Dr Aidin Rawshani

Hyperosmolar syndrome in diabetes


Hyperosmolar non-ketotic syndrome (diabetic coma)

Hyperosmolar syndrome is a serious condition that most often affects elderly people with diabetes. The condition can affect both people with type 1 diabetes or type 2 diabetes, but it is more common among those with type 2 diabetes. Hyperosmolar syndrome is caused by high blood sugar, which is due to poor disease control. Most often there is a trigger factor, such as infection, side effects of medications, dehydration, surgery or other acute diseases.

The hyperosmolar syndrome occurs when you have very high blood sugar, which leads to the body trying to get rid of the sugar by urinating it. So you need to pee more than usual. Unfortunately, when urinating a lot, the body loses fluid (water). This causes dehydration and then you actually start producing less urine (you urinate less again) which is also darker because it is more concentrated. By now, you’re also thirstier than usual.

Hyperosmolar syndrome is dehydrated by high blood sugar, as this leads to the urination of large amounts of water. If you do not drink enough water, dehydration can be so severe that you eventually experience convulsions, coma (diabetic coma) or death at worst.

It may take several days, or even weeks, for this condition to develop. Therefore, it is important to prevent it from worsening by controlling its blood sugar and drinking enough water.

What are the symptoms of hyperosmolar syndrome?

  • You feel sick and tired.
  • Blood sugar is higher than 30 mmol/L.
  • You’re dry in your mouth and mucous membranes.
  • One is very thirsty. However, note that the thirst can gradually subside, despite the fact that the condition worsens.
  • The skin is warm and dry (you practically do not sweat).
  • You may have a fever (body temperature higher than 38°C).
  • You get tired, sleepy and/or confused.
  • Vision is getting worse.
  • You can start hallucinating, which means you hear or see things that aren’t real.
  • The muscles of the body (in the arms and legs) become very weak.

In fact, people are diagnosed with type 2 diabetes when they become ill with the hyperosmolar syndrome.

How to avoid hyperosmolar syndrome?

As with all other complications of diabetes, disease control is the most important measure to prevent disease. Many people with type 2 diabetes, who are the most often affected by this condition, unfortunately, lack a blood glucose meter, which makes it impossible to control blood sugar. It is important to monitor blood sugar regularly, even days when you feel well. People with type 1 diabetes do several blood sugar controls every day, allowing them to easily detect and prevent the hyperosmolar syndrome. People with type 2 diabetes, especially the elderly, usually do not control their blood sugar as often and therefore they are at a higher risk of suffering from this condition.

All people with diabetes need to know the following:

  • How to measure blood sugar
  • How to interpret blood sugar values
  • What blood sugar values should be sought
  • What to do if blood sugar is too high
  • What to do if you get low blood sugar (hypoglycemia)
  • When you are sick or otherwise not feeling well, you should be extra careful to control blood sugar because illness can lead to sharp fluctuations in blood sugar, as well as high and low values. When you are sick, it is important to get enough fluid (in the form of water).
  • It is important to receive information on how to act in case of illness. Discuss and consult your healthcare provider about this.

What is the difference between hyperosmolar syndrome and ketoacidosis?

Ketoacidosis is another very serious condition that also involves having high blood sugar. However, in ketoacidosis, the main problem is that you are acidic in the body and this is due to a lack of insulin. Ketoacidosis in principle only affects people with type 1 diabetes because their pancreas stopped producing insulin. Absence of insulin leads to the collection of acidic substances in the blood and then the body becomes acidic. These acidic substances are called ketones (ketone bodies).

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