Hyperosmolar hyperglycaemic state (HHS) as the first manifestationof type 2 diabetes in a child

Area of Science:

• Endocrinology
• Pediatrics
• Metabolic Disorders

Background:

• Hyperglycaemic hyperosmolar state (HHS) is a serious diabetic emergency characterized by extreme hyperglycemia and dehydration.
• While often seen in adults, HHS can occur in younger populations with type 1 and type 2 diabetes, and even in infants.

Observation:

• A 13-year-old obese patient (BMI > 40 kg/m²) presented with severe HHS (glucose 647 mg/dl, osmolarity 370 mOsm/kg) during pneumonia.
• The patient had newly diagnosed type 2 diabetes (HbA1c 15.5%) with preserved C-peptide levels (2.63 ng/ml).
• Initial management involved insulin, followed by metformin, dietary changes, and rehabilitation, leading to substantial weight reduction (37 kg in 6 months).

Findings:

• The case illustrates HHS development in a severely obese adolescent with type 2 diabetes, triggered by an acute illness (pneumonia).
• Effective management included pharmacotherapy adjustments (discontinuation of insulin, initiation of metformin), lifestyle interventions, and rehabilitation.
• Despite significant clinical improvement and weight loss, the patient required ongoing respiratory support (CPAP) for nocturnal breathing disorders.

Implications:

• This case underscores the importance of recognizing HHS in pediatric patients, particularly those with obesity and type 2 diabetes.
• Aggressive management of hyperglycemia, dehydration, and underlying triggers like infection is crucial for favorable outcomes.
• Long-term strategies involving weight management and multidisciplinary care are essential for preventing recurrence and managing comorbidities in this population.