Quote from KitkatPRN
I'm thinking cancer, too. The family (wife, mainly) is wish-washy in regards to starting comfort measures, which has been brought up to her many times by the NP, MD & nurse manager. When I worked last night, he was in the 550's, given 10 units regular insulin, 3 hours later was still in the mid 500's, had not eaten anything & was taking in fluids. It's just so frustrating not to at least get the blood sugars where they need to be for him. I'm hoping the tests show something today but I'm not holding my breath. Thanks for the input !!
What is he drinking? What liquid is he drinking that can elevate his glucose?
As someone has already said..the elderly are more prone to HHS -- hyperosmolar hyperglycemic state. The cause of his diaeties is just that his body and it's systems are old and don't work anymore. Hyperosmolar hyperglycemic state
is a complication of diabetes mellitus (usually Type II) in which high blood sugars cause severe dehydration, increases in osmolarity (relative concentration of solute) and a high risk of complications, coma and death. It is related to diabetic ketoacidosis (DKA), another complication of diabetes more often (but not exclusively) encountered in people with type 1 diabetes; they are differentiated with measurement of ketones, that are the underlying driver for DKA but are usually not detectable in HHS.
The treatment of HHS consists of correction of the dehydration with intravenous fluids, reduction of the blood sugar levels with insulin, and management of any underlying conditions that might have precipitated the illness, such as an acute infection.Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) - American Diabetes Association
Older names for HHS are hyperosmolar non-ketotic coma
(HONK), nonketotic hyperosmolar coma
, hyperosmolar hyperglycemic nonketotic syndrome
(favored by the American Diabetes Association
The increasing hemoconcentration and volume depletion can result in:
- Disordered mental functioning.
- Neurologic signs including focal signs such as sensory or motor impairments or focal seizures or motor abnormalities, including flaccidity, depressed reflexes, tremors or fasciculations.
- Hyperviscosity and increased risk of thrombosis
- Ultimately, if untreated, will lead to death
Is his dementia really dementia or a symptom of undiagnosed HHS from untreated Type II Diabeties
Hyperosmolar hyperglycemic state (HHS) Medscape: Medscape Access
medscape requires registration but it is FREE and an excellent resource.
HHS most commonly occurs in patients with type 2 DM who have some concomitant illness that leads to reduced fluid intake. Infection is the most common preceding illness, but many other conditions can cause altered mentation, dehydration, or both. Once HHS has developed, it may be difficult to differentiate it from the antecedent illness. The concomitant illness may not be identifiable. (See Etiology.) HHS has also been reported in patients with type 1 DM, in whom DKA is more common.
HHS usually presents in older patients with type 2 DM and carries a higher mortality than DKA, estimated at approximately 10-20%