Case: Mr. Wang, 65 years old, was diagnosed with diabetes 10 years ago and had been taking oral metformin to lower his sugar. Recently, he had a gastrointestinal reaction due to a cold, with symptoms of nausea and vomiting with diarrhea and gradually worsened. Then he went to the hospital for examination, and the diagnosis showed that he was diabetic lactic acidosis. Mr. Chen was confused, what is lactic acidosis? Diabetes combined with lactic acidosis is one of the three major acute complications of diabetes and has a very high mortality rate. Let’s get to know more about diabetes mellitus and lactic acidosis. I. What is lactic acidosis? Lactic acidosis is a series of symptoms caused by elevated blood acidity due to increased lactic acid levels in the blood for various reasons. It mainly occurs in elderly diabetic patients who have taken benzidine (also called hypoglycemia, be sure to remember the name of this drug) with heart, liver and kidney disease for a long time or in excess. Lactic acidosis generally has a rapid onset and is mainly characterized by the clinical features of metabolic acidosis of varying degrees. When blood lactic acid is significantly elevated, it can have serious effects on the central nervous, respiratory, digestive and circulatory systems. Patients with mild cases may have symptoms such as nausea, abdominal pain, decreased appetite, dizziness and drowsiness, while patients with more severe or serious conditions may have symptoms such as vomiting, deep breathing, impaired consciousness and coma. Laboratory tests may reveal elevated blood lactate levels and obvious acidosis, but elevated blood and urine ketone bodies are not obvious. Why are diabetic patients prone to lactic acidosis? 1. Diabetic patients have impaired glucose metabolism, which reduces lactic acid catabolism, so many diabetic patients usually have mild hyperlactatemia. 2. Acute complications of diabetes, such as infections and ketoacidosis, can cause further increase of lactic acid accumulation in the body and induce lactic acidosis. 3. Chronic complications of diabetes, such as combined heart, liver and kidney diseases, increased levels of glycated hemoglobin, resulting in tissue and organ hypoxia, causing increased lactic acid production; liver and kidney dysfunction can also affect the metabolism, conversion and excretion of lactic acid, leading to lactic acidosis. 3. Under what circumstances lactic acidosis is likely to occur 1. Diabetic patients with poor blood sugar control. 2. Other acute complications of diabetes, such as various infections and ketoacidosis, can be the cause of diabetic lactic acidosis. 3. Diseases of other important organs, such as cerebrovascular accident and myocardial infarction, can aggravate poor blood perfusion in tissues and organs, leading to hypoxemia and lactic acidosis. 4. Large amounts of hypoglycemia and biguanides, especially hypoglycemia, can enhance anaerobic enzymes and increase the production of lactic acid in vivo, so it has the effect of causing lactic acidosis. Fourth, how to prevent lactic acidosis? 1. In the process of diabetes treatment, do not take phenylephrine, hepatic and renal insufficiency, chronic hypoxic cardiopulmonary disease, and older than 70 years of age and poor cardiopulmonary function of patients, other biguanides should not be used. 2. The incidence of lactic acidosis caused by metformin is much lower than that of phenibut, so it is recommended that patients who need to be treated with metformin should choose metformin as much as possible. 3. Patients using metformin should suspend the drug and switch to insulin therapy when they encounter acute critical illness. 4. Long-term users of biguanide should regularly check liver and kidney function, cardiopulmonary function, and discontinue it in time if it is not suitable for use of biguanide. In addition, many so-called sugar-lowering Chinese medicine contains a large number of phenethylguanidine drug ingredients, this drug is very easy to lead to lactic acidosis, therefore, diabetic patients should not change the doctor’s prescription to take their own medication or take all kinds of sugar prescriptions to avoid diabetes lactic acidosis and other serious diseases.