What is diabetic ketoacidosis primarily caused by?

Diabetic ketoacidosis (DKA) is primarily caused by insufficient insulin, which is crucial for regulating blood glucose levels. When there's not enough insulin available, glucose cannot effectively enter the body's cells to provide energy. As a result, the body begins to break down fat instead for fuel. This process leads to the production of ketones, which can accumulate in the bloodstream. The presence of high levels of ketones, combined with elevated blood glucose, results in a state of acidosis, leading to the symptoms and complications associated with DKA.

The other options do not directly contribute to the physiological process that leads to DKA. For example, excess glucose may be a symptom of uncontrolled diabetes but it is the lack of insulin that prevents glucose from being utilized. Low blood sugar levels would not lead to DKA; in fact, they are typically a sign of too much insulin or insufficient caloric intake. Overproduction of insulin would lower blood glucose levels, thus preventing the development of DKA from occurring. Understanding the role of insulin in energy metabolism is key to grasping how DKA arises.