Pitfalls

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.