Hyperglycemic hyperosmolar syndrome
What is HHS?
- Hyperglycemic hyperosmolar syndrome, HHS for short
- A complication of diabetes that is characterized by extremely elevated blood sugar levels over an extended period of time, eventually leading to dehydration and mental status changes.
- Unlike diabetic ketoacidosis (DKA), there are no ketones present in HHS.
- HHS develops slowly and is often misdiagnosed, making it a potentially dangerous and life-threatening condition.
Let’s dig into the causes, symptoms, treatment and prevention of HHS.
What causes HHS?
- Anything that elevates blood sugar or lowers hydration can contribute to the development of HHS
- Dehydration
- Infection
- Illness
- Surgery
- Certain medications (such as steroids or diuretics)
- Inadequate diabetes treatment plan
- Undiagnosed diabetes
- Pancreatitis (inflammation of the pancreas)
What are the symptoms of HHS?
- Extremely elevated blood sugar, often >600 mg/dL
- Extreme thirst
- Dry mucous membranes
- Confusion
- Dizziness
- Lethargy
- Fever
- Warm, dry skin
- Excessive urination
- Neurologic changes
How is HHS treated?
Effective treatment of HHS requires hospitalization.
Treatment goals involve:
- Providing adequate fluids to rehydrate
- Correcting electrolyte deficits (sodium, phosphorus, potassium and magnesium are likely to be impacted)
- Providing adequate insulin to restore and maintain normal glucose metabolism
- Preventing complications via frequent monitoring of blood sugar levels, blood pressure, electrolytes and fluid status
- Treating underlying medical condition that may have caused HHS
- Providing patient and family education and plan for follow-up
How can I prevent HHS?
- Be aware of your blood sugar levels through frequent monitoring
- Understand how you feel when your blood sugar is elevated and what may have caused your high blood sugar level
- Follow the diabetes treatment plan set by your doctor
- Be sure to have a sick day plan for managing diabetes from your doctor, including staying well-hydrated with water when feeling sick
- Understand if and when you would need to make medication adjustments
- Know when to call your physician
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This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.