Diabetes complications: differences between Diabetic Keto-acidosis (DKA) and Hyperglycemic Hyperosmotic Syndrome (HHS)

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Diabetes complications: differences between Diabetic Keto-acidosis (DKA) and Hyperglycemic Hyperosmotic Syndrome (HHS)

Diabetes is one of the most common chronic lifestyle diseases in the world. Diabetes is a disease where increased sugar levels in the bloodstream can damage the heart, blood vessels, and eyes over time. It is caused due to the resistance of cells to insulin hormone or the decreased production of insulin by the pancreas or both, which makes the insulin useless to control high blood sugar levels.  

DKA (Diabetic Ketoacidosis) 

Type 1 diabetes is commonly associated with diabetic ketoacidosis. It happens when high blood sugar levels, lead to increased ketones (acidic substances) in your blood- which can lead to a coma or even death too. Ketones are produced when your body burns fats to get energy instead of glucose.  


  • infections 
  • illnesses 
  • psychological stress 
  • clogs in your insulin pump 
  • missing an insulin injection 
  •  not following your treatment plan 
  • pregnancy 


  • The urge to pee frequently 
  • Extreme thirst and dry mouth 
  • High blood sugar levels 
  • High ketone levels in urine 
  • Nausea, vomiting, and stomach cramps 
  • Breath smelling fruity or  
  • Fatigue 
  • Confusion 
  • Rapid breathing 

 If you have any of these symptoms, seek emergency help because it is profoundly serious and dangerous.  

HHS (Hyperglycemic Hyperosmolar Syndrome) 

HHS is also known as Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS). It is mostly found in type 2 diabetes. It happens when your blood sugar levels go extremely high (hyperglycemia), and your kidneys try to remove the extra sugar through urination. But if you don’t drink enough fluids to replace the fluids you lost through pee, blood sugar levels keep increasing and become concentrated (hyperosmolarity), so your body starts taking water from other organs like your brain.  


  • Remarkably high blood sugar levels 
  • Substance misuse 
  • Infections (such as pneumonia, urinary tract infection), or sepsis 
  • Certain medications (like drugs for psychosis) 
  • Not following your treatment plan for diabetes 


  • Extremely high blood sugar levels 
  • Dry mouth and excessive thirst 
  • Rapid heart rate 
  • frequent urination 
  • Nausea or vomiting and stomachache 
  • Confusion 
  • Slurred speech 
  • Weakness on one side of your body 
  • Blurred vision 
  • Hallucinations  

If you see any of the symptoms stated above, contact emergency care as fast as you can.  

Differences and similarities between DKA and HHS 

  • Both are life-threatening. One develops when the body doesn’t get glucose and starts creating energy from body fat, while the other develops because of extremely high blood sugar levels in our body.  
  • Both have hyperglycemia (high blood sugar level) components in them. 
  • DKA develops in a few hours while HHS takes several days or weeks to develop.  
  • DKA is found with type 1 diabetes while HHS is mostly found with type 2 diabetes.  

Some symptoms are common in both like nausea, vomiting, frequent urination, confusion, etc. And both need immediate help from medical health providers once the symptoms are visible. 

Treatments of DKS and HHS 

Both need immediate medical care. The main treatment of DKA and HHS include: 

  • giving you fluids to rehydrate, 
  •  insulin therapy,  
  • electrolyte replacement, and  
  • discovering and treating the causes of the coexisting conditions.  

Both complications are life-threatening. But monitoring your symptoms can go a long way in preventing them. You can take precautions like taking your meds on time, eating a balanced diet, checking your blood sugar levels regularly, keeping yourself hydrated, etc.  

Do you want to know more about diabetes and its complications? To learn more about diabetes and its management visit our Endocrinology page. You can also visit our website at https://doralhw.org  if you have any queries. Call us on +1-347-384-5690 to get answers to your queries or pay us a visit at 1797 Pitkin Avenue, Brooklyn, New York 11212. And if you have diabetes or have its symptoms, come to us for diagnosis and treatment, we have the best endocrinologists and diabetes specialists to help you throughout the process. 

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