Which of the following factors is associated with a high risk for hyperosmolar hyperglycemic syndrome (HHS)?

Hyperosmolar hyperglycemic syndrome (HHS) is a serious condition often seen in patients with type 2 diabetes, characterized by extremely high blood glucose levels and increased osmolality without significant ketoacidosis. Each of the identified factors contributes to the risk of developing HHS.

Recent myocardial infarction can lead to a physiological state that increases insulin resistance, particularly due to stress and illness. This situation can precipitate hyperglycemia, heightening the risk for HHS.

Age is another critical factor; older individuals are often more susceptible to various stressors, have a higher incidence of type 2 diabetes, and may have comorbidities that complicate their glycemic control. Specifically, an age of 77 years reflects an increased likelihood of urinary tract infections or other infections, which are frequently triggers for HHS.

Influenza, or any significant infection, can exert a stress response, leading to the release of counter-regulatory hormones such as glucagon and cortisol. This response can further exacerbate hyperglycemia and lead to dehydration, both of which are integral components contributing to HHS development.

The combination of these factors highlights that multiple interplaying physiological and pathological processes can enhance the risk for hyperosmolar hyperglycemic syndrome, thereby