What should you know about HHS in type 2 diabetes?

Hyperosmolar hyperglycaemic state, or HHS, happens when blood glucose becomes extremely high and the body loses substantial fluid through increased urination. The blood becomes more concentrated, and dehydration can affect the brain. Confusion, drowsiness, weakness, intense thirst, dry mouth, and frequent urination may develop over hours or days.

Infection, missed diabetes treatment, a new illness, reduced fluid intake, heart problems, kidney disease, or medicines such as steroids can contribute. HHS is different from ordinary day-to-day high glucose and can occur without the typical ketone pattern of diabetic ketoacidosis. A diagnosis requires urgent clinical assessment and blood testing.

Treat suspected HHS as an emergency. Call emergency services or go to the nearest emergency department, especially if the person is confused, very sleepy, unable to drink, vomiting, or becoming weaker. Do not leave them alone or ask them to drive. Bring their diabetes medicines and glucose readings if this does not delay help.

Hospital treatment usually replaces fluid and corrects glucose and mineral disturbances while clinicians look for a trigger such as infection. Do not take extra diabetes medicine unless a healthcare professional gives specific instructions.

Seek emergency help for confusion, reduced alertness, fainting, seizures, severe weakness, breathing difficulty, repeated vomiting, or inability to keep fluids down. High glucose with signs of dehydration, fever, a new infection, or rapidly worsening illness also needs urgent assessment. A glucose reading alone cannot safely rule HHS in or out.

Ask how to manage diabetes during fever, vomiting, poor appetite, or reduced drinking; when to check glucose and ketones; and which medicines need special sick-day instructions. Ask for a written emergency plan and advice on preventing dehydration.