• 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.
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