The stress of the disease also results in an increase in cortisol secretion. It is the inability of the diabetic patient to metabolize and use glucose, the subsequent metabolism of body fat, and the fluid loss and electrolyte imbalance that causes metabolic acidosis. It is the hyperglycemia and ketoacidosis coupled with vascular wall disease (microangiopathy and atherosclerosis) that alters the body’s ability to manage infection and heal