- Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher.
- Excessive thirst.
- Dry mouth.
- Increased urination.
- Warm, dry skin.
- Fever.
- Drowsiness, confusion.
- Hallucinations.
What is the difference between HHS and HHNS?
Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), also known as Hyperosmolar Hyperglycaemic State (HHS) is a dangerous condition resulting from very high blood glucose levels. HHNS
can affect both types of diabetics
, yet it usually occurs amongst people with type 2 diabetes.
What are the symptoms of HHNS?
- High blood sugar level (over 600 mg/dL).
- Confusion, hallucinations, drowsiness or passing out.
- Dry mouth and extreme thirst that may eventually get better.
- Frequent urination.
- Fever over 100.4 degrees Fahrenheit.
- Blurred vision or loss of vision.
How do you treat HHS?
Treatment of HHS
Treatment is
0.9% (isotonic) saline solution
at a rate of 15 to 20 mL/kg/hour, for the first few hours. After that, the corrected sodium should be calculated. If the corrected sodium is < 135 mEq/L (< 135 mmol/L), then isotonic saline should be continued at a rate of 250 to 500 mL/hour.
Can Type 1 diabetics get HHS?
Hyperglycemic hyperosmolar state (HHS) is characterized by severe
hyperglycemia
and hyperosmolality without significant ketosis and acidosis. The discrimination between HHS of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) in initial presentation is difficult.
Which is worse DKA or HHS?
Hyperosmolar hyperglycemic state (
HHS
) is one of two serious metabolic derangements that occur in patients with diabetes mellitus (DM). It is a life-threatening emergency that, although less common than its counterpart, diabetic ketoacidosis (DKA), has a much higher mortality rate, reaching up to 5-10%.
Why are there no ketones in HHS?
Compared to DKA, the production of ketone bodies is scant in HHS. As
a result of the deficiency of insulin
, there is increase lipolysis that causes an increased release of the fatty acid as an alternative energy substrate for the peripheral tissues.
How can HHS be prevented?
- Know the early warning signs of HHS, and don’t ignore them.
- Check your blood sugar levels regularly, especially when you feel sick.
- Take your prescribed medications regularly and consistently.
- Maintain a healthy diet as recommended by your doctor.
- Exercise regularly.
Why is HHS worse than DKA?
Patients with HHS have been reported to have
higher insulin concentration
(demonstrated by basal and stimulated C-peptide levels),12 and reduced concentrations of FFA, cortisol, growth hormone, and glucagon compared to patients with DKA.
What does hyperosmolar mean?
The loss of water also makes the blood more concentrated than normal. This is called hyperosmolarity. It is
a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances
. This draws the water out of the body’s other organs, including the brain.
How is hyperosmolar treated?
Treatment typically includes:
Fluids given through a vein (intravenously) to treat dehydration
.
Insulin given
through a vein (intravenously) to lower your blood sugar levels. Potassium and sometimes sodium phosphate replacement given through a vein (intravenously) to help your cells function correctly.
What are the causes of HHS?
- Have an illness or infection, such as pneumonia or a urinary tract infection.
- Stop taking medication to manage their diabetes.
- Have a heart attack or stroke.
- Take certain medications—such as steroids or diuretics—that can cause the syndrome.
How do you detect hyperosmolar state?
Hyperosmolar hyperglycemic state is diagnosed by
blood tests
that show very high levels of glucose and very concentrated blood. Treatment is intravenous fluids and insulin.
Is diabetic ketoacidosis Type 1 or 2?
DKA is
most common among people with type 1 diabetes
. People with type 2 diabetes can also develop DKA. DKA develops when your body doesn’t have enough insulin to allow blood sugar into your cells for use as energy. Instead, your liver breaks down fat for fuel, a process that produces acids called ketones.
What is the major difference between diabetic ketoacidosis and hyperglycemic hyperosmolar state?
DKA is characterized by ketoacidosis and
hyperglycemia
, while HHS usually has more severe hyperglycemia but no ketoacidosis (table 1). Each represents an extreme in the spectrum of hyperglycemia. The precipitating factors, clinical features, evaluation, and diagnosis of DKA and HHS in adults will be reviewed here.
Why is DKA more common in type 1?
DKA is most prevalent in type 1 diabetes
when blood glucose is too high and can arise from a lack of insulin
. Although rare, DKA is possible in type 2 diabetes if ketones are too high. Being ill while on a low-carb diet may also increase your risk for DKA.
