In untreated type 1 diabetes, the hepatocyte's citric acid cycle becomes overwhelmed with acetyl‑CoA from excessive fatty acid oxidation. Although the excess acetyl‑CoA is not toxic, it must be diverted into the formation of ketone bodies: acetone, acetoacetate, and D‑β‑hydroxybutyrate.

What problem would arise if the excess acetyl-CoA were not converted to ketone bodies?

a. Fatty acid oxidation would stop when all the COA is bound as acetyl-CoA.
b. While acetyl-CoA is not toxic, it inhibits D-β- ohydroxyacyI-CoA dehydrogenase.
c. While acetyl-CoA is not toxic, it prevents transfer of fatty acids into the mitochondria by forming acetyl carnitine.
d. Formation of acetyl-CoA requires uptake of a proton, and the increased pH inhibits further oxidation.