diabetes
Introduction
Introduction to diabetes Diabetes is a group of metabolic diseases characterized by high blood sugar. Hyperglycemia is caused by defects in insulin secretion or its biological effects, or both. Hyperglycemia, which persists in diabetes, causes chronic damage and dysfunction of various tissues, especially the eyes, kidneys, heart, blood vessels, and nerves. basic knowledge The proportion of patients: 8.3% (International Diabetes Federation statistics, 2013 prevalence rate of 8.3% in adults aged 20-79) Susceptible people: obese people, family history of diabetes Mode of infection: non-infectious Complications: diabetic ketoacidosis Diabetes lactic acidosis Diabetic neuropathy Hypertension Uremia
Cause
Causes of diabetes
Genetic factors for type 1 diabetes (15%):
There is significant genetic heterogeneity in type I or type II diabetes. There is a family morbidity in diabetes, and 1/4 to 1/2 patients have a family history of diabetes. Clinically, at least 60 genetic syndromes can be associated with diabetes. Type I diabetes has multiple DNA sites involved in the pathogenesis, and the DQ locus polymorphism in the HLA antigen gene is most closely related.
Genetic factors for type 2 diabetes (35%):
A variety of well-defined genetic mutations have been discovered in type 2 diabetes, such as insulin genes, insulin receptor genes, glucokinase genes, mitochondrial genes, and the like.
Type I diabetes environmental factors (20%):
Patients with type 1 diabetes have abnormalities in the immune system, causing autoimmune reactions and destroying insulin beta cells after infection with certain viruses such as Coxsackie virus, rubella virus, and parotid virus.
Environmental factors for type 2 diabetes (30%):
Eating too much, obesity caused by reduced physical activity is the most important environmental factor for type 2 diabetes, making individuals with genetic susceptibility to type 2 diabetes susceptible to disease.
Prevention
Diabetes prevention
Daily prevention
1. Primary prevention: establish a correct attitude towards eating and adopt a reasonable lifestyle. Although there are certain genetic factors in diabetes, the key is life factors and environmental factors. Excessive calorie intake, overnutrition, obesity, and lack of exercise are important causes of the disease. Proper calorie intake, low salt, low sugar, low fat, high fiber, and sufficient vitamins are the best dietary compatibility.
2. Secondary prevention: Regularly measure blood sugar to detect asymptomatic diabetes as soon as possible. Blood glucose measurement should be included in the routine physical examination items of middle-aged and old people, even if it is normal, it should be measured regularly. Anyone who has diabetes can be found, such as skin paresthesia, sexual dysfunction, poor vision, polyuria, cataract, etc., should be measured and carefully identified in time, in order to diagnose early, to win valuable time for early treatment.
3, tertiary prevention: Diabetes is easy to concurrent with other chronic diseases, patients are life-threatening due to complications. Therefore, it is necessary to strengthen the monitoring of chronic complication of diabetes, to achieve early detection, early prevention, and in the advanced stage, the effect is often poor. Early diagnosis and early treatment can often prevent the occurrence of complications, so that patients can live close to normal life for a long time.
Publicity and education
Since more than half of the early patients have no symptoms or mild symptoms, they are often unable to be diagnosed and prevented in time. Therefore, it is necessary to vigorously carry out diabetes publicity and education so that the diagnosed patients can understand diabetes and gradually become familiar with diet, exercise, medication and urine sugar. The comprehensive treatment principles of basic measures such as blood glucose monitoring, in conjunction with the medical staff to improve the quality of control, let the subjects >50 years old, especially the aforementioned high-risk subjects, do a blood glucose screening test 2 hours after the meal every year, so that asymptomatic patients as soon as possible Get diagnosed and prevented. The content of education still needs to include the importance of long-term adherence to diet therapy. Urine sugar and blood glucose meter detection methods must pay attention to insulin therapy, and should also learn aseptic injection, hypoglycemia reaction and preliminary treatment.
Complication
Diabetes complications Complications Diabetes ketoacidosis Diabetes lactic acidosis Diabetic neuropathy Hypertension Uremic disease
Diabetic patients with longer duration and poor control are often accompanied by various complications or concomitant symptoms. A variety of infections are clearly complications, ketoacidosis and other symptoms may be a serious manifestation of the disease, microvascular disease based pathology such as kidney lesions, fundus lesions, neuropathy, etc. are important chronic complications of diabetes, but large Vascular lesions such as atherosclerosis and heart, brain, kidney and other diseases and hypertension are closely related to diabetes, and can also be seen in non-diabetics, whether it is a complication, need to be specifically analyzed.
First, diabetic ketoacidosis and coma
Second, diabetes non-ketotic hyperosmolar coma
Third, diabetes lactic acidosis
Fourth, the infection is common in the following groups:
1, skin infections: such as body lice, nail files, athlete's foot and sputum and other purulent infections are very common, sometimes can lead to sepsis.
2, tuberculosis: especially tuberculosis, once sick, rapid expansion, widespread spread, lesions are exudative two casein-like pneumonia, easy to become empty, the incidence rate is 3 to 5 times higher than ordinary people. Fluctuations with the control of tuberculosis.
3, urinary tract infection: which is more common with pyelonephritis and cystitis, sometimes with fungal vaginitis, infection is not easy to control, and must be strictly controlled with diabetes, in order to obtain better results. Domestic necrotizing renal papillitis is rare.
4, gallbladder, cholangitis, cholelithiasis, periodontitis, gingival pus and sinusitis.
Symptom
Symptoms of Diabetes Common Symptoms Increased blood sugar levels, polydipsia, weight loss, urinary qi, yin deficiency, polydipsia, thirst, high blood sugar, high blood sugar after meal
The symptoms of diabetes can be divided into two categories: a large class is related to metabolic disorders, especially the "three more and one less" associated with hyperglycemia, more common in type 1 diabetes, type 2 diabetes is often not very obvious or only There are some manifestations, and another major category is the performance of various acute and chronic complications.
More urine
Because the blood sugar is too high, exceeding the renal sugar threshold (8.89~10.0mmol/L), the glucose filtered by the glomerulus can not be completely absorbed by the renal tubules, forming osmotic diuresis. The higher the blood sugar, the more urine sugar is excreted. The more urine, the 24h urine volume can reach 5000 ~ 10000ml, but the elderly and kidney disease, kidney sugar threshold increased, urine sugar excretion disorder, when the blood sugar is mildly moderate, polyuria may not be obvious.
2. Drink more
Mainly due to hyperglycemia, the plasma osmotic pressure is significantly increased, combined with polyuria, excessive water loss, intracellular dehydration, increased hyperglycemia, further increase plasma osmotic pressure, stimulate thirst center, leading to thirst and more drink, Drink more to further increase polyuria.
3. Eat more
The mechanism of polyphagia is not very clear. Most scholars tend to reduce glucose utilization (difference in glucose concentration in arteriovenous blood before and after tissue cells). In normal people, the difference in glucose concentration in arteriovenous blood is reduced, which stimulates the feeding center. Hunger sensation, increased blood glucose after ingestion, increased concentration difference in arteriovenous blood (greater than 0.829mmoL/L), inhibition of feeding center, fullness of satiety center, disappearance of feeding requirements, but diabetics due to absolute or relative lack of insulin or Tissue is not sensitive to insulin, tissue intake and utilization of glucose decline, although blood sugar is at a high level, but the concentration difference of glucose in arteriovenous blood is very small, tissue cells are actually in a "starved state", thereby stimulating the feeding center, causing hunger, and more Food, in addition, the body can not make full use of glucose, a large amount of glucose is excreted from the urine, so the body is actually in a semi-starved state, energy deficiency also causes appetite hyperactivity.
4. Weight loss
Diabetes patients have normal or even increased appetite and food intake, but their weight loss is mainly due to absolute or relative lack of insulin or insulin resistance. The body can not fully utilize glucose to produce energy, resulting in increased fat and protein decomposition, excessive consumption, and negative nitrogen balance. The weight gradually declines, and even loses weight. Once the diabetes is properly treated and well controlled, the weight loss can be controlled or even rebounded. For example, if the diabetes patient continues to lose weight during the treatment or is obviously thin, it may indicate that the metabolic control may not be Good or combined with other chronic wasting diseases.
5. Weakness
It is also common in diabetic patients. Because glucose can not be completely oxidized, that is, the human body can not fully utilize glucose and effectively release energy, while tissue loss of water, electrolyte imbalance and negative nitrogen balance, etc., it feels weak and weak.
6. Vision loss
Many patients with diabetes complained of decreased or blurred vision during early treatment. This may be caused by changes in crystal osmotic pressure caused by hyperglycemia, which cause changes in crystal diopter. In the early stage, most of them are functional changes. Once blood sugar is well controlled, vision can be Get back to normal faster.
Examine
Diabetes check
Blood sugar
It is the only standard for diagnosing diabetes. Those who have obvious symptoms of "three more and one less" can be diagnosed with an abnormal blood sugar level. Asymptomatic patients need two abnormal blood glucose levels to diagnose diabetes. Suspicious people need to do a 75g glucose tolerance test.
2. Urine sugar
Often positive. Urine sugar is positive when the blood glucose concentration exceeds the renal sugar threshold (160-180 mg/dl). When the renal sugar threshold is increased, even if the blood glucose reaches the diagnosis of diabetes, it can be negative. Therefore, urine sugar determination is not a diagnostic criterion.
3. Urine ketone body
Urinary ketone body positive in ketosis or ketoacidosis.
4. Glycosylated hemoglobin (HbA1c)
It is a product of the non-enzymatic reaction of glucose and hemoglobin. The reaction is irreversible and the HbA1c level is stable, which can reflect the average blood glucose level 2 months before blood collection. It is the most valuable indicator for judging blood sugar control status.
5. Glycosylated serum protein
It is a product of the non-enzymatic reaction of blood glucose and serum albumin, reflecting the average blood glucose level 1 to 3 weeks before blood collection.
6. Serum insulin and C peptide levels
Reflects the reserve function of islet beta cells. Type 2 diabetes early or obese serum insulin is normal or increased, with the development of the disease, islet function gradually declines, insulin secretion capacity declines.
7. Blood lipids
Diabetic patients have common dyslipidemia, especially when blood sugar control is poor. It is characterized by elevated levels of triglycerides, total cholesterol, and low-density lipoprotein cholesterol. High density lipoprotein cholesterol levels are reduced.
Diagnosis
Diagnostic diagnosis of diabetes
Diagnosis of diabetes is generally not difficult, fasting blood glucose greater than or equal to 7.0 mmol / liter, and / or two hours after the meal, blood glucose greater than or equal to 11.1 mmol / liter can be diagnosed. To diagnose after diagnosis of diabetes:
Type 1.1 diabetes
The age of onset is light, mostly <30 years old, sudden onset, polydipsia, polyuria, polydipsia, weight loss, high blood sugar levels, many patients with ketoacidosis as the first symptom, serum insulin and C-peptide levels are low, ICA, IAA Or GAD antibodies can be positive. Oral administration alone is not effective and requires insulin therapy.
Type 2.2 diabetes
Common in middle-aged and elderly people, obesity has a high incidence, often accompanied by high blood pressure, dyslipidemia, arteriosclerosis and other diseases. Insidious onset, no symptoms in the early stage, or only mild fatigue, thirst, blood sugar is not obvious, need to do a glucose tolerance test to confirm the diagnosis. Serum insulin levels are normal or elevated early and are low in the late stage.
