Diabetic hyperglycemic hyperosmolar syndrome (HHS) is a complication of type 2 diabetes. It involves extremely high blood sugar (glucose) levels without the presence of ketones. Ketones are waste products of fat breakdown.

Causes
Diabetic hyperglycemic hyperosmolar syndrome is a condition of:
-- Extremely high blood sugar (glucose) level
-- Extreme lack of water (dehydration)
-- Decreased consciousness (in many cases)

Buildup of ketones in the body (ketoacidosis) may also occur. But it is unusual and is often mild compared with diabetic ketoacidosis. This condition is usually seen in people with type 2 diabetes who don't have their diabetes under control. It may also occur in those who have not been diagnosed with diabetes. The condition may be brought on by:
-- Infection
-- Other illness, such as heart attack or stroke
-- Medicines that decrease the effect of insulin in the body
-- Medicines or conditions that increase fluid loss

Normally, the kidneys try to make up for a high glucose level in the blood by allowing the extra glucose to leave the body in the urine. But this also causes the body to lose water. If you do not drink enough water, or you drink fluids that contain sugar and keep eating foods with carbohydrates, the kidneys can no longer get rid of the extra glucose. As a result, the glucose level in your blood can become very high.

The loss of water (dehydration) also makes the blood more concentrated than normal. This is called hyperosmolarity. It is a condition in which the blood has a high concentration of salt (sodium), glucose, and other substances that normally cause water to move into the bloodstream. This draws the water out of the body's other organs, including the brain. Hyperosmolarity creates a cycle of increasing blood glucose levels and dehydration.

Treatment
The goal of treatment is to correct the dehydration. This will improve the blood pressure, urine output, and circulation. Fluids and potassium will be given through a vein (intravenously). High glucose level is treated with insulin given through a vei