It has been suggested that these drugs may alter the normal counter-regulatory hormonal response to insulin deficiency, particularly during periods of metabolic stress, leading to reduced glucose utilization and ketone production.[7] Additionally, DPP-4 inhibitors may impair insulin secretion and promote glucagon release under stressful conditions such as head trauma, exacerbating the development of ketoacidosis despite normal or low blood glucose levels. This evidence concerns the gene INS and diabetes mellitus.