Diabetes is a disease caused byinsulinIt is caused by absolute or relative insufficiency of secretion and utilization obstaclehyperglycemiaMarkedchronic disease。The disease is mainly divided into type 1, type 2 andGestational diabetesThree types.The etiology is mainly attributed to the combined effect of genetic factors and environmental factors, including the decrease of insulin secretion caused by islet cell dysfunction, or the body is not sensitive to insulin action or both, which makes the glucose in the blood unable to be effectively used and stored.Some diabetic patients and families have disease aggregation.In addition, the incidence and prevalence of diabetes in the world are on the rise.
The main symptoms of diabetes are "more than three and less", that is, more drink, more urine, more food and weight loss.In addition, patients with a long course of disease may cause chronic progressive disease, dysfunction and even failure of eyes, kidneys, nerves, heart, blood vessels and other tissues and organs, and may cause acute severe metabolic disorder.
The main treatment of diabetes is to maintain the blood sugar level within the normal range, prevent the occurrence of acute metabolic disorder, prevent or delay the occurrence and development of complications, and improve the quality of life through scientific and reasonable treatment methods.The prognosis depends on the condition control and the existence of complications.The prevention of diabetes mainly depends on a healthy lifestyle, including a balanced diet, moderate exercise, maintaining normal weight, regular physical examination, etc.
Some recent studies show that diabetes has a certain genetic susceptibility, and there is a phenomenon of family clustering.However, epidemiological and clinical medical research has been very clear, resulting inType 2 diabetesThe main reasons are poor lifestyle, including age growth, modern lifestyle, over nutrition, insufficient physical activity, etc.Therefore, improving the social environment that promotes the formation of unhealthy lifestyles is the fundamental way to reduce the number of diabetic patients.
TCM disease name
diabetes
Visiting department
Endocrinology Department, Ophthalmology Department, Neurology Department
Multiple population
Teenagers, adults, especially those over 40, obese
Common location
Eye, kidney, cardiovascular, nerve
Common causes
Genetic factors, environmental factors, immune system defects
The etiology of diabetes has not yet been clarified. Different types of diabetes have different causes, even in the same type.
Generally speaking, genetic factors and environmental factors together lead to the occurrence of diabetes.Mainly due toislet cellsCaused by dysfunctioninsulinDecreased secretion, or the body is not sensitive to insulin or both, resulting inglucoseIt cannot be used and stored effectively.
At present, the molecular etiology of most diabetes is not clear, except for some specific types of diabetes.Diabetes has a certain genetic susceptibility, and there is a phenomenon of family aggregation.
However, epidemiological and clinical medical research has been very clear, resulting inType 2 diabetesThe main reason is poor lifestyle.If we want to reduce the number of diabetic patients in China, improving the social environment that promotes the formation of unhealthy lifestyles is the fundamental way out.
Genetic factor
Genetic factorsType 1 diabetesIt plays an important role in the pathogenesis. More than 50 genetic variations have been found to be related to the genetic susceptibility of type 1 diabetes.
The occurrence of type 2 diabetes is also related to genetic factors. At present, more than 400 genetic variations have been found to be associated with the risk of type 2 diabetes or hyperglycemia.
It should be noted that the genetic background only endows individuals with a certain degree of disease susceptibility, which is not enough to cause disease. Generally, the overall effect of multiple gene abnormalities under the action of environmental factors leads to the occurrence of diabetes.
Environmental (external) factors
The environmental factors related to the occurrence of type 1 diabetes are unknown, and virus infection may be one of the environmental causes of type 1 diabetes, includingRubella virus、Mumps virus、Coxsackie virusThese viruses can directly damage pancreatic isletsβAnd can start the autoimmune reaction to further damage the isletsβCells.
Some chemical poisons, such as the rodenticide pymetronide phenylurea, can also cause pancreatic isletsβThe destruction of cells can induce type 1 diabetes.In recent years, with the widespread use of programmed death receptor 1 (PD-1) inhibitors in tumor treatment, the number of patients with type 1 diabetes caused by these drugs has also increased significantly.
Environmental factors are particularly important in the occurrence of type 2 diabetes, including age growth, modern lifestyle, excess nutrition, lack of physical activity and so on.The most important environmental factor leading to the increased risk of type 2 diabetes is the social environment leading to the formation of unhealthy lifestyles.
Autoimmune system defect
Under the combined effect of environmental factors and genetic factors, the immune system launches an attack on insulin producing islet cells, that is, autoimmunity, leading to isletsβCell damage and disappearance eventually lead to the reduction or lack of insulin secretion.
symptom
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The typical symptoms of diabetes are "more than three and less" related to hyperglycemia, skin infection, fatigue, vision changes and other symptoms and clinical manifestations, but many early patients often have no symptoms or mild symptoms.
With the development of the disease, diabetic patients will gradually appear multiple system injuries and clinical symptoms related to complications.
a precursor
The early stage of diabetes is often not manifested, so there is no precursor.Most of the patients found illness through physical examination and blood sugar test. When the symptoms such as "more than three, less" appear, they are usually more serious.
Typical symptoms
Diabetics generally go through several stages:
The patient has diabetes related pathophysiological changes, but the glucose tolerance is still normal;
As the disease progresses, pre diabetes occurs, which is an intermediate state between normal glucose homeostasis and diabetic hyperglycemia, includingImpaired fasting blood glucose(IFG) and/orAbnormal glucose tolerance（IGT）；
The final development is diabetes.
early symptom
In fact, the early stage of diabetes refers to the early stage of diabetes. In this stage, there are generally no obvious symptoms and clinical manifestations, and it is mainly found by detecting blood sugar.
Type 1 diabetes
Type 1 diabetes is more common in adolescents, and generally has an acute onset. Before the disease is diagnosed and treated, it can be manifested as "more than three and less", that is, more drink, more urine, more food, and weight loss. A few patients may take diabetic ketoacidosis coma or acute abdomen as the first symptom.
Insulin treatment is generally required from the beginning of the disease.Some adult patients also have a slow onset and no obvious clinical manifestation in the early stage, so the disease can only be found with the help of blood glucose detection.
Type 2 diabetes
Type 2 diabetes is more common in adults. It often starts after the age of 40, and most of the onset is hidden. Half of the patients have no symptoms at the early stage. Many patients have family history because of chronic complications or illness found during physical examination.
It often occurs simultaneously or successively with obesity, dyslipidemia, hypertension and other diseases.With the increasing prevalence of obesity among Chinese adolescents, the number of people who develop diabetes before the age of 40 is gradually increasing.
Some diabetic patients with significantly higher blood sugar can also have vision changes, skin infectionsVulvitis(female)Prepuceitis(male)gingivitisEtc.
In the early stage of diabetes, some patients may havehypoglycemiaThe symptoms are panic, nausea, cold sweat and other symptoms 3~5 hours after the meal.
Complications and/or accompanying manifestations
When the disease progresses to complications, the symptoms of corresponding organ damage will appear.
eye
Long term increase in blood sugar can lead to retinal vascular disease, resulting in decreased vision and even blindness.The incidence of cataract, glaucoma and other eye diseases in diabetic patients is also significantly increased.
foot
Wounds on feet are difficult to heal after injury, and wound infections and ulcers may occur (diabetic feet).In serious cases, systemic infection and osteomyelitis may occur, which may lead to amputation when the treatment effect is poor.
cardiovascular
The risk factors of atherosclerosis, such as obesity, hypertension, and dyslipidemia, have a high incidence in the diabetic population. Therefore, diabetic patients have a high prevalence of atherosclerosis, onset earlier, and progress faster.
kidney
Diabetic nephropathy, which may eventually lead to renal failure, is an important cause of death due to diabetes.Severe renal failure requires dialysis and kidney transplantation to maintain life.
nerve
The most common is polyneuritis, which produces abnormal sensation of the extremities. Sensation allergy, tingling, burning sensation and sock like sensation are the main reasons for diabetic foot.Diabetes can also affect the autonomic nervous system, leading to gastrointestinal function, reproductive system function and heart function disorders.
In case of increased blood sugar in physical examination, or "more than three, less" (i.e., more drink, more urine, more food and weight loss), fatigue, blurred vision, fatigue and other symptoms, seek medical advice in a timely manner.
Medical indications:
Those with elevated blood sugar and positive urine sugar found in physical examination;
People who have experienced the above "three more or less" symptoms or suspected symptoms;
Patients with diabetic complications or complications;
Repeated hypoglycemia;
Acidosis, shock, coma, dehydration, etc. of unknown cause;
Repeated infection;
High risk group of diabetes: people with impaired glucose regulation history, over 45 years old, overweight or obese;There are first degree relatives with type 2 diabetes;Have a history of gestational diabetes mellitus;Suffering from polycystic ovary syndrome, long-term treatment with antipsychotic drugs, etc.
Diagnostic basis
The contents of doctor's inquiry and collection of medical history include: specific symptoms, time, etc., and also ask whether there are other diseases, whether there is a history of diabetes in the family, usual eating habits, and previous diabetes treatment history.
At the same time, the doctor will judge whether there is diabetes and classify diabetes according to the patient's clinical manifestations and examination results, and judge whether there are complications and complications according to the clinical symptoms and examination results.
The doctor will select an appropriate treatment plan based on the patient's diabetes type and the development of the current condition.
Classification of sugar metabolism status
Classification of sugar metabolism
Intravenous plasma glucose (mmol/L)
/
Fasting blood glucose
Glucose load test 2h blood glucose
Normal blood sugar
<6.1
<7.8
Impaired fasting blood glucose
6.1~7.0
<7.8
Impaired glucose tolerance
<7.0
7.8~11.1
diabetes
≥7.0
≥11.1
Note: Impaired fasting glucose and impaired glucose tolerance are collectively referred to as impaired glucose regulation.
Diagnostic criteria for diabetes
diagnostic criteria
Intravenous plasma diabetes (mmol/L) or glycosylated hemoglobin level
Diabetes symptoms: acute metabolic disorders such as polydipsia, polyuria, weight loss, skin itching and blurred vision caused by hyperglycemia
Random blood glucose ≥ 11.1
Or fasting blood sugar
≥7.0
Or glucose load test 2h blood glucose
≥11.1
glycosylated hemoglobin
≥6.5%
Those without symptoms of diabetes need to repeat the examination another day.
be careful:
Fasting means fasting for at least 8 hours;
Random blood glucose refers to blood glucose at any time of the day, regardless of the time of last meal, and cannot be used to diagnose impaired fasting blood glucose or abnormal glucose tolerance;
Transient hyperglycemia may occur under acute infection, trauma or other stress conditions. If there is no clear history of hyperglycemia, recheck must be conducted after the stress is eliminated to determine the state of glucose metabolism.
Visiting department
Those with elevated blood sugar, positive urine sugar or related typical symptoms are preferred to go to the endocrine department for treatment;
Those with blurred vision and other symptoms can go to the ophthalmology department for treatment;
In case of limb paresthesia, go to neurology department for treatment;
When seeing a doctor in a primary hospital, you can go to the general practice department.
Relevant inspection
physical examination
Height, abdominal circumference, weight, blood pressure and heart rate were measured.
laboratory examination
Fasting blood glucose
It reflects the ability of the body to maintain the steady state of sugar metabolism without eating.
Oral glucose tolerance test
Reflects the body's ability to handle sugar load.
Urine sugar test
When the glucose in the blood exceeds the endurance of the kidney, it will appear in the urine.The positive result is an important clue to find diabetes, but it cannot be used as a diagnostic basis.
HbA1c reflects the blood glucose level in recent 2-3 months;GA reflects the average blood glucose level in the last 2-3 weeks.
Islets of langerhansβCell function test
Including insulin release test and C-peptide release test, reflecting the basic and glucose mediated isletsβThe ability of cells to release insulin.
matters needing attention:
The patient must have an empty stomach for more than 10 hours before the examination, and generally fasted after 12:00 p.m. the day before the examination;
In the oral glucose tolerance test, patients did not drink tea and coffee, smoke, or do strenuous exercise.
differential diagnosis
The most important differential diagnosis of diabetes is to differentiate between type 1 diabetes and type 2 diabetes.
category
Type 1 diabetes
Type 2 diabetes
onset
Acute onset with obvious symptoms
Slow onset, often asymptomatic
Clinical characteristics
Weight loss, polyuria, thirst, and excessive drinking
Obesity, strong family history of diabetes, may have concomitant diseases such as acanthosis nigricans, polycystic ovary syndrome, hypertension, fatty liver, etc
ICA, GAD Ab, IAA and other antibodies are negative
treatment
insulin
Diet control, exercise, oral or injectable hypoglycemic drugs
Related autoimmune diseases
High chance of occurrence
Low chance of occurrence
treatment
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At present, diabetes cannot be cured, but most diabetics can have the same quality of life and life span as non diabetics through scientific and reasonable treatment methods.
Treatment objectives
The goal of diabetes treatment: to control the symptoms of diabetes, prevent acute metabolic complications, prevent chronic complications, improve the quality of life of diabetic patients, establish a more complete diabetes education management system, and provide individualized guidance for lifestyle intervention and drug treatment for patients.
Comprehensive diabetes control objectives (China's guidelines for prevention and treatment of type 2 diabetes in 2020)
Test index
target value
Fasting blood glucose
4.4~7.0mmol/L
Non fasting blood glucose
＜10.0mmol/L
Glycated hemoglobin (HbA1c)
＜7.0%
blood pressure
＜130/80mmHg
High density lipoprotein cholesterol (HDL-C) in men
＞1.0mmol/L
High density lipoprotein cholesterol (HDL-C) in women
＞1.3mmol/L
triglyceride
＜1.7mmol/L
Low density lipoprotein cholesterol (LDL-C) without atherosclerotic cardiovascular disease (ASCVD)
＜2.6mmol/L
Low density lipoprotein cholesterol (LDL-C) with atherosclerotic cardiovascular disease (ASCVD)
＜1.8mmol/L
Body mass index (BMI)
＜24kg/m2
Urine albumin/creatinine ratio
＜30mg/g
Main aerobic activities
≥ 150min/week
General treatment
The treatment of diabetes needs comprehensive treatment.In view of the different condition and age of each diabetes patient, the treatment plan is also different, but no matter what type of diabetes, no matter the severity of the disease, diet treatment should be carried out, and as much as possible to accept diabetes knowledge, improve self-management ability, at the same time, the enthusiasm of the patient and his family must be mobilized to achieve better control effect.
The five key points of comprehensive management of diabetes (also known as the "five carriages") include: diabetes education, medical nutrition treatment, exercise treatment, drug treatment, and blood glucose monitoring.
Diabetes education
Patients and their families should learn as much as possible about diabetes and its complications, actively seek help from professionals, treat patients according to doctors' instructions, and improve their awareness and ability of self-management.
Medical nutrition treatment
Medical nutrition treatment is the basic management measure of diabetes. It aims to help patients develop nutrition plans, form good eating habits, determine reasonable total energy intake, reasonably and evenly distribute various nutrients, and restore and maintain ideal weight.
Generally, the ideal weight can be estimated according to the height (cm) - 105.Adult people with normal weight need to be given 15~20kal of energy per kilogram of ideal weight every day when they are completely in bed, and 25~30kcal when they are at rest. Energy intake should be increased as appropriate according to physical work.
Dietary nutrition distribution should be balanced. Carbohydrate supply accounts for 50~60% of total calories. The daily intake of staple food for adult patients is 250~400g, and the intake of monosaccharide and disaccharide should be limited.Protein intake accounts for 15-20% of total calories. Adult patients are given 0.8~1.2 g per kg ideal weight every day, and at least half of the protein should come from animal protein.
Daily fat intake accounts for 25-30% of total calories, of which saturated fatty acid intake is less than 10% of total energy, and cholesterol intake is less than 300mg/d.Food rich in dietary fiber is recommended.Daily energy intake shall be reasonably distributed among meals, which can be distributed according to 1/5, 2/5, 2/5 or 1/3, 1/3, 1/3 of the three meals per day.
Exercise therapy
Exercise therapy is particularly important for type 2 diabetic patients with obesity. It should be carried out under the guidance of doctors. It is recommended to exercise at a moderate intensity of 150 minutes per week.
Blood glucose monitoring
It is also very important to monitor the condition mainly based on blood glucose monitoring.Blood glucose monitoring indicators are mainly fasting and postprandial blood glucose and glycosylated hemoglobin (HbA1c).Glycated albumin (GA) can be used to evaluate the short-term efficacy of blood glucose control program adjustment.Patients can use the portable blood glucose meter to conduct self blood glucose monitoring at home.
In addition, the condition monitoring should also include the monitoring of cardiovascular risk factors and complications. Patients should have at least one blood lipid examination and comprehensive heart, kidney, nerve, fundus and other related examinations every year.
medication
At present, diabetes drugs include oral drugs and injection preparations.
includeGlibenclamide、Glizite、Glipizide、GliquidoneEtc.This kind of drugs can promote pancreatic isletsβCells secrete insulin to control blood sugar. Improper use can lead to hypoglycemia, especially in elderly patients and those with liver and kidney dysfunction;It will also cause weight gain.
This kind of medicine is applicable toMetforminOr use it together with other hypoglycemic drugs to control blood sugar.
Precautions during use include that patients with mild renal insufficiency can choose gliquidone;Those with poor compliance are advised to choose the drugs taken once a day.
Glinides
includeRegeline、Naglini。These drugs play a hypoglycemic role by increasing insulin secretion, and their usage is the same as that of sulfonylurea drugs.Such drugs take effect quickly and have short action time after absorption.Improper use can lead to hypoglycemia, but the incidence and degree of hypoglycemia are less than those of sulfonylurea drugs.
Non insulin secreting agent
They include metformins, thiazolidinediones and a-glycosidase inhibitors.
Metformin
MetforminIt has almost no effect on normal people, but has obvious hypoglycemic effect on diabetic patients, does not affect insulin secretion, reduces the output of liver glucose, and has a slight weight loss effect, which can reduce the risk of cardiovascular disease and death and prevent diabetes from developing into diabetes in the early stage of diabetes.
Metformin alone does not cause hypoglycemia.
Metformin is the first-line drug recommended by the current diabetes guidelines for the treatment of type 2 diabetes, which can be used alone or in combination with other hypoglycemic drugs.
Thiazolidinediones
Common drugs includeRosiglitazone、Pioglitazone。These drugs can improve blood sugar by increasing insulin sensitivity.Side effects include weight gain, edema, and increased risk of heart failure.When used alone, it will not cause hypoglycemia, and the risk of hypoglycemia can be increased when used in combination with insulin or secretagogues.
Thiazolidinediones can be used together with metformin or other hypoglycemic drugs to treat hyperglycemia of type 2 diabetes, especially those with obesity and obvious insulin resistance.
α-Glucosidase inhibitor drugs
includeAcarbose、Voglibose。It is applicable to patients who take carbohydrate as the main food component and whose blood sugar is significantly increased after meals.Its mechanism of action is to inhibit the absorption of carbohydrates in the upper part of the small intestine, reduce postprandial blood glucose and improve fasting blood glucose.When used, there are usually gastrointestinal reactions.
DPP-4 inhibitor
Improve blood sugar mainly by increasing insulin secretion.Currently listed in China areShagliptin、Sigliptin、Viggliptin、Liggliptin、Agliptin5 kinds.It can be used alone or in combination to treat type 2 diabetes.Single use does not increase the risk of hypoglycemia, nor does it increase weight.
SGLT-2 inhibitor
It can reduce blood sugar by inhibiting the reabsorption of glucose by the kidney and promoting the excretion of glucose from the urine. It can also reduce body weight and blood pressure. It can also reduce uric acid level, urinary protein excretion, and triglycerides.Type 2 diabetes can be treated with single or combined drugs.Single use does not increase the risk of hypoglycemia.
MainlyDaggligin, KangglijingEnggligin。Both daggligin and engegliptin can be taken before and after meals, and kangliptin should be taken orally before the first meal.
In addition to having a strong hypoglycemic effect, these drugs also have a strong role in reducing the risk of cardiovascular disease, heart failure and renal failure in patients with type 2 diabetes independently of the hypoglycemic effect.
Injecting drugs
insulin
It can be divided into conventional insulin, quick acting insulin, medium acting insulin, long-acting insulin and premixed insulin.Select different insulin according to the specific hypoglycemic needs of patients.The common side effects of insulin are hypoglycemia and weight gain. Patients receiving long-term insulin injection may also have subcutaneous fat hyperplasia and atrophy.Insulin allergy is rare.
GLP-1 receptor agonist
It exerts hypoglycemic effect by activating GLP-1 receptor.It can enhance insulin secretion, inhibit glucagon secretion, delay gastric emptying, and reduce food intake through central appetite inhibition.
The GLP-1 receptor agonists currently listed in China areExenatide, BenarutideLilalutideDulagopeptide and Dulagopeptide should be injected subcutaneously.
The clinical trial results showed that lilalutide and dulaglutide had an independent effect on reducing the risk of cardiovascular disease in type 2 diabetic patients, in addition to the hypoglycemic effect.
The common side effects of GLP-1 receptor agonists are nausea and anorexia.
surgical treatment
The main surgical method is metabolic surgery.
Indications
Obese type 2 diabetic patients aged 18~60 years, generally in good condition, who are difficult to control their blood sugar through lifestyle intervention and various drug treatments, or obese type 2 diabetic patients with other cardiovascular risk factors.
Contraindication
Patients with drug abuse, alcohol addiction, and uncontrollable mental illness;
Patients who lack the ability to understand the risks and expected consequences of metabolic surgery;
Patients with type 1 diabetes;
Islets of langerhansβType 2 diabetic patients with obvious cell failure;
Surgical contraindication;
BMI＜25kg/m2；
Gestational diabetes and other special types of diabetes.
Common surgical methods
Sleeve gastrectomy
The operation is relatively simple, and the postoperative complications and reoperation rate are the lowest among all metabolic operations.At present, it is considered to be the first choice for moderate and severe obesity with type 2 diabetes.
Gastric bypass
The operation is complicated, with great trauma and high complication rate. More attention should be paid to the monitoring and supplementation of nutrients after operation.For patients with type 2 diabetes who have a relatively long course of disease and need to lose more weight.
Operation management
Preoperative evaluation was conducted for patients with metabolic surgery indications.
Total calories should be limited after surgery. Patients should adopt a progressive stage diet, avoid eating concentrated desserts, ensure protein intake, supplement water, vitamins and micronutrients. In addition, patients should also adhere to exercise, improve health-related quality of life, and have lifelong follow-up.
TCM treatment
There is clinical evidence that traditional Chinese medicine can control the blood sugar of patients with type 2 diabetes and improve the symptoms related to diabetes.Whether the long-term treatment of traditional Chinese medicine can reduce the risk of chronic diabetic complications and the safety of long-term application of traditional Chinese medicine need further research and evaluation.
It should be noted that traditional Chinese medicine is not recommended to control blood sugar in type 1 diabetes.
Other treatments
Pancreas and islet cell transplantation
It is used to treat type 1 diabetes.
Pancreatic islet cell transplantation is generally used in type 1 diabetes mellitus where blood sugar is difficult to be controlled satisfactorily and severe hypoglycemia occurs repeatedly;Pancreatic transplantation is generally used to treat type 1 diabetes that requires kidney transplantation.
If necessary, patients with type 1 diabetes need to receive transplantation treatment in medical centers that have rich experience in pancreas and islet cell transplantation and have carried out the above-mentioned transplantation in clinical practice.
Frontier treatment
Stem cell therapy
It is still in the research stage. At present, there is no sufficient medical evidence of effectiveness and safety to support the clinical routine use of stem cells to treat type 1 diabetes and type 2 diabetes.
prognosis
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At present, type 1 and type 2 diabetes can not be completely cured, but since the discovery of medical insulin, diabetes has been well treated and controlled by combining diet control with hypoglycemic drugs or insulin supplementation.
Gestational diabetes is usually relieved after delivery.
Curative
Neither type 1 diabetes nor type 2 diabetes can be cured. The goal of treatment is to control the progress of the disease and prevent complications that seriously endanger the health of patients.
Type 1 diabetes must rely on insulin injection to regulate blood sugar throughout life;Type 2 diabetes has not yet reached the stage of diagnosis, and it is possible to restore blood sugar to normal through diet regulation, exercise and other measures. However, long-term patients with type 2 diabetes can not reverse their condition by improving their lifestyle, and they need lifelong drug treatment.
Diabetic complications are also difficult to cure, or slow progress, or recurrent.
harmfulness
Diabetes can cause vascular and neurological diseases, and there are various complications, which seriously threaten the health and life of patients.
Central neuropathy will accelerate the aging of the brain and cause senile dementia.
Autonomic neuropathy can affect the functional regulation of multiple organs, resulting in a series of complex diseases such as diarrhea, constipation, gastroparesis, tachycardia, hypotension, urinary incontinence, urinary retention, impotence, abnormal light reflex, sweating or sweating less.
Peripheral neuropathy will make patients lose their sense of pain, and can not be detected in time when they are injured or suffer from some diseases, which will delay their condition.
Peripheral vascular diseases will cause vascular occlusion, blood flow interruption, and limb ulcers or even necrosis, and eventually have to amputate.
Diabetic retinopathy can gradually reduce the vision of patients until they become blind.
Diabetic nephropathy will slowly progress to renal failure, requiring dialysis or kidney transplantation.
The impact of diabetes on blood vessels will also increase the risk of chronic cardiovascular and cerebrovascular diseases.
In addition, high blood sugar will make it difficult to cure the infection, make the wound difficult to heal, and make it difficult to treat many diseases.Diabetes and treatment lead to high or low blood sugar, which can also directly cause death of patients.
complication
Infected
Diabetes is prone to infection, mainly due to the decline of immune function and the invasion of pathogens. Among them, bacterial infection is the most commonmycotic infection。If easy to be concurrentFuruncle、CarbuncleEtc. pyogenic bacteria infection, occurrencecystitis、pyelonephritis, trichosis, and so on, but also increased the incidence of tuberculosis.
Preventive measures include good blood sugar control to keep blood sugar at a stable level;Ensure proper exercise and enhance the body's immunity.
The main treatment is insulin to control blood sugar;Choose the rightantibiotic, and perform surgical treatment when necessary, especially whenDiabetic foot diseaseDuring the treatment.
Severe disorder syndrome of glucose, fat and protein metabolism caused by severe insulin deficiency and inappropriate elevation of glucocorticoid.
It is one of the serious acute complications of diabetes.
cause
Acute infection, inappropriate reduction of insulin or sudden interruption of treatment, improper diet, surgery, pregnancy, etc.
clinical manifestation
More urine, thirst, and drink, and then loss of appetite and nausea;Further development, serious water loss;In the late stage, all kinds of reflexes are sluggish or even disappear, and eventually come to coma.
Dehydration and nervous system symptoms, including disorientation, hallucination, flapping rough tremor of upper limbs, coma and positive pathological signs.
prevention
Good blood sugar control to keep blood sugar at a stable level;Ensure proper exercise and enhance the body's immunity.
treatment
A large amount of fluid replacement is used to restore blood volume, reduce blood sugar, correct electrolyte and acid-base imbalance, and actively seek and eliminate incentives to prevent and treat complications.
The most common microvascular complication of diabetes.
It refers to foot infection, ulcer and (or) deep tissue destruction in diabetic patients due to nerve abnormalities and different vascular diseases at the distal end of the lower limb.
Risk factors
Including age, course of disease, blood pressure, obesity, environmental pollutants, infection, etc.
prevention
Good control of blood sugar and lipids, maintain stable blood pressure, monitor blood sugar, and prevent infection.
Regularly check whether patients have risk factors of diabetic foot disease;Identify risk factors;Educate patients and their families;Wear proper shoes and socks;Remove and correct the factors that easily cause ulcers.
treatment
Change bad lifestyle and reduce protein intake. The source of protein should be mainly high-quality animal protein, control blood sugar, control blood pressure, dialysis treatment and transplantation, and correct abnormal blood lipids.
Good control of blood sugar, blood pressure and blood lipids;Patients with sudden blindness, retinal detachment or other ocular symptoms should be immediately referred to the ophthalmology department.
For nerve ulcer, braking decompression, decompression insole, diabetic foot shoes, etc. are mainly used.Thorough debridement of foot ulcer infection and hyperbaric oxygen treatment can improve the inflammation and microcirculation of the wound and promote wound healing.
