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A. Schuyler, NP
A. Schuyler, NP, Nurse Practitioner
Category: Health
Satisfied Customers: 16047
Experience:  Board Certified NP, MS, RN. 25 years private practice & hospitalist
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Could you tell me about treatment forDiabetic hyperglycemic

Customer Question

Could you tell me about treatment forDiabetic hyperglycemic hyperosmolar syndrome ? Does this cause swelling of the brain ? Possibly cause lose of motor skills or even coma and death ? What is the normal course of treatment? Is the patient immediately placed on insulin ? Thanks doc for the info
Submitted: 9 months ago.
Category: Health
Expert:  A. Schuyler, NP replied 9 months ago.

Hi, Charles,

Dr. Chip doesn't seem to be available.

Diabetic hyperglycemic hyperosmolar syndrome is a serious condition caused by extremely high glucose levels that leads to serious dehydration as your body tries to get bid of the excess glucose and sodium through the urine. Treatment is aimed at eliminating the dehydraton with IV fluids containing sodium, potassium and possibly sodium phosphate administered to achieve normal levels. Insulin is also immediately administered through the vein to lower glucose to more normal levels.

The condition itself can lead to symptoms of hallucinations, stroke or coma. Brain swelling (cerebral edema) is a complication. Diabetic hyperglycemis hyperosmolar syndrome is extremely dangerous, and the death rate is as high as 40%.

Please let me know if you have questions.

Best regards,



Customer: replied 9 months ago.
Thank you for your reply. Is there a chance whereby insulin is not immediately administered ? That is someone who has cerebral edemea due to this complication? Would someone be immediately be admitted to the hospital with this condition after diagnosis ?
Expert:  A. Schuyler, NP replied 9 months ago.

Yes, they would be immediately admitted for IV treatment, including immediate rehydration and IV insulin.

Customer: replied 9 months ago.
there would be no circumstance where they wouldn't admitted. Say for example if they were in the beginning stages of it ?
Expert:  A. Schuyler, NP replied 9 months ago.

That is highly unlikely. Instead of playing guessing games, please let me know what happened.

How high was the glucose?

What other blood tests were done?

What were the symptoms?

Customer: replied 9 months ago.
Ok ....1. There was no knowledge of diabetes2. Headaches, passing out, tingling and numbness in hand3. Had CT brain was swilling (edema) this was what was causing bad headache.4. Put on diabetic diet and have to check blood sugar 4 times a day.
Expert:  A. Schuyler, NP replied 9 months ago.

That doesn't mention a diagnosis of diabetic hyperglycemic hyperosmolar syndrome.

Sometimes you can get this diagnosis for someone who doesn't know they have diabetes and therefore it isn't treated. Usually there are ample symptoms (excessive urination and thirst, loss of weight) to make someone seek medical help and that's when they are diagnosed with diabetes.

When someone has DHHS their blood glucose is extremely high (500-900 mg/dL and even higher), and they are having other terrible symptoms like halluciantions and may even be passed out.

If it was just that his blood sugar was high (without approaching dangerous levels), a diabetic diet is reasonable. The treating provider would have the test results to determine if the person needed hospitalization or not. Certainly for true DHHS, this would not be the treatment.

Best regards,



Customer: replied 9 months ago.
didn't know that diabetes was present and therefore was diagnosed with it after blood work. Does diabetes usually show up in routine blood work ? Can diabetes go undetected ?
Expert:  A. Schuyler, NP replied 9 months ago.

A blood glucose level is done with every fasting comprehensive metabolic panel (CMP) which is a routine blood test that most people have with their yearly checkup. Levels over 100 mg/dL are followed over time and sometimes called "prediabetes" or impaired glucose tolerance. Diabetes doesn't just occur overnight. The blood glucose levels increase over time, so that most people can be warned and put on a diabetic diet and counseled to maintain a normal weight and exercise regularly.

If someone doesn't get medical testing at least yearly, and they are one of the few diabetics who don't get frequent urination and excessive thirst, they can get into deep trouble, just as this person did.

So, yes it can go undetected if someone doesn't have routine medical checkups. I've seen many a case where the person didn't know they had diabetes until they showed up in my ER in a coma with a blood glucose of 1200 mg/dL. Sadly, it happens.

Best regards,



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