How does the time course of Diabetic Ketoacidosis (DKA) compare to Hyperglycemic Hyperosmolar State (HHS)?

The time course of Hyperglycemic Hyperosmolar State (HHS) is characterized by a gradual evolution, typically developing over several days to weeks. This slower onset is mainly due to the body’s ability to produce some insulin, even in the setting of significant hyperglycemia. Patients often present with substantial dehydration and may initially exhibit milder symptoms, leading to a longer duration before diagnosis compared to Diabetic Ketoacidosis (DKA).

In contrast, DKA usually develops more acutely, often within hours to a day. The presence of significant ketoacidosis due to an absolute insulin deficiency leads to a more rapid deterioration in the patient's condition, with symptoms manifesting quickly. Therefore, understanding this distinction between the two conditions is crucial for timely recognition and intervention, as HHS can be particularly insidious due to its protracted onset.