Hyperglycemic hyperosmolar nonketotic coma is most commonly associated with which type of diabetes?

• A. Type 1
• B. Type 2
• C. Gestational diabetes
• D. Maturity onset diabetes of the young

Answer: (B)

Hyperglycemic hyperosmolar nonketotic coma is driven by very high blood glucose with profound dehydration and a high serum osmolarity, while insulin activity is enough to suppress ketogenesis. This pattern is most typical of type 2 diabetes, especially in older adults who become dehydrated during illness or stress. In type 1 diabetes, lack of insulin typically leads to diabetic ketoacidosis with metabolic acidosis, rather than the rare severe hyperosmolar state seen in HHS. Gestational diabetes and MODY are less commonly associated with this severe hyperosmolar condition. So, the presentation aligns best with type 2 diabetes.