Pitfalls
- Unlike DKA, complete correction of electrolyte and osmolality abnormalities is unlikely to be achieved within 24 hours and too rapid correction may be harmful.
- As many of these patients are elderly with multiple co-morbidities, recovery will largely be determined by their previous functional level and the underlying precipitant of HHS.
- Early mobilisation is essential as is the need for good nutrition and, where indicated, multivitamins and phosphate (to prevent re-feeding syndrome).
- IV insulin can usually be discontinued once they are eating and drinking but IV fluids may be required for longer if intake is inadequate.
- Most patients should be transferred to subcutaneous insulin (the regime being determined by their circumstances).
- For patients with previously undiagnosed diabetes or well controlled on oral agents, switching from insulin to the appropriate oral hypoglycaemic agent should be considered after a period of stability (weeks or months).
- People with HHS should be referred to the specialist diabetes team as soon as practically possible after admission.
- All patients will require diabetes education to reduce the risk of recurrence and prevent long-term complications.