Preventing a hyperosmolar state

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Preventing a hyperosmolar state

A hyperosmolar state develops when a person with type 2 diabetes has very high blood sugar—often more than 600 milligrams per deciliter (mg/dL). In a hyperosmolar state, the blood glucose level rises well above a safe range because there is not enough insulin to help the body's cells use glucose. The blood begins to pull water from the cells in an attempt to reach the proper chemical balance, and the kidneys begin flushing glucose out of the body with the extra water. As hyperosmolarity progresses, the person becomes increasingly dehydrated, and the cells shrink and do not function well. When this happens to brain cells, disorientation, coma, and even death can result.

How can you prevent hyperosmolarity?

You can help prevent hyperosmolarity by keeping your blood glucose from rising above the safe range and by drinking water so you do not become dehydrated.

Medicines for some disorders may contribute to the development of hyperosmolarity, particularly phenytoin (an antiseizure medicine), glucocorticoids (such as cortisone, which is used for a variety of joint and lung problems), immunosuppressive agents (such as transplant medicines), and diuretics (which remove water from the body). If you seek medical treatment for hyperosmolarity, be sure to have a list of all of your medicines with you.

What are the symptoms of a hyperosmolar state?

Try to identify the symptoms of a hyperosmolar state early. At first you will only notice an increase in thirst and urination. If you feel very thirsty, drink plenty of fluids and check your blood glucose. If your blood glucose rises above 400 mg/dL, seek medical attention. If your blood glucose remains high, your symptoms may advance to thirst combined with confusion, seizures, or coma.

If you become dehydrated, you may notice that you are not urinating as much. This is a danger sign, because sugar levels may rise rapidly if you stop making urine due to extreme dehydration.

Your family and friends should be aware of the possibility of this acute episode so that they can help you get medical help early. Since you may lose consciousness, you should not try to drive yourself to a medical center. Instead, call an ambulance or have a friend or family member drive you.

The longer you are in a hyperosmolar state before recognizing it and seeking treatment, the more likely you are to have long-term organ and tissue damage. If it advances to a hyperosmolar nonketotic diabetic coma, the effect on your brain and heart can be so severe that it causes death.

How is it treated?

Hospital treatment for hyperosmolar state includes:

• Fluids, to rehydrate your body. Because excessive urination also results in a loss of vital salts, you will receive fluids that contain salts like those in your blood.
• Insulin, to reduce your blood sugar level. Intravenous administration of insulin is considered the method of choice. It ensures rapid distribution of insulin throughout the body. If an initial administration of insulin does not remedy the situation, you will continue to receive increasingly larger doses of insulin until your blood glucose levels respond to treatment.
• Treatment for the underlying cause. For example, if your insulin production was sharply decreased because of an infection and the resultant stress on your body, you will take antibiotics to kill the bacteria that caused the infection.

Credits

Last updated:	August 14, 2007
Author:	Caroline Rea, RN, BS, MS
Reviewed By:	Caroline S. Rhoads, MD - Internal Medicine, Matthew I. Kim, MD - Endocrinology & Metabolism
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC