Clinically reviewed by K Stanley, CDCES, RDN, LD, MSEd, BCADM, MLDE, Diabetes Educator

What Is Hyperosmolar Hyperglycemic State (HHS)?

Hyperosmolar hyperglycemic state (HHS) is a potentially life-threatening condition that occurs when blood sugar levels are too high over time. The condition is a complication associated with diabetes, most commonly type 2 diabetes. HHS can lead to severe dehydration and confusion and may be life-threatening if left untreated. It requires immediate medical attention.

Risk Factors

HHS tends to affect people with type 2 diabetes especially if blood sugar is not managed. If diabetes is managed well, the risk for HHS is low.

Risk factors include:

• Type 2 Diabetes
• Poorly managed diabetes
• Being 65 years or older
• Having certain illnesses or medical conditions (heart condition, illness such as a virus or infection, or dehydration)
• Medications that cause dehydration

Symptoms

Symptoms of HHS appear gradually and may take days to weeks to develop. Common symptoms include:

• Extremely high blood sugar levels (over 600 mg/dL or 33 mmol/L)
• Dry mouth, excessive thirst, and frequent urination leading to dehydration and weight loss
• Mental status changes including confusion, delirium, or hallucinations 
• Altered mental status or loss of consciousness
• Neurologic changes including blurry vision, headaches, focal seizures, muscle weakness, myoclonic jerking, or reversible paralysis
• Motor abnormalities including depressed reflexes, tremors, muscle twitches
• of blood including increased risk of blood clot

Additional symptoms include:

• Tachycardia (elevated heart rate)
• Hypotension (low blood pressure)
• Tachypnea (rapid or shallow breathing)
• Hyperthermia, (elevated body temperature) if illness is present

If you or someone you know are experiencing these symptoms, please seek emergency care immediately.

Note: HHS has similar symptoms as Diabetic Ketoacidosis (DKA), however with HHS, the individual does not typically have ketones present in the urine or blood on laboratory studies.

Complications

If HHS is left untreated or not treated in time, it can lead to other health complications.

Complications may include:

• Seizures
• Coma
• Organ failure
• Death

If you are experiencing symptoms of HHS, seek medical help immediately.

Treatment

In treating HHS, it is critical to determine any underlying medical condition or illness. There are four main approaches for treating HHS:

• Intravenous rehydration (IV for fluids)
• Electrolyte management
• Intravenous insulin
• Diagnosis and management of any underlying medical condition or illness

It is likely that you will have to stay overnight in the hospital while doctors monitor your status and watch for any complications.

Prevention

There are several effective ways to prevent HHS from occurring. But the two primary categories of prevention include managing your diabetes and maintaining a healthy lifestyle.

This includes:

• Regularly monitoring blood sugar levels
• Insulin management
• Medication management
• Meeting regularly with your diabetes doctor, especially if you have concerns
• Determining what diet is most beneficial for managing your diabetes
• Getting appropriate rest
• Monitoring your blood sugar more frequently when sick
• Seeking help immediately if you are having symptoms of HHS

When to Seek Medical Attention for HHS

If you or someone you know is experiencing symptoms of HHS, seek medical help immediately. If you are concerned about your diabetes management or symptoms you are experiencing, you can schedule an appointment to see a Baptist Health doctor today!