Common Health Issues

Hyperglycemic Hyperosmolar State

• By Rich Health Editorial Team
• November 01, 2021

Hyperglycemic hyperosmolar state (also known as Hyperglycemic Hyperosmolar Nonketotic Syndrome, HHNS) is similar in some ways to diabetic ketoacidosis, but is much more likely to affect people with type 2 diabetes. Both conditions occur when blood glucose levels climb too high. If you have diabetes type 2, you can be at risk for hyperglycemic hyperosmolar state whether you manage your diabetes through diet and exercise alone, take oral agents or use insulin. 

 

However, most cases of hyperglycemic hyperosmolar state occur in people who don’t use insulin. In many instances, hyperglycemic hyperosmolar state develops in people who don’t even realize that they have diabetes.

 

Hyperglycemic hyperosmolar state begins when your blood glucose levels rise too high. Your body produces more urine to get rid of excess glucose and dehydration sets in. This process can go on for days and even weeks. As dehydration continues, you can become confused and disoriented. This makes it even more difficult for you to get a needed drink of water, make it to toilet, or even recognize that hyperglycemic hyperosmolar state is occurring. If unchecked, the severe dehydration in hyperglycemic hyperosmolar state can lead to seizures, coma and death.

HYPERGLYCEMIC HYPEROSMOLAR STATE SYMPTOMS

Unlike diabetic ketoacidosis, the body does not produce ketones during hyperglycemic hyperosmolar state and so the symptoms are not as recognizable. If you have hyperglycemic hyperosmolar state, you might not even realize what is happening until it is too late. 

 

The symptoms of hyperglycemic hyperosmolar state include dry parched mouth, extreme thirst (although this can disappear during the course of hyperglycemic hyperosmolar state), sleepiness, feeling confused or disoriented, warm dry skin with no sweating, and high blood glucose (over 350mg/dl). If you experience any of these symptoms, check your blood glucose levels at once and call your doctor

 

HYPERGLYCEMIC HYPEROSMOLAR STATE RISKS

Hyperglycemic hyperosmolar state occurs almost exclusively in people with type 2 diabetes. Elderly people with type 2 diabetes, especially those in nursing homes, are at an especially high risk for developing hyperglycemic hyperosmolar state. One-third of all cases of hyperglycemic hyperosmolar state happen to people in nursing homes. People who have diabetes but have not yet been diagnosed are also prime targets for hyperglycemic hyperosmolar state, because their blood glucose can rise to high levels without them even knowing it.

 

Hyperglycemic hyperosmolar state is most likely to occur during times of illness or infection. Any kind of physical or psychological trauma or stress can increase your risk for hyperglycemic hyperosmolar state. Certain medications can also make an episode of hyperglycemic hyperosmolar state more likely. If you are undergoing peritoneal dialysis or intravenous feeding, you will be given large amounts of glucose, and this increases your chances for developing hyperglycemic hyperosmolar state. Any circumstances that make you stop taking insulin or skip an insulin dose can also put you at high risk for hyperglycemic hyperosmolar state. Alcohol abuse also makes hyperglycemic hyperosmolar state more likely.

 

WHAT YOU SHOULD DO

If your blood glucose level is over 350mg/dl, call your doctor or a member of your health care team right away. If your blood glucose is over 500mg/dl, have someone take you to a hospital immediately. If no one is available, call for emergency help at once.

 

HYPERGLYCEMIC HYPEROSMOLAR STATE TREATMENT

The treatment for hyperglycemic hyperosmolar state is similar to that for diabetic ketoacidosis. If you have severe hyperglycemic hyperosmolar state and require emergency treatment, you will be given insulin, fluids and electrolytes. You may be given an initial dose of insulin that depends on your weight and then a smaller continuous dose of insulin, depending on how fast your glucose level falls. 

 

Once your blood glucose levels fall below 200mg/d, you will be given an infusion of glucose solutions and your insulin dose will be lowered further. It may take as long as 4 to 6 hours for glucose levels to fall to safe levels.

 

Dehydration is a big problem if you have hyperglycemic hyperosmolar state. It is not uncommon to lose fluids in an amount equal to 15% of your body weight. If you have hyperglycemic hyperosmolar state, you will be given normal saline solution for several hours until your fluid volume approaches normal. 

 

Once this is achieved, saline will continue to be given at a reduced level and perhaps a lower concentration. Fluid input and urine output will be carefully monitored. In addition to fluid, several electrolytes will need replenishing. It is most important to replace lost potassium, and this will be given to you throughout the first 24 hours, as long as urine output is sufficient

 

HYPERGLYCEMIC HYPEROSMOLAR STATE PREVENTION

The best way to prevent hyperglycemic hyperosmolar state or any form of hyperglycemia from occurring is to monitor blood glucose levels regularly. If you test your blood glucose once or twice a day, you will be alerted to the problem before it gets out of control. If you notice a high reading, don’t ignore it. 

Talk to the members of your health care team in advance about what action to take if your blood glucose reaches a high level (greater than 250mg/dl). Even if you don’t take insulin on a regular basis, you may need to take it if your blood glucose levels rise too high. If you are ill or have an infection, monitor your blood glucose 3 to 4 times a day. You may also want to monitor more frequently if you are feeling stressed out, either physically or emotionally. 

 

If you do take insulin regularly, don’t skip any doses, even if you are feeling sick and have to force yourself to eat. Also, make sure to drink plenty of fluids and avoid the use of caffeine or alcohol, especially when you are not feeling well. Most importantly, develop a plan of action with the members of your health care team to handle any swings in your blood glucose level.

 

Sources and References

• The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette

 

• Hyperglycemic Hyperosmolar State by Anna Milanesi, Jane Weinreb et al

 

• Diabetic ketoacidosis and hyperglycemic hyperosmolar state by Jelena Maletkovic and Andrew Drexler