What is the diff. btwn DKA and HHNS??

[kirsteen0926]

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

[blondy2061h, MSN, RN]

Both have high blood sugar, but the mechanism of action of the two conditions- and what causes the "critical" problem is the difference.

HHNK is almost exclusively seen in type 2 diabetics. There's generally enough insulin present, but WAY too much glucose. The insulin can't keep up with the glucose. The body can still use some of the glucose for energy (since there is insulin to "unlock" the cells), so the cells aren't starving for energy, but the blood keeps becoming thicker from all the extra glucose- hence "hyperosmolar." If you're seeing glucose values in the 1000s and such, it's safe to say the person is "hyperosmolar" however, even if DKA is the diagnosis. Due to the hyperosmolarity, blood can't flow through organs properly. You'll start seeing kidney problems, liver problems, and altered levels of consciousness.

In DKA, there's not enough insulin. Therefore, the cells can't use glucose for energy, and start burning muscle and fat for energy instead, a byproduct of which is ketones. Ketones are very acidotic, and thus the body trys to buffer with bicarb (and eventually fails) and uses kussmaul respirations to try and blow off acid. The main problem in DKA is that the cells are literally starving for energy, and the person is acidotic. Hypokalemia is usually a problem as well.

With both conditions you'll see hyperglycemia and the resulting glycouria.

[GilaRRT]

Also remember something like 30% of HHNKC cases do not have a prior diagnosis of diabetes. HHNKC is not exclusive to diabetics unlike DKA.

[blondy2061h, MSN, RN]

Many people with type 1 diabetes fine out they have type 1 cause they went into DKA.

[Daytonite, BSN, RN]

The primary feature of both is dehydration. It is the dehydration that leads to most of the symptoms that the patient has. The pathophysiology of these two are:

• With HHNS glucose levels continue to rise as a result of an infection, drugs such as glucocorticoids that interfere with glucose tolerance or increased fluid losses from diuretics so that the metabolism falls behind in processing the glucose and the blood sugar elevates. Once the glucose levels are elevated, the body starts to compensate by attempting to dump sugar through the kidneys-->resulting in dehydration
  
• With DKA there just isn't enough insulin to process the glucose in the body. Once the glucose levels are elevated, the body starts to compensate by attempting to dump sugar through the kidneys-->resulting in dehydration

[Ilithya]

Your tissues are still getting some sugar so you don't need to break down ketones. Your blood sugar gets so high because your body is trying to compensate and trying to compensate until it simply can't anymore

[NurseNature]

I've come up with two questions while reading the posts. One, does the hyperosmolarity of the blood put these patients at an increased risk for CVA's? It seems as though it would. And, two, Why would insulin ever work for type two diabetics if it is a problem of cell acceptance of insulin? Oh, and a third question... this is probably a dumb question, but is there a blood test or something that tests for circulating insulin?

[GilaRRT]

People who are poorly controlled or people with chronic elevations of their sugars are at higher risk for developing CVA's among other problems.

The cells still accept insulin; however, higher levels are required as the cells are insulin resistant.

You typically look at the insulin relationship indirectly by measuring blood sugar and A1C's.

[Daytonite, BSN, RN]

NurseNature said:

I've come up with two questions while reading the posts. One, does the hyperosmolarity of the blood put these patients at an increased risk for CVA's? It seems as though it would. And, two, Why would insulin ever work for type two diabetics if it is a problem of cell acceptance of insulin? Oh, and a third question... this is probably a dumb question, but is there a blood test or something that tests for circulating insulin?

• The dehydration creates a risk for a CVA due to the concentration of the blood.
• The insulin made by the cells of Type II diabetes is faulty (crappy insulin, second rate stuff that doesn't work well). A boost of injected insulin is like giving them Ethol gasoline. It's the primo stuff.
• Yes, there is a test for serum Insulin. It was how my insulin resistance was detected. My insulin levels were 4 times normal! (I am a case of my pancreas putting out crappy insulin that isn't worth squat.)

[classicdame, MSN, EdD]

DKA is high BS and ketones. HHNS is high BS but not-so-high ketones, because the patient has just enough insulin to prevent that. Both are treated with fluids and insulin.

[giane]

with type 1 DM no insulin is produced, but with type 2 THERE is STILL some functioning insulin ,or there may be some resistance to it.. therefore, there is no need for the body to metabolize fatty acids which turn to ketones which are acidic..

In HHNS, it develops slowly,over days, so blood sugar accumulates in the blood reaching a certain high level(that's why BS level is higher in HHNS). so the main difference is that there is little or no ketones involved in HHNS.

[Dr. Silvestri]

Kirsten,

They are both serious. The major difference between HHNS and DKA is that ketosis and acidosis do not occur with HHNS; enough insulin is present with HHNS to prevent the breakdown of fats for energy, thus preventing ketosis. Treatment is the same as in DKA and but treatment with insulin for HHNS plays a less critical role because ketosis and acidosis are not present in HHNS. HHNS is most often seen in type 2 diabetes; DKA most often in type 1. Dr. Linda Anne Silvestri

[tokmom, BSN, RN]

RedhairedNurse said:

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.

I think the OP is trying to understand what she has read and wants a more simplistic way of understanding it?