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''Diabetic ketoacidosis''  (more common)
hyperglycaemia (usually but not always), ketonaemia (>3mmol/l), ketonuria (++ or more) and metabolic acidosis (ph <7.3, venous bicarb <15mmol/l)
occurs within 24-48 hours of lack of insulin, can occur in type 2 with severe intercurrent illness (sepsis or MI)
ketone level indicates severity better than glc level (may have glc 10-14 and severe DKA)

''Hyperglycaemic hyperosmolar syndrome''  (10-15% type 2 emergency)
hyperglycaemia, drowsy, dehydration, ?thirsty, NOT ketonaemia or ketonuria, osmolality >320
takes 1-2 weeks to develop
coma, convulsions, focal neurology are possible
signs - drowsy, tachycardia, hypotensive, poor skin turgor
usually in elderly, prognosis is worse than DKA (due to co-morbidities?) but unrelated to severity of hyperglyc

insulin deficiency occurs with increased counterreg hormones glucagon, cortisol, GH, adrenaline
Hyperglycaemia - from dec peripheral glc uptake and inc glycogen breakdown and gluconeogenesis (inc protein breakdown) leads to ...
osmotic diuresis - loss of water and electrolytes (esp Na and K) and ...
ketosis - n/v, abdo pain, mvt K out of ICF

In HHS - insulin levels are enough to prevent lipolysis (ketones) but not hyperglycaemia (usually type 2)
slower dvlpment but fluid losses may be huge (higher than DKA), 
lactic acidosis may develop 2ndary to dehydration 

//Management DKA//
Always in 2ndary care
May give IV fluids plus bolus insulin if transfer delay but not routine.

If on insulin pt needs to be able to test blood glc and ketones (Blood or urine), have soluble insulin and be able to follow "sick day rules".
''rules''
never stop insulin
measure glc and ketones 2-4hrly 
- if glc trend is over 7, then inc usual insulin by 10% per dose
- if ketones - give 20% of 24hr insulin dose as extra dose (repeat 2-4
hrly)
drink glc drink if not eating
if signs of DKA - hospital

//Management of HHS//
Osmolality = 2(Na+K)+glc+urea
different to DKA as high osmolality, very high glc and no ketones

''Hypoglycaemia''
severe - needs 3rd party to sort out - pts on insulin or sulphylureas
10% type 1 per year less in type 2
below 4 counterreg hormones inc autonomic (tremor, sweating, hunger, palpitations, aggression) and neuro dysfunction (confusion, visual disturb, tingling round lips, 
below 3 - severe 
below 1.5 - fits, focal signs, TIA,
inc with coeliac, addisons, renal disease, cirrhosis, pancreatectomy
not with cushings