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Hyperosmolar hyperglycemic state
Hyperosmolar hyperglycemic state occurs primarily in people with type 2 diabetes. This state is characterized by hyperglycemia often greater than 30 mmol/L, and severe dehydration.

During a hyperglycemic episode, the accumulation of glucose in the blood increases the frequency and volume of urination. This can cause excessive water loss and significant dehydration. This can be followed by a drop in blood pressure leading to decreased consciousness and eventually to coma if the HHS is left untreated.

Lack of insulin is the cause. However, contrary to diabetic ketoacidosis, in HHS there is normally no significant presence of ketones in the blood or urine because insulin is not totally absent.

The symptoms are typical of hyperglycemia, including frequent and abundant urination, intense thirst and exhaustion, as well as such signs of dehydration as dry mouth, sunken eyes, dry skin, etc.

People with kidney problems are more susceptible to HHS because their kidneys are less efficient in eliminating excess glucose in the blood when hyperglycemic.

The elderly are less aware of their own thirst, so are consequently more at risk.
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Diabetic ketoacidosis mainly occurs in people with type 1 diabetes. It is characterized by hyperglycemia often greater than 20 mmol/L, with the presence of ketones in the blood or urine.

Ketones are produced from the breakdown of fats. Their accumulation in the blood is toxic for the body. This situation arises when the body lacks insulin and must use its fat reserves for the energy it normally gets from glucose.

Diabetic ketoacidosis can arise due to a forgotten or skipped insulin dose, an improper adjustment to the insulin dose, an insulin pump that stops working, or a serious medical problem (e.g., heart attack, pneumonia).

The following symptoms are associated with diabetic ketoacidosis:

deep, rapid breathing
fruity breath (acetone odour)
nausea, vomiting
abdominal pain
decreased consciousness, confusion, agitation, unusual behaviour
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There are two types of hyperglycemic emergencies: diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). These situations require emergency medical intervention, since they can lead to serious conditions such as coma, even death, if left untreated.

Diabetic ketoacidosis and hyperosmolar hyperglycemic state have the same cause: insufficient insulin
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