Hyperosmolar Hyperglycemic State (HHS): Care Instructions

Hyperosmolar hyperglycemic state (HHS) is a serious problem that can happen when you have diabetes. HHS can happen if your blood sugar (glucose) gets very high. This is usually blood sugar levels of 600 milligrams per deciliter (mg/dL) or more.

When your blood sugar is very high, your kidneys try to get rid of the extra sugar through your urine. This can cause you to lose a lot of fluid. If you can't drink enough to replace the fluid you lost, you can become very dehydrated. Your blood also becomes more concentrated. This means your blood has lower levels of water and higher levels of things like sugar and salt than normal.

Things that raise your blood sugar and lead to severe fluid loss can cause HHS. For example, HHS can happen if you do not take your insulin or other diabetes medicines as prescribed. Being very sick or taking certain medicines can also cause it. Anyone with diabetes can get HHS. But it is more common in people with type 2 diabetes.

HHS can be dangerous. It needs to be treated right away. Without treatment, it can lead to a coma or death. HHS is treated in the hospital with intravenous (I.V.) fluids and insulin. If another health problem is causing HHS, like an infection, that will be treated too.

• Take your insulin and other diabetes medicines on time and in the right dose.
• Test your blood sugar as often as your doctor advises. Use a continuous glucose monitor (CGM), if possible. If you know your blood sugar is high, treat it before it gets worse.
• If you have an infection, make sure to take the full course of antibiotics if your doctor prescribed them.
• Wear or carry medical ID for emergencies when you can’t speak for yourself. Also, teach others at work and at home how to check your blood sugar in case you can’t.
• Talk to your doctor about when you can start to exercise again.
• Follow your meal plan. Also, drink plenty of water to help prevent dehydration.
• Get enough sleep. Try to get 7 to 9 hours of sleep each night. Going to bed at the same time and keeping your room quiet and dark can help.
• Don’t smoke, vape, or use other tobacco or nicotine products. If you need help quitting, talk to your doctor about quit programs and medicines. These can improve your chances of quitting for good.
• Find healthy ways to manage stress. Deep breathing or meditation may help. Also consider going to counseling or joining a support group.
• Work with your doctor to create a sick-day plan. When you’re sick, follow your plan for taking your medicines, checking your blood sugar, drinking extra fluids, and eating.