1.How much do you know about the early symptoms of diabetes?
I believe many people are aware of the symptoms of diabetes, such as polyuria, polydipsia, polyphagia and lethargy, but do you know that when these symptoms appear, it is likely that your diabetes is already very serious? For diabetes, the earlier you treat it, the better your chances of recovery.
So what are the early symptoms of diabetes? How much do you know? Patients with diabetes do not always have the typical symptoms of “three more, one less”, especially those with type 2 diabetes. Therefore, the following conditions should also be suspected of having diabetes.
(1) A family history of diabetes. A clear family history of mild diabetes has a high probability of type 2 diabetes and should be noted.
(2) A history of abnormal childbirth. For example, a history of unexplained multiple miscarriages, stillbirths, stillbirths, premature births, malformed or giant babies, etc.
(3) Recurrent infections. Those with persistent vulvar pruritus, or recurrent vulvar or vaginal mycotic infections, or repeated boils and carbuncles, may have diabetes. Many female patients are found to have diabetes because they went to gynecology for vulvar itching. In addition, those with repeated respiratory, biliary, and urinary tract infections with non-healing wounds are suspected of having diabetes.
(4) Impotence. Male patients presenting with impotence are suspected of having diabetes after local lesions of the genitourinary tract have been excluded.
(5) There is polyuria, thirst and excessive drinking or there is recent unexplained weight loss.
(6) Occasional positive urine glucose with normal fasting glucose should also be suspected of diabetes mellitus and further examination should be performed.
(7) Reactive hypoglycemia. It mostly occurs 3 hours or more after meal, manifested as panic, sweating, hunger, trembling, etc. If the blood sugar is measured, it is at or below the normal low value, and the above symptoms can disappear after eating sugary food. In some obese patients with type 2 diabetes mellitus, it can be manifested in the early stage.
(8) Diabetes mellitus should be suspected in young patients with arteriosclerosis, coronary artery disease, and fundus lesions.
(9) When the elderly unexplained perceptual disorders, such as numbness, pain or sensory allergy of the limbs; autonomic dysfunction, excessive sweating, especially hemiplegia, postural hypotension, unexplained urinary retention; urinary incontinence, unexplained diarrhea or alternating diarrhea and constipation.
Lower extremity vascular lesions, such as cold, slop, intermittent claudication, extremity necrosis, blisters, ulcers, etc.; coronary heart disease myocardial infarction, kidney disease, cerebrovascular accidents and other conditions; unexplained coma, etc. should be suspected when there is diabetes mellitus.
2. Is diabetes without typical symptoms a disease?
Diabetes is a chronic disease caused by disorders of sugar, fat and protein metabolism and secondary disorders of water-electrolyte metabolism due to insufficient insulin secretion or disorders of insulin action in human body.
In clinical practice, diabetic patients with typical symptoms of “three more and one less” are easy to attract the attention of patients and doctors, but two-thirds of patients lack typical clinical symptoms, especially the middle-aged and elderly patients, so patients and doctors tend to miss and misdiagnose diabetes.
How to detect diabetes early from certain clinical signs and symptoms?
(1) One of the “three more and one less” symptoms is the prominent manifestation. Clinically, it is rare for diabetes to present with the typical four symptoms of “three more and one less”, but often one or two of the four symptoms are complained of, with dry mouth and excessive drinking being the common symptoms.
(2) The symptoms of hypoglycemia before meals are the prominent manifestation. In adults with diabetes mellitus over 40 years of age, some of them have hypoglycemic symptoms before meals. This is due to the delayed peak of insulin secretion by the patient’s pancreatic islet cells and the relatively high level of insulin before meals, which leads to hypoglycemic symptoms.
(3) Prominent manifestation of some kind of diabetic complications, the patient complains of some kind of co-morbidities, commonly pubic pruritus, cataract, skin, periodontal recurrent septic infection, peripheral neuritis, cerebral arteriosclerosis, cerebral thrombosis, nephropathy, vegetative nerve dysfunction, etc.
(4) The main start manifests ketoacidosis or hyperosmolar non-ketotic coma. Patients are not easily thought of as diabetic because of the coma emergency and no past history of diabetes mellitus, the latter being common in the elderly.
(5) Pregnant women who deliver huge fetuses, the incidence of diabetes in pregnant women with diabetes who deliver huge fetuses is about 10 times higher than that of pregnant women in general. The direct cause of huge fetuses is fetal blood hyperinsulinemia, and insulin has the effect of promoting fat and protein synthesis, so the fetus develops huge, so pregnant women who deliver huge fetuses should consider the possibility of having diabetes.
(6) Patients with certain diseases often associated with diabetes mellitus, such as hyperthyroidism, idiopathic hypothyroidism, myasthenia gravis, pernicious anemia, chronic thyroiditis, Addison’s disease, etc. coexist with diabetes mellitus, probably because of the presence of their common genetic factors.
(7) Positive family history of diabetes mellitus. It has long been recognized that diabetes mellitus has a genetic predisposition. The incidence of diabetes in the children of couples with diabetes is about 50% or more, the incidence of diabetes in monozygotic twins is about 48%, the incidence of diabetes in dizygotic twins is about 20%-22%, and the likelihood of inheritance from mother to child is about 3 times greater than that of the father. These figures suggest that those with a positive family history should be alerted to the possibility of developing diabetes.
(8) In clinical practice, there are many cases of diabetes mellitus due to physical examination, and geriatric diabetes mellitus is detected in 30% of systematic examinations. Therefore, it is recommended that urine glucose and blood glucose measurement should be routinely done for middle-aged and elderly patients in outpatient clinics and inpatients. In addition, atypical symptoms of diabetes, often itchy skin, fatigue, weight loss, cataracts, pediatric enuresis, impotence, foot ulcers, and urinary retention, should be promptly examined.
In summary, the clinical manifestations of diabetes mellitus are often atypical, with a wide variety of manifestations, and only with adequate knowledge of this can we not miss or misdiagnose the disease. If the clinical signs suspect diabetes, urine sugar, fasting and 2 hours postprandial glucose should be routinely checked. If the urine sugar is negative and fasting glucose is normal, a glucose tolerance test is required to rule out the disease before a conclusion can be made.
3.Five characteristics to identify the type of diabetes
There are many types of diabetes, but there are mainly type 1 and type 2. The main problem of type 1 diabetes is lack of insulin, while the main problem of type 2 diabetes is insulin resistance.
Type 1 diabetes needs to be treated with insulin and type 2 diabetes generally does not need to be treated with insulin. How is the type of diabetes determined? It may be somewhat difficult to determine the type in patients with complex or atypical presentations of diabetes, but it is not very difficult to determine the type in most diabetic patients.
Here are some basic methods to help diabetic patients to self-identify.
(1) Look at the age at onset: the younger the age, the greater the likelihood of type 1; the older the age, the greater the likelihood of type 2. If the patient is under 30 years old, the likelihood of type 1 is greatest; if the patient is 30-40 years old, the likelihood of type 1 is least and the likelihood of type 2 is greatest; if the patient is over 40 years old, the likelihood of type 2 is greatest and the likelihood of type 1 is least.
(2) Look at the body type before and after the onset of the disease: the thinner the body type, the greater the possibility of type 1, and the fatter the body type, the greater the possibility of type 2; if the body type is thinner than most normal people, the possibility of type 1 is greater and the possibility of type 2 is smaller; if the body type is similar to most normal people, the possibility of type 1 is smaller and the possibility of type 2 is greater; if the body type is overweight or obese, the possibility of type 1 is the smallest and the possibility of type 2 is the greatest.
(3) Look at the presence of ketosis after the onset: ketosis is often a characteristic of type 1, while type 2 generally does not show ketosis.
(4) Look at the response to treatment: ineffective treatment with oral hypoglycemic agents suggests type 1, and better treatment with oral hypoglycemic agents suggests type 2. However, a small number of type 1 patients have some effect on oral hypoglycemic drugs at the beginning of the disease, but soon become ineffective, a period we call the “honeymoon period”.
(6) Look at insulin level: low blood insulin level indicates type 1, normal or higher than normal indicates type 2.
The human anterior pituitary gland secretes adrenocorticotropic hormone, thyroid stimulating hormone and growth hormone, which act on the adrenal glands and thyroid gland to increase the secretion of adrenocorticotropic hormone and thyroid hormone in the body, directly contributing to the rise of blood sugar.
Growth hormone also produces an anti-insulin effect by inhibiting glucokinase, which increases blood glucose. When a tumor occurs in the pituitary gland, the relevant function decreases, causing a decrease in the secretion of growth hormone, adrenocorticotropic hormone and thyroid hormone, and the blood glucose value decreases. At this time, the symptoms of diabetic patients can be automatically reduced or even disappear.
These patients are more sensitive to insulin and are prone to drop and unstable blood glucose, and even have severe hypoglycemic performance. A series of symptoms of hypoadrenocorticism, hypothyroidism and hypogonadism, such as fear of cold, dry hair, loss of hair, loss of appetite, loss of libido, irregular menstruation and even amenorrhea, low blood pressure, may also occur.
Clinically, in addition to active treatment of pituitary tumors, patients can be given appropriate prednisone, thyroxine and sex hormones, and insulin should be avoided as much as possible. In case of hypoglycemia or hyperalgesia crisis, prednisone and sodium supplement should be used along with glucose input.
4.The main characteristics of elderly diabetic patients
Because of the declining function of the organs of the elderly and the weakened responsiveness of the body, diabetes has become a common and frequent disease of the elderly, and its clinical manifestations are very different from those of the general diabetic patients. The main characteristics are
(1) Lighter, slower progress, more stable
Diabetes in the elderly is often less symptomatic and may only have clinical manifestations of chronic complications or concomitant diseases, such as atherosclerosis, coronary artery disease, hypertension, hyperlipidemia, obesity, gout, neuropathy, nephropathy, cataract, fundus lesions, etc. Diabetes is only discovered when they have cerebrovascular accidents, or due to surgical operations, or due to concomitant serious infections. Therefore, regular blood glucose and urine sugar checks should be performed on the elderly in order to detect diabetes early.
(2) Cardiovascular complications are often more serious and are the main cause of death
Due to the disorder of sugar, protein and fat metabolism in diabetic patients, large blood vessels, microvessels and myocardium are often involved, and they often occur in the asymptomatic stage of diabetes. Patients may have tachycardia at rest, heart rate greater than 90-120 beats per minute when lying down, postural hypotension, angina pectoris, myocardial infarction, heart failure, etc.
(3) Easy co-infection
Old age is an eventful time in a person’s life. The body’s ability to adapt to the surrounding environment, especially to changes in external temperature, is weakened, and the internal glycation of the body makes its own immunity decline, and pulmonary ventilation and body blood flow are reduced. After the resistance is reduced, it is easy to complicate respiratory, urinary and skin infections, etc. The infection can lead to ketoacidosis in heavy cases.
(4) Easily combined with hyperosmolar non-ketotic diabetic coma
The main causes are serious infection, surgery, cerebrovascular accident, gastrointestinal disorders with severe vomiting and diarrhea, or when suffering from other diseases, due to rehydration with large amounts of glucose solution or eating more sweet drinks, blood glucose rises significantly, exceeding 33 mmol/L, with a high of 138 mmol/L, blood sodium is often greater than 145 mmol/L, and plasma osmolality is greater than 330 mmol/L.
Patients show severe water loss, unresponsiveness, drowsiness or restlessness, confusion, disorientation, coma, and also muscle twitching of the limbs, fluttering tremor, focal grand mal seizures, hemiplegia and hemiparesis. If not diagnosed early and actively rescued, the death rate can be about 50%.