Diabetes Mellitus - Diabetic Ketoacidosis Vs Hyperglycemia Hyperosm...

Hello friends, In my previous post I wrote on Diabetes Mellitus, and I discussed the type 1 and type 2 diabetes where i mentioned that type 1 diabetes is as a result of the Pancreas being destroyed by the body, thereby causing the person to use insulin life-long, while type 2 diabetes, there are few insulin receptors functioning, this can happen as a result of lifestyle and diet, of it can be genetic. When a patient has type 2 diabetes, the first thing to do is to correct their diet, and lifestyle, including doing exercise, oral medications, and insulin.

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During peaks, it is important to give food and sugar so the patient to not end up having a dead brain as a result of low sugar. During peak time, sugar level below 70 is monitored. When patients has hypoglycemia, they will present with pale, shaky, sweaty, or clammy look, and when it happens, you can give the patient sweet/candy. If the patient is unresponsive, they should be stabbed with IV D50 (Dextrose 50). With insulin with no peaks and mixes are to be administered to aged people, where the insulin are drawn in different syringes. It is important to know that the IV only insulin is regarded as the regular insulin, and it is important to draw up the clear insulin first before the drawing up the cloudy ones. The location for jabs are rotated within two weeks, and it is best giving near the umbilicus/belly button in the abdomen. It is important to not aspirate when administering insulin as it can lead to scar tissue or swellings. Heat is also not added after the injection and massage is also not done after injection. Insulin should be increased on days of stresses on the patient such as surgery, sepsis, and so on.

Patients with Type 1 diabetes usually have Diabetic Ketoacidosis (DKA), while Type 2 diabetic patients usually suffer from Hyperglycemia Hyperosmolar non-ketotic syndrome (HHNS). Diabetic Ketoacidosis (DKA), usually occur as a result of no insulin being produced, thereby leading to no sugar in the cell, causing the body to burn fat for fuel thereby producing fat waste ketone bodies. Ketones are acidic thereby leading to acidosis in the body. DKA is usually quick to detect and easier to fix as it is common with younger patients. DKA can occur as a result of infection (sepsis), stress such as surgery, or in cases where they miss their insulin doses. Patients with DKA will present with signs and symptoms which includes a dry skin and high sugar as a result of lack of insulin in the body. The sugar level can range from 250 to about 500+. Ketones and kussmaul respiration, abdominal pain, and metaboolic Acidosis with pH of 7.35 or less. It should be treated by treating the drive first which is dehydration and that is done using fluids (normal saline), Control the sugar level by reducing the sugar level slowly and prevent hypoglycemia. Even if the patient is extremely sick and not eating, it is important to still give insulin to the patient. It is important to add potassium along side when giving Insulin, to prevent a potassium crash, and it is important to prevent a heart crash while giving potassium because it controls the heart and excessive dose will kill the heart by over working. It is important to monitor the heart when administering potassium.

With Hyperglycemia Hyperosmolar non-ketotic syndrome (HHNS) which occurs in type 2 diabetic patient who have little insulin production which puts little sugar into the cell and there is no fat burn in this case just that the carbohydrate isn't enough, causing additional diabetic stress in the patient. HHNS has a slower onset, it is found in elderly, and it is difficult to treat. Patient usually present with high sugar loss, high fluid loss leading to extreme dehydration, Neurological manifestation such as confusion, and a slower onset of manifestation. For the treatment of HHNS, it is important to treat the dehydration first by hydrating the patient with normal saline, stabilize the sugar with insulin, correct the sugar slowly to prevent hypoglycemia. It is important to reassess the blood sugar and hydration levels when treating. Ensure that the skin is not pale or cold, the patient should respond to treatment having a warm and colored.

Both DKA and HHNS are triggered when patient suffer from additional physiological stress which could be from infection, drugs, cardiovascular disease, or inadequate diabetic treatment. The mortality rate is higher in Hyperglycemia Hyperosmolar non-ketotic syndrome (HHNS), compared to Diabetic Ketoacidosis (DKA). While DKA presents with Acidosis, HHNS doesn't present with Acidosis.

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Diabetes Mellitus - Diabetic Ketoacidosis Vs Hyperglycemia Hyperosmolar non-ketotic syndrome