What is the typical clinical course and management considerations for DKA versus HHS in older adults?

• A. HHS is more common in older adults with type 2 diabetes and has higher mortality; management focuses on careful fluid and electrolyte correction.
• B. DKA is more common in older adults with type 2 diabetes.
• C. DKA and HHS have identical presentations and outcomes.
• D. Insulin therapy is contraindicated in older adults with HHS.

Answer: (A)

In older adults with type 2 diabetes, hyperosmolar hyperglycemic state is the typical scenario and carries a higher mortality than DKA, largely because of profound dehydration and multiple comorbidities. The management emphasis is on meticulous fluid resuscitation and careful electrolyte correction to restore volume and reduce hyperosmolarity, with insulin therapy begun after adequate hydration to avoid rapid shifts in osmolality; close monitoring of potassium and renal function is essential, and bicarbonate is reserved for only severe acidosis. This contrasts with diabetic ketoacidosis, which is more common in younger patients with type 1 diabetes and presents with ketosis and acidosis, guiding a somewhat different balance of fluids, insulin, and electrolyte management. The idea that DKA is more common in older adults or that insulin is contraindicated in older adults with HHS does not fit the typical pattern.