WPADE.org

Hyperglycemic Hyperolmolar Non Ketosis (HHNK) is an acute complication of diabetes associated with non insulin dependent diabetes. The insulin produced is enought to prevent ketoacidosis, but not hyperglycemia or hyperolmolality. An elevated BUN, reflecting the decreased renal perfusion that results from hypovolemia, characterizes this condition. HHNK can be related to stress and has an onset from days to weeks after illness or surgery or physical stress. It is more common in older patients and may have a mortality rate as high as 50% if untreated immediately. If the patient is either unable to recognize thirst or unable to keep down liquids, ther is a higher mortality rate depending on the degree of hyperosmolality. If severely dehydrated, a hypotonic solution must be rapidly infused until the osmolality normalizes and the blood glucose level stablizes. Electrolytes must be monitored, especially for potassium and sodium. The elderly are more intolerant of extremes in electrolyte levels, consequently they must be checked more frequently using both serum and cardiac monitoring. Cerebral dehydration can accompany HHNK so neuro status should also be evaluated and precautions taken to prevent seizures. Another complication of this condition that can develop is pulmonary edema, especially in those with kidney failure or older patients.
Annette Karnash

No other condition has been as clearly linked to our modern way of life as diabetes. The growing presence of both type 1 and tpe 2 diabetes has come about due to the influence of dieting and lifestyle factors common to all developed societies. Diabetes was rare in people whose cultures had diets composed of wholesome natural foods, who exercised vigorously, lived and worked outdoors under natural sunlight and had minimum exposure to environmental pollutants. Unfortunately, the economy and lifestyles have created thriving multitudes of consumers who congregate in polluted cities, live sedentary indoor lives, eat more calories that they expend and rely on all the pleasures and conveniences offered them through the powerful forces of marketing.
For many, the comforts of inactivity and temporary gratification of un-natural ‘junk food’ have led to the damaging and disabling effects of diabetes; resulting in pain, disability and the degradation of good health. One can reverse these harmful effects, but to achieve good health requires discipline and willingness to change. Initially, change may be uncomfortable and difficult, but as educators, it is one of our goals to assist patients to face this need and go in another direction. The first step is in letting the patient know that they are headed toward disaster and to help them realize that they have the power to change in order to achieve better outcomes and enjoy a longer, healthier life. It begins with an attitude. Rather than viewing diabetes as a disability or a burden, it can be viewed somewhat as a coach; one who oversees and helps in good decision making in order to win the game. Research shows that individuals with chronic disease who maintain a positive and optimistic view of life and circumstances, tend to have better outcomes.
Denial is a barrier to change. The patient needs to realize that some of his or her habits may be destroying their life. They must lose weight, stop smoking, monitor the blood glucose consistently, use caution in their diet and not live a sedentary life. Depression is common in those with diabetes, often prior to diagnosis. Insulin resistance may contribute to biochemical changes that render the brain more susceptible to depression. Obesity is related to diminished self esteem, also contributing to depression. This can erode a person’s self worth, making it difficult to develop a positive attitude and remain motivated. If diabetes is controlled, depression will either diminish or disappear, but if not treated, it may be impossible for the individual to make the changes necessary for diabetes control. Attitude determines the quality of life. It isn’t what occurs in our lives that determines our direction, but how we respond to these events that shape the quality of health and life. Everyone experiences hardships and failures in life, but they often serve as a spark to happines, excitement and success. The question is- do we view these as stepping stones or as stumbling blocks? Helping people with diabetes cope with their diagnosis, develop a sense of empowerment and make lifestyle changes is an important aspect of care for the diabetes educator.
Annette Karnash