Hyperglycemic Hyperosmolar Nonketotic Syndrome

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Female nurse with male patient in hospital

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a long name that describes a potentially deadly condition that can develop in people with diabetes. Some also refer to this as a “diabetic coma.” Here are the most frequently asked questions about HHNS and how to prevent it.

What Is HHNS?

HHNS can occur when glucose levels go very high (typically above 600 mg/dl) and the person becomes severely dehydrated. When blood glucose levels get that high, the blood becomes thicker and more urine is produced as a way for the body to try and lower the glucose level. The result is frequent urination, which can result in serious or even life-threatening dehydration. If these fluids are not adequately replenished, the condition can eventually result in a coma or even death.

HHNS is typically brought on either by an infection, such as pneumonia or a urinary tract infection, or poor management of your blood sugar.

What Are the Symptoms of HHNS?

In addition to frequent urination and blood glucose levels over 600 mg/dl, common symptoms include:

  • extreme thirst
  • confusion
  • fever (usually over 101 degrees Fahrenheit)
  • weakness or paralysis on one side of the body

What Are the Risk Factors for HHNS?

Most people who experience HHNS are older adults with type 2 diabetes. But those with type 1 diabetes and the young can experience HHNS as well, although it is less common.

You are also at increased risk if you do not take your diabetes medications as prescribed or have another chronic condition, such as congestive heart failure or kidney disease.

How Is HHNS Different From Diabetic Ketoacidosis (DKA)?

DKA is also a serious condition and potentially life-threatening if not treated promptly. In contrast to HHNS, DKA is almost exclusively a condition that occurs in people with type 1 diabetes. A lack of insulin causes a build-up of glucose in the blood that cannot get into the cells of the body to be used for energy. The body compensates by looking for an alternative energy source in stored fat. When stored fat is used for energy it creates a toxic waste product called ketones, which can poison the body.

The symptoms of DKA are different from HHNS, and include:

  • breath that has a fruity odor
  • labored breathing
  • nausea and vomiting
  • a rapid and weak pulse
  • abdominal pain

In addition, HHNS does not produce ketones.

How Is HHNS?

Treatment typically involves starting intravenous fluids to rehydrate the body quickly. It may also require insulin to bring down the blood sugar levels.

How Can HHNS Be Prevented?

The best way to prevent this serious condition is to manage your diabetes by:

  • Checking your blood sugar according to your doctor’s instructions. When you are sick, you should check your blood about every four hours. Your blood sugar tends to be naturally higher when your body if fighting a virus or infection.
  • Taking your diabetes medications, including insulin, as directed by your doctor
  • Drinking an ample amount of fluid each day, especially when you are ill
  • Staying in contact with your diabetes healthcare team when your blood sugar is consistently above 300 mg/dl.

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