What is hyperosmolar hyperglycemic state (HHS)?

Hyperosmolar hyperglycemic state is a serious medical condition that arises from dangerously high levels of blood glucose. Diabetic patients who have blood sugar levels that is above 33 mmol/L for long periods have a higher risk of having HHS. This metabolic condition usually occurs in patients with type 2 diabetes, although it can also affect those with type 1 diabetes. HHS, which is also referred to as nonketotic hyperosmolar syndrome, is normally caused by an infection or a medical condition, including stroke and myocardial infarction. Hyperosmolar nonketotic syndrome is a diabetes mellitus complication resulting from high levels of blood sugar without reaching the state of diabetic ketoacidosis.

Usually, hyperosmolar hyperglycemic state leads to abnormally high levels of blood sugar (hyperglycemia) and dehydration without causing significant diabetic ketoacidosis. Diabetic ketoacidosis is a serious diabetes complication that occurs when there is not enough insulin for the body to use glucose for fuel. As a result, the body starts to break down fat for energy which leads to a high amount of blood acids known as ketones. Unlike diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic coma is less common—although it has a higher fatality rate compared to the former. When the HHS affects diabetic people, the level of blood sugar will rise and the body will excrete the excess glucose via urine. Glucose that is excreted through urine will draw fluids with it, which could lead to dehydration if the patient doesn’t drink enough water regularly. If left untreated, it can become severe leading to coma or even death.

Signs and symptoms of hyperglycemic hyperosmolar nonketotic coma

If you have diabetes mellitus, there are possible warning signs and symptoms you can watch out for. The symptoms of hyperosmolar hyperglycemic nonketotic coma usually manifest themselves in diabetic people who are older and have high levels of blood sugar without knowing. Normally, the signs and symptoms of HHS can take days or weeks before they start to show. In case you experience the following signs and symptoms, you should seek medical help:

  • Extreme thirst
  • Hallucinations
  • Fever
  • Increased urination
  • Nausea
  • Confusion or drowsiness
  • Dry mouth
  • Excessive thirst

The best way to avoid symptoms of hyperosmolar nonketotic coma is by checking your levels of blood sugar regularly, and making sure it is under control if it falls outside the normal range. In case your blood sugar level is 22.2 mmol/L or above, you should contact your doctor for medical advice. If it still doesn’t improve even after following your doctor’s advice for treatment, you should seek emergency help immediately. Do not wait until your blood glucose level is very high.

Causes of HHS

Nonketotic hyperosmolar coma is often caused by certain conditions or illnesses that lead to a rise in blood glucose levels.

These conditions include:

  • Heart attack or stroke
  • Kidney disease
  • Infection
  • Medications such as diuretics

Also, if you do not take your insulin drugs as it is recommended by your health-care provider, it may cause a hyperosmolar hyperglycemic state. Usually, when the level of blood glucose rises, the kidney will try to remove the extra blood sugar through your pee. This process also leads to loss of body fluids. If you do not drink enough water to make up for the lost fluids and you keep eating food that contains high amounts of carbohydrates, your kidneys will be overworked and may not function properly. This increases the risk of having a nonketotic hyperosmolar coma.

Hyperosmolar hyperglycemic nonketotic syndrome treatment

Before treatment can start, your doctor will ask you about your symptoms or other medical conditions you have. They may perform blood and urine tests to check your ketones and blood glucose levels. Your doctor may also look for signs of infection, dehydration, or any other medical conditions that can cause a nonketotic hyperosmolar coma. Once you are diagnosed, your health-care provider may recommend you stay in a hospital so that your condition can be controlled and treated. Your doctor may first need to treat dehydration by giving you IV fluids and electrolytes like potassium. To control your levels of blood sugar, your doctor may give you insulin. Hyperosmolar hyperglycemic state can be prevented if you follow your diabetes treatment program and you regularly check your blood sugar levels.

Disclaimer: Please note that the contents of this community article are strictly for informational purposes and should not be considered as medical advice. This article, and other community articles, are not written or reviewed for medical validity by Canadian Insulin or its staff. All views and opinions expressed by the contributing authors are not endorsed by Canadian Insulin. Always consult a medical professional for medical advice, diagnosis, and treatment.