There are many complications of diabetes but diabetic ketoacidosis (DKA) and hyperosmotic hyperglycemic nonketotic state (HHNK) represent the most dangerous of them. DKA and HHNK present themselves differently and the confirmation of definitive diagnosis is based on laboratory investigation.
Usually, the presence of a plasma glucose level of 14 mmol/L or greater indicates ketoacidosis, although patients with type 1 diabetes and such a plasma glucose level may not develop ketoacidosis. Since in HHNK hyperglycemia is commonly more serious than in DKA, then a plasma glucose level of 34 mmol/L could help in the diagnostic process.
Other major indicators for the presence of DKA and HHNK, such as elevated leukocyte count, are usually in the range of 10.0–15.0 х 109/L and elevated amylase levels.
In cases of DKA and HHS, insulin therapy is indicated, insulin being administered by means of an infusion pump that releases small doses of intravenous infusion.
The treatment of DKA and HHS with rehydration and insulin is usually associated with a rapid decrease in the plasma potassium concentration, hence, when levels fall below 5.0 mmol/L, potassium replacement therapy must be initiated.