Published: 12:20 AM, 01 August 2026
The Rising Threat of HHS in Bangladesh
Fahima Hossain Muna
Not all diabetic emergencies present the same way. While diabetic ketoacidosis (DKA) is widely recognised, Hyperosmolar Hyperglycaemic Syndrome (HHS) remains a lesser-known but potentially more deadly complication of diabetes.
HHS primarily affects people with Type 2 diabetes. It is characterised by extremely high blood glucose levels and severe dehydration, causing the blood to become highly concentrated. Unlike DKA, HHS develops gradually over several days or even weeks, often without obvious warning signs. Blood glucose levels frequently exceed 600 mg/dL and the condition carries a mortality rate of up to 20 per cent. By the time a patient collapses, the crisis has often been silently progressing for days.
The question generally arises: why is Bangladesh particularly vulnerable in this regard? Bangladesh has one of the highest diabetes burdens in the South-East Asia region. According to the International Diabetes Federation (IDF) Diabetes Atlas, the number of adults living with diabetes rose from 1.8 million in 2000 to 13.9 million in 2024, and is projected to reach 23.1 million by 2050.
The challenge extends beyond the growing number of cases. A large proportion of people with diabetes remain undiagnosed and untreated. The Bangladesh Demographic and Health Survey (2017–18) found that approximately 61 per cent of people with Type 2 diabetes are unaware of their condition. Around 65 per cent receive no treatment, while nearly 72 per cent fail to maintain adequate blood glucose control.
The situation is particularly concerning in rural and low-income communities. Nearly 59 per cent of rural patients are unaware they have diabetes, compared with 42.5 per cent in urban areas. Among the poorest households, the proportion of undiagnosed cases rises to 75.9 per cent.
Acute illnesses such as infections can rapidly transform poorly controlled diabetes into a life-threatening emergency. Infections account for roughly 57 per cent of HHS cases, with pneumonia and urinary tract infections among the most common triggers. Poor adherence to diabetes medication is another major contributing factor. In a country where many people with diabetes remain undiagnosed or untreated, the conditions for HHS are already in place.
HHS often begins with vague symptoms that can easily be overlooked. Early signs include weakness, leg cramps and blurred vision, which are frequently mistaken for fatigue or dehydration.
As blood glucose levels continue to rise and dehydration worsens, symptoms become more pronounced. Excessive thirst and frequent urination are often the first clear warning signs.
As the condition progresses, confusion, difficulty speaking, profound drowsiness and extreme lethargy may develop as dehydration affects brain function. Some patients experience seizures, focal neurological deficits or even loss of consciousness. Because these symptoms closely resemble those of a stroke, HHS is frequently misdiagnosed, particularly in individuals with no previous diagnosis of diabetes.
Family members should remain alert if an older adult with diabetes—or someone who has never been tested—becomes unusually confused after several days of poor food or fluid intake, particularly following an infection such as pneumonia or a urinary tract infection. A dry mouth, dry skin, sunken eyes and difficulty responding appropriately are serious warning signs that require immediate medical attention.
HHS is a medical emergency that demands urgent hospital care. Treatment focuses on correcting severe dehydration and gradually lowering dangerously high blood glucose levels through intravenous fluids, insulin and careful monitoring.
With prompt treatment, patients often show significant improvement within hours. However, delaying medical care can have fatal consequences. If a person develops severe confusion, extreme drowsiness or signs of dehydration, they should be taken to the nearest emergency department immediately.
Do not wait to see whether the person recovers with rest and do not attempt to manage the condition at home by administering extra insulin. HHS requires specialised hospital treatment and continuous laboratory monitoring.
Preventing HHS begins with good diabetes management. Regular blood glucose monitoring, adherence to prescribed medication and routine medical follow-up are essential. People with diabetes should never stop taking their medications during illness unless advised by a healthcare professional. Maintaining adequate hydration is equally important, particularly during Bangladesh's hot summer months when dehydration can develop rapidly.
People who have never been screened for diabetes should consider getting tested, especially if they have risk factors such as older age, obesity or a family history of the disease. Because diabetes often progresses silently, many people remain unaware they have the condition until serious complications develop.
Hyperosmolar Hyperglycaemic Syndrome does not develop overnight. It is the result of gradually worsening, uncontrolled diabetes combined with dehydration, infection or inadequate access to healthcare.
Greater public awareness, earlier diagnosis and timely treatment can prevent many cases of HHS and save lives. As Bangladesh's diabetes burden continues to rise, recognising this often-overlooked medical emergency has become more important than ever.
Fahima Hossain Muna is a public
health researcher.
