Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS) are two serious and potentially life-threatening emergencies that can occur in people with diabetes. Both conditions develop when blood sugar levels become dangerously high, but they affect the body in different ways.
DKA is more common in people with Type 1 diabetes and occurs when the body starts breaking down fat for energy, producing harmful substances called ketones. HHS is more common in people with Type 2 diabetes and is characterised by extremely high blood sugar levels and severe dehydration, but without significant ketone production.
Both conditions require urgent medical treatment. Without prompt care, they can lead to coma, organ failure, and death. Recognising the warning signs early and seeking immediate medical attention can save lives.
If you or a loved one has diabetes and develops symptoms such as severe thirst, vomiting, confusion, deep breathing, or loss of consciousness, urgent medical assessment is needed. Through Hope Plus, you can quickly speak with a licensed healthcare provider for guidance on diabetes management and learn when emergency treatment is necessary.
Key Takeaways
- DKA and HHS are medical emergencies caused by dangerously high blood sugar levels.
- DKA is more common in Type 1 diabetes, while HHS is more common in Type 2 diabetes.
- Symptoms include severe dehydration, excessive thirst, confusion, weakness, and altered consciousness.
- Immediate hospital treatment with fluids, insulin, and close monitoring is essential.
- Good diabetes control and prompt treatment of infections can help prevent these emergencies.
What Are DKA and HHS?
Although both conditions involve very high blood sugar levels, they develop differently.
What Is Diabetic Ketoacidosis (DKA)?
DKA occurs when the body does not have enough insulin to use glucose for energy.
As a result, the body begins breaking down fat stores. This produces ketones, which build up in the blood and make it dangerously acidic.
DKA can develop rapidly, often within 24 hours.
What Is Hyperosmolar Hyperglycaemic State (HHS)?
HHS occurs when blood sugar levels become extremely high over several days or weeks.
The high sugar levels cause the body to lose large amounts of water through urine, leading to severe dehydration and reduced blood volume.
Unlike DKA, significant ketone production and acidosis are usually absent.
What Causes DKA and HHS?
Several factors can trigger these emergencies.
Newly Diagnosed Diabetes
Some people first discover they have diabetes when they develop DKA or HHS.
Poorly Controlled Diabetes
Persistently high blood sugar levels increase the risk of both conditions.
Missing Diabetes Treatment
Stopping insulin or diabetes medications can quickly lead to dangerous blood sugar elevations.
Common reasons include:
- Running out of medication
- Forgetting doses
- Deliberately stopping treatment
- Difficulty accessing healthcare
Infections
Infections increase the body’s stress response and can raise blood sugar levels.
Common examples include:
- Pneumonia
- Urinary tract infections
- Skin infections
- Malaria and other severe illnesses
Trauma or Major Illness
Serious injuries, surgery, heart attacks, and other major medical conditions can trigger DKA or HHS.
Symptoms of Diabetic Ketoacidosis (DKA)
Symptoms usually develop quickly.
Early Symptoms
Many people experience:
- Excessive thirst
- Frequent urination
- Drinking large amounts of water
- Tiredness
- Unexplained weight loss
Later Symptoms
As the condition worsens, symptoms may include:
- Nausea
- Vomiting
- Severe abdominal pain
- Weakness
- Dizziness
Severe Symptoms
In advanced DKA, patients may develop:
- Deep, rapid breathing
- Fruity or sweet-smelling breath
- Confusion
- Drowsiness
- Loss of consciousness
- Coma
- Very low blood pressure
Symptoms of Hyperosmolar Hyperglycaemic State (HHS)
HHS often develops more slowly than DKA.
Severe Dehydration
People may experience:
- Extreme thirst
- Very dry mouth
- Dry skin
- Reduced urination despite dehydration
Neurological Symptoms
As dehydration worsens, symptoms may include:
- Confusion
- Drowsiness
- Weakness
- Difficulty speaking
- Seizures in some cases
- Loss of consciousness
Key Difference Between HHS and DKA
Unlike DKA:
- Ketones are absent or very low
- The breath does not usually have a fruity smell
- Significant acidosis is not present
- Dehydration is often more severe
When Should You Go to Hospital Immediately?
Seek emergency medical care if a person with diabetes develops:
- Persistent vomiting
- Severe abdominal pain
- Deep or laboured breathing
- Extreme weakness
- Confusion
- Loss of consciousness
- Very high blood sugar readings
- Signs of severe dehydration
These symptoms should never be ignored.
How Are DKA and HHS Diagnosed?
Healthcare providers use a combination of symptoms, examination findings, and laboratory tests.
Blood Sugar Testing
Blood sugar levels are usually very high.
Urine Testing
Urine may be checked for ketones.
Positive ketones strongly support a diagnosis of DKA.
Blood Tests
Healthcare providers may perform:
- Full blood count
- Kidney function tests
- Electrolyte testing
- Other investigations to identify the cause
Emergency Treatment of DKA and HHS
Treatment is provided in hospital and usually requires close monitoring.
Step 1: Close Monitoring
Healthcare providers regularly monitor:
- Blood pressure
- Blood sugar levels
- Urine output
- Level of consciousness
- Heart rate
- Breathing
Patients who are unconscious may require a urinary catheter to monitor urine output accurately.
Step 2: Treat the Underlying Cause
Healthcare providers look for factors that triggered the emergency.
For example:
- Antibiotics may be given if an infection is present.
- Other medical conditions are identified and treated appropriately.
Step 3: Fluid Replacement
Severe dehydration is one of the most dangerous aspects of DKA and HHS.
Intravenous fluids are given to:
- Restore blood volume
- Improve circulation
- Correct dehydration
- Support kidney function
As blood sugar levels improve, different fluids may be used depending on the patient’s condition.
Step 4: Insulin Treatment
Insulin is given to lower blood sugar levels safely.
Healthcare providers continue insulin treatment until:
- Ketones disappear
- Blood sugar levels improve
- The patient is able to eat and drink safely
Once the patient stabilises, treatment is usually switched to a regular insulin regimen given under the skin.
Step 5: Potassium Replacement
Potassium is an important mineral that helps muscles and the heart function properly.
During treatment, potassium levels can fall rapidly.
Healthcare providers monitor potassium levels and add potassium to intravenous fluids when necessary.
Step 6: Prevent Blood Clots
Patients who are unable to move for prolonged periods may receive medicines to reduce the risk of blood clots forming in the legs or lungs.
Recovery After DKA or HHS
Most people recover fully when treatment is started early.
Before discharge, healthcare providers often:
- Review diabetes treatment plans
- Adjust medications if necessary
- Provide education on blood sugar monitoring
- Discuss warning signs of future emergencies
- Address factors that triggered the episode
Preventing DKA and HHS
Many cases can be prevented through good diabetes management.
Take Diabetes Medicines as Prescribed
Never stop insulin or diabetes medications without medical advice.
Monitor Blood Sugar Regularly
Regular monitoring helps identify problems before they become serious.
Seek Early Treatment for Infections
Prompt treatment of infections can prevent dangerous rises in blood sugar.
Attend Regular Diabetes Reviews
Routine clinic visits help healthcare providers identify problems early.
Learn the Warning Signs
People living with diabetes and their family members should know the symptoms of DKA and HHS and seek help immediately if they occur.
Hypoglycaemia: Another Diabetes Emergency
While DKA and HHS are caused by high blood sugar, severe low blood sugar (hypoglycaemia) can also be life-threatening.
Symptoms may include:
- Sweating
- Shaking
- Confusion
- Seizures
- Loss of consciousness
In severe cases, healthcare providers may administer glucagon injections or intravenous glucose to rapidly raise blood sugar levels.
Frequently Asked Questions
1. What is the difference between DKA and HHS?
DKA involves high blood sugar, ketone production, and acid build-up in the blood. HHS involves extremely high blood sugar and severe dehydration but usually does not involve significant ketone production.
2. Which people are most likely to develop DKA?
DKA is most common in people with Type 1 diabetes, although it can occasionally occur in people with Type 2 diabetes.
3. Which people are most likely to develop HHS?
HHS is more common in older adults with Type 2 diabetes.
4. Can infections trigger DKA or HHS?
Yes. Infections are among the most common triggers because they increase the body’s stress hormones and raise blood sugar levels.
5. Can DKA or HHS cause death?
Yes. Both conditions are medical emergencies and can be fatal if treatment is delayed.
6. How can I prevent DKA and HHS?
Regular blood sugar monitoring, taking medications correctly, treating infections promptly, and attending follow-up appointments can significantly reduce the risk.
7. Can DKA happen in someone who does not know they have diabetes?
Yes. For some people, DKA is the first sign that they have diabetes.
Conclusion
Diabetic Ketoacidosis (DKA) and Hyperosmolar Hyperglycaemic State (HHS) are serious complications of diabetes that require urgent hospital treatment. They can develop when diabetes is undiagnosed, poorly controlled, or triggered by infections and other illnesses. Recognising the symptoms early and seeking immediate medical care can prevent severe complications and save lives. With proper diabetes management, regular monitoring, and prompt treatment of infections, most cases can be prevented.
