B

Insulin deficiency in uncontrolled diabetes activates hormone-sensitive lipase in adipose tissue, accelerating lipolysis and free-fatty-acid flux to the liver, while simultaneously lowering the insulin-dependent activity of lipoprotein lipase that normally clears VLDL and triglycerides from plasma. The combination of increased HSL and decreased LPL leads to accumulation of VLDL and elevated triglycerides [Sztalryd 1995, PMID 7476323; Brunzell 1979, PMID 481215].