resulting in inhibition of the HMG-CoA reductase enzyme
QuestionChoice
No, this is not the correct answer. This patient has diabetic ketoacidosis (DKA) secondary to type 1 diabetes mellitus (T1DM). The lyase enzyme is not inhibited in this hormonal state, it is activated.
10007843
d
A lower insulin/glucagon ratio resulting in inhibition of the lyase enzyme
QuestionChoice
No, this is not the correct answer. HMG-CoA reductase is responsible for converting HMG-CoA to mevalonate and subsequently cholesterol. It does not lead to ketones in the urine.
10007841
b
A lower insulin/glucagon ratio resulting in an increased activation of the HMG-CoA reductase enzyme
QuestionChoice
No, this is not the correct answer. This patient has diabetic ketoacidosis (DKA) secondary to type 1 diabetes mellitus (T1DM). They therefore have a lower insulin/glucagon ratio.
10007844
e
A higher insulin/glucagon ratio resulting in increased activation of the lyase enyzme
QuestionChoice
Yes, this is the correct answer. This patient has diabetic ketoacidosis (DKA) secondary to type 1 diabetes mellitus (T1DM). In T1DM, there is autoimmune destruction of the beta cells of the pancreas responsible for producing insulin. Hence there is a lower insulin/glucagon ratio which results in increased activation of lyase.

Lyase is responsible for the conversion of HMG-CoA to acetoacetate, bringing about the synthesis of other ketone bodies (such as acetone and beta hydroxybutyrate)
10007840
a
A lower insulin/glucagon ratio resulting in an increased activation of the lyase enzyme
Concept
Chapter
2693
3937
Type 1 Diabetes
Topic
133
Endocrinology
14115
A 19-year-old man presents to A&E with symptoms of nausea, vomiting, and abdominal pain. Her mother notes that he has been losing weight in recent months, despite eating and particularly drinking a great deal.


The clinician reports that the patient is breathing very quickly, and has fruity-smelling breath.


A series of investigations are requested:


 **Blood (BM stick)**


Plasma glucose: 20 mmol/L (normal <6.1 mmol/L))


 **Urine multistick**


Ketones: +++


Glucose: 9% (<5%)


Which of the following best explains the ketone levels in the patient's urine?
a