Ketogenesis is strongly suppressed by insulin and is stimulated in states of insulin deficiency and glucagon excess ((4),(6)).

How does insulin affect ketogenesis?

In the liver insulin increases fatty acid synthesis and esterification. At the same time malonyl-CoA formation is increased, which inhibits the acylcarnitine transferase system and thus decreases the transport of fatty acids into mitochondria and hence fatty acid oxidation and ketogenesis.

Does insulin increase or decrease ketogenesis?

Ketogenesis is considered to be controlled by the islet hormones, insulin and glucagon (20). Insulin strongly inhibits ketosis, predominantly by reducing lipolysis in adipocytes and reducing the supply of free fatty acids, the substrate for ketone body production.