Which patient population is more commonly affected by hyperosmolar hyperglycemic state?

Which patient population is more commonly affected by hyperosmolar hyperglycemic state?

• A. Elderly patients with type 2 diabetes.
• B. Younger patients with type 1 diabetes.
• C. Children with no diabetes.
• D. Healthy adults.

Answer: (A)

Hyperosmolar hyperglycemic state arises from extreme hyperglycemia with profound dehydration and high serum osmolality, but with little or no ketoacidosis. It is most common in elderly patients with type 2 diabetes. In type 2 diabetes there is enough insulin to suppress significant ketone production, so ketoacidosis doesn’t develop despite very high glucose levels. However, insulin deficiency and resistance still drive severe hyperglycemia and osmotic diuresis, leading to fluid loss and high osmolality. Older adults are at higher risk because of factors like reduced thirst sensation, limited fluid intake, dehydration from illnesses, comorbidities, and polypharmacy that can impair fluid balance. This combination makes the elderly with type 2 diabetes the population most commonly affected by HHS.

Hyperosmolar hyperglycemic state arises from extreme hyperglycemia with profound dehydration and high serum osmolality, but with little or no ketoacidosis. It is most common in elderly patients with type 2 diabetes. In type 2 diabetes there is enough insulin to suppress significant ketone production, so ketoacidosis doesn’t develop despite very high glucose levels. However, insulin deficiency and resistance still drive severe hyperglycemia and osmotic diuresis, leading to fluid loss and high osmolality. Older adults are at higher risk because of factors like reduced thirst sensation, limited fluid intake, dehydration from illnesses, comorbidities, and polypharmacy that can impair fluid balance. This combination makes the elderly with type 2 diabetes the population most commonly affected by HHS.