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Management of hyperosmolar non-ketotic hyperglycaemia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Seek expert advice.

As for DKA except:

  • If plasma sodium is greater than 145mmol/l then half-normal saline is used for rehydration.
  • Lower doses of insulin are required because there is greater insulin sensitivity.

An example insulin infusion rate is presented below. Check with local guidelines.

blood glucose

insulin rate (u/hour)

>20

3

13-20

2

5-13

1

<5

0.5

If the blood glucose has not fallen by 10mmol/l after the first 2 hours of treatment then the infusion rate should be doubled.

  • there is a high risk of thromboembolism - give subcutaneous heparin.
  • HONK has a lower total body potassium than in DKA and the plasma level is more variable when treatment begins. The levels should be checked at 30mins after starting insulin and then 2-hourly
  • most patients with HONK can subsequently managed on oral hypoglycaemics once the daily insulin requirement has fallen to about 20 units

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