What can precipitate a hyperosmolar hyperglycemic state?

Inadequate insulin therapy is a key factor that can precipitate a hyperosmolar hyperglycemic state (HHS). This condition is characterized by extremely high blood glucose levels, which lead to increased plasma osmolarity and dehydration. In people with diabetes, particularly those with type 2 diabetes who may have underlying insulin resistance, insufficient insulin can prevent glucose from entering the cells for energy. As a result, glucose levels in the blood rise, causing hyperglycemia.

Furthermore, without enough insulin, the body might start breaking down fats for energy, leading to the production of ketones, although HHS is primarily associated with minimal ketone formation compared to diabetic ketoacidosis. The dramatic increase in blood glucose levels, coupled with dehydration from osmotic diuresis (increased urination due to high glucose levels), further exacerbates the condition. Thus, inadequate insulin therapy plays a direct role in triggering HHS.

Other options may influence diabetes management or overall health, but they do not have the same direct causative relationship to hyperosmolar hyperglycemic state as inadequate insulin therapy.