Learning About Hyperosmolar Hyperglycemic State

Hyperosmolar hyperglycemic state (HHS) is a serious problem that can happen when you have diabetes. Diabetes is a condition in which sugar (glucose) stays in the blood instead of entering the body's cells, where it can be used for energy. This results in high blood sugar.

HHS can happen if your blood sugar gets very high. This is usually blood sugar levels of 600 milligrams per deciliter (mg/dL) or more. Your kidneys try to get rid of the extra sugar through your urine. This can cause you to lose a lot of fluid. If you can't drink enough to replace the fluid you lost, you can become very dehydrated. Your blood also becomes more concentrated. This means your blood has lower levels of water and higher levels of things like sugar and salt than normal.

HHS can be dangerous. It needs to be treated right away. Without treatment, it can lead to a coma or death.

Things that raise your blood sugar and lead to severe fluid loss can cause HHS. For example, HHS can happen if you:

• Do not take your insulin or other diabetes medicines as prescribed.
• Have diabetes but don't know it, so you are not being treated.
• Have an illness, such as the flu or a urinary tract infection (UTI). Other health issues (like a heart attack, a stroke, or surgery) can also put you at risk.
• Take certain medicines. These include water pills (diuretics), beta-blockers, steroids, or antipsychotic medicines.

People with any type of diabetes are at risk for HHS. But it is more common in people with type 2 diabetes.

The symptoms of HHS can form over several days or weeks. They can include:

• Being very thirsty.
• Urinating more often than usual.
• Weight loss.
• Fatigue or weakness.
• Blurred vision.
• Dry skin and a dry mouth.
• Drowsiness or difficulty waking up.
• A fast heart rate and a weak pulse.
• Confusion.
• Passing out.
• Seizures.
• A coma.

Your doctor will ask you questions about your symptoms and health history. The doctor will also do a physical exam.

You will also have tests, including blood and urine tests. Blood tests can measure how much sugar is in your blood. They can also check how concentrated your blood is. And they can check your electrolyte levels, including potassium and sodium. Urine tests can help find infections and other causes of HHS. You may also have an electrocardiogram (EKG or ECG). This is a test to see how well your heart is working.

HHS is treated in the hospital. You will be given fluids through an intravenous (I.V.) line to treat dehydration. You will likely get electrolytes, like potassium. You will also be given insulin through an I.V. line to lower your blood sugar.

Your doctor will also find and treat any health problems that may have caused the HHS, such as an infection.

To help prevent HHS, always take your insulin and other diabetes medicines as prescribed. Also test your blood sugar as directed by your doctor. And be sure to treat high blood sugar before it gets worse.

Following your meal plan and being active can also help prevent HHS. So can drinking plenty of fluids to avoid dehydration. Don't smoke, vape, or use other tobacco or nicotine products. Talk to your doctor if you need help quitting.

Work with your doctor to create a plan for when you are sick. The plan can include how to adjust your insulin and other medicines, if needed. It can also include how often to check your blood sugar, what symptoms to watch for, and what to do in case of an emergency.