Under normal circumstances, the body uses glucose to produce energy. However, people with diabetes who cannot utilize insulin well are unable to absorb and use glucose. As a result, the body begins to use fat as a source of energy.
Ketones are a byproduct of fat metabolism, and too much ketones can be harmful to the body. Why? Because ketones can abruptly change the pH level of the blood, making it acidic. This is what happens in diabetic ketoacidosis. Interestingly, patients with type 1 diabetes mellitus will likely develop DKA than patients with type2 diabetes mellitus.
DKA can present with the following symptoms:
- Nausea or vomiting
- Generalized weakness
- Abdominal pain
- Decrease in appetite
- Increased urination
- Altered mental status
- Fruity breath
Hyperosmolar Hyperglycemic Syndrome
Hyperosmolar hyperglycemic syndrome or HHS, on the other hand, usually evolves over several days to weeks, in contrast to DKA that develops within a 24-hour period. In addition, HHS is more common in patients with type 2 diabetes mellitus. Unlike in DKA, patients with HHS do not have elevated ketone bodies in their blood.
So what happens in HHS? Under normal circumstances, all of the glucose that goes through the kidneys is reabsorbed back into the body. When the blood glucose level reaches approximately 180mg/dl, the blood becomes saturated with glucose, which halts further reabsorption of glucose. The glucose that remains in the kidney is therefore excreted in the urine. This increases the saturation of urine, and a signal is sent to the kidneys to increase water excretion to reverse the supersaturation. Because of the increase in water excretion, glucose concentration in the blood further increases, leading to severe hyperglycemia.
Because of an increase in urination, patients with HHS are more severely dehydrated than patients with DKA. They may show signs of dehydration such as increased heart rate, dry lips and mouth, sunken eyes, and decreased skin turgor. Other signs and symptoms of HHS include:
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