Understanding Diabetic Hyperglycemic Hyperosmolar Syndrome (HHS)

~ by Jo Jordan

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HHS is a metabolic complication of type 2 diabetes characterized by extremely high blood glucose levels. When blood sugar levels top 600 milligrams per deciliter (mg/dL),¹diabetic hyperglycemic hyperosmolar syndrome has set in. HHS is also known as hyperglycemic hyperosmolar coma, nonketotic hyperglycemic hyperosmolar coma, and hyperosmolar nonketotic coma.

What Happens to Your Body When You Have HHS?

The kidneys try to accommodate for high blood sugar levels by allowing extra glucose to exit the body through urine. If drinks containing sugar are consumed, or not enough fluids are drunk, the kidneys are unable to continue the purge of excess glucose.

Blood sugar levels become very high, and the blood becomes thick and syrupy blood (referred to as hyperosmolarity). This condition is characterized by high salt and glucose concentrations in the blood, which triggers a filtering process resulting in an enormous loss of bodily fluids, including loss of water to the brain.

Immediate medical attention is required; untreated, HHS - which creates a cycle of increasing blood-glucose levels and dehydration - can lead to life-threatening dehydration.

Hyperglycemic Hyperosmolar Syndrome Warning Signs and Symptoms

Coma
Confusion
Convulsions
Dry, parched mouth
Dysfunctional movement
Excessive thirst
Extreme dehydration
Generalized weakness
High blood sugar level
High body temperature (exceeding 100.4 degrees fahrenheit)
Increased heart rate
Increased urination
Lethargy
Loss of feeling or muscle function
Low systolic blood pressure
Nausea
Sleepiness
Speech impairment
Vision loss
Warm, dry skin with no sweating
Weakness confined to one side of the body

Causes of Hyperglycemic Hyperosmolar Syndrome

Altered consciousness
Exceedingly high blood sugar levels
Extreme dehydration
Ketoacidosis (ketone build-up) may also be a factor

Triggers and Risk Factors for Hyperglycemic Hyperosmolar Syndrome

Most common in older adults with type 2 diabetes, undiagnosed diabetes - or diabetes that is not being properly managed - can trigger HHS. It can also be brought on by,

Discontinuance of insulin intake
Discontinuance of medications that lower glucose levels
Impaired thirst and/or limited access to, or neglect of water consumption
Infection and/or illness (such as congestive heart failure, heart attack, stroke, or recent surgery)
Medications that increase fluid loss (i.e. water pills/diuretics)
Medications that lower glucose tolerance
Poor kidney function
Substance abuse

Hyperglycemic Hyperosmolar Complications

Acute circulatory collapse (shock)
Blood clot formation; blood vessel blockages may lead to heart attacks
Brain swelling
Coma
Convulsions
Death
Kidney damage
Lactic acidosis (increased blood acid levels)

Diagnosing Hyperglycemic Hyperosmolar Syndrome and Its Causes

Measuring the amount of creatinine, potassium, and/or nitrogen in the blood
Performing a hematocrit blood test; it measures the proportion of red blood cells to fluid in the blood
Testing for blood sugar levels of 600 mg/dL or higher

An investigation of the possible underlying causes may include,

Blood cultures
Chest X-rays
Electrocardiogram (ECG)
Urinalysis

Hyperglycemic Hyperosmolar Syndrome Prevention, Treatment, and Prognosis

Prevention

Ask your health care provider for instructions on how to carefully track blood sugar levels
Be informed and watchful for early signs of dehydration and infection
Know what to do should blood glucose levels rise too high - i.e. eating less, exercising, or taking medication
Stay in control of type 2 diabetes

Treatment

Treatment is geared toward correcting dehydration by way of the administration of saline solution - fluids and potassium - to restore water to tissues, raise blood pressure, and improve circulation and urine output.

Sometimes chlorine, potassium, and/or sodium supplements are indicated to assist in proper cell functioning. Short-acting insulin is sometimes part of treatment as it assists tissue to absorb glucose. Underlying infections are also treated.

Prognosis

Those who develop HHS are often already ill; the mortality rate for this condition is cited as high as forty percent.²

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Notes:
1. MayoClinic.com, "Diabetic hyperosmolar syndrome,"
http://www.mayoclinic.com/health/diabetic-hyperosmolar-syndrome/DS00664 html (accessed June 15, 2009). 2. The Merck Manuals, "Hyperosmolar Hyperglycemic State," http://www.merck.com/mmpe/sec12/ch158/ch158d.html (accessed June 15, 2009).