Hyperosmolar non-ketotic acidosis (HONK)

Hyperosmolar non-ketotic acidosis (HONK) is a condition that can occur in people with very high blood glucose levels, caused by a severe lack of insulin. People with Type 2 diabetes who have hyperglycaemia (high blood glucose) are at risk of developing it if their blood glucose level is left untreated. If you have HONK, your blood glucose level can reach as high as 30-60mmol/L.

HONK usually develops slowly and you are likely to feel increasingly ill over several days. When your blood glucose level rises, your body will try to "flush out" the glucose through your urine. This loss of fluid causes dehydration, which will make you extremely thirsty, leave your skin feeling dry and can cause you to feel confused. Sometimes people are left so confused they do not realise how unwell they are feeling. If someone with HONK is left untreated, they will experience severe drowsiness and can eventually slip into a coma. Very high blood glucose levels and loss of fluid can cause your blood to become thick and sticky (viscous). You may then form blood clots, which could put you at risk of having a heart attack or stroke.

If you fear you have HONK or have been diagnosed with the condition, you should go to hospital. Hospital treatment for HONK involves replacing the lost fluid and having insulin therapy to lower your blood glucose level. You may also be given medication to thin your blood, in order to reduce the risk of heart attack or stroke.

HONK is more common in older people with Type 2 diabetes. Many people who develop HONK were previously unaware that they had diabetes. If you are one of these people, you will still be treated with insulin and fluids, but may not need to stay on insulin therapy . When your HONK has been treated, you may be able to manage your diabetes with diet and tablets alone. Speak with your diabetes healthcare team who will put together a suitable treatment plan for you.


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