Hyperglycemic Crisis in a 37 Year Old Man with Multiple Substance Use and Depression

Uncontrolled hyperglycemia termed hyperglycemic hyperosmolar syndrome (HHS) is a serious but relatively common presentation of new-onset diabetes mellitus. The diagnosis of the disorder itself is fairly straight forward, but the search for trigger factors can be challenging. Infections are the usual precipitating factor, but a variety of other stressors can be involved such as the abuse of substances like alcohol, cocaine, and cannabis. Available evidence suggests that depression is common among diabetic patients. When such patients are also dependent on substances, it becomes challenging to distinguish between diabetes-related depression and substance-related depression. Clinicians managing diabetic patients need to be aware of comorbid conditions that may negatively impact patient care. We report herein a patient presenting with hyperglycemic hyperosmolar state with two possible precipitating factors; infection and substance abuse.