Diabetic Hyperosmolar Hyperglycemia

November 12, 2012

Diabetic Hyperosmolar Hyperglycemia

Diabetic hyperosmolar hyperglycemia is a serious complication of diabetes that is commonly seen in older, Type 2 diabetes patients. The condition involves high blood sugar levels without ketones, the byproducts of fat metabolism.

Causes

Hyperosmolar hyperglycemia occurs when the kidneys are unable to remove excess sugars via urine. The increased sugar levels in the blood increase its osmolarity and cause water from organs and tissues to move into the blood. Infections, certain illnesses such as heart disease and stroke, and stopping anti-diabetes medications can cause hyperosmolar hyperglycemia, especially in Type 2 diabetes patients. Other risk factors include kidney failure, old age and low water intake in individuals with dementia. The condition may also occur in individuals who have not been diagnosed with diabetes and in patients who are unable to control their diabetes. Dehydration, excessive thirst and reduced consciousness are the characteristic symptoms of the disease.

Symptoms

Most patients with hyperosmolar hyperglycemia experience frequent urination in the early stages. The urine production, however, decreases with the progression of the disease. In fact, the urine becomes very dark in the later stages. Most patients also experience excessive thirst and should consume large amounts of water to overcome the concentrated sugar levels in the blood. It is important to drink large amounts of water to help the kidneys remove the excessive sugar.

Other hyperosmolar hyperglycemia symptoms include lethargy, weakness, weight loss, confusion, convulsions and coma. Patients may also experience a loss of movement, speech or feeling. The symptoms usually worsen over a period of time. Most experts consider hyperosmolar hyperglycemia as a medical emergency and recommend immediate treatment.

Diagnosis

Apart from the characteristic signs and symptoms, blood and urine analysis in the laboratory may help confirm the diagnosis of hyperosmolar hyperglycemia. High blood glucose, creatinine and sodium levels as well as high serum osmolarity indicate positive diagnosis.

Treatment and Prognosis

The treatment procedures aim to treat the dehydration and lower blood sugar levels. Intravenous administration of fluids and potassium can help improve blood pressure, urine output and circulation. Intravenous administration of insulin can improve sugar metabolism and improve blood glucose levels.

Most patients with hyperosmolar hyperglycemia may also develop other complications including swelling of brain and circulatory collapse. Blood acid levels may increase significantly. They are also at an increased risk of blood clots, which can also lead to heart failure or stroke. The death rate is as high as 40 percent.

The best way to prevent hyperosmolar hyperglycemia is to prevent dehydration and infection in Type 2 diabetes patients.

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