Mhlhauser I(1), Overmann H, Bender R, Jrgens V, Berger M. (1)Department of Nutrition and Metabolic Diseases WHO Collaborating Centre for Diabetes, University of Dsseldorf, Germany. Type 2 diabetes is a serious condition that can lead to life threatening complications. The following are answers to common questions about type 2 diabetes. Heart attack symptoms may appear suddenly or be subtle, with only mild pain and discomfort. According to guidelines established by experts in the field, there are multiple stages of diabetes, each of which are defined by physiological changes within the body. Continue reading >>, Diabetes is amongst the foremost leading cause of deaths in most of the countries. See Fast Fact #291 regarding hypoglycemia management at the end of life. See additional information. Among the same number of the general population the figure would be estimated at 52,800. If you feel extreme high or low blood sugar signs or symptoms and think you might pass out, call 911 or your local emergency nu Other factors, like having a sibling or close relative with type 1 diabetes, can also increase disease risk. Pressure ulcers Cryer PE. Both types of diabetes can cause severe long-term illnesses, such as renal failure, which can end in mortality before the patient reaches the age of 65. These ketones could be extremely deadly, causing deaths in patients. Centers for Disease Control and Prevention. The state took Jakob Blodgett into its custody on Dec. 9 after his father, Richard Blodgett, was . Health care providers should always exercise their own independent clinical judgment and consult other relevant and up-to-date experts and resources. Last medically reviewed on August 22, 2022, Glucagon-like peptide-1 receptor agonists are drugs that people use to manage type 2 diabetes. Mayo Clinic, Rochester, Minn. July 24, 2018. Explore the Fast Facts on your mobile device. Accessed July 11, 2022. Continue reading >>, People with type 2 diabetes are at increased risk of many serious health problems, including heart attack, stroke, vision loss, and amputation. If we combine this information with your protected When blood sugar levels rise, glucose attaches to the hemoglobin and converts it to hemoglobin A1C. It can also be helpful to connect with others who understand what living with type 2 diabetes is like. Death. You won't notice symptoms during this stage, nor will those around you. If you lapse into a diabetic coma, you're alive but you can't awaken or respond purposefully to sights, sounds or other types of stimulation. Type 2 diabetes is the most common type of diabetes. Some people have a very gradual decline; others will fade quickly. You may notice their: Eyes tear or glaze . 3. The person may begin to resist or refuse meals and liquids, or accept only small amounts of bland foods (such as hot cereals). In this stage, vascular complications can occur as a result of high blood sugar. Even favorite foods hold little appeal. Continue reading >>, You are here: Home / Someone You Love Is Dying Although it is impossible to totally prepare for a death, a death may be made easier if you know what to expect. But you still need to test your blood sugar levels using a blood glucose meter even if you're using one of these monitors. Other influential factors include symptom severity and progression, the appearance of complications, and the bodys response to treatment. Swelling of the abdomen, such as edema or ascites. health information, we will treat all of that information as protected health This was comforting to her because he gets more confused when his blood sugar goes low. Meat, which is hard to digest, may be refused first. National Institute of Diabetes and Digestive and Kidney Diseases. A similar system for children under 12 is called the pediatric model for end-stage liver disease (PELD). Learn the factors your. Most people with cancer do well physically for a long time and then gradually lose their ability to function as they near the end of life. Diabetic ketoacidosis is one of the most serious complications of diabetes. To find the best HbA1c test kits, we looked at cost, website use, and follow-up, Insulin syringes come in multiple sizes to deliver different doses of insulin. Tight glycemic control is not a coherent goal near the end of life, and can be dangerous as it encourages hypoglycemia. If you experience any symptoms of high or low blood sugar, test your blood sugar and follow your diabetes treatment plan based on the test results. Additional strategies for maintaining optimal health while living with diabetes include: Learn more about type 2 diabetes treatments. If you don't start to feel better quickly, or you start to feel worse, call for emergency help. Hypoglycemia in adults with diabetes mellitus. Background Management of diabetes can pose challenges as patients approach death. While theres no cure for diabetes, it can be managed through the appropriate treatment, which may include medications, dietary changes, and lifestyle interventions. Generally, insulin doses should be tailored to keep fasting blood sugars >180mg/dL to minimize the risk of hypoglycemia, however this goal needs to be individualized. When blood sugar is very high, the extra sugar passes from the blood into the urine. The leading cause of these complications is the disorder of the lipids in a diabetic patient. There are a number of reasons for this, including medication side effects, constipation and the tumour itself. High blood sugar (hyperglycemia) If your blood sugar level is too high, you may experience: Increased thirst Frequent urination Fatigue Nausea and vomiting Shortness of breath Stomach pain Fruity breath odor A very dry mouth A rapid heartbeat Low blood sugar (hypoglycemia) Signs and symptoms of a low blood sugar level may include: Shakiness or nervousness Anxiety Fatigue Weakness Sweating Hunger Nausea Dizziness or light-headedness Difficulty speaking Confusion Some people, especially those who've had diabetes for a long time, develop a condition known as hypoglycemia unawareness and won't have the warning signs that signal a drop in blood sugar. As liver failure progresses, you may experience some or all of the following symptoms: Jaundice, or yellow eyes and skin Confusion or other mental difficulties Swelling in the belly, arms or legs Severe fatigue The warning signs of hypoglycemia include: confusion, dizziness, and nausea feeling hungry feeling shaky, nervous, irritable or anxious sweating, chills, and pale, clammy skin rapid heartbeat. These issues can be signs of developing diabetes in your pup, along with other possible complications. Symptoms of Diabetic Coma Before you lapse into a diabetic coma, there are usually warning signs of blood sugar levels that are too low or blood sugar levels that are too high. MNT is the registered trade mark of Healthline Media. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Learn more about type 2 diabetes treatments, Centers for Disease Control and Prevention (CDC), hyperglycemic hyperosmolar syndrome (HHS), https://link.springer.com/article/10.1007/s00125-018-4729-5, https://www.sepsis.org/sepsisand/diabetes/, https://www.niddk.nih.gov/health-information/diabetes/overview, https://link.springer.com/article/10.1007%2Fs12020-016-1168-2, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2791200, https://pubmed.ncbi.nlm.nih.gov/30852132/, https://www.ahajournals.org/doi/10.1161/JAHA.118.011295, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5241767/, http://clinical.diabetesjournals.org/content/diaclin/early/2018/12/16/cd18-0105.full.pdf, https://link.springer.com/article/10.1007/s00125-017-4532-8, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7213739/, https://www.nejm.org/doi/10.1056/NEJMoa1504347#t=articleBackground%20, https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/managing-stress-for-diabetes-health-care-professionals, How it works: Combination therapy for type 2 diabetes, Diabetes research breakthrough may open new possibilities, Non-insulin drugs for treating type 2 diabetes, Behind the counter: Glucagon-like peptide-1 receptor agonists for type 2 diabetes, New diet that matches biological clock may be better for diabetes, Lunch ideas for people with type 2 diabetes. That means they don't have warning symptoms that signal a drop in blood sugar. This information is not medical advice. Some Fast Facts cite the use of a product in a dosage, for an indication, or in a manner other than that recommended in the product labeling. Fast Facts are not continually updated, and new safety information may emerge after a Fast Fact is published. Nerve damage associated with type 2 diabetes can cause a loss of feeling in your feet, which makes you more vulnerable to injury and infection. Treatment burdens include painful fingersticks and gastrointestinal side effects of oral hypoglycemics. Palliat Med. Although beta cell dysfunction is more serious at this stage, there are still no symptoms yet. Lethargy. Higher blood sugars over a period of time allow diabetic complications to set in, su 2012; 105:3-9. Vomiting. Continuous glucose monitors are devices that use a small sensor inserted underneath the skin to track trends in blood sugar levels and send the information to a wireless device, such as a smart phone. According to the Centers for Disease Control and Prevention (CDC), there are several risk factors for developing type 2 diabetes. Copy-edited by Sean Marks in September 2015. If you see these symptoms of either high or low blood sugar, be sure to let your primary care team know . Type 1 diabetics or type 2 diabetics prone to HHS should continue insulin therapy to prevent DKA, assuming that is compatible with their care goals. But y Long-acting sulfonylureas and metformin in particular should be stopped. We explain what insulin sizes mean, how to choose the correct size for, Singer Nick Jonas, who has type 1 diabetes, debuted a new blood glucose monitoring device during a Super Bowl television commercial, Researchers say there are a number of factors that may be responsible for people with autism having a higher risk for cardiometabolic diseases. There are also experimental drugs that may help in the management of type 2 diabetes. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. Prolonged, unexplained weight loss. An approach to diabetes mellitus in hospice and palliative medicine.J Palliat Med. In April 2014, the Centers for Disease Control and Prevention (CDC) reported that major diabetes-related complicationsincluding lower limb amputation, late-stage kidney failure, heart attack, stroke, and death from high blood sugarhave declined significantly among adults in the United States over the past 20 years. There is no way anyone should die like this. However, with proper care, regular exercise, following a proper diet, and taking timely me Without treatment, these elevated levels can cause long-term damage to the body. Vegetables are rich in vitamins, minerals, antioxidants, and plant compounds. Emotional & Communication ConsiderationsFor some patients and families, careful attention to diabetes management is an empowering and satisfying health promotion activity, and can continue to be so near lifes end. Heart failure is preventable and treatable. Every health professional should take note of how much more common heart failure is among patients with diabetes. Difficulty eating. The Office for National Statistics estimates life expectancy amongst new births to be: 77 years for males 81 years for females. People with type 2 diabetes may also need medications to prevent their blood sugar levels from getting too high. These include obesity, smoking, and stress. QJM. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Continuous glucose monitor and insulin pump, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota. Your loved one will still get treatment for pain relief and comfort, but hospice also offers emotional and spiritual support for them as well as you and close family. My husband is a diabetic, he doesn't have insurance and can't afford his insulin, his sugar levels are never under 600, over the last several months he has lost control of his bodily functions mainly while sleeping, sometimes while awake though, he is also becoming more and more irrate, he is also skin and show more My husband is a diabetic, he doesn't have insurance and can't afford his insulin, his sugar levels are never under 600, over the last several months he has lost control of his bodily functions mainly while sleeping, sometimes while awake though, he is also becoming more and more irrate, he is also skin and bones, he gets staff infections almost every 3 months or so, I have been online searching to see if there are signs that he might be in final stages before death, I have 2 small children and I need to be prepared if he is slipping away, he is only 36 years old. American Diabetes Association. Can You Die from Diabetes? information submitted for this request. Accessed July 11, 2022. The idea of a diabetic coma can be scary, but you can take steps to help prevent it. It develops when the body can no longer respond to insulin correctly. Blood sugar that's either too high or too low for too long may cause the following serious health problems, all of which can lead to a diabetic coma. She did state that he wasnt having any low blood sugars. Fast Facts can only be copied and distributed for non-commercial, educational purposes. About four to six minutes later, brain cells start to die from the loss of . The main symptom is unconsciousness. Expert recommendations have suggested targeting fasting glucose up to 180 mg/dL (1); however some raise the target to 270 and even 360 (5, 6). If you have diabetes, dangerously high blood sugar (hyperglycemia) or dangerously low blood sugar (hypoglycemia) can lead to a diabetic coma. Accessed July 11, 2022. Today, the disease is widespread like an epidemic and the several complications which diabetes leads to often make people wonder #Can you Die from Diabetes?. As death approaches, your role is to be present, provide comfort, and reassure your loved one with soothing words and actions that help maintain their comfort and dignity. Depending on your diagnosis and personal needs, your treatment plan may include reaching out to: According to experts in the field of diabetes research, diabetes staging plays an important role in the prevention, diagnosis, and treatment of diabetes. Continue reading >>, Heres what you need to know about the life-threatening diabetes complication called diabetic ketoacidosis. J Diabetes Metab 2:167. doi:10.4172/2155-6156.1000167 Copyright: 2011 Soumya D, et al. These diabetic symptoms are: * Extreme and excessive thirst that is quite abnormal * Hunger even when meals have recently been taken * Excessive weight loss at such a short period of time * Nagging impatience that has recently been developed Go to : Your bod Treatment of type 2 diabetes includes tracking a persons blood sugar levels, which helps them identify peaks and address the cause. Having problems such as eyesight loss, nerve damage, and infections that can lead to amputations can increase the probability of having an accident and being injured, leading to death. Excessive fatigue and sleep The person may begin to sleep the majority of the day and night as metabolism slows and the decline in food and water intake contribute to dehydration. Increased susceptibility to infections. 2006; 20(3):197-203. People living with this condition tend to have a shorter life expectancy than those not living with the condition. Continue reading >>, Are there any signs of the final stages before death from diabetes? The following physical and emotional signs of approaching death are described to help you understand what can happen. A continuous glucose monitor, on the left, is a device that measures blood sugar every few minutes using a sensor inserted under the skin. Ford-Dunn S, Smith A, Quin J. Take your early symptoms seriously. Clinical presentation, diagnosis and initial evaluation of diabetes mellitus in adults. [emailprotected] AIMS: To assess predictors of mortality and end-stage diabetic complications inpatients with Type 1 diabetes mellitus on intensified insulin therapy.METHODS: A cohort of 3,674 patients (insulin treatment before age 31) who hadparticipated in a 5-day in-patient group treatment and teaching programme forintensification of insulin therapy between 9/1978 and 12/1994 were reassessedafter 10 +/- 3 (mean +/- SD) years.RESULTS: Vital status and data on blindness, amputations, and renal replacementtherapy were documented for 97% patients; 7% patients had died, 1.3% had becomeblind, 2% had amputations and 4.6% started renal replacement therapy. If you adapt or distribute a Fast Fact, let us know! Diabetes Ketoacidosis: The high sugar level in the blood which is a characteristic of diabetes often leads to the high amount of ketone cells in the body. Diabetic ketoacidosis and hyperosmolar hyperglycemic state in adults: Clinical features, evaluation, and diagnosis. Much like the previous guidelines above from 2015, the DBCD care model helps clinicians take preventative steps to reduce type 2 diabetes complications. As blood sugar levels remain high, damage can occur within the vascular system, leading to potential complications like: While end-stage diabetes isnt a commonly used term, diabetes can lead to whats known as end-stage diabetic complications, or advanced complications. the unsubscribe link in the e-mail. Some corticosteroids can cause blood glucose levels to rise because they don't allow the body to use insulin properly. Causes of Diabetic Coma The main cause of a diabetic coma is an extremely high blood sugar or an extremely low blood sugar. Accessed July 11, 2022. If you have ketones (measured in blood or urine) and high blood sugar, the condition is called diabetic ketoacidosis. Weight loss. Stop peeing and having bowel movements. In this stage, there's a significant loss of beta cells due to autoimmunity and symptoms are present, resulting in a type 1 diabetes diagnosis. Inzucchi SE, et al. Using theCox proportional hazards model, the following risk factors of mortality asassessed at baseline were identified: nephropathy (at least macroproteinuria),hazard ratio 3.8 (95% confidence interval 2.6-5.6); smoking, 1.9 (1.4-2.6);diabetes duration, 1.5 (1.2-1.8) for a difference of 10 years; serum cholesterol,1.1 (1.0-1.2) for a difference of 1 mmol/l; lower social status, 1.4 (1.1-1.8)for a difference of 1 out of 3 levels; age, 1.3 (1.1-1.6) for a difference of 10 years; male sex, 1.4 (1.1-1.9); systolic blood pressure, 1.1 (1-1.2) for adifference of 10 mmHg. All rights reserved. Cardiovascular disease is the leading cause of death among people with diabetes. Monika wasnt sure if the steps taken by the staff to manage his diabetes were enough. High dose steroids and diabetes. The impact on life expectancy depends on various factors, such as how soon a person receives a diagnosis and treatment, and how well they and their healthcare team manage the condition. A 9-year-old boy who died last year while in the care of Arizona's child welfare agency was hospitalized twice for a life-threatening diabetes complication in the weeks leading up to his death, according to an autopsy report released this month. If youve been diagnosed with diabetes, its important to stay educated about your condition so that you can more easily manage it in the long-term. This pamphlet may be helpful in preparing you as family and/or caregiver to understand the final stage of life. Insel RA, et al. Long-acting sulfonylureas and metformin in particular should be stopped. A diabetic coma is a medical emergency. 2011; 14(1):83-7. The effects of diabetes on the blood vessels and nerves that control the heart make it more likely that someone with diabetes will have other health conditions that raise the risk of heart disease, such as high blood pressure, high triglycerides, and high cholesterol. entertainment, news presenter | 4.8K views, 28 likes, 13 loves, 80 comments, 2 shares, Facebook Watch Videos from GBN Grenada Broadcasting Network: GBN News 28th April 2023 Anchor: Kenroy Baptiste. A person living with type 2 diabetes who maintains an active lifestyle, eats a healthy diet, refrains from smoking, and receives prompt treatment for complications, such as infections or cardiovascular disease has a higher likelihood of a better outlook. https://www.diabetes.org/healthy-living/medication-treatments/insulin-other-injectables/insulin-pumps-relief-and-choice. Common symptoms in this period also include physical changes, such as: Chronic fatigue. The first stage, known as clinical death, occurs when a person's heart stops beating. Vandenhaute V. Palliative care and type II diabetes: A need for new guidelines? information is beneficial, we may combine your email and website usage information with We decided to look into this for Monika. Although you may feel finedo not be fooled. The risk of premature death among people with diabetes was also much higher with 24,900 more deaths in 2012 than would normally be expected. Continuous glucose monitoring. Join now to receive our weekly Fast Facts, PCNOW newsletters and other PCNOW publications by email. In this stage, blood sugar levels remain abnormally high, leading to a diagnosis of type 2 diabetes. Copyright: All Fast Facts and Concepts are published under a Creative Commons Attribution-NonCommercial 4.0 International Copyright (http://creativecommons.org/licenses/by-nc/4.0/). Often, high dose corticosteroids such as dexamethasone are prescribed to relieve pain or pressure from tumours in people towards the end stages of life. Continue reading >>, Print Overview A diabetic coma is a life-threatening diabetes complication that causes unconsciousness. A diabetic coma is a life-threatening disorder that causes unconsciousness. Among people with Type 1 diabetes, which usually develops in childhood, 3,300 died in 2012, compared to the 1,440 expected among the same number of the general population. According to the literature on these guidelines, understanding the various stages of diabetes can allow physicians and patients to take a more comprehensive approach to preventive care and disease management. Death is never a pleasant subject but it's human nature to want to know 'how long can I expect to live'. Continue reading >>. Chronic cough and phlegm production. These signs of approaching death are specific to the natural dying process (apart from the effects of particular illnesses the person may have). Insulin pumps: Relief and choice. A 2016 meta-analysis that included data from over 13,000 people found that those who engaged in diabetes self-management education appeared to have longer life expectancies than those who did not. This stage is also called end-stage dementia or advanced dementia. There's a Big Difference; Too much sitting linked to heart disease, diabetes, premature death; Treat type 2 diabetes 'like cancer': How THIS major complication can lead to early death It's a frightening experience for everyone involved. End- or late-stage alcoholism can cause a variety of physical and mental health conditions, including: Cirrhosis Jaundice from liver failure Itchy skin Fluid retention Fatigue Malnutrition Chronic pancreatitis Heart failure Anemia Wernicke-Korsakoff syndrome (also called alcohol dementia ) Alcoholic Liver Disease/Cirrhosis There are two stages of death. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia. Smoothies are a great diabetes-friendly way to give yourself a sweet treat without causing a big spike in your blood sugar. Mechanick JI, et al. Palliat Med. https://www.uptodate.com/contents/search. The management of diabetes in terminal illness related to cancer. A study from 2019 found that microvascular complications from diabetes, like nephropathy, increase risk for cardiovascular events and death in people with type 1. Excessive hunger. Symptoms can take you by surprise, coming on in just 24 hours or less. Type 1 and Type 2 Life Expectancy, Emergency Preparedness: Diabetes Emergency Kit, Incidence and Risk Factors of Type 1 Diabetes: Implications for the Emergency Department, Studies on Medical Marijuana and Illness, Part 4: Arthritis, Diabetes, and Chronic Pain, Type 2 diabetes? For example, if the blood sugar is too high, the you may experience tiredness, abdominal pain, shortness of breath, increased urination, increased thirst, a rapid heart rate, a dry mouth, and a fruity smell to your breath. During American Diabetes Month, Healthline helps facilitate some important conversations for those living with diabetes. Sustained, severe hyperglycemia (often >800 mg/dL) causes a hyperosmolar hyperglycemic state (HHS, also known as hyperosmolar nonketotic hyperglycemia), associated with thirst, dry mouth, lethargy, and coma. Hospice staff have frequently observed that even the predictions by physicians about the length of time from the original diagnosis till death is often inaccurate. Diabetic retinopathy is a progressive eye disease classified by two types and four stages. There may also be a genetic factor to diabetes, which means that people with family members living with the condition may be more likely to develop it. But blood sugar levels still remain within the normal range, and no symptoms are present. All rights reserved. J Pain Symptom Manage. Being aware of how high blood sugar can go before death, the next concern is to figure out the last stages of diabetes before death. Its important to use your A1C as part of your diabetes monitoring. People who have diabetes cannot regulate their blood sugar levels and if the disease isn't tightly controlled, blood sugar can spike to abnormally high levels, a condition called . Hyperglycemia, sustained for several days, can cause an osmotic diuresis leading to dehydration, thirst, and polyuria. Continue reading >>, 1Department of Microbiology, Chaitanya Postgraduate College, Kakatiya University, Warangal, India 2Department of Biotechnology, Presidency College, Bangalore University, India *Corresponding Author: Department Of Microbiology, Chaitanya Postgraduate College affiliated to Kakatiya University, Warangal, India E-mail: [emailprotected] Citation: Soumya D, Srilatha B (2011) Late Stage Complications of Diabetes and Insulin Resistance. Avoid jostling the person awake. Hyperglycemia (high blood glucose). Fewer calories are needed, so loss of appetite and decreased. Credit: ABC. Doctors classify heart failure into stages. Hemoglobin is the protein found in red blood cells. Johnson & Johnsons new diabetes drug linked to coma and death. Visit for more related articles at Journal of Diabetes & Metabolism Abstract Diabetes mellitus is considered one of the main threats to human health in the 21st century. Well, although the answer to the above question cannot be a straight Yes, there is no denying of the fact that diabetes can, in fact, turn out to be a deadly disease. Low blood glucose (hypoglycemia). (Diabetic ketoacidosis most often affects people with type 1 diabetes, but there is also type 2 diabetes ketoacidosis.) https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring. That's because your brain needs glucose to function. If you go into a diabetic coma, you're alive but you can't wake up or respond purposefully to sights, sounds or other types of stimulation. Is the ketogenic diet right for autoimmune conditions? Diabetes is an umbrella term for three primary conditions: type 1 diabetes, type 2 diabetes, and gestational diabetes. The American Diabetes Association (ADA) provides information on new medications and screening techniques that continue to improve diagnostics and treatment of type 2 diabetes. Hypoglycemia from insulin or oral hypoglycemics causes diaphoresis, anxiety/panic, tremors, weakness, palpitations, seizure, coma. Heres a list of things to ask your doctor in the first 30 days, six months, and year after changing your type 2 diabetes treatment plan. This content does not have an English version. But the pancreas compensates for this by producing more insulin, which helps keep blood sugar levels within normal range. In the process of breaking down fat for energy, your body releases fatty acids and acids called ketones. Healthline Media does not provide medical advice, diagnosis, or treatment. Significantly elevated blood sugar levels can lead to diabetic ketoacidosis in people with type 1 diabetes or hyperglycemic hyperosmolar syndrome (HHS) in people with type 2 diabetes.
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