management of hyperosmolar non-ketotic hyperglycaemia
Last reviewed 06/2022
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