Diabetes info from HHS: Signs, tests, remedies, and additional details
Hyperglycemic Hyperosmolar Syndrome (HHS): A Potentially Life-Threatening Complication of Type 2 Diabetes
Hyperglycemic Hyperosmolar Syndrome (HHS), also known as hyperosmolar nonketotic coma (HONK), nonketotic hyperglycemic coma, and hyperglycemic hyperosmolar nonketotic syndrome (HHNS), is a serious complication predominantly affecting people with Type 2 diabetes. This condition is characterized by extremely high blood glucose levels, severe dehydration, and increased blood osmolarity, often triggered by an underlying illness or reduced fluid intake.
Causes
HHS occurs mainly due to a combination of insulin deficiency and insulin resistance, which impairs glucose metabolism and leads to markedly elevated blood glucose levels. Common precipitating factors include infections, stroke or other neurological events, heart attack, kidney failure, reduced fluid intake leading to dehydration, and other systemic illnesses causing physiological stress.
Symptoms
HHS typically develops gradually over days to weeks and presents with extremely high blood glucose (often >600 mg/dL or 33.3 mmol/L), severe dehydration (dry mouth, extreme thirst, decreased urination), warm, dry skin due to volume depletion, altered mental status ranging from confusion to coma, weakness or lethargy, and possible seizures or other neurological symptoms due to high osmolarity. Unlike Diabetic Ketoacidosis (DKA), HHS usually does not involve significant ketone production or acidosis.
Treatment
Management of HHS is a medical emergency and includes correcting dehydration with intravenous fluids (usually isotonic saline), which also helps reduce blood glucose by improving renal perfusion. Insulin therapy via continuous infusion is used to lower blood glucose levels carefully, often less insulin is needed than in DKA because rehydration alone reduces glucose. Monitoring and correction of electrolyte imbalances, especially potassium, is crucial as insulin administration and fluid shifts can cause hypokalemia. Identification and treatment of any underlying precipitating causes are essential, and close monitoring of vital signs, blood glucose, electrolytes, and urine output throughout treatment is necessary.
Prevention
It is crucial for a person with diabetes to work with their care team to manage their blood sugar to prevent HHS and other serious complications of diabetes. Risk factors for developing HHS include type 2 diabetes, dehydrating medications, morbid obesity, and a family history of diabetes.
Diagnosis
A person is diagnosed with HHS if they have blood sugar levels over 600 mg/dl, blood pH levels of 7.3 or higher, and mild metabolic anion-gap acidosis (present in half of patients). Illness or infection accounts for the majority of HHS occurrences. HHS can be caused by an infection, other illness, certain medications, or not managing blood sugar levels appropriately.
If a person develops HHS after a cardiac event, they may have additional symptoms like chest pain, headache, and heart palpitations. A stroke or heart attack can lead to HHS. HHS can cause serious complications, including abnormal electrolyte levels, stroke, heart attack, seizure, and coma. With prompt treatment, a person is likely to recover from HHS, but older adults who are in a coma and have low blood pressure due to HHS have a worse prognosis compared to younger adults with easily treatable underlying illnesses.
In summary, HHS in Type 2 diabetes results from insufficient insulin action plus stressors causing extreme hyperglycemia and dehydration, manifests with profound fluid loss and altered consciousness, and requires prompt IV fluids, insulin, electrolyte management, and treatment of underlying causes to prevent serious complications including coma and death.
- The extreme high blood glucose levels found in Hyperglycemic Hyperosmolar Syndrome (HHS) are a result of insulin deficiency and resistance, common medical-conditions in Type 2 Diabetes.
- Chronic diseases like Type-2 Diabetes increase the risk of developing complications such as HHS, which is characterized by high blood glucose levels, severe dehydration, and increased blood osmolarity.
- Science has uncovered that HHS is often precipitated by underlying illnesses, reduced fluid intake, or other systemic illnesses causing physiological stress, particularly in individuals with Type-2 Diabetes.
- Effective management of HHS involves addressing both dehydration with intravenous fluids and insulin deficiency with insulin therapy, emphasizing the importance of understanding and managing chronic diseases like Type-2 Diabetes for overall health-and-wellness.
