This needs to look at an overview of treatments for DKA and HHS (UK specific, but some brief mention of treatments in US and Canada can add some depth, prospective changes/pioneering treatments etc.). There is no need to go into substantial detail regarding pathophysiology of DKA or HHS as this will already be covered elsewhere.
Focus instead on differences in treatments for these two conditions e.g. DKA is corrected quicker than HHS due to slow onset of Hyperosmolar state and risk of deterioration and severe dehydration. HHS likely requiring more intensive support than DKA.
Describe use of insulin infusion, including initial and subsequent dose rates. Also use of fluids, touching on difference between use of sodium chloride or ringers lactate, and the interaction of these fluids on electrolyte levels.
Then draw similarities to what paramedics can identify in a pre-hospital setting, and how ultimately a good history take, assessment and clinical presentation is the only current key identifier in the community, but in future there could be routine use of urine analysis to find both glucose and ketones in the community. Looking at both the positives and limitations of this analysis method, Possibly look at various other point of care testing methods similar to glucose monitoring implants.
Worth noting that the UK is currently pioneering beta-hydroxybutyrate measurement in hyperglycaemic emergencies, as this ketone seems to be a more accurate method of determining if patients condition is improving. Acetoacetate levels fluctuate as condition improves therefore may give a false representation of condition.
