Prevention of diabetic hyperosmolar hyperglycemic syndrome

Hyperosmolar hyperglycemic non-ketonic syndrome (English abbreviation HHNS) is as dangerous as an attack of DSA. Von Frerichs and Dreshfeld first described this syndrome in about 1880. They studied diabetic patients with deep hyperglycemia and glycosuria without classical Kussmaul respiration and without acetone in the urine. Since this condition often led to coma, then this syndrome was called “non-ketonic hyperglycemic coma”. Although hyperosmolar hyperglycemic non-ketonic syndrome (hereinafter referred to as HGNS) occurs much less frequently than an attack of diabetic ketoacidosis (hereinafter referred to as PDCA), the mortality from it is 10 times higher and amounts to 10-20%. Iv

When HGNS the body tries to get rid of excess blood sugar, releasing it into the urine. This leads to dehydration and a strong load on the kidneys.

The difference between the symptoms of GGNS and PDCA is as follows:

1. HGNS occurs much more often in patients with type 2 diabetes (while PDCA – with 1);

2. Develops much slower – within a few days or even weeks (and PDCA – during the day);

3. Much more often affects older people, especially after 65 (while the peak of PDCA falls on 30-year-olds and often affects even very young ones);

4. The blood sugar level is much higher and is more than 600 mg / dl or, in other units. measurements – more than 30 mmol / l (with PDCA, the corresponding limit is 240 mg / dl, that is, 13.3 mmol / l);

5. Fever and body temperature more than 38 * C (uncharacteristically for PDCA);

6. The skin is very dry, flaky, without sweat, even with heavy drinking (uncharacteristically for PDCA);

7. Very blurry vision, sometimes to temporary blindness (uncharacteristic for PDCA);

8. Lack of severe dyspnea (characteristic of PDCA);

9. Lack of rapid and weak pulse (characteristic of PDCA);

10. Anemia or paralysis of one of the halves of the body (uncharacteristic for PDCA);

11. Visual and auditory hallucinations (not typical for PDCA);

12. Drowsiness (uncharacteristic for PDCA);

13. Gradual darkening of the urine and a decrease in the frequency of urge to urinate.

as the syndrome develops (uncharacteristic for PDCA);

14. A sharp increase in the level of sugar in the urine (with PDCA, the sugar in the urine is usually normal);

15. There is no fruity odor in breathing (with PDCA, this is a typical symptom);

16. The level of ketones in the blood and urine is not elevated (with PDCA, the level of ketones, on the contrary,

greatly elevated, which is his main diagnostic criterion);

Common symptoms GGNS and PDKA:

1. Severe thirst (with HGSN may decrease with time);

2. Frequent urination (with GGNS gradually decreases);

3. General weakness (with GGNS especially muscular);

4. The fall in blood pressure (with GGNS, especially when standing up);

5. Abdominal pain, nausea and vomiting (with GGNS stomach sometimes does not hurt);

6. Confusion of consciousness.

Factors provoking GGNS (almost the same as for PDCA):


Infectious disease or HIV;

Heart attack;



Insufficient fluid intake for any reason;

Big age, especially over 65 years;

Weak or diseased kidneys;

Insufficient intake of insulin;

Taking medications that reduce insulin levels;

Emergency measures (in a medical institution):

Restoration of intravascular fluid volume with correction of electrolyte deficiency (Na +, K +, Ca ++, Mg ++, PO4 ++), elimination of hyperglycemia (decrease in sugar level) and serum hyperosmolarity by first adding 0.9% saline solution to

hemodynamic stabilization, and then the introduction of insulin in 0.45% saline solution at a rate of 0.1 units per kilogram of weight per hour, with the addition of 5% dextrose and a decrease insulin infusion doses as soon as the glucose level drops to 250-300 mg / dl.

Self-prevention GGNS:

Often monitor blood sugar levels, including overnight (at least 3-4 times

hours, especially in children);

Keep handy, easily digestible liquid carbohydrate food in case of nausea.

Keep a fast-acting insulin with you in order to take an additional dose agreed upon with a doctor if there are signs of an impending syndrome;

Closely monitor the health of their kidneys;

To be vaccinated and vaccinated so as not to get sick and so not to provoke the syndrome;

Do not take medicines not approved by your doctor (especially

corticosteroids and diuretics), since they can lower your insulin levels and thus trigger the development of the syndrome;

Always carry a bottle of water;

Drink plenty of water regularly (avoid commercial drinks), and in case of impending signs of the syndrome, drink plenty of it;

Create a diabetic bracelet or card (with your full name, address, doctor, clinic phone, patient ID, brief information on your diabetes, list of prescribed medications and their modes of administration, and action instructions for bystanders);

Teach family members, friends, and co-workers what actions they should take if you feel very unwell or lose consciousness;

Follow the general prescriptions for all diabetics: do not eat sweets, do not smoke, do not abuse alcohol and drugs, do not skip insulin, eat regularly and varied, keep your heart in a healthy state through exercise and taking your prescribed medications.

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