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Hyperosmolar Hyperglycemic State


What is 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.

What are the causes of HHS?

HHS usually develops because of other illnesses or conditions that cause blood sugar levels to rise, such as the following:

  • Infections such as pneumonia and urinary tract infections
  • Stroke or heart attack
  • Pancreatitis (inflammation of the pancreas)
  • Medicines that raise your blood sugar level
  • Not taking insulin or diabetes medication at all, or taking them incorrectly

What are the signs and symptoms of HHS?

Signs and symptoms of HHS usually develop over days or weeks. You may have more than one of the following:

  • Blood sugar level above 600 mg/dL
  • Frequent urination
  • More thirst than usual or a dry mouth
  • Blurred vision
  • Weakness
  • Dizziness, drowsiness, or confusion
  • Seizures

How is HHS diagnosed?

Your healthcare provider will ask about your symptoms and when they started. He may also ask about other health conditions you have and about medicines that you take. Your blood and urine will be tested to check your blood sugar level and ketones. Your healthcare provider will also check for signs of dehydration, infection, or other conditions that may have led to HHS.

How is HHS treated?

HHS can be treated and controlled most of the time, but early treatment is very important. Healthcare providers will first treat dehydration by giving you fluids and electrolytes such as potassium through an IV. Healthcare providers may also give you insulin to help lower your blood sugar. Healthcare providers may need to treat other conditions that may have led to HHS.

How can I prevent HHS?

  • Check your blood sugar level regularly: 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. He will tell you what your target level should be. Ask how often you should check your blood sugar levels.
    How to check your blood sugar
  • Take your insulin or diabetes medicine: Take your medicines as directed 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 you talk 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. 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 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.

What are the risks of HHS?

Treatment with insulin may cause your blood sugar level to become too low. Very low blood sugar levels may cause seizures, or you may become unconscious. IV fluid replacement may cause trouble breathing from fluid buildup. Fluids may also cause cerebral edema (fluid buildup around the brain), which can be life-threatening. Without treatment, high blood sugar levels can lead to severe dehydration. Other serious medical problems, such as seizures or a coma, can also develop. HHS can be life-threatening.

Where can I find support and more information?

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

When should I contact my healthcare provider?

  • Your blood sugar levels are higher than your healthcare provider says they should be.
  • You have blurred vision.
  • You are urinating more often than usual.
  • You are more thirsty than usual.
  • You have a fever.

When should I seek immediate care or call 911?

  • 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.

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. 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.

© 2017 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.