Hyperosmolar Hyperglycemic State (HHS) is a serious medical condition that occurs when blood sugar levels become dangerously high, usually as a result of illness combined with dehydration. The condition is classed as a short term diabetes complication as it can develop quickly, and largely affects people with type 2 diabetes.

What causes Hyperosmolar Hyperglycemic State?

Hyperosmolar Hyperglycemic State develops when blood glucose levels become very high (often over 600 mg/dL). This rise in blood glucose is often caused by a combination of illness, dehydration and an inability to take anti-diabetic medication due to the effect of illness. When blood sugar levels become dangerously high (severe hyperglycemia), the body passes excess sugar into the urine, causing frequent urination. A lack of water or intake of other liquids can lead to dehydration, and this can become severe and result in loss of consciousness, seizures and coma and even death. Unlike diabetic ketoacidosis (DKA), HHS does not usually lead to the presence of ketones in the urine. For this reason, it used to be called hyperosmolar hyperglycemic nonketotic coma (HONK), and is still sometimes referred to as diabetic nonketotic coma, hyperosmolar nonketotic state, or hyperosmolar nonketotic hyperglycemia (HNKH)

Am I at risk of HHS ?

Hyperosmolar Hyperglycemic State usually develops in older people with type 2 diabetes, but it can affect those with type 1 diabetes too. Older people tend to be at higher risk of HHS due to the fact they may be less aware of hyperglycemia and how to treat it, particularly those who live alone or suffer from Alzheimer’s and other forms of dementia. Cases of HHS in children are, however, increasing in line with the rising incidence of childhood obesity and type 2 diabetes. In fact, as the prevalence of type 2 diabetes grows in the general population, HHS is becoming an increasingly common community-based emergency

What are the symptoms of HHS ?

The warning signs of HHS for people with diabetes can include:

In severe cases where the condition progresses unchecked, patients may gradually lose consciousness, increasing the risk of seizures, which occur in up to 25% of cases, and coma.

Treatment and prevention of HHS?

HHS can best be avoided by keeping on top of your diabetes – i.e. making sure your blood sugar levels stay within the recommended target range. If you monitor your blood sugars, you may need to test more regularly. You should also always ensure you take your diabetes medication, even if you don’t feel well and can’t eat. If you can’t eat, replace meals with snacks containing carbohydrate and drink more unsweetened fluids.

Hyperosmolar Hyperglycemic State is a potentially life-threatening emergency

If HHS develops, urgent assessment and treatment is vital as patients usually become very ill very quickly. Treatment for HHS generally involves replacement fluid and insulin being administered via an intravenous drip to correct dehydration and reduce blood glucose.