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Related Concept Videos

Hypoglycemia and Glucagon01:15

Hypoglycemia and Glucagon

Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
Hypoglycemia01:26

Hypoglycemia

Hypoglycemia is a blood glucose level below 70 mg/dL. It commonly occurs in individuals using insulin or insulin-secreting drugs, but may also arise in non-diabetic conditions. People with type 1 diabetes are at the highest risk because they depend on exogenous insulin. People with type 2 diabetes are also at risk, especially when treated with insulin or medications such as sulfonylureas, which increase insulin release regardless of blood glucose levels. It develops when insulin levels exceed...
Hyperglycemia01:29

Hyperglycemia

Hyperglycemia is an abnormally high blood glucose level. It is diagnosed by fasting glucose ≥126 mg/dL, 2-hour oral glucose tolerance test (or OGTT) ≥200 mg/dL, random glucose ≥200 mg/dL with symptoms, or HbA1c ≥6.5%. However, HbA1c results may be unreliable in certain conditions, such as anemia or hemoglobinopathies, and the diagnosis should be confirmed unless classic symptoms are present. Postprandial hyperglycemia is typically considered significant when glucose levels exceed 180 mg/dL two...
Hyperosmolar Hyperglycemic State01:21

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State, or HHS, is a serious and life-threatening complication of type 2 diabetes mellitus. It is characterized by three main features: severe hyperglycemia, profound dehydration, and elevated serum osmolality, all occurring without significant ketoacidosis.HHS typically develops in older adults or individuals with limited access to fluids. This may result from illness, cognitive impairment, or medications such as diuretics or corticosteroids. These factors reduce...
Diabetic Ketoacidosis l: Introduction01:25

Diabetic Ketoacidosis l: Introduction

DefinitionDiabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus, characterized by a triad of hyperglycemia (blood glucose >250 mg/dL), ketonemia or ketonuria, and metabolic acidosis (arterial pH <7.30 and serum bicarbonate <18 mEq/L). It results from insulin deficiency combined with elevated levels of counterregulatory hormones—glucagon, catecholamines, cortisol, and growth hormone—leading to increased lipolysis, hepatic ketone production, and...
Diabetic Ketoacidosis ll: Pathophysiology01:22

Diabetic Ketoacidosis ll: Pathophysiology

Diabetic ketoacidosis (DKA) is a metabolic emergency characterized by hyperglycemia, ketonemia, and metabolic acidosis. It results from severe insulin deficiency and an excess of counterregulatory hormones, leading to uncontrolled lipolysis, ketogenesis, and widespread electrolyte and fluid disturbances.Pathophysiology The central event in DKA is a profound loss of insulin action. Without insulin, glucose uptake in insulin-dependent tissues is impaired, while hepatic glucose production...

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A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
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Hyperosmolar Hyperglycemic State.

Spencer S Lovegrove1, Sarah B Dubbs1

  • 1Department of Emergency Medicine, University of Maryland School of Medicine, 110 South Paca Street, 6th Floor Suite 200, Baltimore, MD 21201, USA.

Endocrinology and Metabolism Clinics of North America
|February 8, 2026
PubMed
Summary
This summary is machine-generated.

Hyperosmolar hyperglycemic state (HHS) is a serious diabetic emergency. Prompt recognition and treatment, including aggressive fluid replacement and insulin therapy, are crucial for managing this condition.

Keywords:
Altered mental statusDiabetic emergencyEndocrine emergencyHyperglycemiaHyperosmolar hyperglycemic stateHyperosmolar nonketotic state

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Area of Science:

  • Endocrinology
  • Internal Medicine
  • Emergency Medicine

Background:

  • Hyperosmolar hyperglycemic state (HHS) is a severe diabetic complication.
  • HHS presents with high morbidity and mortality.
  • Features of HHS can overlap with diabetic ketoacidosis, necessitating careful differentiation.

Purpose of the Study:

  • To summarize the key characteristics of HHS.
  • To highlight diagnostic differentiators between HHS and diabetic ketoacidosis.
  • To outline current treatment recommendations for HHS.

Main Methods:

  • Review of existing literature and clinical guidelines.
  • Analysis of diagnostic criteria for HHS.
  • Synthesis of recommended therapeutic interventions.

Main Results:

  • Key HHS indicators include serum osmolality >320 mOsm/kg, absence of metabolic acidosis, and minimal ketones.
  • Common triggers for HHS are infections, stroke, and acute coronary syndromes.
  • Effective treatment involves aggressive volume repletion and insulin therapy, alongside addressing the underlying cause.

Conclusions:

  • HHS is an underrecognized but critical diabetic emergency.
  • Accurate diagnosis relies on specific laboratory values and clinical context.
  • Timely and comprehensive management is essential to improve patient outcomes.