HHS occurs more commonly in which type of diabetes?

• A. Type 2
• B. Type 1
• C. Gestational
• D. Prediabetes

Answer: (A)

Hyperosmolar Hyperglycemic State (HHS) is driven by severe high blood glucose with profound dehydration but little or no ketone production. This pattern fits best with type 2 diabetes, especially in older adults, where there is enough endogenous insulin to suppress ketogenesis but not enough to prevent extreme hyperglycemia. The combination of insulin resistance and relative insulin deficiency leads to marked hyperglycemia that causes osmotic diuresis and dehydration, raising serum osmolality and risking mental status changes. In contrast, type 1 diabetes involves an absolute lack of insulin, which promotes lipolysis and ketone formation, so diabetic ketoacidosis (DKA) is the more typical presentation rather than HHS. Gestational diabetes can have serious complications but HHS is less common in pregnancy, and prediabetes isn’t at the stage where HHS typically occurs.