Hyperglycemic Hyperosmolar State (HHS)
What is Hyperglycemic Hyperosmolar State (HHS)?
Hyperglycemic hyperosmolar state is a serious diabetes emergency that happens when blood sugar climbs extremely high, often above 600 mg/dL. Your body tries to get rid of the excess sugar through urine, but this process removes massive amounts of water from your body. The result is severe dehydration and dangerously concentrated blood.
HHS occurs almost exclusively in people with type 2 diabetes. Unlike diabetic ketoacidosis, HHS does not produce high levels of ketones, which are acids your body makes when it burns fat for energy. Instead, the main problem is dehydration so severe it can lead to confusion, seizures, or coma. This condition develops slowly over days or weeks, making it different from other diabetes emergencies that happen quickly.
Without immediate medical treatment, HHS can be life threatening. The mortality rate ranges from 10 to 20 percent, making early detection and prevention critical. Understanding your blood sugar patterns and staying hydrated can help you avoid this dangerous condition.
Symptoms
- Extreme thirst that persists even after drinking fluids
- Very dry mouth and cracked lips
- Blood sugar readings above 600 mg/dL
- Confusion, disorientation, or difficulty concentrating
- Excessive urination at first, then reduced urination as dehydration worsens
- Weakness or paralysis on one side of the body
- Vision problems or hallucinations
- Fever without infection
- Drowsiness or difficulty staying awake
- Seizures in severe cases
HHS develops gradually over several days to weeks. Many people do not notice the early warning signs until symptoms become severe. By the time confusion appears, the condition has already reached a dangerous stage and requires emergency medical care.
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Causes and risk factors
HHS typically develops when type 2 diabetes is poorly controlled or undiagnosed. An illness or infection often triggers the condition by raising stress hormones that increase blood sugar. Common triggers include pneumonia, urinary tract infections, heart attacks, and strokes. Some medications also raise blood sugar levels, including steroids and certain diuretics. Older adults are at higher risk because they may not feel thirst as strongly and can become dehydrated more easily.
People who skip their diabetes medications or do not take enough insulin face increased risk. Not drinking enough water during illness makes dehydration worse and accelerates the development of HHS. Those who live alone or have limited access to water are particularly vulnerable. Kidney disease can impair the body's ability to remove excess sugar, making HHS more likely to occur.
How it's diagnosed
Doctors diagnose HHS through blood tests that measure glucose levels, electrolytes, and blood concentration. Blood sugar is typically above 600 mg/dL, and sometimes exceeds 1,000 mg/dL. Urine tests show extremely high glucose levels as your body tries to eliminate excess sugar. Blood osmolality tests reveal how concentrated your blood has become from dehydration. Unlike diabetic ketoacidosis, ketone levels remain low or absent in HHS.
Regular monitoring of blood sugar and urine glucose can help you catch dangerous patterns before HHS develops. Rite Aid offers testing for urine glucose through Quest Diagnostics locations nationwide. Testing twice per year helps you track your diabetes management and identify problems early. If you notice blood sugar consistently above 300 mg/dL or symptoms of severe dehydration, seek emergency medical care immediately.
Treatment options
- Emergency hospitalization for intravenous fluids to reverse severe dehydration
- Insulin therapy to gradually lower blood sugar levels over several hours
- Electrolyte replacement, especially potassium and sodium
- Treatment of any underlying infection or illness that triggered HHS
- Careful monitoring in an intensive care unit until stable
- Diabetes education to prevent future episodes
- Regular blood sugar monitoring at home, checking at least twice daily
- Staying hydrated by drinking water throughout the day
- Taking diabetes medications exactly as prescribed without skipping doses
- Creating a sick day plan with your doctor for managing diabetes during illness
Concerned about Hyperglycemic Hyperosmolar State (HHS)? Get tested at Rite Aid.
- Simple blood draw at your nearest lab
- Results in days, not weeks
- Share results with your doctor
Frequently asked questions
HHS affects mainly people with type 2 diabetes and develops slowly over days to weeks. Diabetic ketoacidosis is more common in type 1 diabetes and develops within hours. HHS causes severe dehydration without high ketone levels, while diabetic ketoacidosis produces dangerous acids called ketones. Both are medical emergencies but require slightly different treatments.
HHS typically develops gradually over several days to weeks, unlike other diabetes emergencies. This slow progression means symptoms may not seem urgent at first. Blood sugar climbs higher each day as dehydration worsens. By the time confusion appears, the condition has already become life threatening and requires immediate hospital care.
Yes, HHS sometimes occurs in people who have undiagnosed type 2 diabetes. In fact, HHS may be the first sign that someone has diabetes. Older adults are especially at risk for this scenario. If you experience extreme thirst, confusion, and excessive urination, seek medical attention even without a diabetes diagnosis.
Blood sugar above 600 mg/dL typically indicates HHS, though levels often exceed 1,000 mg/dL. Normal blood sugar ranges from 70 to 100 mg/dL when fasting. If your blood sugar reading is above 400 mg/dL and you feel unwell, contact your doctor immediately. Do not wait for symptoms to worsen before seeking help.
Aim for at least 8 glasses of water daily, and increase this amount during illness or hot weather. People with diabetes should drink extra fluids when blood sugar is elevated. If you notice increased urination, drink even more water to replace lost fluids. Talk to your doctor about specific fluid goals based on your health conditions.
No, HHS never resolves without medical treatment. This condition requires emergency hospitalization for intravenous fluids and insulin. Trying to treat HHS at home can result in coma or death. If you suspect HHS, call 911 or go to the emergency room immediately.
Yes, physical stress from illness or injury can trigger HHS by raising stress hormones. These hormones tell your liver to release stored sugar, raising blood sugar levels. Emotional stress alone rarely causes HHS but can contribute to poor diabetes management. Always monitor blood sugar more closely during periods of physical illness or stress.
Monitor blood sugar at least twice daily and keep a log of your readings. Take all diabetes medications exactly as prescribed without skipping doses. Stay well hydrated by drinking water throughout the day. Create a sick day plan with your doctor that includes when to check blood sugar more often and when to seek emergency care.
Steroids like prednisone can raise blood sugar significantly. Some diuretics, or water pills, increase urination and dehydration risk. Certain antipsychotic medications also elevate blood sugar. Always tell your doctor about all medications you take so they can adjust your diabetes treatment plan if needed.
Both conditions are medical emergencies, but HHS has a higher mortality rate at 10 to 20 percent. Low blood sugar can cause immediate loss of consciousness but responds quickly to treatment. HHS develops slowly and causes multi organ stress from severe dehydration. Both require immediate medical attention, but HHS typically needs longer hospitalization and intensive care.