Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) is a dangerous and life threatening condition caused by extremely high blood glucose levels. HHNS, which is also known as Hyperosmolar Hyperglycemic State (HHS), can affect people suffering from various conditions, including both types of diabetics. However, it is particularly common among people suffering from type 2 diabetes. In most cases, HHNS is caused by an infection or illness.

Major warning signs of HHNS for people with diabetes.

• Elevated blood glucose levels
• Fever
• Warm skin without sweating
• Extreme thirst
• Dry mouth
• Feeling sleepy
• Nausea
• Hallucinations
• Confusion
• Vision Loss
• Weakness on one side of the body

Risk Factors of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)

• Diabetes and other conditions

Infection or periods of illness can raise blood sugar levels significantly, which can lead to Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) if medication does not lower blood sugar levels effectively.

Having blood sugar levels above 600 mg/dL (33 mmol/L) for an extended period of time increases the risk of HHNS occurring.

• Infectious diseases

In kids and young adults with diabetes, HHNS can be caused by infectious diseases or disorders of the genitourinary, respiratory, and circulatory systems. Other factors that have led to a surge in the incidence of HHNS include incessant consumption of beverages that are rich in carbohydrates and obesity.

• Medications

Some medications used for the treatment of other conditions and ailments in elderly people with type 2 diabetes can also trigger HHNS. Examples of such drugs are glucocorticoids, beta-blockers, thiazide diuretics, and some antipsychotics.

• Cardiovascular insult

Cardiovascular insults like myocardial infection, angina pectoris, stroke can trigger the release of counter-regulatory hormones. The body’s stress response can lead to increased blood sugar levels causing dehydration, osmotic diuresis with the result being HHNS.

• Diet

In the United States, the increase of obesity which is attributed to the consumption of carbohydrate-rich foods in high amounts, there’s an increase in the number of people being diagnosed with type 2 diabetes. This trend may lead to an increase in the incidence of HHNS especially in children and young adults.

• Ethnic background

There’s also a disproportionately high prevalence of HHNS among Hispanics, Native Americans, and African Americans. This may be related to the high incidence of type 2 diabetes in these population groups.

• Age

Serious complications of chronic conditions such as HHNS usually present themselves amongst older folks. This is usually attributed to the fact that older people may be less aware of the signs and symptoms of high blood sugar levels and how they should be treated.

Diagnosis

Physical examination and the patient’s history are very critical in the diagnosis of HHNS. This is largely because in most cases there’s an overlap in the symptoms obderved in diabetic ketoacidosis (DKA) and Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS). In the initial diagnosis, the doctor pays particular attention to overconsumption of foods rich in carbohydrates, missed doses of the hypoglycemic agent, the insulin regimen, or use of drugs that can cause dehydration or hypoglycemia.

If HHNS is preceded by an infectious process, signs and symptoms include:

• Malaise
• Tachycardia
• General weakness
• Tachypnea
• Fever

If HHNS is preceded by a vascular or cardiac condition, symptoms include:

• Dizziness
• Headache
• Chest tightness
• Palpitation
• Chest pain

What is the relationship between diabetes and HHNS?

When a person with diabetes develops Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS), blood glucose levels increase significantly and the body gets rid of the excess glucose through the urine. Initially, this causes frequent bathroom trips, and as the condition worsens, the color of urine also changes.

Other symptoms such as dehydration can also occur if the person does not drink liquids regularly. This can lead to other serious complications such as seizures, coma, and even death.

Therefore, when Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) occurs in people in diabetes, the condition is mainly accompanied by profound glycosuria and hyperglycemia without the classic acetone in the urine or kussmaul breathing observed in diabetic ketoacidosis. The condition was formerly known as hyperosmolar non-ketotic coma (HONK), hyperosmolar hyperglycemic non-ketotic syndrome, and non-ketotic hyperglycemic coma.

Type 2 diabetes is mainly associated with hyperglycemia, which occurs as a result of relative or absolute insulin deficiency. The main function of insulin in the body is to regulate the amount of sugar in the blood by promoting glycogenesis (uptake of blood glucose by the skeletal muscle and adipose tissue). Insulin also prevents lipolysis (breakdown of fat). However, this action is countered by other hormones such as catecholamines and glucagon.

Type 2 diabetes accounts for approximately 90% of all diabetes cases and it mostly occurs in people with obesity. As a result of the high body mass index (BMI) and obesity, resistance to the action of insulin occurs in the peripheral tissue.  Although beta cells continue to produce insulin, the amount is usually not enough to counter the effects of the resistance of end organs to its effects.

The mortality rate of Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS) is about 20%, which is 10 times higher than the mortality rate in diabetic ketoacidosis. Prognosis and clinical outcome in HHNS is determined by various factors such as the lack or presence of other comorbidities, age, and the degree of dehydration.

How can people with diabetes avoid HHNS?

If you keep your blood sugar levels within the recommended range, you can avoid HHNS. It’s recommended that people with diabetes check their blood sugar levels regularly and take appropriate action if their readings fall outside the target blood sugar range.

Your doctor or healthcare provider should advise you on the effective blood sugar range and what should be done if a reading falls outside of it.

If your blood sugar levels are high and you’re experiencing the signs and symptom of HHNS (Hyperosmolar Hyperglycemic Nonketotic Syndrome), keep yourself well hydrated and seek immediate medical attention.