In patients with diabetes the glucose control is disturbed by both the underlying condition and medicines used to treat their condition. The amount of ketones produced in individuals with diabetes is much higher than those observed in fasting subjects, as the low levels of insulin (or resistance) , with the high levels of the counter-regulatory hormone glucagon, increases the release of fatty acids and conversion to circulating ketones.

There becomes an in balance between ketogenesis and ketolysis with a build-up of ketones in the blood and an increased risk of a rapid onset of ketoacidosis.

As well as fasting, feasting during Ramadan also carries risk for patients with diabetes.