Which statement best describes the difference between HHNK and DKA?

• A. HHNK typically has little or no ketones in the blood
• B. HHNK always presents with abdominal pain
• C. DKA occurs only in type 2 diabetes
• D. DKA and HHNK have identical glucose levels

Answer: (A)

The main concept here is the presence of ketosis and acidosis distinguishing DKA from HHNK. In HHNK, there’s usually enough insulin to limit lipolysis, so ketone production is minimal. That means little to no ketones in the blood and no significant metabolic acidosis. In diabetic ketoacidosis, there is a marked insulin deficiency that drives ketone formation, leading to high ketone levels and a metabolic acidosis.

This makes the statement that HHNK typically has little or no ketones the best description of the difference. It also helps explain why glucose levels alone don’t tell the whole story: HHNK often presents with very high glucose due to severe dehydration and osmotic diuresis but without the acid-base disturbance seen in DKA. Abdominal pain can occur in DKA, so it isn’t a reliable differentiator. DKA is classically associated with type 1 diabetes (though it can occur in type 2 under certain conditions), whereas HHNK more commonly occurs in type 2 or in adults with some insulin production remaining. Finally, glucose levels are not identical between the two conditions; HHNK typically shows higher glucose levels than DKA.