I. A lesson of misdiagnosis in a diabetic patient Why diabetic patients should pay attention to dynamic comparative observation of their body shape changes, let us start with a case of a diabetic patient’s tortuous treatment process. A middle-aged female diabetic patient was diagnosed with type 2 diabetes 7 years ago and was treated with oral hypoglycemic drugs. 2 years later, because of the poor effect of oral hypoglycemic drugs, she changed to subcutaneous insulin injection for blood glucose control, but the patient’s daily insulin dosage increased substantially year by year, from more than 40 units of insulin injected subcutaneously daily at the beginning to more than 100 units of insulin injected subcutaneously daily in recent years, but her blood glucose was still not The patient’s blood sugar is still not under ideal control and ketone bodies often appear in the urine. For this reason, the patient went to several hospitals to adjust the treatment plan, but his condition was not satisfactorily controlled. After seeing the patient’s broad face, protruding jaw, hypertrophied nose and lips when he came to our hospital, the patient was asked to carefully recall whether there were any changes in his body shape, such as whether his face had become wider, and his hands and feet had become thicker to the point that his ring ring and shoe size kept increasing. After receiving the patient’s affirmative answer, he was given blood growth hormone and pituitary MRI examinations, which revealed that the patient had a tumor in the pituitary area of the skull, and the blood growth hormone level was significantly elevated, thus clarifying that the reason for the diabetic patient’s poor blood sugar control was the combination of pituitary growth hormone tumor, because the tumor secreted a large amount of growth hormone that had a counteracting effect on the hypoglycemic effect of insulin and caused blood sugar to rise. After the surgery to remove the tumor in the skull, the patient’s blood glucose was soon under ideal control and the insulin dosage was reduced from more than 100 units per day to more than 50 units per day. Special types of diabetes related to body type changes The World Health Organization classifies diabetes into four major categories, namely: type 1 diabetes, type 2 diabetes, idiopathic diabetes and gestational diabetes. The above-mentioned growth hormone tumor is a type of diabetes caused by endocrine disease among the specific type of diabetes, which means that growth hormone tumor itself can cause diabetes or aggravate the existing diabetes. Other endocrine diseases that cause or worsen diabetes include Cushing’s syndrome, hyperthyroidism, pheochromocytoma, and glucagonoma. Both Cushing’s syndrome and hyperthyroidism can cause changes in body image in patients with diabetes. The characteristic body shape of Cushing’s syndrome is centripetal obesity of the face and trunk including: full moon face, fat accumulation on the back of the neck, bulging, and abdominal bulge. The extremities appear relatively small due to fat and muscle atrophy, and the face is red and shiny with lipid overflow. The skin is thin and prone to purpura and petechiae. Purple skin streaks are also a specific sign of the disease, about 56% positive, often distributed on the lower abdomen, buttocks, shoulders, anterior axillae, etc. The purple streaks are wide in the center and thin at both ends, with a purplish-red color. Acne frequently occurs on the skin of the face and back. Body hair increases, thickens and darkens, and some patients have hair loss. Hyperthyroidism is manifested as thinness, protruding eyes, thick neck and other body shape changes. Of course, diabetic patients can lose weight with dietary control, exercise and application of biguanides, but when excessive weight loss occurs, besides considering hyperthyroidism, attention should also be paid to exclude malignant tumors. For example, a male patient with a 6-year history of diabetes mellitus lost 20 kg in the past 5 months, accompanied by poor nausea and nausea, did not use biguanides to control blood glucose, and was treated with traditional Chinese medicine and western medicine in many hospitals with poor results, and the symptoms of poor nausea and nausea worsened.