Background: A Hyperosmolar Hyperglycaemic state (HHS) is one of the most serious acute metabolic emergencies in diabetic patients. In HHS, severe hyperglycaemia develops gradually over a period of days or weeks without remarkable ketone production; in other words, without ketosis or severe acidosis. Case presentation: The patient is a 55-year-old male; he weighs 134 kg and his height is 192 cm. His body mass index (BMI) is 36.35 kg/m2. He is unable to work due to back problems and suffering from shortness of breath on exertion (SOBE). His blood glucose level was high (32.3 mmol/L), with an increase in urinary frequency. He has type 2 diabetes mellitus, hypertension, and chronic kidney disease. HHS developed after using furosemide in modest doses for seven weeks. Conclusion: Patients' urine and blood glucose levels should be monitored at regular intervals in diabetic patients receiving furosemide as it may prompt the development of HHS in patients taking modest doses
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