Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition caused by extremely high blood sugar levels. The condition most commonly occurs in people with type 2 diabetes. It's often triggered by illness or infection.
In diabetic hyperosmolar syndrome, your body tries to rid itself of the excess blood sugar by passing it into your urine. Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential.
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Diabetic hyperosmolar syndrome can take days or weeks to develop. Possible signs and symptoms include:
- Blood sugar level of 600 milligrams per deciliter (mg/dL) or 33.3 millimoles per liter (mmol/L) or higher
- Excessive thirst
- Dry mouth
- Increased urination
- Warm, dry skin
- Drowsiness, confusion
- Vision loss
When to see a doctor
Consult your doctor if your blood sugar is persistently higher than the target range your doctor recommends or if you have signs or symptoms of diabetic hyperosmolar syndrome, such as those listed above.
Seek emergency care if:
- Your blood sugar level is 400 mg/dL (22.2 mmol/L) or higher and doesn't improve despite following your doctor's instructions for treatment. Don't wait until your blood sugar is high enough to cause diabetic hyperosmolar syndrome.
- You have confusion, vision changes or other signs of dehydration.
Diabetic hyperosmolar syndrome may be triggered by:
- Illness or infection
- Not following a diabetes treatment plan or having an inadequate treatment plan
- Certain medications, such as water pills (diuretics)
Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome.
Your risk of developing diabetic hyperosmolar syndrome might be higher if you:
- Have type 2 diabetes. If you don't monitor your blood sugar or you don't yet know you have type 2 diabetes, your risk is higher.
- Are older than age 65.
- Have another chronic health condition, such as heart disease or kidney disease.
- Have an infection, such as pneumonia, a urinary tract infection or a virus, which causes blood sugar levels to rise.
- Take certain medications. Some drugs — such as corticosteroids (prednisone), diuretics (hydrochlorothiazide and chlorthalidone) and certain inhalers such as terbutaline.
Diabetic hyperosmolar syndrome can lead to:
- Heart attack
Without prompt treatment, diabetic hyperosmolar syndrome can be fatal.
Good daily control of your diabetes can help you prevent diabetic hyperosmolar syndrome.
- Know the symptoms of high blood sugar. Be alert for the warning symptoms of high blood sugar, as well as the situations that put you at risk of developing hyperosmolar syndrome, such as illness or infections.
- Monitor your blood sugar level. Monitoring will help you stay in your target range and alert you to dangerous highs. Ask your doctor how often you should test your blood sugar. Monitor more often when you're sick.
- When you're sick, drink plenty of liquids. Drink a glass of nonalcoholic, caffeine-free beverage hourly until you can ask your doctor for advice.
- Follow your diabetes management plan. Eat healthy meals, take medications as directed and exercise regularly.
- Educate your loved ones, friends and co-workers. Teach people you spend time with to recognize early signs and symptoms of blood sugar extremes — and to get emergency help if you pass out.
- Wear a medical ID bracelet or necklace. If you're unconscious, the ID can provide valuable information to others, including emergency workers.
- Stay current on vaccinations. Get an annual flu shot and ask your doctor if you need the pneumococcal vaccine, which protects against some forms of pneumonia.
July 25, 2020
- Hirsch IB, et al. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Epidemiology and pathogenesis. https://www.uptodate.com/contents/search. Accessed June 23, 2020.
- Hirsch IB, et al. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis. https://www.uptodate.com/contents/search. Accessed June 23, 2020.
- Walls RM, et al., eds. Diabetes mellitus and disorders of glucose homeostasis. In: Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed June 23, 2020.
- American Diabetes Association. Diabetes care in the hospital. Standards of Medical Care in Diabetes—2020. Diabetes Care 2020; doi:10.2337/dc20-S015.
- Hirsch IB, et al. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Treatment. https://www.uptodate.com/contents/search. Accessed June 23, 2020.
- Goldman L, et al., eds. Diabetes mellitus. In: Goldman-Cecil Medicine. 26th ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed June 23, 2020.
- Hyperglycemia (high blood glucose). American Diabetes Association. https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hyperglycemia. Accessed June 24, 2020.
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Diabetic hyperosmolar syndrome