What is the diff. btwn DKA and HHNS??

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HI,

I am a nursing student and I have never been able to grasp the difference between DKA and HHNS. Can somebody help me to understand better? I know that HHNS is r/t type 2 diabetes and DKA is more r/t Type 1. Which one is more serious? What is the exact difference? They both seem pretty similar to me. I have struggled with this for almost 2 years. I would like to know the difference.

Thanks so much,

Kirsten

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Specializes in Med Surg, Ortho.

Your nursing text should point out the difference. I would tell you, but I'd just have to look it up and my books are in storage. I could also google it, but something you can also do as well. Sorry.

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Specializes in Med/Surg/Pedi.

In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine, your body tries to compensate. This usually happens to type 2s

In DKA there is little to no circulating insulin. DKA occurs mainly, but not exclusively, in Type 1 diabetes because Type 1 diabetes is characterized by a lack of insulin production in the pancreas. It is much less common in Type 2 diabetes because the latter is closely related to cell insensitivity to insulin, not -- at least initially -- to a shortage or absence of insulin. Some Type 2 diabetics have lost their own insulin production and must take external insulin; they have some susceptibility to DKA. You get acidosis in DKA because ketones lower the bloods pH.

Does that help?

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Specializes in cardiac, ortho, med surg, oncology.

Blood sugar levels tend to be higher in HHNS...almost double DKA

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Specializes in LTC/SNF, Psychiatric, Pharmaceutical.

Ketone bodies are formed in the bloodstream from the metabolism of fatty acids to support cellular respiration, since the body does not have the insulin required to effectively utilize glucose. Hence, DKA is occurs predominantly in Type I.

In type II, there is insulin available, but the body's cells are resistant to the effects of it. Since the body is able to utilize some glucose, there is little fatty acid metabolism and little production of ketones... but the excess sugar causes the blood to become hyperosmolar (concentrated), which draws fluid out of the interstitial spaces, similar to drowning in salt water. Some Type IIs can run extremely high blood sugars before becoming seriously ill, if their bodies are accustomed to high concentrations of blood glucose.

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Specializes in Psychiatry.

An easy way I learned it:

HHNS levels are dangerously high, but no ketones.

DKA- pts have ketones present (ie "fruity breath" smell)

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Specializes in Cardiac Care.

Also, keep in mind that the "N" in HHNS means non-ketotic. Because of that, there's no breakdown to fatty acids, so no acidosis... the pH tends to stay normal. DKA causes the pH to drop to acidosis levels.

One of my instructors told us to remember it this way: HH can mean "hugely high". She said it's not unheard of for blood glucose in HHNS patients to reach four digits...

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Yeah, I'm lost on this one too. I get that there's way more sugar in the blood in HHNS, but why doesn't the body use insulin to store that excess sugar, and if the reason is that the body is resistant to insulin, then why doesn't the body feel low on energy because it is resistant to insulin and can't store/use glucose? And as a consequence, because it is resistent and can't store /use glucose, why doesn't it then go down the same pathway as DKA and break down fat and make ketones? I don't get it either.

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Let's see if we can better understand these two concepts.

With DKA, the body typically does not produce insulin. Therefore, other substances are utilized to produce energy because we cannot utilize sugar. This process is very "dirty" and we see the byproducts in the form of ketone bodies. Hence, the "keto." These bodies are acidotic hence, "ketoacidosis." However, surgar continues to accumulate beacuse it has nowhere to go. This explains the elevated blood sugars and acidosis seen with DKA.

HHNKC; however, is a different animal. With HHNKC, we still make insulin and we still have sugar enter the cells. So, alternative pathways are not needed to produce energy in most cases. No ketone bodies are produced. The profound hyperglycemia is a bit more complicated to explain. We must remember HHNKC is not an exclusive diabetic condition. It is confusing and incorrect to compare this condition to DKA. Many cases of HHNKC are precipitated by an even that dramatically alters the bodies mechanisms of glucose balance. For example, people who develop pancreatitis are at risk for developing HHNKC. The normal mechanisms of glucose balance are dramatically altered leading to profoundly elevated sugars. However, insulin is present, thus preventing the development of ketone bodies.

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Specializes in LTC/SNF, Psychiatric, Pharmaceutical.
donster said:
Also, keep in mind that the "N" in HHNS means non-ketotic. Because of that, there's no breakdown to fatty acids, so no acidosis... the pH tends to stay normal. DKA causes the pH to drop to acidosis levels.

One of my instructors told us to remember it this way: HH can mean "hugely high". She said it's not unheard of for blood glucose in HHNS patients to reach four digits...

I saw a few patients (as well as personally knew someone) whose blood sugars were too high to register on their glucometers (most of them had glucometers that would only accurately register up to 600 mg/dL). The one I knew personally would feel lightheaded and weak when this happened, but I saw people that constantly ran this high and were apparently asymptomatic - that is, no change from their normal mentation or activity level could be detected.

Needless to say, the feet of these patients were handled with kid gloves and pampered and lubricated. Once a wound got going on the lower extremities of a patient with such persistently high blood sugar, it generally never got better for the rest of their lives.

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Specializes in L&D, OB Triage.

Didn't read all the replies so not sure if this was already said....

DKA will present with Kussmaul respirations (rapid,deep breathing) and fruity breath, HHNKS will not (biggest diff/easiest way to tell what is what right off the bat)

Both are treated the same way (lots of fluids/hydration), but if I remember correctly HHNKS needs more, faster...

Get your book out and make a table of the symptoms, effects, pathophys/m of a etc, an d it wll be easier for you to understand :)

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