One day, the old Liang and the old Zhang in the park exercise coincidentally met, long time no see, chatting very happy. The old Liang said: recently, I always feel weak, eyelids, calf swelling (calf) a pit, I do not know if the kidneys out of the problem. The old Zhang alarm recently added a new disease – hypertension, a period of time to eat antihypertensive drugs, blood pressure is at least stabilized, but also appeared ankle edema, the original quite fit shoes, now are squeezed feet can not be worn. Chen Yan of the Department of Endocrinology at Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine, said Liang and Zhang, while thinking, we both have diabetes, and now we both have swollen lower limbs, so it seems to be related to diabetes. The two of us are going to go to the hospital tomorrow to have a checkup and see what is going on. The two of them are going to go to the hospital tomorrow to see what’s going on. After the hospital examination, Liang’s urine protein is positive, and his swelling is related to diabetic nephropathy caused by hypoproteinemia, which requires a low-protein diet, strict control of blood sugar, blood pressure, blood lipids, and Chinese medicine to protect the kidneys; while Zhang’s urine protein is negative, his kidney function is normal, and his swelling is related to taking nifedipine, an antihypertensive drug. disappears. The cause of edema is seemingly the same, but the cause is very different, and the treatment is also two different, so sugar lovers should not copy others to avoid deterioration and timely prevention. Edema is a pathological phenomenon of excessive fluid accumulation in the interstitial space of tissues, and it is most common in clinical practice, especially in the lower limbs. In addition to a few causes, most of the lower limb edema in glucose patients is related to various chronic complications of diabetes and is a sign of many chronic complications. Edema is commonly seen in the following conditions, and doctors will treat the symptoms according to the appropriate etiology In severe cases, cardiovascular diseases such as coronary artery disease and cardiomyopathy can be complicated by cardiac insufficiency (especially right heart insufficiency), causing stasis and sodium retention in the circulation, resulting in jugular venous anger, hepatosplenomegaly and symmetrical edema of both lower limbs. Such patients are often accompanied by cardiovascular symptoms such as panic, chest tightness, shortness of breath and ischemic changes in the electrocardiogram, which will help the doctor identify the cause. Diabetes complicated by renal insufficiencyDiabetic nephropathy is the most common cause of lower extremity edema in glucose patients. When renal damage occurs in glucose patients, swelling of both lower limbs, eyelids and face is caused by large leakage of urine protein, decreased glomerular filtration rate and severe hypoproteinemia, and generalized swelling may occur in severe cases. The patient’s routine urine examination shows protein with tubular pattern and elevated renal function indicators (e.g. creatinine, urea nitrogen), indicators that will help the physician identify the cause. 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), causing peripheral vasodilatation and congestion, and edema due to venous stasis in both lower limbs; in addition, increased local capillary permeability caused by neurotrophic disorders can also lead to swelling in the lower limbs. Most edema caused by diabetic neuropathy is accompanied by symptoms such as numbness, pain, and glove-like sensory loss in the extremities, and these symptoms will help the doctor identify the cause. Diabetes combined with lower extremity vascular disease When patients have lesions in the veins of the lower extremities (such as deep vein thrombosis in the lower extremities, venous valve closure insufficiency), resulting in venous return obstruction and venous hypertension, lower extremity edema can occur, but often unilateral edema. Diabetes combined with foot infections, the local inflammatory response can also lead to edema, which is often accompanied by acute inflammatory manifestations such as increased local skin temperature, skin redness and pain. Diabetes mellitus combined with severe malnutrition Some sugar mellitus, due to long-term excessive dieting, calorie and protein intake is seriously insufficient, resulting in hypoproteinemic and malnutrition swelling. Diabetes mellitus combined with hypothyroidism Some glucose patients (especially elderly women) also have hypothyroidism, which can cause mucinous edema of the lower extremities or face, characterized by depressions that do not appear when the edema is pressed with the finger. In addition, patients with hypothyroidism often have symptoms such as lethargy, drowsiness, coldness, bradycardia, constipation, and low thyroid function (FT3, FT4). Idiopathic edema When female glucose patients have swollen lower extremities, it is important to rule out “idiopathic edema”. This type of edema often occurs during the reproductive years and is often associated with symptoms of neurosis. A positive “standing water test” will help in the diagnosis of idiopathic edema. Some hypoglycemic drugs and antihypertensive drugs can cause water and sodium retention, resulting in swelling of the lower extremities. The former, such as insulin, thiazolidinediones (such as rosiglitazone, pyrrolidone); the latter, such as calcium antagonists (such as nifedipine, amlodipine, etc.). The common feature is that edema occurs after the drug is administered and disappears shortly after discontinuation. Other conditions, such as chronic liver disease, can also be associated with lower limb edema. Patients with chronic liver disease manifestations (e.g., poor performance, liver disease face, liver palm, spider nevus, jaundice, etc.) and abnormal liver function, combined with liver and biliary ultrasound examination, etc. will provide corresponding data to help doctors identify the cause. In conclusion, the causes of diabetic edema are multifaceted and should be analyzed on a case-by-case basis, taking into account the specific situation of the patient.