Dr. Einhorn shares what a hyperosmolar nonketotic hyperglycemic coma is.
Hyperosmolar nonketotic hyperglycemic coma is a crisis in type 2 diabetes primarily, where the sugar levels rise very, very high, and the blood in a sense becomes so thick that normal cognitive processes are not possible. You’re not thinking clearly anymore, and you gradually slip into a sleep or coma, and there can be consequences for the body as well.
This happens typically slowly. So a person with type 2 diabetes is getting a large amount of nutrients, but is not getting enough of water, enough fluid. So when you are, for example, taking over the nutrition for somebody who is sick, you have to be sure to not give them just food, you have to give them enough water to balance out the essentially osmolar load, glucose load of their food.
It is primarily treatable, again, in the hospital by fluid. That’s the big rescue agent, although the sugar may be very, very high in this condition, the real problem is volume, is fluid. Typically tiny amounts of insulin will bring the blood sugar down quite effectively as long as you’re giving large amounts of fluid and the fluid means not just water, it means saline, it means salt and water.
About Dr. Einhorn:
Dr. Daniel Einhorn received his undergraduate degree from Yale University, his medical degree from Tufts University School of Medicine, and his internship, residency and fellowship at Harvard Medical School. He served on the faculty of Harvard until coming to San Diego in 1984, and has since been a clinical endocrinologist with Diabetes and Endocrine Associates, Associate Clinical Professor of Medicine (Voluntary) at University of California, San Diego, and, until 2000, the Medical Director of the Diabetes Treatment and Research Center at Sharp Healthcare. He is the Medical Director of the Scripps Whittier Institute Diabetes Program. Dr. Einhorn has held many leadership positions with the Board of the American Association of Clinical Endocrinologists, the American Medical Association's Diabetes Advisory Council and The Endocrine Society. He Chaired the American College of Endocrinology Task Force on the Insulin Resistance Syndrome and the Conference on the Insulin Resistance Syndrome. He has served on the American Diabetes Association (ADA) Managed Care Initiative and on the regional ADA and Juvenile Diabetes Foundation, and as Chair of the Diabetes and Pregnancy Program of San Diego and Imperial Counties. He is a fellow of the American College of Physicians and the American College of Endocrinology. His research and publications cover diabetes prevention and reversal, recognition and treatment of diabetic complications, new technologies, new pharmaceuticals, combination therapies, and clinical decision-making.
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