Unveiling the Most Common Causes of Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS)


Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS) is a severe and potentially life-threatening complication of diabetes characterized by dangerously high blood sugar levels and extreme dehydration. Understanding the underlying causes of HHNS is critical for individuals with diabetes, healthcare providers, and caregivers. In this comprehensive guide, we will explore the most common causes of HHNS, shedding light on the factors that contribute to the development of this serious condition.

Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS): A Complex Condition:

HHNS is an acute complication typically seen in individuals with type 2 diabetes, though it can also occur in type 1 diabetes. It arises when blood sugar levels become excessively elevated, leading to profound dehydration and hyperosmolarity (increased concentration of solutes in the blood). Unlike diabetic ketoacidosis (DKA), HHNS does not involve significant ketone production. HHNS is often triggered by a combination of factors, and identifying the most common causes is crucial for effective prevention and management.

The Most Common Causes of HHNS:

Inadequate Insulin: The primary cause of HHNS is a deficiency of insulin in the body, which can result from various factors:

    • Insulin Resistance: In type 2 diabetes, the body’s cells become resistant to the effects of insulin, leading to elevated blood sugar levels. This resistance often worsens over time, contributing to HHNS.
    • Medication Non-Adherence: Failing to take prescribed diabetes medications, including insulin, as directed by healthcare providers can lead to uncontrolled blood sugar levels and HHNS.
  1. Infection or Illness: Illnesses and infections can cause stress on the body, leading to an increase in blood sugar levels. The immune system’s response to infection can also interfere with insulin action. Infections such as urinary tract infections or pneumonia are common triggers for HHNS.
  2. Dehydration: Chronic dehydration can be a significant contributor to HHNS. Dehydration may result from inadequate fluid intake, excessive urination due to high blood sugar levels, or other underlying health conditions. Dehydration exacerbates hyperosmolarity, a hallmark of HHNS.
  3. Medications: Certain medications, such as diuretics or corticosteroids, can affect fluid and electrolyte balance, potentially leading to HHNS in individuals with diabetes.
  4. Underlying Medical Conditions: Coexisting medical conditions, such as heart disease, kidney disease, or liver disease, can complicate blood sugar management in individuals with diabetes, increasing the risk of HHNS.
  5. Advanced Age: Older adults with diabetes are more susceptible to HHNS due to various factors, including reduced thirst sensation, decreased kidney function, and comorbidities.


Hyperglycemic Hyperosmolar Non-Ketotic Syndrome (HHNS) is a severe complication of diabetes that can have life-threatening consequences. While several factors can contribute to its development, the most common causes include inadequate insulin, infection or illness, dehydration, medication effects, underlying medical conditions, and advanced age. Recognizing these factors is crucial for diabetes management and HHNS prevention.


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