Hyperglycaemic presentations in type 2 diabetes

Aust J Gen Pract. 2019 May;48(5):263-267. doi: 10.31128/AJGP-12-18-4785.


Background: Hyperosmolar hyperglycaemic state (HHS) is a syndrome that occurs in patients with type 2 diabetes mellitus (T2DM) and is comparable to diabetic ketoacidosis (DKA) seen in patients with type 1 diabetes. For a general practitioner working in a rural emergency department, recognition of HHS in a patient presenting with the triad of severe dehydration, hyperglycaemia and hyperosmolality is important to guide management and plan for disposition.

Objectives: This article reviews the hyperglycaemic states that can occur in patients with T2DM. The reasons for the biochemical derangements in both HHS and DKA are outlined, with a focus on the recognition and management of HHS.

Discussion: Knowledge of the pathophysiology that influences HHS helps understand of its clinical presentation and treatment. HHS has a high mortality rate (5–20%), and having access to clinical guidelines from a referring hospital is useful to guide early management strategies.

MeSH terms

  • Blood Glucose / analysis
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Ketoacidosis / blood
  • Diabetic Ketoacidosis / etiology
  • Diabetic Ketoacidosis / physiopathology
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / etiology*
  • Hyperglycemia / physiopathology
  • Hyperglycemic Hyperosmolar Nonketotic Coma / blood
  • Hyperglycemic Hyperosmolar Nonketotic Coma / etiology
  • Hyperglycemic Hyperosmolar Nonketotic Coma / physiopathology
  • Male
  • Middle Aged


  • Blood Glucose