Unusual Case of a Hyperosmolar Hyperglycemic State in a Young Adult with Type 1 Diabetes Mellitus

Abstract Hyperosmolar hyperglycemic State (HHS) is a severe acute complication primarily associated with type 2 diabetes but very rare in type 1 diabetes mellitus (T1DM). T1DM necessitates consistent insulin management to prevent acute complications such as HHS. HHS is characterized by extreme hyperglycemia (exceeding 600 mg/dL), significant dehydration, and hyperosmolarity, typically without the presence of significant ketosis or acidosis. This condition leads to an altered mental status, which can range from confusion to coma, whereas diabetic ketoacidosis (DKA) is more commonly observed in T1DM and is characterized by hyperglycemia (generally lower than in HHS), ketosis, and metabolic acidosis due to the breakdown of fats into ketones. DKA presents with symptoms such as abdominal pain, nausea, vomiting, and deep, rapid breathing (Kussmaul respirations). The presence of acidosis distinguishes DKA from HHS and necessitates a different treatment approach. HHS has a higher mortality rate than that of DKA due to its more insidious onset and the severity of dehydration and electrolyte imbalance that often accompany it. We present the case of an 18-year-old male with T1DM, who experienced HHS due to irregular insulin use caused by work and financial constraints, alongside a diet high in sugary foods, necessitating emergency intervention.