Why is hyperosmolar coma type 2 DM?

[studylol]

Hello friends,

I understand that insulin in T2DM prevents DKA. What's up with hyperosmolar coma and T2DM then and why doesn't it happen with type 1?

Thanks!

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[solitarius]

HNKC requires a higher threshold of glucose concentration before it kicks in.

 

[Instatewaiter]

HNKC requires a higher threshold of glucose concentration before it kicks in.

And the type I's tend to go into DKA, feel like crap and present before this can happen.

 

[Jabbed]

It's the difference between insulin resistance and complete absence of insulin.

Without talking about the whole pathophys of the disease processes, the basal level of insulin produced in a T2DM patient is usually enough to prevent severe ketosis. The hyperosmolarity is due to the hyperglycemia and resulting osmotic diuresis. This results in the hyperosmolar hyperglycemic non-ketotic syndrome.

Since T1DM has no insulin production, their metabolism becomes wholly dependent on lipolysis and ketosis. Again the hyperosmolarity is due to the hyperglycemia and resulting osmotic diuresis.

Keep in mind that this is more a rule of thumb than anything else: T1DM usually develop DKA and T2DM usually develop HHS.

PS: Remember to re-calculate the serum sodium!

 

[studylol]

Thanks for the explanations! Helped a lot.