Hyperosmolar Hyperglycemic State

What is hyperosmolar hyperglycemic state?

Hyperosmolar hyperglycemic state is also called HHS. HHS is a serious medical condition that can happen to people with diabetes. HHS happens when blood sugar levels get very high and the body tries to get rid of the extra sugar through the urine. This causes you to go to the bathroom often. Eventually, you may become thirsty and get very dehydrated (lose too much body fluid). The severe dehydration may lead to other serious health problems. 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.

What are the causes of hyperosmolar hyperglycemic state?

HHS usually develops because of other illnesses or conditions that cause blood sugar levels to rise. The following are conditions that may lead to HHS:

• Infections such as pneumonia and urinary tract infections
  
  
• Stroke or heart attack
  
  
• Heat stroke
  
  
• Trauma or severe burns
  
  
• Pancreatitis (inflammation of the pancreas)
  
  
• Alcohol abuse
  
  
• Medicines that raise your blood sugar
  
  
• Not taking insulin or diabetes medication at all, or taking them incorrectly
  
  
• Undiagnosed diabetes (having diabetes and not knowing it)

What are the signs and symptoms of hyperosmolar hyperglycemic state?

HHS usually develops over days or weeks. Signs and symptoms of HHS may include the following:

• The signs and symptoms that appear first are caused by high blood sugar levels (usually over 600 mg/dL):
  
  
  • Blurred vision
    
    
  • Feeling very tired
    
    
  • Frequent urination
    
    
  • Leg cramps
    
    
  • More thirsty than usual
    
    
  • Weight loss
  
  
• Later signs and symptoms are caused by dehydration:
  
  
  • Dry eyes or mouth
    
    
  • Weakness
    
    
  • Leg cramps
    
    
  • Dizziness
    
    
  • Drowsiness or confusion
    
    
  • Seizures
    
    
  • Irregular or fast breathing, fast or pounding heartbeat, and low blood pressure

How is hyperosmolar hyperglycemic state diagnosed?

• You may need to stay in the hospital for tests and treatment. Your caregiver will take a detailed health history from you. This history may include information on other health conditions you have that may have led to HHS. Caregivers may also ask about medicines that you regularly use or have used in the past.
  
  
• Caregivers will do a complete checkup to look for problems or signs of infection. They will also do blood tests and check your blood sugar and ketone levels. Caregivers may also do a urinalysis (urine test) to find out how your kidneys are working. Caregivers also check 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. Other tests may be done to find out if another health condition led to HHS.

How is hyperosmolar hyperglycemic state treated?

HHS can be treated and controlled most of the time, but early treatment is very important. Caregivers will first treat dehydration by giving fluids and electrolytes (mineral salts) such as potassium through an IV. An IV is a tube placed in your vein for to give you medicine or liquids. Caregivers may also give you insulin to help lower your blood sugar. Caregivers may need to treat other conditions that may have led to HHS. They may also change your medicine.

How can I 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 caregiver for information on how to check your blood sugar. 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 or diabetes medicine. Take your insulin or diabetes medicines regularly and in the amount prescribed by your caregiver. This will help you to control your blood sugar levels. Tell your caregiver if the medicines are causing side effects or are not working well. Do not stop taking your insulin or medicines before talking to your caregiver.
  
  
• 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 caregiver about a sick day plan that will work best for you. Your caregiver 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 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 caregiver which type of ketone testing is best for you. Your caregiver 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 caregiver where to get these items.

For support and more information:

Diabetes is a life-changing disease for you and your family. It may be hard to accept that you have diabetes. You may want to join a support group of people who also have diabetes. Contact the following for more information:

• American Association of Diabetes Educators
  American Association of Diabetes Educators
  200 West Madison Street, Suite 800
  Chicago , IL 60606
  Phone: 1- 800 - 338-3633
  Web Address: http://www.aadenet.org
  

• American Diabetes Association
  1701 North Beauregard Street
  Alexandria , VA 22311
  Phone: 1- 800 - 342-2383
  Web Address: http://www.diabetes.org
  

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.

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.

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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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