When Type 1 Diabetes Breaks The Rules: A Rare Hyperosmolar Hyperglycemic State Presentation

Abstract

Hyperosmolar Hyperglycaemic State (HHS) is a medical emergency with a high mortality rate. It occurs less often than diabetic ketoacidosis (DKA) and mainly affects individuals with pre-existing or new type 2 diabetes mellitus. Although it increasingly impacts adults, it is uncommon in type 1 diabetes patients due to the underlying mechanisms of insulin deficiency. 

In this rare setting of a type 1 diabetes mellitus patient with pure Hyperosmolar Hyperglycaemic State (HHS) presentation, we try to present and discuss potential risk factors, diagnostic challenges, and underlying pathophysiology to achieve better outcomes and decrease further morbidity and mortality

Delayed recognition may increase morbidity and mortality. Emergency physicians and internists should be aware of Hyperosmolar Hyperglycaemic State HHS to make an early diagnosis for appropriate management, as it can be complicated in adult patients with T1 diabetes mellitus.

Patient concerns: The patient was admitted due to GI symptoms and severe dehydration associated with severe hyperglycemia and hyperosmolarity without significant acidosis.

Diagnoses: On the basis of clinical manifestations and history with laboratory results, she was diagnosed with Hyperglycaemic State (HHS).

Interventions: Treatment was started with intravenous fluid and regular insulin.

Outcomes: She was discharged without any complications related to Hyperglycaemic State (HHS) and adjusted her insulin therapy.