Why do diabetics have the fruity smell of ketones on their breath?

Question

Skylar Alexander · Accepted Answer

Diabetics don't typically have the fruity smell of ketones on their breath, but they do when...

They are in diabetic ketoacidosis (DKA), which is a serious medical emergency. Because people with Type-1 diabetes are unable to produce insulin and must rely on injections to control their blood sugar, they become hyperglycemic, or have too much glucose in their blood but not enough insulin to move it to the liver or cells. This can lead to diabetic ketoacidosis (DKA). The body first tries to expel the extra glucose through the urine, but this needs water. Eventually, the patient will become extremely dehydrated, which is exacerbated by the sharp loss of other ions in the urine, like potassium and sodium. At this point, the liver begins to release fatty acids and convert an increasing amount of its glucagon stores into glucose, a process that is typically inhibited by insulin. The fatty acids are broken down into mildly acidic ketone bodies via beta-oxidation, which then causes the pH of the blood to decrease; hence the state of keto-acidosis. The body tries to buffer the acidosis by hyperventilation, 'blowing-off' excess #CO_2#, and it's at this point that the enormous levels of ketones in the patient's blood can be detected in the patient's breath.

Easton Jones · Answer

undefined Diabetics may have a fruity smell of ketones on their breath due to the body breaking down fat for energy in the absence of sufficient insulin. This process produces ketones, and their accumulation can lead to a distinctive odor in the breath.