Definition

Diabetes is a metabolic disorder that causes high levels of glucose in the blood. Glucose, derived from food and beverages, is essential for energy. The hormone insulin helps transport glucose into the cells. 

Diabetes can be categorized into two types, they are type 1 and type 2. Type 1, where the body cannot produce insulin, and Type 2, where the body either does not make enough insulin or cannot use it effectively. Without sufficient insulin, glucose remains in the bloodstream, leading to elevated blood sugar levels.

A severe complication of diabetes is hyperglycemic hyperosmolar syndrome (HHS), which typically occurs in individuals with Type 2 diabetes, particularly those who are obese. Obesity and a high body mass index (BMI) can contribute to insulin resistance. 

HHS is a life-threatening condition marked by extremely high blood sugar without the presence of ketones, leading to severe dehydration and mental confusion. Immediate treatment is critical, as untreated HHS can be fatal.

Causes

Hyperosmolar hyperglycemia results from exceedingly high blood sugar levels, which cause severe dehydration and affect mental status. Proper diabetes management can lower the risk of developing HHS. 

However, several conditions may trigger hyperosmolar hyperglycemia in individuals with poorly managed diabetes. Some triggers include:

• Stopping diabetes medication

Discontinuing diabetes medication without medical guidance can lead to dangerously high blood sugar, precipitating hyperosmolar hyperglycemia.

• Certain medications

Drug classes such as corticosteroids, thiazide diuretics, and atypical neuroleptics can disrupt carbohydrate metabolism, potentially triggering HHS.

• Cardiovascular disorders

Sudden cardiovascular events like stroke, pulmonary embolism, or heart attack can release stress hormones that contribute to hyperosmolar hyperglycemia.

• Infections

Infections like pneumonia, urinary tract infections, and sepsis can also trigger this condition.

When blood sugar levels rise, the kidneys work to eliminate excess sugar through urination, which can lead to dehydration. Over time, prolonged high blood sugar causes blood to become more concentrated and thicker than normal, a condition known as hyperosmolarity.

Risk Factors

Hyperosmolar hyperglycemia primarily affects individuals with diabetes, particularly those with type 2 diabetes. Several factors can increase the risk of developing this condition:

• Poor diabetes management
• Being 65 years of age or older
• Having other health conditions, such as infections or heart disease

Symptoms

The symptoms of hyperosmolar hyperglycemia develop gradually over a period of several days to weeks. Common symptoms include:

• Extremely high blood sugar (above 600 mg/dL or 33 mmol/L)
• Mental changes such as confusion, reduced consciousness, delirium, or hallucinations
• Loss of consciousness
• Dry mouth or intense thirst (polydipsia)
• Frequent urination
• Blurred or lost vision
• Weakness or paralysis, often worsening on one side of the body

Diagnosis

In a hospital setting, the doctor will conduct a physical exam and review the symptoms you’ve been experiencing. A patient’s diabetes history is essential. The doctor may also perform blood tests, such as a comprehensive metabolic panel, to assess blood sugar and other relevant factors. If blood sugar is over 600 mg/dL (33 mmol/L) with low ketone levels, this indicates hyperosmolar hyperglycemia.

Management

For treating hyperosmolar hyperglycemia, the doctor will typically administer intravenous (IV) therapy, including:

• Fluids to rehydrate the body
• Electrolytes (like potassium) to restore the balance of minerals
• Insulin to regulate blood sugar levels

The underlying cause of hyperosmolar hyperglycemia, such as infections or other triggering conditions, will also be treated. You may need to stay in the hospital overnight to be monitored for complications by a healthcare team.

Complications

Untreated hyperosmolar hyperglycemia can result in serious complications, including seizures, coma, heart failure, and death. Approximately 10-20% of hyperosmolar hyperglycemic cases result in fatality. During treatment, complications can arise if blood sugar levels drop too rapidly.

If your blood sugar drops too quickly it can lead to changes in brain fluid and potentially cause cerebral edema (brain swelling). Such complications are rare with proper treatment.

Prevention

The best way to prevent hyperosmolar hyperglycemia is through proper diabetes management and a healthy lifestyle. Key preventive measures include:

• Regularly checking blood sugar levels to ensure they remain within your target range
• Taking prescribed medications and using insulin as directed by your doctor
• Visiting your doctor regularly for diabetes management, especially if you face challenges in controlling your condition
• Following a diet suitable for your health needs
• Ensuring you get sufficient rest and monitoring your blood sugar more frequently when ill
• Being aware of the symptoms of hyperosmolar hyperglycemia and seeking immediate medical help if they occur

When to See a Doctor?

Hyperosmolar hyperglycemia is a serious condition that requires urgent medical attention. If you have diabetes, call 911 immediately if you:

• Have blood sugar levels exceeding 600 mg/dL
• Experience confusion or disorientation
• Notice changes in your vision
• Feel weakness or paralysis in any part of your body

If you've previously had hyperosmolar hyperglycemia, discuss ongoing management with your doctor after returning home from the hospital. You can reduce the risk of recurrence by carefully managing your diabetes, diet, and lifestyle.

Looking for more information about other diseases? Click here!