What is Diabetic Coma (DLA & HHS) #diabetic #diabetes

Added: 2026-05-20

[00:00:00]A diabetic patient arrives unconscious.

[00:00:02]How do you know if it is DKA or HHS?

[00:00:05]Let's build it from pathophysiology, not memory.

[00:00:09]In DKA, insulin is almost absent.

[00:00:12]Glucose is high in blood, but cells are starving. So, the body switches fuel source to fat.

[00:00:20]Fat breakdown produces ketones. Ketones accumulate, and ketones are acidic. So, DKA equals high sugar plus acid buildup.

[00:00:30]Now, let's connect mechanism to symptoms. Fruity breath happens due to acetone ketones. Deep rapid breathing due to trying to blow off acid cosmo.

[00:00:38]Dehydration due to osmotic diuresis.

[00:00:40]Abdominal pain due to acidosis irritation. Now, HHS is there ketone production here? No. Good. In HHS, insulin is still present, just not enough. So, fat is not broken down, but glucose keeps rising. Water moves out of cells into blood. In HHS, what kills the patient is not acid. It is extreme dehydration and hyperosmolarity.

[00:01:00]A patient has glucose 33, no ketones, very dry skin, confusion. What is it?

[00:01:04]HHS. Good. And your first priority is fluid resuscitation.

[00:01:09]Nursing is not about memorizing. It is understanding mechanism. If you understand what the body is doing, you will never guess again. In DKA or HHS, always ask, is it acid or is it dehydration?