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.

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