Hyperosmolar Hyperglycemic State

WHAT YOU SHOULD KNOW:

• Hyperosmolar hyperglycemic state (HHS) is a serious medical condition that can happen to people with diabetes. HHS happens when blood sugar levels get very high because of an illness or other conditions. Some of these conditions include infections, stroke, heart attack, heat stroke, and trauma or severe burns. Other conditions that can lead to HHS include undiagnosed diabetes or not taking insulin or diabetes medicines correctly. HHS usually happens in older people with type 2 diabetes. However, it can happen in people of any age and in people with type 1 diabetes.
  
  
• With HHS, the body tries to get rid of the extra sugar through the urine. This causes you to go to the bathroom often. You may also become thirsty and get very dehydrated. The severe dehydration may lead to other serious health problems. HHS develops over a period of days to weeks. The first signs and symptoms are caused by high blood sugar levels. These signs and symptoms may include frequent urination, being very thirsty, feeling very tired, and blurred vision. Later signs and symptoms are caused by dehydration. These signs and symptoms may include weakness, leg cramps, dizziness, drowsiness or confusion, and dry eyes or mouth.

INSTRUCTIONS:

Medicines:

• Keep a current list of your medicines: Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists. Use vitamins, herbs, or food supplements only as directed.
  
  
• Take your medicine as directed: Call your primary healthcare provider if you think your medicine is not working as expected. Tell him about any medicine allergies, and if you want to quit taking or change your medicine.
  
  
• Taking insulin: You may need to take insulin if your diabetes cannot be controlled with diet, exercise, or diabetes medicine. You may need 1 or more doses of insulin every day to decrease the amount of sugar in your blood. Ask your primary healthcare provider for more information about insulin medicine.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

Prevent hyperosmolar hyperglycemic state:

• Check blood sugar levels. Use a glucose meter to check your blood sugar levels regularly. A glucose meter (also called a glucometer) is a small machine used to test the amount of sugar in your blood. First, you prick your finger to get a small drop of blood. Then, you place the blood onto a testing strip and put the strip into the glucose meter. A screen on the glucose meter will show the amount of sugar in your blood. Ask your primary healthcare provider for information on how to check your blood sugars. He will tell you what your target level should be. Ask how often you should check your blood sugar levels. You will need to check your blood sugar levels at least 3 times each day if you use an insulin pump or take multiple doses of insulin.
  
  
• Take your insulin and diabetes medicine. Take your insulin or diabetes medicines regularly and in the amount prescribed by your primary healthcare provider. This will help you to control your blood sugar levels. Tell your primary healthcare provider if the medicines are causing side effects or are not working well. Do not stop taking your insulin or medicines before talking to your primary healthcare provider.
  
  
• Drinking liquids: Men 19 years old and older should drink about three Liters of liquid each day (about 13 eight-ounce cups). Women 19 years old and older should drink about two Liters of liquid each day (about 9 eight-ounce cups). Follow your caregiver's advice if you must change the amount of liquid you drink. High sugar or carbohydrate drinks may make your blood sugar go up. Drinking alcohol may make your blood sugar drop too low. Liquids that will not affect your blood sugar are water, sugar-free drinks, tea, and coffee. Try to drink enough liquid each day, and not just when you feel thirsty.
  
  
• Get help from others. Older people are at increased risk of HHS. Older people who live alone should have someone visit them regularly. The visitor should watch for signs and symptoms of high blood sugar. The visitor should also remind you to drink enough liquids. It may be helpful to write down the amount of liquids you drink each day.
  
  
• Prepare for sick days. Your blood sugar levels increase when you are sick and it can be hard to keep them under control. It is important to plan for sick days so that you can keep your blood sugar levels from getting too high. Talk to your primary healthcare provider about a sick day plan that will work best for you. He may suggest some of the following:
  
  
  • Check your blood sugar more often than usual. You may need to check your blood sugar level at least 4 times a day if you have type 2 diabetes. You may need to check your blood sugar levels even more often if you have type 1 diabetes.
    
    
  • Check for ketones. You can check for ketones in your urine or blood at home. Ketone test kits are sold in pharmacies and some stores. You can also buy meters that measure the amount of ketones in your blood. To check for ketones, follow the instructions that come with the ketone test kit or meter. Ask your primary healthcare provider which type of ketone testing is best for you. He will tell you when and how often to check ketones.
    
    
  • Continue taking your insulin or diabetes medicine. Take your insulin and diabetes medicine, even if you are having a hard time eating. You need your insulin or diabetes medicine to lower your blood sugar.
    
    
  • Continue your normal meal plan if you can. Eat your regular meals and drink plenty of calorie-free drinks such as water and diet drinks. If you cannot continue your meal plan, eat other foods that are easier for your body to digest (break down). These foods include apple sauce, gelatin, crackers, soup, pudding, and fruit-flavored yogurt. If you cannot eat these foods, drink liquids with calories in them instead. Some liquids that have calories include juice, broth, and regular soft drinks.

Medical alert bracelet or necklace:

Remember to wear your medical alert jewelry or carry a card that says you have diabetes. Ask your primary healthcare provider where to get these items.

Contact your primary healthcare provider if:

• Your blood sugar levels are higher than your caregiver says they should be.
  
  
• You have signs and symptoms of high blood sugar:
  
  
  • Blurred vision
    
    
  • Feeling very tired
    
    
  • Frequent urination
    
    
  • Leg cramps
    
    
  • More thirsty than usual
    
    
  • You are losing weight without trying

Return to the emergency department if:

• You have chest pain.
  
  
• You have shortness of breath.
  
  
• You have signs of dehydration such as:
  
  
  • Drowsiness or confusion
    
    
  • Dry eyes or mouth
    
    
  • Irregular or fast breathing, fast or pounding heartbeat, and low blood pressure
    
    
  • Leg cramps
    
    
  • Weakness or dizziness

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Hyperosmolar Hyperglycemic State (Aftercare Instructions)