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If not promptly treated, it can lead to a heart attack or stroke. In some cases, it can be fatal. It is crucial for people with diabetes to know the symptoms of HHS so they can seek prompt medical attention and treatment. This article discusses what HHS is, its symptoms, treatment, and more. What is HHS Share on PinterestPeter Dazeley/Getty ImagesHHS happens when a person’s blood sugar levels are very high. When a person has HHS, their body will try to lower its blood sugar by passing sugar through the urine. If a person does not drink enough fluids to make up for the fluids they are losing, it can lead to a further spike in blood sugar levels. It also leads to hyperosmolarity, which is when the blood is more concentrated and less hydrated than usual. HHS normally does not involve ketosis. It has also been called:hyperosmolar nonketotic coma (HONK)nonketotic hyperglycemic comahyperglycemic hyperosmolar nonketotic syndrome (HHNS) HHS rarely affects people with type 1 diabetes. Of all HHS cases, 90–95% occur in people with type 2 diabetes. It is more likely to occur in people who have obesity. HHS can happen due to an infection or other illness, such as a heart attack or stroke. It can also be brought on by:taking medications that increase fluid losstaking medications that decrease the effect of insulin in the bodyrunning out of, or not taking, prescribed diabetes medications Symptoms of HHS According to a 2021 article, symptoms of HHS include:increased urinationincreased thirstweaknessmalaise, or a general feeling of illnessfatigue People with HHS may also have symptoms of dehydration, which can include dry mouth, lips, and eyes. People with HHS are often severely dehydrated, which may alter their brain function. This can cause cognitive symptoms, including:drowsinessconfusionhallucinationloss of visioncoma A person with HHS may have other symptoms depending on how they developed it. Often, people develop HHS following an infection or cardiac event. A stroke or heart attack can lead to high stress levels, known as a stress response. This can cause an increase in adrenaline and cortisol, which raises blood sugar levels. If a person develops HHS after an infection, they may have the following additional symptoms:fevergeneral weaknessabnormally rapid breathingtachycardia If a person develops HHS after a cardiac event, they may have the following additional symptoms:chest pain and tightnessheadacheheart palpitations HHS vs DKA Another serious complication of diabetes is diabetic ketoacidosis (DKA). DKA happens when the body starts breaking down fat too quickly. This can lead to a high level of ketones, or acidic substances, in the blood. Although they are two distinct conditions, HHS and DKA have similar symptoms. For example, both conditions present with high blood sugar and frequent urination. According to a 2021 article, over 30% of diabetic patients have features of both conditions. The following chart from the same article highlights some of the differences between HHS and DKA:ConditionPrimarily affectsBlood sugar levelsArterial pH levelsMortality rateDifference in symptomsHHSpeople with type 2 diabetesmore than 600 milligrams per deciliter (mg/dl)more than 7.310–50%• fast heart rate• symptoms present over days or weeksDKApeople with type 1 diabetesmore than 250 mg/dlless than 7.31.2–9%• fruity-smelling breath• high ketone levels in urine• symptoms present within a few hours Causes and risk factors of HHS Illness or infection accounts for the majority of HHS occurrences, causing over 50% of cases. Other factors that may cause HHS include:a cardiac event such as a stroke or heart attackcertain medications that can make a person more prone to dehydration, such as diureticsundiagnosed type 2 diabetesnot managing blood sugar levels appropriately through the use of diet, exercise, and medication Some people may have other factors that raise their risk of developing HHS. Risk factors for developing HHS include:type 2 diabetes dehydrating medications like diuretics, beta-blockers, and certain antipsychoticsmorbid obesitya family history of diabetes HHS and ethnicity HHS affects certain groups of people more than others. These groups include:African AmericansNative AmericansHispanics Research suggests the disproportionately high number of people affected by HHS in these groups may be due to a high prevalence of type 2 diabetes. This could be because they are more likely to experience barriers to methods that could lower their risk of developing it. Learn more about why diabetes is more common in African Americans. Find out more about racial discrimination in healthcare. Diagnosing HHS If a person has HSS, receiving a prompt diagnosis and medical care is crucial. Diagnosis generally happens in an emergency room, where a person will undergo a physical exam and several lab tests. Lab tests to diagnose HHS include testing blood sugar levels, urine, kidney function, and more. A doctor will likely diagnose a person with HHS if they meet the following criteria:blood sugar levels of over 600 mg/dlblood pH levels of 7.3 or highermild metabolic anion-gap acidosis (present in half of patients) Find out more about kidney function tests. Treating HHS Treatment is crucial to a successful outcome for people with HHS. Prompt emergency treatment can remedy HHS quickly. Treatment involves intravenous therapy. This means a healthcare professional will administer medication straight into a person’s vein through an IV drip. Intravenous treatment of HHS involves giving the person:fluids to treat dehydrationinsulin to lower blood sugarelectrolytes to replace those lost through dehydration Throughout treatment, a doctor will monitor a person’s electrolyte levels and heart rhythm. If an infection or another health condition triggers a person’s HHS, a doctor will also treat the underlying condition. Additionally, after treatment ends, a person who has recovered from HHS should discuss their blood sugar management and diabetes treatment plan with a healthcare professional to prevent HHS in the future. What are the possible side effects of HHS treatment Treatment for HHS can lead to side effects. Taking too much insulin and fluid too quickly can cause a person’s blood sugar to drop rapidly. This can lead to cerebral edema. Cerebral edema is a rare complication of HHS that occurs when the brain swells due to rapid rehydration and a drop in blood sugar levels. Other complications from treatment can include acute respiratory distress syndrome. Possible complications HHS can cause serious complications and is fatal in up to 20% of cases. Complications of HHS can include:abnormal electrolyte levelsstrokeheart attackseizurecoma Contacting a doctor HHS is a serious medical emergency. If a person believes they or a loved one may have HHS, they should seek immediate medical attention. Outlook With prompt treatment, a person is likely to recover from HHS. A person’s age and underlying conditions generally affect their outlook. Older adults who are in a coma and have low blood pressure due to HHS have a less favorable outlook than younger adults with easily treatable underlying illnesses. Summary HHS is a medical emergency that is a complication of type 2 diabetes. It often occurs after an illness or other medical event, such as a heart attack. Outcomes are better with prompt, careful treatment. A person with diabetes should work with their care team to manage their blood sugar to prevent HHS and other serious complications of diabetes. Last medically reviewed on May 27, 2022DiabetesType 1Type 2 4 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Adeyinka, A., et al. (2021). Hyperosmolar hyperglycemic nonketotic coma. https://www.ncbi.nlm.nih.gov/books/NBK482142/Gosmanov, A. R., et al. (2021). Hyperglycemic crises: Diabetic ketoacidosis and hyperglycemic hyperosmolar state.https://www.ncbi.nlm.nih.gov/books/NBK279052/Stoner, G. D. (2017). Hyperosmolar hyperglycemic state.https://www.aafp.org/afp/2017/1201/p729.htmlVarela, D., et al. (2018). Overview of cerebral edema during correction of hyperglycemic crises.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5983073/FEEDBACK:Medically reviewed by Kelly Wood, MD — By Jenna Fletcher on May 27, 2022 Latest newsWhat sets 'SuperAgers' apart? Their unusually large neuronsOmega-3 may provide a brain boost for people in midlifeSeasonal affective disorder (SAD): How to beat it this fall and winterCDC: Monkeypox in the US 'unlikely to be eliminated in the near future'Why are more women prone to Alzheimer's? New clues arise Related CoverageWhat is diabetic hypoglycemia?Medically reviewed by Marina Basina, M.D. People with diabetes can experience low blood sugar. Learn more. 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