The comments of Rosival (1) on the American Diabetes Association Position Statement regarding hyperglycemic crises (2) in this issue of Diabetes Care are appreciated. We offer the following responses:
1) The studies cited by Rosival regarding regulations of free fatty acids to β-oxidation and ketogenesis are at least 20 years old. More updated studies on the mechanism were discussed in our technical review (3), on the basis of which the Position Statement on hyperglycemic crises was written.
2) Regarding successful treatment of diabetic ketoacidosis (DKA), Rosival has misinterpreted our statement, as we did not mention anything regarding correlation of blood glucose with ketones. Our statement was about “Successful treatment of DKA and HHS requires correction of dehydration, hyperglycemia, and electrolyte imbalances…” (3).
