What causes Hyperosmolar Hyperglycemic state?

Hyperosmolar Hyperglycemic State (HHS) is primarily caused by severe hyperglycemia combined with significant dehydration. In individuals with HHS, blood glucose levels can rise to extremely high levels, often exceeding 600 mg/dL. This severe elevation in blood sugar leads to an increase in the osmolarity of the blood, drawing water out of the cells and causing profound dehydration. The lack of sufficient insulin results in a state where the body cannot effectively utilize glucose, exacerbating both hyperglycemia and hyperosmolarity.

In this state, the body's compensatory mechanisms, such as increased urination, attempt to manage the excess glucose but ultimately lead to further fluid loss and dehydration. It is crucial to understand that HHS typically occurs in individuals with type 2 diabetes, often as a result of illness or infection, which can precipitate inadequate insulin action alongside the high blood glucose levels.

This condition differs from those related to excessive ketones in the blood, low blood sugar levels, or inadequate insulin production alone. Ketones are more associated with Diabetic Ketoacidosis (DKA), while low blood sugar hypoglycemia would not lead to HHS, and while inadequate insulin production is related, it is the severe hyperglycemia