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Hyperosmolar Hyperglycemic State


Hyperosmolar hyperglycemic state (HHS) is a serious medical condition that develops if you have diabetes and your blood sugar levels get very high. Your body gets rid of the extra sugar through your urine. This leads to severe dehydration. You can develop HHS at any age and whether you have type 1 or type 2 diabetes.



  • Insulin: You may need to take insulin if you have type 2 diabetes that cannot be controlled with diet, exercise, or other diabetes medicine. You may need 1 or more doses of insulin every day to decrease the amount of sugar in your blood. Ask your healthcare provider for more information about insulin.
  • Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell him of her if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.

Follow up with your diabetes specialist or healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

Prevent HHS:

  • Check your blood sugar level regularly: 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. Ask your healthcare provider for information on how to check your blood sugar level with a glucose meter. He will tell you what your target level should be and how often you should check.
    How to check your blood sugar
  • Take your insulin or diabetes medicine: Take your insulin or diabetes medicines regularly and in the amount prescribed by your healthcare provider. This will help you to control your blood sugar levels. Tell your 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 healthcare provider.
  • Get help from others: Older people are at increased risk of HHS. Have someone visit you regularly if you live alone. 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 healthcare provider about a sick day plan that will work best for you. Your healthcare provider 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 each 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. Ask your healthcare provider which type of ketone testing is best for you. Your healthcare provider will tell you when and how often to check ketones.
    • Take your insulin or diabetes medicine as directed: Take your insulin and diabetes medicine, even if you do not feel well and are eating less than usual. They help to keep your blood sugar under control. Talk to your healthcare provider before you make any changes to your dose of insulin or diabetes medicine.
    • 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. These foods include apple sauce, gelatin, crackers, soup, pudding, and 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 identification:

Wear medical alert jewelry or carry a card that says you have diabetes. Ask your healthcare provider where you can get these items.

For support and more information:

  • American Diabetes Association
    1701 North Beauregard Street
    Alexandria , VA 22311
    Phone: 1- 800 - 342-2383
    Web Address:

Contact your healthcare provider if:

  • Your blood sugar levels are higher than you were told they should be.
  • You have blurred vision.
  • You are urinating more often than usual.
  • You are more thirsty than usual.
  • You have a fever.

Return to the emergency department if:

  • You are more drowsy than usual.
  • You begin to breathe fast or are short of breath.
  • You become weak and confused.
  • You have a seizure.

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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.