Diabetic ketoacidosis was previously reported to be associated with a decrease in arterial AcAc/β-HB ratio with a relatively high level of generation of β-HB, while insulin treatment decreases serum β-HB long before serum AcAc in diabetic ketoacidosis, resulting in an increased AcAc/ β-HB ratio [5]. Here, INS is linked to diabetic ketoacidosis.