Hyperglycemic Hyperosmolar States (HHS)

HHS is a life-threatening emergency associated with very high blood sugars (greater than 600 mg/dl), that occurs in people with type 2 diabetes, mostly elderly people.

The dangerous chain of events that causes HHS

  • Starts with high sugars that lead to excessive urination and dehydration.
  • The dehydration is due to loss of excess water with high amount of sugar in urine.
  • The imbalance causes the blood to become more concentrated and the blood sugar to rise even more.
  • The higher the blood sugar the more the body tries to dispose of the excess sugar in the urine, which just worsens the dehydration.
  • Ultimately the person has very high blood sugars and is very dehydrated and is confused or in a coma (unconscious).

Signs and symptoms of HHS include:

  • Urination may be frequent at first, but then decrease.
  • Severe dehydration.
  • You may become very thirsty.
  • Your urine will become very dark.

Warning signs and symptoms of HHS include:

  • a blood sugar level of over 600 mg/dl,
  • a dry thirsty mouth,
  • extreme thirst that may gradually disappear,
  • warm dry skin that does not sweat,
  • fever over 101° Fahrenheit,
  • sleepiness or confusion,
  • vision loss,
  • seeing or hearing things that are not there, weakness on one side of the body.

You can prevent HHS by

  • Checking your blood glucose levels regularly.
  • Drink plenty of liquids to remain hydrated.


  • HHS is a life-threatening medical emergency requiring hospitalization.
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