Edema is a pathological phenomenon of excessive fluid accumulation in the interstitial spaces of tissues, and is most common in the clinical setting, especially in the lower extremities. Lower extremity edema occurs frequently in patients with hypertension, nephropathy, and some elderly patients, but is not a common symptom in patients with diabetes mellitus.
When lower limb edema occurs in diabetic patients, it is mostly associated with various chronic complications of diabetes, and some common causes are as follows.
1.Diabetes complicated by renal insufficiency
Diabetic nephropathy is the most common cause of lower extremity edema. When the kidney is damaged, it causes edema of both lower limbs, eyelids and face due to large leakage of urine protein, decreased glomerular filtration rate and severe hypoproteinemia, and generalized edema may occur in severe cases. In severe cases, generalized edema may occur. The patient’s urine routine examination may show protein and tubular pattern, and renal function indexes (such as creatinine and urea nitrogen) may be increased.
2.Diabetes complicated by heart disease
In severe cases, cardiac insufficiency (especially right heart insufficiency) may cause stasis and sodium retention in the circulation, resulting in jugular venous anger, hepatosplenomegaly and symmetric edema of both lower limbs. The patient also has symptoms such as panic, chest tightness and shortness of breath, and the electrocardiogram shows ischemic changes.
3.Diabetes combined with peripheral neuropathy
Diabetic neuroedema is mostly seen in both lower extremities and is related to body position and activity. This is due to damage to the vegetative nerves (mainly sympathetic nerves), which causes peripheral vasodilatation and congestion, and edema due to venous stasis in both lower extremities; in addition, increased permeability of local capillaries caused by neurotrophic disorders can also lead to swelling in the lower extremities. Most of the edema caused by diabetic neuropathy is accompanied by numbness and pain in the extremities.
4.Diabetes combined with lower limb vasculopathy
When patients have lesions in the veins of the lower extremities (such as deep vein thrombosis and venous valve incompetence), resulting in venous blood flow obstruction and venous hypertension, lower extremity edema can occur, but it is often unilateral.
5.Diabetes combined with foot infection
Patients with foot skin damage infection, local inflammatory reaction can also lead to edema, patients are often accompanied by local skin temperature, redness, pain and other acute inflammatory manifestations.
6.Diabetes combined with severe malnutrition
In some patients, due to long-term excessive dieting, the caloric and protein intake is seriously insufficient, resulting in hypoproteinemic and malnutrition edema.
7.Drug factors
Some hypoglycemic drugs such as insulin, thiazolidinediones (such as rosiglitazone, pyrrolidone); some antihypertensive drugs such as calcium antagonists (such as nifedipine, aminoglutethimide) can cause water and sodium retention, resulting in lower limb edema. It can subside after stopping the medication.
8, diabetes combined with hypothyroidism
The latter can cause mucinous edema of the lower extremities or face, which is characterized by depressed changes that do not appear when the edema is pressed with the finger. FT4 ) is low.
9. Idiopathic edema
In female patients with lower limb edema, it is important to exclude idiopathic edema. This edema often occurs during the reproductive years and is often associated with symptoms of neurosis and sometimes with the menstrual cycle. A positive standing water test will help in the diagnosis of idiopathic edema.
10.Other
Other patients with diabetes mellitus, such as those with chronic liver disease, may also present with lower limb edema. If patients with chronic liver disease show signs (such as weakness, liver disease, liver palms, spider nevus, jaundice, etc.) and liver function abnormalities, they can be identified by combining with hepatobiliary ultrasound examination.