Which statement about hyperosmolar hyperglycemic state (HHS) is false?

Which statement about hyperosmolar hyperglycemic state (HHS) is false?

• A. Hyperglycemia occurs because of a relative insulin deficiency.
• B. Severe dehydration results from osmotic diuresis.
• C. There is little or no ketoacidosis in HHS.
• D. Hyperglycemia occurs because of a total insulin deficiency.

Answer: (D)

In HHS the problem is a relative, not total, insulin deficiency. There is enough insulin to suppress extensive fat breakdown and ketone production, so ketoacidosis is minimal or absent. However, insulin is insufficient to handle the body's glucose production or to prevent osmotic diuresis, leading to extreme hyperglycemia and profound dehydration with high serum osmolality. The statement implying hyperglycemia occurs because of a total insulin deficiency is incorrect because some insulin is present and ketosis is not driving the illness.

In HHS the problem is a relative, not total, insulin deficiency. There is enough insulin to suppress extensive fat breakdown and ketone production, so ketoacidosis is minimal or absent. However, insulin is insufficient to handle the body's glucose production or to prevent osmotic diuresis, leading to extreme hyperglycemia and profound dehydration with high serum osmolality. The statement implying hyperglycemia occurs because of a total insulin deficiency is incorrect because some insulin is present and ketosis is not driving the illness.