Aug 29, 2014
73
9
Status
Medical Student
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!
 

solitarius

7+ Year Member
May 20, 2010
1,355
946
Status
Medical Student
HNKC requires a higher threshold of glucose concentration before it kicks in.
 

Jabbed

5+ Year Member
Jan 30, 2013
1,636
1,896
North of the Wall
Status
Resident [Any Field]
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!
 
  • Like
Reactions: Transposony