Inconsistent timing of meals or missed meals An improper exercise regimen Alcohol Too much insulin
Short Term Complications
Usually Below 70mg/dL… Although the exact value that causes symptoms depends on the person, it is usually defined as being under 70 mg/dL
How it can be prevented: Stick to the insulin regimen outlined by a provider Measure blood sugar levels and urine ketones as instructed Be aware of sick days and new medications Reach out to a diabetes educator if part of a support program
Extremely High Blood Glucose This really high concentration of glucose in the blood results in what’s known as a “high osmolar state” and forces water to leave important organs like the brain to help dilute the concentration of glucose in the blood.
The body does not need to rely on a backup pathway because it still has enough insulin to bring some glucose into cells This prevents ketones from forming and prevents the blood from becoming acidic
The Use of a Backup Pathway Unlike DKA, HHS does not use the backup pathway to gain energy, and ketones are not formed. HHS is therefore sometimes referred to as, “Hyperosmolar Nonketotic Coma”.
Common triggers include: Illnesses like a heart attack, pneumonia, or UTI A broken insulin pump, an inappropriate insulin regimen, or skipping insulin doses New medications No medications Severe dehydration
The presence of just enough insulin to bring glucose into cells prevents the need to perform the backup pathway that creates ketones.
No HHS does not use the backup pathway that forms ketones. It is sometimes called “hyperosmolar nonketotic coma”
The blood becomes dangerously acidic!