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.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

HHS is a very serious health condition. High blood sugar levels can lead to severe dehydration. Over time, other serious medical problems can develop and lead to death.

WHILE YOU ARE HERE:

Informed consent:

A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.

Oxygen:

You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your caregiver before you take off the mask or oxygen tubing.

Tests:

You may need 1 or more of the following tests to help caregivers plan your treatment:

• Blood gases: This is also called an arterial blood gas, or ABG. Blood is taken from an artery (blood vessel) in your wrist, arm, or groin. Your blood is tested for the amount of oxygen and carbon dioxide in it. The results can tell caregivers how well your lungs are working.
  
  
• Blood sugar checks: Your blood sugar level may be checked many times each day. This is usually done before meals and at bedtime. Your finger is pricked to draw blood and the blood is put into a glucose monitor (glucometer). A glucometer is a small hand-held machine used to test the amount of sugar in your blood.
  
  
• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• CT scan: This test is also called a CAT scan. An x-ray and computer are used to take pictures of your skull and brain. You may be given dye, also called contrast, before the test. Tell the caregiver if you are allergic to dye, iodine, or seafood.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• Urinalysis: This is a urine test that may help caregivers find out how your kidneys are working. Caregivers may also check the urine for white blood cells, protein, sugar, blood, and bacteria that are not normally there. A urinalysis can also help caregivers find out if you are dehydrated.
  
  
• Chest x-ray: This is a picture of your lungs and heart. Caregivers use it to see how your lungs and heart are doing. Caregivers may use the x-ray to look for signs of infection like pneumonia, or to look for collapsed lungs. Chest x-rays may show tumors, broken ribs, or fluid around the heart and lungs.

Treatment options:

• Intravenous therapy: You may receive liquids through a tube that is placed in your vein to treat your dehydration. The liquids may also include electrolytes (mineral salts) such as potassium.
  
  
• Insulin: This medicine may be given to decrease the amount of sugar in your blood. It helps your body move the sugar to your cells, where it is needed for energy.
  
  
• Other treatments: Caregivers may also treat other conditions which led to HHS. If you are using medicines that put you at risk for HHS, they may have to be changed or stopped.

Monitoring:

• Body weight: You may be weighed each day. Your caregiver may compare your weight from day to day. This will help your caregiver to see how much fluid is in your body. Your body does not work well when it has too much or too little fluid.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Intake and output: Caregivers will keep track of the amount of liquid you are getting. They also may need to know how much you are urinating. Ask how much liquid you should drink each day. Ask caregivers if they need to measure or collect your urine.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.

Diet:

A dietitian may work with you to find a meal plan that will help you control your blood sugar. Ask caregivers how your favorite foods may fit into this meal plan.

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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.

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