March 24, 2015

Hyperglycemic Hyperosmolar Nonketotic Syndrome – Part 1

Hyperosmolar Hyperglycemic Nonketotic Syndrome, or HHNS, is a serious condition most frequently seen in older persons. HHNS can happen to people with either type 1 or type 2 diabetes that is not being controlled properly; however, it occurs more often in people with type 2.

It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by:
  • Infection
  • Other illness, such as heart attack or stroke
  • Medicines that decrease the effect of insulin in the body
  • Medicines or conditions that increase fluid loss
In HHNS, blood sugar levels rise, and your body tries to get rid of the excess sugar by passing it into your urine. You will make lots of urine at first, and you will have to go to the bathroom more often. Later you may not have to go to the bathroom as often, and your urine becomes very dark. Also, you may become very thirsty. Remember, even if you are not thirsty, you need to drink plenty of liquids. If you don't drink enough liquids at this point, you will become dehydrated.

If HHNS continues, the severe dehydration will lead to seizures, coma, and eventually death. HHNS may take days or even weeks to develop. Learn the warning signs of HHNS.
  • Blood sugar level over 600 mg/dl (33.3 mmol/L) or higher
  • Dry, parched mouth
  • Extreme thirst (although this may gradually disappear)
  • Warm, dry skin that does not sweat
  • High fever (over 101 degrees Fahrenheit, for example)
  • Sleepiness or confusion
  • Loss of vision
  • Hallucinations (seeing or hearing things that are not there)
  • Weakness on one side of the body
If you have any of these symptoms, call or have someone call your doctor immediately. HHNS requires immediate medical attention..

Risk factors include:
  • A stressful event such as infection, heart attack, stroke, or recent surgery
  • Congestive heart failure
  • Impaired thirst
  • Limited access to water (especially in patients with dementia or who are bedbound)
  • Older age
  • Poor kidney function
  • Poor management of diabetes -- not following the treatment plan as directed
  • Stopping insulin or other medications that lower glucose levels
HHNS only occurs when diabetes is uncontrolled. The best way to avoid HHNS is to check your blood glucose regularly. Many people check their blood sugar several times a day, such as before or after meals. Talk with your health care team about when to check and what the numbers mean. Learn self-monitoring of blood glucose (SMBG) and what the blood glucose readings mean when matched to a food log and other logs. Learn to keep your blood glucose levels as near to normal as possible and do not let them exceed 140 mg/dl (6.3 mmol/L). When your blood glucose levels consistently exceed this, or you are having too many episodes of hypoglycemia (lows) you should talk to your doctor. When you are sick, you should check your blood glucose more often, and drink a glass of water every hour. Work with your doctor to develop your own sick day plan.

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