Hyperglycemic / Hyperosmolar States

older man with head down

Hyperglycemia means very high blood sugar. Symptoms include:

  • Greatly increased urination
  • Thirst
  • Extreme fatigue
  • Confusion
  • Seizure
  • Coma

HHS is a life-threatening emergency associated with very high blood sugars (greater than 600 mg/dl), that occurs in people with type 2 diabetes. It is an uncommon, but life threatening situation.  

Acute: Hyperglycemic Hyperosmolar States (HHS)

HHS is a vicious cycle of high sugars that lead to excessive urination and dehydration. The dehydration causes the blood to become more concentrated and the blood sugar to rise even more. The higher the blood sugar the more the body tries to dispose of the excess sugar in the urine, which just worsens the dehydration. There is usually just enough insulin produced by the pancreas to keep fat in fat cells and prevent ketone formation, so ketone levels are normal or only slightly elevated in HHS.

Ultimately the person has very high blood sugars and is very dehydrated and is confused or in a coma (unconscious). This is a serious medical emergency that can lead to death. Immediate hospitalization is required.

HHS usually happens to people who don’t know they have diabetes. It also happens to people who know they have diabetes and are sick with something else and don’t check their blood sugars or drink enough fluid.

Symptoms:

  • Greatly increased urination
  • Thirst
  • Extreme fatigue
  • Confusion
  • Seizure
  • Coma
  • Blood glucose over 600 mg/dl
  • No ketone or low ketone levels

Treatment:

HHS is a life-threatening medical emergency requiring hospitalization. Treatment often includes IV fluids, low dose insulin and close monitoring and treatment in a hospital setting.

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