Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia due to defective insulin secretion and/or impaired insulin action. Persistent hyperglycemia and long-term metabolic disorders can lead to damage to tissues and organs throughout the body, especially the eyes, kidneys, cardiovascular and nervous systems, as well as their dysfunction and failure. In severe cases, acute complications such as ketoacidosis and hyperosmolar coma can be caused by water loss, electrolyte disorders and acid-base imbalance.
The symptoms of diabetes mellitus can be divided into two categories: one is the performance related to metabolic disorders, especially the “three more and one less” related to hyperglycemia, which is mostly seen in type 1 diabetes mellitus, and type 2 diabetes mellitus is often not very obvious or only part of the performance, and the other category is the performance of various acute and chronic complications.
1.Polyuria
The higher the blood sugar, the more urinary sugar excretion, the more urine volume, 24h urine volume up to 5000 ~ 10000ml, but the elderly and people with kidney disease, the renal sugar threshold increased, urinary sugar excretion is impaired, in the light to moderate increase in blood sugar, polyuria may not be obvious. However, in elderly people and people with kidney disease, the renal glucose threshold increases and urinary sugar excretion is impaired.
2.Drinking
Mainly due to high blood glucose, plasma osmolality increases significantly, coupled with polyuria, excessive water loss, intracellular dehydration, aggravating hyperglycemia, further increasing plasma osmolality, stimulating the thirst center, leading to thirst and polyuria, and polyuria is further aggravated by polyuria.
3.Polyphagia
The mechanism of polyphagia is not very clear, most scholars tend to be caused by the decrease of glucose utilization (the difference of glucose concentration in arterial and venous blood before and after entering and leaving the tissue cells), the difference of glucose concentration in arterial and venous blood is reduced in normal people when fasting, which stimulates the feeding center and produces hunger, after feeding, the blood glucose rises, the difference of concentration in arterial and venous blood increases (more than 0,829mmoL/L), the feeding center is inhibited, the satiety center However, in diabetic patients, due to absolute or relative lack of insulin or insensitivity of tissues to insulin, the ability of tissues to take in and use glucose decreases, and although blood glucose is at a high level, the difference in concentration of glucose in arterial and venous blood is very small, and tissue cells are actually in a “starvation state”, which stimulates the feeding center and causes hunger and overeating. In addition, the body can not make full use of glucose, and a large amount of glucose is excreted from urine, so the body is actually in a semi-starvation state, and the lack of energy also causes hyperphagia.
4.Weight loss
Although the appetite and food quantity of diabetic patients are normal, or even increase, but the weight loss is mainly due to absolute or relative lack of insulin or insulin resistance, the body can not make full use of glucose to produce energy, resulting in the strengthening of fat and protein decomposition, excessive consumption, negative nitrogen balance, weight loss gradually, and even wasting, once the diabetes is reasonably treated and well controlled, weight loss can be controlled, and even regained. If a diabetic patient continues to lose weight or lose weight significantly during the treatment process, it suggests that the metabolism may be poorly controlled or combined with other chronic wasting diseases.
5. Lethargy
It is also common in diabetic patients, as glucose cannot be fully oxidized, i.e. the body cannot make full use of glucose and release energy effectively, while tissue water loss, electrolyte imbalance and negative nitrogen balance, etc., thus feeling generalized weakness and mental depression.
6, vision loss
Many diabetic patients complained of vision loss or blurred vision when they visited the clinic in the early stage, which may be mainly due to the change of crystal osmolarity caused by high blood sugar, resulting in the change of crystal refractive index, which is generally functional in the early stage.
2.Clinical manifestations
1.Typical symptoms: three more and one less symptoms, i.e. polyuria, polydipsia, polyphagia and emaciation.
2, atypical symptoms: some patients with type 2 diabetes have atypical symptoms, only dizziness, weakness, etc., or even no symptoms. Some early onset or pre-onset stage of diabetes may show symptoms of hypoglycemia before lunch or dinner.
3, the performance of acute complications: the condition is aggravated under stress and other circumstances. Loss of appetite, nausea, vomiting, abdominal pain, aggravation of polyuria, dizziness, drowsiness, blurred vision, difficulty in breathing, coma, etc. may appear.
4. Main manifestations of chronic complications.
①Diabetic retinopathy: the presence of vision loss and the degree and duration of the loss; whether the fundus or fundus fluorescence imaging has been examined; whether the retinal photocoagulation treatment has been received.
②Diabetic nephropathy: the presence of swelling, increased foam in the urine or proteinuria.
③Diabetic neuropathy: abnormal skin sensation in the extremities, numbness, pins and needles, anthroposis. Feeling of stepping on cotton on the soles of the feet, alternating diarrhea and constipation, urinary retention, hemiplegia or occasional profuse sweating, sexual dysfunction.
④ Recurrent infections: for example, recurrent skin infections such as boils and carbuncles, long-lasting calf and foot ulcers. Recurrent urinary tract infections, rapidly developing tuberculosis. Female vulvar itching.
3.Disease treatment
The treatment of diabetes includes several aspects of diabetes education, diet therapy, exercise therapy, medication, blood glucose monitoring, and the detection and control of other cardiovascular disease risk factors
3.1 Education about diabetes mellitus
Once diabetes is diagnosed, patients should be educated about diabetes, including general knowledge of diabetes. Self-monitoring of blood glucose and urine sugar. The use of hypoglycemic drugs, the observation and treatment of adverse reactions, etc. and the manifestation and prevention of various complications [4].
3.2 Diet therapy
The primary measure of the basic treatment of all types of diabetes mellitus. The principles of dietary therapy are: control of total calories and body weight. Reduce the fat content of food, especially saturated fatty acids, and increase the fiber content of food, so that the proportion of carbohydrates. The proportion of fat and protein in food is reasonable. Control the total dietary energy intake and distribute various nutrients in a reasonable and balanced manner. Maintain a reasonable body weight. The goal of weight reduction for overweight/obese patients is to lose 5-10% of body weight in a period of 3-6 months. Lean patients should regain and maintain their ideal weight over time through a balanced nutrition program.
①Fat: Dietary fat should provide no more than 30% of total energy, and saturated fatty acid intake should not exceed 10% of total energy. Cholesterol intake in food <300mg/day.
②Carbohydrates: The energy provided by carbohydrates in the diet should account for 50%-60% of the total energy. Food should be rich in dietary fiber.
③Protein: In patients with normal renal function, the recommended protein intake is 10%-15% of the total energy. Patients with dominant proteinuria should have a protein intake of <0.8g/kg body weight/day; from the time GFR decreases, a low protein diet of <0.6g/kg body weight/day should be implemented and supplemented with compounded a-keto acid preparations.
④ Alcohol consumption: Alcohol consumption is not recommended for diabetic patients. No more than 1-2 standard servings per day (one standard serving: 350ml of beer, 150ml of red wine or 45ml of low-grade white wine, each containing about 15g of concentrate)
⑤ Salt: Salt intake is limited to 6g per day, and patients with hypertension should strictly limit the intake.
3.3 Exercise therapy
It is also one of the basic treatment methods for diabetes. According to the actual situation of the patient, choose the appropriate exercise program, according to the ability, step by step, it is valuable to support. Exercise mode . Intensity. The frequency should be determined by the actual situation of the patient. Generally, moderate intensity aerobic exercise is recommended (such as brisk walking. Taijiquan. Bicycling. Golfing and gardening activities) for at least 150 minutes per week. When blood glucose > 14-16 mmol/L. Significant hypoglycemia or large fluctuations in blood glucose. People with acute metabolic complications of diabetes and serious chronic complications of various cardiac and renal organs are not suitable for exercise for the time being.
3.4 Quit smoking
Smoking is harmful to health, especially in patients with type 2 diabetes who are at high risk for macroangiopathy. Every diabetic patient who smokes should be advised to stop smoking as an important part of lifestyle intervention.