# What is the difference between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS)? Canonical page: https://clinicsjo.com/en/faq/diabetic-ketoacidosis-vs-hyperosmolar-hyperglycemic-state-differences Language: en Category: diabetes Publisher: ClinicsJo Published: 2026-09-13T17:52:51.961Z Content updated: 2026-09-13T17:52:51.961Z Translation (ar): https://clinicsjo.com/ar/faq/diabetic-ketoacidosis-vs-hyperosmolar-hyperglycemic-state-differences Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are serious medical emergencies resulting from severely elevated blood glucose levels, typically affecting people with diabetes. The primary difference lies in the presence of ketones in the blood. Diabetic ketoacidosis occurs when there is insufficient insulin to allow glucose to enter cells, forcing the body to break down fat for energy, which results in the buildup of acidic ketones in the blood. Conversely, hyperosmolar hyperglycemic state is characterized by extremely high blood glucose and severe dehydration without producing large amounts of ketones. ## What is Diabetic Ketoacidosis (DKA)? Diabetic ketoacidosis most often occurs in people with type 1 diabetes, but it can also affect patients with type 2 diabetes. When the body does not have enough insulin, cells cannot use glucose for energy. Instead, the liver begins to break down fat to produce fuel, leading to the production of acids called ketones. When ketones accumulate too quickly and in dangerous amounts, they can become life-threatening [\[1\]](). Symptoms of diabetic ketoacidosis include difficulty breathing, nausea or vomiting, abdominal pain, confusion, and a feeling of extreme fatigue or sleepiness [\[1\]](). There may also be a fruity breath odor and severe dry mouth [\[2\]](). If blood sugar levels are very high, it is recommended to check the level of ketones in the urine or blood. If the test shows moderate or high levels of ketones, or if testing is unavailable, you should call your doctor immediately or seek emergency medical help [\[1\]](). ## What is Hyperosmolar Hyperglycemic State (HHS)? Hyperosmolar hyperglycemic state (HHS) is another serious complication of hyperglycemia, usually occurring in patients with type 2 diabetes, especially older adults. This condition is characterized by extremely high blood sugar levels (significantly higher than usually seen in DKA), which leads to severe dehydration. Unlike DKA, the body does not produce large amounts of ketones in HHS because there is enough insulin to prevent full-scale fat breakdown, but not enough to control sugar levels [\[1\]](). Hyperosmolar hyperglycemic state develops slowly over days or weeks, and its symptoms include extreme thirst, frequent urination, confusion, fever, and in severe cases, coma. Both conditions require emergency medical care in a hospital, and treatment often includes intravenous fluids and insulin [\[1\]](). ## Preventing Hyperglycemic Complications To prevent both serious conditions, it is essential to manage diabetes effectively. This includes adhering to a diabetes meal plan, engaging in regular physical activity, taking medications or insulin correctly, and monitoring blood sugar levels regularly [\[1\]](). Regular blood sugar monitoring helps detect hyperglycemia and treat it early before it progresses to serious complications such as DKA or HHS [\[2\]](). You can learn more about danger signs, first aid, and prevention of hyperglycemia complications by visiting [Hyperglycemia: Danger Signs, First Aid, and Prevention of Complications (Arabic)](). ## Medical references - [Hyperglycemia]() - [Hyperglycemia (High Blood Glucose)]() General health education; not a substitute for individualized clinical assessment. Citation URL: https://clinicsjo.com/en/faq/diabetic-ketoacidosis-vs-hyperosmolar-hyperglycemic-state-differences#answer