Hyperosmolar hyperglycemic state is typically associated with which patient profile?

• A. Type 1 diabetes with ketosis
• B. Type 2 diabetes with mild dehydration
• C. Type 2 diabetes with severe dehydration and very high blood glucose
• D. Gestational diabetes

Answer: (C)

Hyperosmolar hyperglycemic state is driven by extremely high blood glucose in the setting of type 2 diabetes with profound dehydration. In type 2, there’s enough insulin to prevent significant ketone production, so ketosis and acidosis aren’t prominent, but not enough to stop very high glucose levels from causing intense osmotic diuresis. The result is severe dehydration and elevated serum osmolality, often with altered mental status. This contrasts with diabetic ketoacidosis, which is more common in type 1 and features ketosis and acidosis. Gestational diabetes isn’t typically associated with this condition, and mild dehydration wouldn’t reach the extreme hyperosmolar state seen in HHS.