Hyperosmolar Hyperglycemic
Metabolic Health
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Hyperosmolar Hyperglycemic Syndrome

Hyperosmolar hyperglycemic state is a diabetic metabolic complication characterized by severe hyperglycemia, excessive dehydration, hyperosmolar plasma, and altered consciousness. It most often happens in type 2 diabetes, frequently in the context of physiologic stress. Severe hyperglycemia, plasma hyperosmolality, and the lack of substantial ketosis characterize hyperosmolar hyperglycemia. IV saline solution and insulin are used to treat the individual and this condition can turn fatal. 

What Is Hyperosmolar Hyperglycemic Syndrome?

Hyperosmolar hyperglycemic syndrome is a hazardous illness characterized by dangerously high blood sugar levels. In this condition your body attempts to eliminate excess blood sugar by excreting it through your urine. Hyperglycemic hyperosmolar syndrome may cause life-threatening dehydration if left untreated and can be fatal. People with type 2 diabetes are more likely to develop the illness. It is often brought on by disease or infection, which causes a severe spike in blood sugar levels. It is a fairly uncommon condition and only affects people with type 2 diabetes and studies suggest that genetics and DNA also have a role to play in who gets affected by this condition. It is much less common than other diabetes related health conditions like heart disease, stroke, etc. 

Causes Of Hyperosmolar Hyperglycemic Syndrome

People with diabetes have excess glucose in their bloodstream due to the fact that their body either does not produce enough insulin naturally or are unable to utilize the insulin their body releases. Diabetic hyperosmolar syndrome occurs when a person’s blood sugar remains abnormally high (hyperglycemia) over an extended period of time. The excess sugar is excreted in the urine, causing the individual to urinate more often. As a consequence, he or she loses a significant amount of fluid, which might result in severe dehydration. Diabetic hyperosmolar syndrome affects people with type 2 diabetes and can be caused due to the following reasons :

  • Illness or some sort of infection like UTI. 
  • When a person stops taking their prescribed prescription. 
  • Post heart attack or stroke
  • Taking certain drugs or steroids. 

Symptoms of Hyperosmolar Hyperglycemic Syndrome

The symptoms of hyperosmolar hyperglycemic syndrome normally appear gradually and might last for days or weeks. Among the symptoms are:

  • High blood sugar (more than 600 mg/dL).
  • Confusion, hallucinations, tiredness, or fainting out are all possible symptoms.
  • Dry mouth and severe thirst that may improve with time.
  • Urination is frequent.
  • A fever of more than 100.4 degrees Fahrenheit.
  • Vision blurriness or lack of vision
  • Weakness or paralysis, perhaps on one side of the body.
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Complications That Are Associated With Hyperosmolar Hyperglycemic Syndrome (HHS)

Hyperosmolar hyperglycemic syndrome is a serious condition which when left untreated can have severe health complications and also turn fatal. While this condition can be treated, there are several complications that can occur such as : 

  • Abnormal Electrolyte Levels
  • Stroke
  • Heart Attack
  • Seizure
  • Coma

Diagnosis of Hyperosmolar Hyperglycemic Syndrome

If a person has hyperosmolar hyperglycemic syndrome, it is critical that they get immediate diagnosis and medical attention. A person is usually diagnosed at an emergency department after undergoing a physical exam and various lab tests.

There are various ways to diagnose HHS. Blood sugar levels, urine, renal function, and other lab tests are used to diagnose HHS. Also read about glucose in urine

A doctor will most likely diagnose HHS if the blood sugar levels are more than 600 mg/dl blood and if pH levels are greater than 7.3 moderate metabolic anion-acidosis. Also know about sugar in urine test.

Treatment of Hyperosmolar Hyperglycemic Syndrome

Intravenous therapy is used for treatment. This implies that a healthcare expert will inject drugs directly into a person's vein using an IV drip. In this therapy, the individual is provided with :

  • Fluids to counteract the dehydration.
  • Insulin to reduce blood sugar levels and electrolytes to restore those lost due to dehydration.
  • A doctor will check a person's electrolyte levels and heart rhythm during therapy.
  • A doctor will address the underlying disease if an infection or another health condition causes a person's HHS.

Furthermore, when treatment is completed, a person who has recovered from HHS should consult with a healthcare practitioner about their blood sugar control and diabetes treatment plan in order to avoid experiencing the same condition in the future.

Side Effects of Treatment of Hyperosmolar Hyperglycemic Syndrome

While hyperosmolar hyperglycemic syndrome can be treated, there are chances that the treatment could have some possible side effects. Not every individual that is treated will experience these negative effects. 

Possible Side effects of HHS when treated with Insulin

  • Hypoglycemia
  • Swelling of arms and legs
  • Possible weight gain

Possible Side effects of HHS when treated with IV Fluids

  • Taking too much insulin and liquids at once might produce a fast decrease in blood sugar. 
  • This may result in cerebral edema. Cerebral edema is an uncommon HHS complication that develops when the brain expands as a result of fast rehydration and a decrease in blood sugar levels.
  • Acute respiratory distress syndrome is another treatment-related consequence.

Hyperosmolar hyperglycemic syndrome is not something that should be left untreated or taken lightly, it can prove to be fatal. Immediate emergency care should be given to the individual to avoid worsening of condition and avoiding possible side effects of treatment. 


Diabetic hyperosmolar syndrome occurs when a person's blood sugar (hyperglycemia) stays excessively high for a lengthy period of time. Excess sugar is expelled in the urine, leading the person to urinate more often and lose bodily fluids and electrolytes. The simplest method to prevent hyperosmolar hyperglycemia is to have a healthy lifestyle and stick to a healthy routine in daily life. People with type 2 diabetes are more prone to getting the disease. It is often caused by an illness or infection that produces a significant rise in blood sugar levels. It can be treated by injecting insulin and fluids via IV and may have possible side effects and complications. This condition can turn fatal so immediate medical attention must be given to the individual. 


1. Can Hyperosmolar Hyperglycemic Syndrome (HHS) be prevented?

The easiest method to avoid hyperosmolar hyperglycemic state is to have a healthy lifestyle, follow a routine and keep diabetes in check. 

  • Check your glucose levels on a regular basis to ensure your blood sugar is within the normal range.
  • Never skip your medication or insulin. Always follow the prescription that your doctor has given you.
  • Maintaining a nutritious diet is crucial in managing blood sugar levels. 
  • Never consume alcoholic beverages on an empty stomach.
  • When you're unwell, get extra rest and monitor your blood sugar levels more often.
  • Know the signs of hyperosmolar hyperglycemic state and immediately contact the doctor in case you feel something is wrong. 

2. When should I call my doctor about HHS?

Hyperglycemic hyperosmolar syndrome is an extremely serious medical condition that should not be treated lightly. You should contact your doctor immediately if you have diabetes and experience any of the symptoms:

  • Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher
  • Excessive thirst
  • Dry mouth or dehydration
  • Increased urination
  • Warm, dry skin
  • Fever
  • Drowsiness, confusion
  • Hallucinations
  • Vision loss
  • Convulsions
  • Coma

3. What is the difference between HHS and HHNS?

Hyperosmolar hyperglycemic syndrome and hyperosmolar hyperglycemic nonketotic syndrome are the same thing. This condition is known by many names and HHS and HHNS are different names for the same medical condition. 


This website's content is provided only for educational reasons and is not meant to be a replacement for professional medical advice. Due to individual differences, the reader should contact their physician to decide whether the material is applicable to their case.