Hhs Diabetes Guidelines

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Management Of Hyperosmolar Hyperglycaemic State In Adults With Diabetes.

Diabet Med. 2015 Jun;32(6):714-24. doi: 10.1111/dme.12757. Management of hyperosmolar hyperglycaemic state in adults with diabetes. Sheffield Teaching Hospitals NHS Trust, Sheffield, UK. Hyperglycaemic hyperosmolar state (HHS) is a medical emergency, which differs from diabetic ketoacidosis (DKA) and requires a different approach. The present article summarizes the recent guidance on HHS that has been produced by the Joint British Diabetes Societies for Inpatient Care, available in full at HHS has a higher mortality rate than DKA and may be complicated by myocardial infarction, stroke, seizures, cerebral oedema and central pontine myelinolysis and there is some evidence that rapid changes in osmolality during treatment may be the precipitant of central pontine myelinolysis. Whilst DKA presents within hours of onset, HHS comes on over many days, and the dehydration and metabolic disturbances are more extreme. The key points in these HHS guidelines include: (1) monitoring of the response to treatment: (i) measure or calculate the serum osmolality regularly to monitor the response to treatment and (ii) aim to reduce osmolality by 3-8 mOsm/kg/h; (2) fluid and insulin administration: ( Continue reading >>

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  1. aprimalmomma

    I have been doing Primal/Keto for the past 2 months...I feel amazing, excellent energy, sleep, skin, etc...weight is and always has been in normal range....would like to lose the last 5 vanity pounds, but not worrying too much about it...anyway, I've noticed that I'm losing a lot more hair on a daily basis and I am growing concerned. Anyone else notice this? I also noticed that my hair is growing a lot faster (need a haircut every 3-4 weeks instead of usual 8 weeks)...any ideas? Thyroid levels were checked about 4-6 months ago and everything was normal...otherwise I feel amazing but am concerned about my thining hair...
    I eat 1-2oz of liverwurst daily and 1 C of bone broth daily. All meat is GF, eggs pastured, veggies organic, etc. I get 8 hours of excellent sleep, low stress, walk 1-1.5 hours daily...calories 1200-1400/day 70-85% fat, 50-60g protein, <20 carbs...love the way I feel so don't want to not be ketogenic...any thoughts?
    42 yo female

  2. Graycat

    Sorry to hear. Some people have no hair shedding problems on keto, but many do. This is most likely due to not getting sufficient sugar in your diet, which is essential for thyroid health. Personally, I struggled with this same problem for a long time and even now over a year later my hair has not yet recovered 100%.
    I would suggest eating more fruit for starters.
    Also, my thyroid tests also came back "normal", whatever that is supposed to mean. My understanding is that doctors do not test the thyroid in enough detail and misdiagnosing or under-diagnosing is a very common occurrence.

  3. Waterlily

    42 is too young to have thinning hair.
    If it was me, I would add a little bit of carbs up until my hair would stop falling out.

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Management Of The Hyperosmolar Hyperglycaemic State (hhs) In Adults With Diabetes (aug 2012)

Management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes (Aug 2012) Management of the hyperosmolar hyperglycaemic state (HHS) in adults with diabetes (Aug 2012) Unlike the other common diabetes emergency, diabetic ketoacidosis (DKA), guidelines on the management of the hyperglycaemic hyperosmolar state (HHS) in adults are uncommon and often there is little to differentiate them from the management of DKA. However, HHS is different and treatment requires a different approach. The person with HHS is often elderly, frequently with multiple co-morbidities but always very sick. Even when specific hospital guidelines are available, adherence to and use of these is variable amongst the admitting teams. In many hospitals these patients are managed by non-specialist teams, and it is not uncommon for the most junior member, who is least likely to be aware of the hospital guidance, to be given responsibility for the initial management of this complex and challenging condition. Diabetes specialist teams are rarely involved at an early stage and sometimes never at all. To address these issues the Joint British Diabetes Societies (JBDS) for inpatient care, supported by Continue reading >>

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  1. warriorscholar

    Hey all,
    I need to be to work in 6 hours and I can't seem to fall asleep. Anyone else get insomnia real bad when ketosis kicks in hard?

  2. DeltaSierra

    That's funny because I normally have terrible insomnia when I'm *not* in ketosis - I sleep much better when I am. I guess it affects everybody so differently - like some people go into "induction sickness" but that never bothered me. I hope you are able to deal with it - incidently have you ever tried melatonin? I swear by it for those nights when, regardless what my diet is, I simply can't sleep.

  3. warriorscholar

    I used to take melatonin back in the day. I never noticed an effect. I guess it couldn't hurt to give it a shot. I suppose I've always had sleeping trouble. I should look into this.

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Hyperosmolar Hyperglycemic State

A serious metabolic complication of diabetes characterized by severe hyperglycemia, hyperosmolality, and volume depletion, in the absence of severe ketoacidosis. Occurs most commonly in older patients with type 2 diabetes. Contributes to less than 1% of all diabetes-related admissions. However, mortality is high (5% to 15%). Presents with polyuria, polydipsia, weakness, weight loss, tachycardia, dry mucus membranes, poor skin turgor, hypotension, and, in severe cases, shock. Altered sensorium (lethargy, disorientation, stupor) is common and correlates best with effective serum osmolality. Coma is rare and, if seen, is usually associated with a serum osmolality >340 mOsm/kg. Treatment includes correction of fluid deficit and electrolyte abnormalities, and IV insulin. Hyperosmolar hyperglycemic syndrome (HHS), also known as non-ketotic hyperglycemic hyperosmolar syndrome (NKHS), is characterized by profound hyperglycemia (glucose >600 mg/dL), hyperosmolality (effective serum osmolality 320 mOsm/kg), and volume depletion in the absence of significant ketoacidosis (pH >7.3 and HCO3 >15 mEq/L), and is a serious complication of diabetes. HHS may be the first presentation of type 2 diabe Continue reading >>

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  1. Vita oldie

    I have been puzzling over this for some time.
    I read or understood after reading, that it is better to test at night (diabetics are a different case as they need to check for medical reasons but may be interested.)
    Most people seem to test in the morning and also people have suggested cutting the sticks in half as they are a little pricy! This being the case then when to use them is important.
    To me testing in the morning after no food overnight seems strange as the ketosis reading will be different to that at the end of the day-when food has been eaten!
    The evening reading will be a warning that you've over done it or "joy of joys" you are on plan!
    THE DAWN INSULIN SURGE is something every has as it the bodies way of preparing us for waking and rising.
    Insulin makes the cells use energy but what we want is to have the body use an alternative-our body fat and not our muscle mass!
    This MUST have an effect on Ketosis and for those only just in Ketosis the reading could be disappointing because the insulin has caused a shift in the readings.
    This is a second reason why evening is perhaps the answer.
    I don't know if this is correct but perhaps someone with an understanding of chemistry could tell me if my reasoning is correct or if not, then why not!
    I have too much time on my hands and I want the correct answer!

  2. Vita oldie

    Showing my age!
    Could't find this on the site so assumed I hadn't posted it properly now it is down twice!!!

  3. svenskamae

    Are you talking about the pricey strips that use blood to test for nutritional ketosis, rather than the urine ketostix? The Phinney and Volek book says that readings for ketosis level are lowest in the morning, so if you were "in ketosis" (reading 0.5 or higher) then, you would presumably be so throughout the day, unless you ate enough carbs to throw you out of ketosis. (Presumably your early morning ketosis reading is reflecting more or less how your body processed what you ate the preceding day). But I think you could pick any time that was convenient for you, so long as you always tested at that time of day. Hope this helps.

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