Hyperglycaemic presentations in type 2 diabetes

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.