Consider two individuals: one with prolonged starvation and one with type 1 diabetes with insufficient insulin. Both have elevated ketones. Which individual is at higher risk of ketoacidosis and why? Analyze physiological mechanisms.

• A. The starving person is at higher risk because prolonged low carbohydrate intake always produces more rapid and dangerous ketone accumulation than any insulin deficiency scenario.
• B. Neither is at risk because ketones are always fully buffered by bicarbonate in the blood and never affect pH meaningfully in pathological ways.
• C. Both are at equal risk because elevated ketone concentrations always produce identical acid-base disturbances regardless of insulin status or cause.
• D. The person with type 1 diabetes is at higher risk because lack of insulin permits uncontrolled lipolysis and ketogenesis while preventing glucose uptake, leading to rapid acid accumulation and inability to regulate ketone production, unlike starvation where insulin is low but regulated.

Answer: (D)