Hyperosmolar Hyperglycemic Syndrome (HHS) is a condition that occurs in those suffering from Type 2 Diabetes who have extremely high blood glucose levels (often above 40mmol/l). It may develop over the course of a few weeks due to a combination of illnesses (e.g.infection) or dehydration.
A few people who don’t realize they suffer from type 2 diabetes aren’t diagnosed until they’re extremely sick with HHS. In addition to HHS there are instances when people suffering from type 2 diabetes might be diagnosed with diabetes ketoacidosis (DKA) however this is less frequent when compared to DKA in those with the type one diabetes.
Stopping diabetes medication during illness (e.g. due to difficulty swallowing or nausea) may be the cause, but blood glucose levels often increase even when the diabetes medication is prescribed because of the effects of other hormones your body creates when it is sick.
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The symptoms of Hyperosmolar Hyperglycemic Syndrome (HHS) can include:
urination,
thirst
nausea
dry skin
Disorientation, and later eventually, drowsiness as well as an ebb and flow of consciousness.
HHS is a potential life-threatening emergency
The hospital treatment of HHS is designed to treat the problem of dehydration and bring blood sugar down to a normal level through replacement of fluid and insulin via an intravenous drip
It is not a common cause in the development or presence of ketones in the urine like during the condition known as diabetic ketoacidosis (DKA), which is the reason it was once called HONK (hyperglycaemic hyperosmolar non-ketotic compa). Ketones form when blood glucose levels are high because of a lack of insulin, which is required to allow glucose into cells to provide energy. Because those with Type 2 diabetes may still produce insulin, ketones could not be produced.
What can you do?
Always remember to take your diabetes medicine regardless of feeling sick and don’t feel well.
If you are monitoring your blood sugar levels then you might be required to take a test more often
Consult your physician If your blood glucose levels are still high (>15mmol/l)
Take plenty of fluids that are unsweetened.
If you are unable to take a meal, substitute your meals with snacks and drinks that contain carbohydrates.
Risk Factors and Causes
HHS is often caused through infections, medication and non-adherence to treatment or treatment, undiagnosed diabetes misuse, and coexisting conditions. Infections are the leading cause (57% of cases); pneumonia, often gram-negative, is the most common infection, followed by urinary tract infection and sepsis.Poor adherence to diabetes medication causes 21% of HHS cases. Other causes include myocardial infarction, cerebrovascular accident, pulmonary embolism, and mesenteric artery thrombosis.Psychoactive medications, especially second-generation antipsychotics, cause glucose elevations, insulin resistance, and diabetes independent of weight gain.Older adults with type 2 diabetes (sometimes undiagnosed) are at higher risk of HHS because they often take dehydrating medications (e.g., diuretics) and may be unable to adequately communicate their symptoms if they live alone or in a nursing home.
Treatment of HHS
IV 0.9 1 % Saline
Treatment of hypokalemia
IV insulin (as long as the serum potassium is > 3.3 milliEq/L (> 3.3 mg/L(as long as serum potassium is >= 3.3 mEq/L [)
Treatment is comprised of IV saline, correction for hypokalemia and insulin injection .
Treatment is 0.9 percent (isotonic) Saline solution in a dose between 15 and 20 mg/kg/hour for the first couple of hours. Then the sodium that has been corrected should be measured. In the event that the adjusted sodium falls below 135 mEq/L (135 mmol/L or less) the isotonic saline must be maintained at the rate of 250 to 500 mg/hour. When the sodium corrected is normal or elevated then 0.45 percent of saline (half normal) is recommended.
Dextrose is recommended to be added when the glucose level is between 250-300 mg/dL (13.9 to 16.7 mmol/L). The amount of IV fluids must be adjusted according to the level of blood pressure, cardiac condition and the balance between fluid output and fluid inflow.
Insulin is administered with 0.1 units/kg of IV,. It is followed by an 0.1 unit/kg/hour infusion following the first Liter of saline has been infused. In some cases, hydration alone will lower plasma glucose levels, therefore the dose of insulin may have to be decreased. An excessively rapid reduction in osmolality could cause cerebral edema. Infrequently, patients suffering from insulin-resistant type 2 diabetes and hyperosmolar hyperglycemic condition require higher doses of insulin. When plasma glucose is at 300 mg/dL (16.7 mg/L) The insulin dose should be reduced to levels that are normal (1 2-units/hour) until rehydration has been completed and the patient can take a meal.
The target plasma glucose ranges from 250 to 300 mg/dL (13.9 to 16.7 mg/L). Following the recovery of episodes of acute illness, individuals are typically changed to doses that are adjusted for subcutaneous insulin.
Potassium replacement is comparable to the diabetic ketoacidosis condition: 40 mEq/hour of serum potassium less than 3.3 milliliters/liter (< 3.3 mmol/L); 20 to 30 mEq/hour for serum potassium between 3.3 and 4.9 mEq/L (3.3 and 4.9 mmol/L); and none for serum potassium > 5 mEq/L (more than 5 mg/L).
