Question

18. What are the most common contributing factors for DKA? What are the most common contributing factors for HHNS? Is high blood sugar present in both? What is the main difference in HHNS?

Answer 1

18. Diabetic ketoacidosis (DKA) is a condition during which the body is unable to produce enough insulin to process high levels of glucose and as a result body starts breaking down fats as fuel instead of glucose. This leads to the build-up of acids called ketones in the blood stream. They are most often observed in type 1 diabetes mellitus patients. This is a serious condition which can cause coma or death of the patient. The most common contributing factors for DKA are:

• High level of blood sugar and low levels of insulin.
• Missing a dose of insulin injection.
• Injecting less amount of insulin than actually required.
• Faulty insulin pumps.
• Any disorders like insulin autoimmune syndrome that result in low insulin levels
• Uncontrolled high level of blood sugar for a continuous period of time

Hyperglycemic hypersmolar non-ketotic syndrome (HHNS) is a condition that occurs as a result of high blood sugar. It occurs in people with type 2 diabetes and causes high osmolarity without ketoacidosis. This is because, in patients with type 2 diabetes enough insulin would be present to suppress ketogenesis. When a diabetic patient is affected by HHNS, excess sugar produced is passed into the urine. The most common contributing factors for HHNS are:

• Uncontrolled high level of blood sugar for a continuous period of time
• Not taking sufficient medication to lower blood sugar levels.
• Age: More common among older people

Yes, high blood sugar is present in both the cases. They are acute complications of diabetes mellitus characterized by hyperglycemia.

Some of the major differences between DKA and HHNS are:

DKA	HHNS
This is mainly seen in Type 1 diabetes patients.	This is mainly seen in Type 2 diabetes patients.
Ketosis and acidosis occurs.	No ketosis or acidosis.
Hyperglycemia with comparatively slightly elevated glucose level (more than 300 mg/dL).	Hyperglycemia is too high (more than 600 mg/dL).
Osmolarity is variable.	Due to very high glucose level, blood is concentrated and hence has high osmolarity.
Major problems associated with this include hypercgycemia, ketosis, and acidosis	Major problems associated with this include extreme hyperglycemia and dehydration as a result of high osmolarity.