An unresponsive 23-year-old male with type 2 diabetes has warm, dry skin and stable vital signs. Which condition should you suspect?

• A. increased intracerebral pressure.
• B. stroke.
• C. hypoglycemia.
• D. hyperglycemia.

Answer: (D)

When someone with diabetes is unresponsive but has warm, dry skin and stable vital signs, think hyperglycemia from dehydration due to osmotic diuresis. As blood glucose climbs, the kidneys excrete glucose with water, leading to dehydration. That dehydration tends to make the skin feel warm and dry and can alter mental status, even if heart rate and blood pressure aren’t severely abnormal yet.

This fits better than hypoglycemia, which usually presents with cool, clammy skin and sweating from adrenergic activation; stroke or increased intracranial pressure would typically show focal neurological signs such as weakness, asymmetry, speech changes, severe headache, or vomiting, not a global dehydration picture.

In a type 2 patient, this could reflect a hyperosmolar hyperglycemic state, which presents with significant dehydration and altered mental status but may have less dramatic acidosis than diabetic ketoacidosis.