Diabetes Emergencies
Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS)
Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) can occur when blood glucose levels exceed 600 mg/dl (33.3 mmol/l), but ketosis (ketone bodies in the blood) is not present. With such high blood sugars, the body becomes severely dehydrated. HHNS occurs most often in the elderly and people who are on medications that raise blood glucose levels. Impaired kidney function is also a risk factor.
HHNS is a life-threatening condition. If you experience any of the following symptoms of the syndrome, seek emergency medical care immediately:
- Excessive thirst and dehydration
- Nausea and vomiting
- Disorientation and confusion
- Sudden hypotension, or low blood pressure (as evidenced by faintness)
- Visual problems
- Extreme, unexplained fatigue
- Fever
- In advanced cases, coma, seizure, and/or hemiplegia (paralysis on one side of the body)
Treatment for HHNS involves administering intravenous fluids (i.e., saline and sometimes electrolyte solutions) to restore fluid balance. Insulin therapy may also be required.
Diabetic Ketoacidosis (DKA)
Ketoacidosis (or DKA) occurs when blood sugars become elevated (over 249 mg/dl, or 13.9 mmol/l) over a period of time and the body begins to burn fat and muscle for energy, resulting in ketone bodies in the blood or urine (a phenomenon called ketosis).
A variety of factors can cause hyperglycemia (high blood glucose), including failure to take medication or insulin, stress, dietary changes without medication adjustments, eating disorders, and illness or injury. This last cause is important, because if illness brings on DKA, it may slip by unnoticed since its symptoms can mimic the flu (aches, vomiting, etc.). In fact, people with type 1 diabetes are often seeking help for the flu-like symptoms of DKA when they first receive their diagnosis.
Symptoms of diabetic ketoacidosis may include:
- Fruity (acetone) breath
- Nausea and/or vomiting
- Abdominal pain
- Dry, warm skin
- Confusion
- Fatigue
- Breathing problems
- Excessive thirst
- Frequent urination
- In extreme cases, loss of consciousness
DKA is a medical emergency, and requires prompt and immediately treatment. A simple over-the-counter urine dipstick test can check for ketones (i.e., Ketostix); anyone who has blood glucose levels above 240 mg/dl (13.3 mmol/l) should test their urine for ketones. There is also at least one glucose meter on the market that tests blood ketone levels. It’s normal to occasionally have trace amounts of ketones in the urine, but you should call your healthcare provider immediately if you experience moderate to heavy ketones.
Treatment for DKA involves administering insulin to lower blood glucose levels and restoring fluid balance to the bloodstream with an intravenous (IV) saline drip. Electrolytes may also be given via IV.