How is hyperglycemic hyperosmolar state (HHS) different from DKA?

Hyperglycemic hyperosmolar state (HHS) is characterized by extremely elevated blood glucose levels without significant ketoacidosis. One of the defining features of HHS is the lack of significant ketone production. In HHS, the body typically has enough insulin to prevent the breakdown of fat into ketones, whereas in diabetic ketoacidosis (DKA), which is more common in Type 1 diabetes, there is a substantial lack of insulin, leading to the production of ketones as the body breaks down fats for energy.

In this condition, the high glucose levels lead to dehydration and hyperosmolarity but do not prompt the metabolic derangement associated with ketosis. Therefore, understanding that HHS does not involve significant ketone production is crucial in differentiating it from DKA, as this affects the management and treatment strategies for patients experiencing these conditions.