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Diabetic hyperosmolar syndrome
By Mayo Clinic staffOriginal Article: http://www.mayoclinic.com/health/diabetic-hyperosmolar-syndrome/DS00664
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Definition
Diabetic hyperosmolar (hi-pur-oz-MOE-lur) syndrome is a serious condition that develops when your blood sugar level tops 600 milligrams per deciliter (mg/dL), or 33 millimoles per liter (mmol/L). When your blood sugar gets this high, your blood becomes thick and syrupy, causing diabetic hyperosmolar syndrome. Excess sugar passes from your blood into your urine, triggering a filtering process that draws tremendous amounts of fluid from your body.
Diabetic hyperosmolar syndrome usually affects people with type 2 diabetes, and may develop in people who haven't yet been diagnosed with diabetes. Other factors that increase your risk of diabetic hyperosmolar syndrome include illness and poor diabetes management.
Left untreated, diabetic hyperosmolar syndrome can lead to life-threatening dehydration. Prompt medical care is essential.
Symptoms
Diabetic hyperosmolar syndrome may take days or even weeks to develop. Pay attention to possible signs and symptoms, which include:
- High blood sugar level
- Excessive thirst
- Dry mouth
- Increased urination
- Warm, dry skin with no sweating
- Fever
- Sleepiness
- Confusion
- Hallucinations
- Vision loss
- Weakness on one side of the body
- Convulsions
- Coma
When to see a doctor
Consult your doctor if your blood sugar is persistently higher than the target range your doctor has recommended, or if you experience any signs or symptoms of diabetic hyperosmolar syndrome, such as:
- Excessive thirst
- Increased urination
- Warm skin without sweating
Seek emergency care if:
- Your blood sugar level is 600 mg/dL (33 mmol/L) or higher
- You experience confusion, vision changes or weakness on one side of the body
Causes
Diabetic hyperosmolar syndrome may be triggered by:
- Illness
- An underlying infection, such as pneumonia or a urinary tract infection
- Not following your diabetes treatment plan
- Certain medications, such as water pills (diuretics)
Sometimes undiagnosed diabetes results in diabetic hyperosmolar syndrome.
Risk factors
Certain factors raise your risk of developing diabetic hyperosmolar syndrome, such as:
- Having type 2 diabetes. Although people with type 1 diabetes can be affected, hyperosmolar syndrome is much more common in people with type 2 diabetes. If you have type 2 diabetes and you don't monitor your blood sugar or you don't yet know you have type 2 diabetes, you have an even higher risk of hyperosmolar syndrome.
- Being middle-aged or older. If you're in these age groups you're more likely to develop diabetic hyperosmolar syndrome.
- Having another chronic health condition. Your risk of hyperosmolar syndrome is increased if you have another chronic illness, such as congestive heart failure or kidney disease.
- Having an infection. Having an illness, such as pneumonia or the flu, causes your blood sugar levels to rise and can increase your risk of diabetic hyperosmolar syndrome.
- Taking certain medications. Some drugs — such as corticosteroids (prednisone), diuretics (hydrochlorothiazide and chlorthalidone) and the anti-seizure medication phenytoin (Dilantin) — can increase your risk of developing hyperosmolar syndrome.
Complications
Diabetic hyperosmolar syndrome can lead to:
- Convulsions
- Coma
- Heart attack
Without prompt treatment, diabetic hyperosmolar syndrome can be fatal.
Preparing for your appointment
Diabetic hyperosmolar syndrome is a medical emergency that you won't have time to prepare for. If you've been feeling the symptoms of high blood sugar, such as extreme thirst and excessive urination, for a few days, check your blood sugar level and call your doctor for advice. If you feel the symptoms of extreme high blood sugar (more than 600 mg/dL or 33 mmol/L), call 911 or your local emergency number. Don't try to drive yourself to the hospital.
If you're with someone with diabetes who is acting confused, has one-sided weakness, or who has passed out, call for immediate medical help.
After you've received treatment and are feeling better, some questions you might want to ask your doctor include:
- How can I better control my diabetes?
- What range does my blood sugar need to be in?
- Do I need to see a specialist?
- What dietary changes do I need to follow?
- Can I get help from a dietitian?
- Does eating a meal with a lot of sugar bring on this syndrome?
- Do I need to consume fluids more regularly?
- Can diabetic hyperosmolar syndrome happen again?
Tests and diagnosis
If you experience a diabetic hyperosmolar syndrome, prompt diagnosis is critical. The emergency medical team will do a physical exam and may ask those who are with you about your medical history.
Lab tests
You may need various lab tests to measure:
- Your current blood sugar level
- Glycated hemoglobin (A1C) — a blood test that indicates your average blood sugar level for the past two to three months
- Whether or not ketones are present in your urine — ketones are byproducts made when fat is used as fuel instead of glucose
- Your kidney function, by testing the amount of nitrogen or creatinine (a breakdown product of creatine, an important part of muscle) in your blood
- The amount of potassium, phosphate and sodium in your blood
You'll be diagnosed with diabetic hyperosmolar syndrome if your blood sugar level is 600 mg/dL (33 mmol/L) or higher.
Treatments and drugs
Emergency treatment can correct diabetic hyperosmolar syndrome within hours. Treatment typically includes:
- Intravenous fluids
- Insulin to lower your blood sugar levels
- Possibly, potassium, sodium or phosphate replacement to help your cells function correctly
If you have an infection, or an underlying health condition, such as congestive heart failure or kidney disease, these conditions will be treated as well.
Prevention
Good day-to-day control of your diabetes can help you prevent diabetic hyperosmolar syndrome. Keep these tips in mind:
- 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 an infection.
- Follow your meal plan. Consistent snacks and meals can help keep your blood sugar level steady.
- Keep an eye on your blood sugar level. Blood sugar monitoring can tell you whether you're keeping your blood sugar level in your target range — and alert you to dangerous highs, especially if you have an infection. Ask your doctor how often you should test your blood sugar.
- Take your medication as directed. If you have frequent episodes of high blood sugar, let your doctor know. He or she may need to adjust the dosage or timing of your medication.
- Exercise regularly. Regular physical activity can help keep your blood sugar levels from going too high. Talk with your doctor before beginning any exercise plan, but for most people, experts recommend 150 minutes of moderate intensity exercise a week — about 30 minutes a day.
- Educate your loved ones, friends and co-workers. Teach loved ones and other close contacts how to recognize early signs and symptoms of blood sugar extremes — and how to summon emergency help should you pass out.
- Wear a medical ID bracelet or necklace. If you're unconscious, the ID can provide valuable information to your loved ones, co-workers and others — including emergency personnel.
- Stay up-to-date on your vaccinations. Be sure to get an annual flu shot, and ask your doctor if you need the pneumococcal vaccine, which protects against some forms of pneumonia.
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