The condition is characterized by hyperglycemia
(high blood sugar, very high with this condition), hyperosmolarity
(thicker blood, more particles/cells in blood and less fluid),
and dehydration (not enough fluid in the body) without significant
ketoacidosis(when the body uses fat for energy it breaks down
the fat and that produces keto acids and they are excreted
in urine. A quick dipstick tests in urine tells you if they
are present thus signaling the body is breaking down fat for
Typically an older patient with type II
diabetes has an illness, flu, infection, where they are not
getting enough fluids and go into HHS.
Unlike patients with diabetic ketoacidosis
(DKA), patients with HHS do not develop significant ketoacidosis,
but the reason for this is not known. Contributing factors
likely include the availability of insulin in amounts sufficient
to inhibit ketogenesis but not sufficient to prevent hyperglycemia.
Additionally, hyperosmolarity itself may decrease lipolysis,
limiting the amount of free fatty acids available for ketogenesis.
Also, lower levels of counter-regulatory hormones have been
found in patients with HHS compared with those with DKA 
Permission granted by Marilyn H. Oermann,
PhD, RN, FAAN, ANEF and Carol F. Durham, EdD, RN, ANEF. University
of North Carolina School of Nursing. (2008).
These videotapes were developed with funding from University
of North Carolina-General Administration through a grant to
M. Oermann, 2008.