Hyperosmolar Hyperglycemic State 

Last updated on January 31st, 2022

Patients with diabetes mellitus tend to have high blood sugar levels due to the malfunction of a hormone called insulin, a substance that generally tells the body to take glucose from the blood for storage. Diabetic patients either have insulin resistance, as in type 2 diabetes mellitus or have decreased insulin produced by the pancreas, as in type 1. Without the action of insulin, the blood sugar rises. This ultimately results in increased urination, leading to dehydration.

Symptoms experienced by patients in a hyperosmolar hyperglycemic state may vary. They usually have a history of increased urination, increased thirst, and poor appetite. With a further rise in blood sugar, they could be confused and eventually pass out. Fainting, dizziness, and rapid heart rate are other possible symptoms.

Also Read: HbA1c Test For Diabetes

The State of Hyperosmolar Hyperglycemia

Summary

The state of hyperosmolar hyperglycemia occurs mainly in people with type 2 diabetes. This condition is characterized by hyperglycemia, often greater than 30 mmol / L, and severe dehydration.

In hyperglycemia, the accumulation of glucose in the blood increases the frequency and volume of urine. This can cause excessive water loss and cause severe dehydration. A drop in blood pressure may ensue, leading to altered consciousness and possibly coma if no medical intervention is taken.

The lack of insulin is the cause. However, unlike diabetic ketoacidosis, there is usually no significant accumulation of ketones in the blood or urine since insulin is not absent.

The symptoms are mainly hyperglycemia, such as frequent and abundant urine, intense thirst and significant fatigue, and signs of dehydration such as dry mouth, hollow eyes, less elastic skin, etc.

People with impaired kidney function are more likely to experience episodes of the hyperglycemic hyperosmolar syndrome because the kidney is less efficient at eliminating excess glucose from the blood during hyperglycemia.

The elderly, who feel less thirsty, are also at greater risk.

Also Read: Homeopathic Medicine For Diabetes

When to Consult Urgently?

See a doctor without delay if one or more of the following occurs:

• No fluids are tolerated due to vomiting or diarrhea;
• There is a variation in the person’s state of consciousness, such as confusion, agitation, lack of reaction to stimulation, hallucinations or unusual behavior;
• There are signs of dehydration: dry mouth, sunken eyes, less elastic skin, etc;
• Body temperature has been above 38.5 ° C for more than 48 hours.

In people with type 1 diabetes:

Blood glucose level is steeper than 14 mmol / L, and there is the presence of ketone bodies:

• In urine: “medium” to “strong” level (value above four mmol / L)
• In the blood: value above 1.5 mmol / L

Blood sugar is above 20 mmol / L with nausea, vomiting and abdominal pain

In people with type 2 diabetes:

Blood sugar is above 25 mmol / L with excessive drowsiness.

Prevent Hyperglycemic Emergencies

Summary

In addition to essential tips for preventing high blood sugar, the following recommendations can help you avoid a high blood sugar emergency.

For the person with type 1 diabetes:

• Check for ketones in blood or urine when blood sugar is above 14mmol / L or on sick days.
• Measure blood sugar more frequently and follow the protocol established by your healthcare team on sick days.
• Hydrate adequately if blood sugar is above 14 mmol / L.

For the person with type 2 diabetes:

• Measure blood sugar more frequently and follow your healthcare team’s recommendations on sick days.
• Hydrate adequately (250 ml of water every hour) if blood sugar is above 14 mmol / L.

Another important aspect of treating the hyperglycemic hyperosmolar condition is determining why blood sugar is high. Often, an infection such as pneumonia or urinary tract infection could trigger the chain of events leading to SHH. In other cases, heart attacks or strokes can lead to developing this disease.

Also Read: Blood Sugar Range

What are the Causes of Hyperglycemic Hyperosmolar State?

Summary

Hyperglycemic Hyperosmolar State is caused by very high blood sugar, usually in people with type 2 diabetes. EHH does not typically occur in people with type 1 diabetes. Instead, they may have diabetic ketoacidosis. Extremely high blood sugar levels make you urinate a lot more than usual. This leads to severe dehydration and a higher concentration of your blood.

You are more at risk of developing HHE if you have type 2 diabetes and if:

• You are old
• You stop taking your diabetes medicine
• You have an infection or other type of stress on the body, such as a heart attack, stroke or surgery.
• You don’t drink enough fluids or tend not to feel thirsty
• You have kidney problems
• You are taking certain medicines, such as corticosteroids and diuretics.

Treatment for Hyperglycaemic Hyperosmolar

Summary

The diagnosis of an hhs hyperglycemia hyperosmolar condition is usually made by incorporating data collected from the patient’s symptoms, physical examination, and laboratory studies. Patients often appear dehydrated on physical examination and have dry mouth and skin. Laboratory results show significantly elevated blood sugar, ranging from 600 to 1200 milligrams per deciliter. They also have an increase in sodium in the blood and an increase in osmolality in the serum, a value that describes the number of substances dissolved in the blood at any given time. Patients may also have reduced kidney function due to the decrease in fluid volume in the body.

Treatment for hyperosmolar hyperglycemia involves giving the patient intravenous fluid and administering insulin. Typically, patients are given 33.8-101.5 ounces (1-3 liters) of fluid over a few hours and then provided additional fluid intravenously at a slower rate for a few days. Patients are also given an insulin infusion immediately, who usually receive a hefty dose of insulin followed by a smaller continuous hourly dose of insulin.

Also Read: Ayurvedic Remedies For High Blood Sugar

FAQs:

References:

• https://www.mayoclinic.org/diseases-conditions/diabetic-hyperosmolar-syndrome/symptoms-causes/syc-20371501
• https://medlineplus.gov/ency/article/000304.htm
• https://care.diabetesjournals.org/content/37/11/3124

Last Updated on January 31, 2022 by Dr. Damanjit Duggal