Hyperosmolar hyperglycemic nonketotic state (HHNS) is most commonly associated with which condition?

• A. Type 1 diabetes
• B. Hypoglycemia
• C. Aortic aneurysm
• D. Type 2 diabetes

Answer: (D)

Hyperosmolar hyperglycemic nonketotic state is driven by severe hyperglycemia in a person with enough residual insulin to prevent fat breakdown and ketosis. This pattern is most commonly seen in type 2 diabetes, especially in older adults, and is often triggered by another illness or dehydration. The result is marked high blood glucose and elevated serum osmolality with little to no ketones, leading to dehydration and mental status changes. Type 1 diabetes, in contrast, usually presents with diabetic ketoacidosis and significant ketosis; hypoglycemia is a different problem altogether, and an aortic aneurysm isn’t related to this condition. So the association is with type 2 diabetes.