Monday, December 20, 2010


Morning!!!  I hope everyone is having a fabulous Monday!  As promised, I'm going to try and go over the differences between two very dangerous hyperglycemic states in diabetics in terms hopefully all will be able to understand.

Now, if you're a geek, like myself, when warning bells shoot off that old robot from "Lost In Space" starts waving his metallic arms and shouts "Warning! Warning, Will Robinson...."  LOL

And if you're a diabetic with blood sugars climbing despite taking your regular medication used to treat your diabetes (either insulin or oral agents such as glucotrol) you should be listening to that robot!  The potential of your body going into either DKA~diabetic ketoacidosis  or HHNK~ hyperglycemic hyperosmolar nonketotic coma is extremely high.  Both conditions are life threatening leading to coma and possibly death.  So pay very close attention...

Let's start with DKA~Diabetic Ketoacidosis~

Simply, DKA is a complication of diabetes that occurs when the body cannot use the glucose that is circulating in the blood.  Remember, our food is broken down into sugar to be used by our cells as "fuel".  Lack of insulin is a result of the pancreas not producing insulin (or not enough insulin) and/or the body doesn't recognize the insulin it does produce.  So, in turn, the body starts to break down our fat stores and uses that as our energy source.  A by product of the fats being broke down is called a ketone which is an acid.  When ketones build up in the blood and urine it puts your body into a metabolic state called "acidosis". 

 Remember basic biology?  You got to play with testing strips checking ph levels of different stuff? Normal body ph is 7.35 to 7.45.    If your ph level is less than 7.35 you're in an acidotic state and if it is greater than 7.45 then you're in an alkalotic state.

Symptoms of DKA~ Blood sugars usually higher than 300~

The warning signs that you are becoming very sick might include:

•Deep, rapid breathing

•Dry skin and mouth

•Flushed face

•Fruity breath (breath odor)

•Nausea and vomiting

•Stomach pain

Other symptoms that can occur include:


•Frequent urination or thirst for a day or more

•Mental stupor that may progress to coma

•Muscle stiffness or aching

•Shortness of breath

•Abdominal pain

•Breathing difficulty while lying down

•Decreased appetite

•Decreased consciousness


Next up...HHNK~ Hyperglycemic Hyperosmolar Nonketotic Coma~

Again, HHNK is characterized by high glucose levels--usually greater than 600!!  Most often occurs in the elderly, with those who have type II diabetes, and usually is precipitated by an illness such as the flu or pneumonia. Or, if you have a chronic condition such as kidney failure or congestive heart failure and you have an exacerbation of that chronic condition, you could go into HHNK. 

The difference between the two conditions--the ketones.  In HHNK, no or very little ketones are produced.

Symptoms of HHNK can include weakness, increased thirst, nausea, lethargy, confusion and ultimately, convulsions, and coma. Onset of these symptoms can be slow and insidious, building over a period of days or weeks.

You must come to the hospital immediately!  You will be placed in the intensive care where you will receive round the clock glucose monitoring along with frequent lab draws, and fluid/electrolyte replacements via an IV and be placed on a continuous insulin infusion. 

 Please, please please!  Don't crab at your nurse because you've been poked  with needles for the one thousanth time!!  Or, because the doctor ordered you to be NPO (nothing to eat or drink).  There are reasons why we have to keep measuring the chemistry levels in your blood and if you will only elevate your blood sugars even more because we will have you on an insulin drip.

I won't go into specific labs that are monitored because then it gets complicated, but on a basic chem 7, the nurse and doctor can see when you are no longer in DKA/HHNK. 

Once your condition evens out, we will need to discuss how you got into your state of either DKA or HHNK so we can prevent it from happening again...

Hope this clears things up!  The main point of this discussion is to get you to monitor your sugars closely.  And just because you are sick with a flu bug or a cold, don't skip taking your insulin or oral diabetic agents!!!  Even if you are not eating because there will be more sugar floating around in your blood because the cells in your body need that sugar to get over the illness.

Happy Monday!!!


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