Diabetes mellitus and tuberculosis are common and frequent clinical diseases, and the two diseases are closely related. According to statistics, the prevalence of tuberculosis is 4 to 8 times higher in diabetic patients than in the general population. Why are diabetes and tuberculosis often present together? This is because patients with diabetes have disorders of sugar, fat and protein metabolism, and increased blood sugar provides a source of nutrition for the growth of Mycobacterium tuberculosis, and the disorders of metabolism in the patient’s body further lead to a decrease in immunity and susceptibility to tuberculosis. Once a diabetic patient has tuberculosis, about 10%-20% of patients have no respiratory symptoms, while about 80% of patients have a rapid onset and progress. Compared with simple tuberculosis, the lung lesions are extensive, with many caseous lesions, many cavities and large bacilli excretion, making treatment relatively difficult. Many patients with diabetes mellitus combined with pulmonary tuberculosis are often confused about the proper treatment and do not know how to treat it. The principles and measures for the treatment of diabetes mellitus combined with pulmonary tuberculosis are described. Diabetes and tuberculosis should be treated simultaneously Diabetes and tuberculosis affect each other when they are complicated, so both diseases must be treated simultaneously. Since the adverse effects of diabetes on tuberculosis are greater than those of tuberculosis on diabetes, diabetes should be controlled first, and the efficacy and prognosis of tuberculosis depends largely on the degree of control of diabetes. The doctor and patient should work closely together to treat diabetes with dietary therapy, oral hypoglycemic drugs or the application of insulin, depending on the type and condition of diabetes. Generally speaking, light or type 2 diabetes can choose oral hypoglycemic drugs. Any diabetic patients with obvious symptoms, heavy, pediatric type, and complications are generally advocated to use insulin first, striving to control diabetes as soon as possible in the short term, and reduce insulin dosage or switch to oral hypoglycemic drugs when blood sugar is stable and TB condition improves. According to the “Trial Standards for Clinical Application of Diabetes Mellitus Complicated by Tuberculosis” formulated by the Chinese Anti-Tuberculosis Association in 1988, the ideal control of diabetes mellitus is the disappearance of diabetic symptoms after treatment, fasting blood glucose <7.2 mmol/liter and 2-hour postprandial blood glucose <9.9 mmol/liter; the better control is the basic disappearance of diabetic symptoms after treatment, fasting blood glucose <8.3 mmol/liter. Blood glucose <8.3 mmol/l and 2 hours postprandial blood glucose <11.1 mmol/l after treatment. The anti-tuberculosis drug treatment for diabetic tuberculosis should follow the same principles of "early, combination, regular, moderate and full course" as for patients with simple tuberculosis, specifically early, multi-drug, regular, moderate and full course. Rifampin, isoniazid and pyrazinamide should be used as the main drugs to form a chemotherapy regimen, and the course of treatment should be extended to 12 months. Diabetes requires lifelong treatment, and tuberculosis also requires long-term follow-up, unstable or not fully controlled diabetes, and tuberculosis needs more regular review. It is important to pay attention to the effects between the treatment of diabetes and anti-tuberculosis drugs: isoniazid can interfere with normal carbohydrate metabolism and make blood sugar fluctuate, which can aggravate the terminal neuritis in diabetic patients; rifampin is an enzyme inducer that can promote the metabolic inactivation of the hypoglycemic drug methotrexate by the liver, so the dosage of the latter should be increased appropriately or changed to other hypoglycemic drugs when rifampin is applied simultaneously with methotrexate. The anti-tuberculosis drug ethionamide has a hypoglycemic effect, but hypoglycemia may occur when combined with glucose-lowering drugs. Ethambutol can bind to calcium ions in the blood, causing a decrease in blood calcium concentration. Sodium p-aminosalicylate can cause false-positive urine glucose and should be taken into account when evaluating diabetic conditions. Patients with diabetic complications should pay attention to the following aspects when using anti-tuberculosis drugs: Streptomycin and kanamycin must be used with caution in diabetic patients with impaired renal function to avoid further damage to renal function. Isoniazid, pyrazinamide and ethambutol are mainly excreted by the kidneys and are not nephrotoxic per se, but they are prone to accumulation toxicity when renal function is impaired and should be used in reduced doses. When diabetes mellitus is complicated by pulmonary tuberculosis, if the tuberculosis meets the indications for surgical treatment, with effective control of diabetes mellitus and patient competence for surgery, surgical treatment seems to take a more aggressive attitude, and surgical resection is more appropriate for lesions that cannot be satisfactorily controlled by chemotherapy, because the chances of reactivation of tuberculosis lesions are quite high in the presence of lifelong diabetes mellitus. Care in life In life, patients should arrange rest and appropriate activities scientifically. Patients with high fever should rest in bed, and when their condition improves, they can do some light activities such as indoor walking, and when their condition is basically stable, they can participate in half-day work, and later they can engage in full-day light work according to the condition recovery. Diet therapy is important for controlling diabetes and promoting recovery from TB. The total calorie intake of patients is increased by about 10% compared with that of simple diabetes, and patients are advocated to eat more coarse grains such as brown rice and cornmeal, to consume high-quality protein such as fish, eggs and meat, to increase the proportion of peanut oil and soybean oil containing unsaturated fatty acids, to avoid spicy and other stimulating condiments, and to adopt the "four fixed" methods of regular meals, fixed rations, fixed nutrients and unspecified food for most patients. For most patients, the "four fixed" methods of regular meals, fixed ration, fixed nutrients and fixed food can be used for the management of basic diet therapy. Patients using insulin and oral hypoglycemic agents should be carefully observed for gastrointestinal reactions such as nausea, vomiting and anorexia, and fasting glucose, urine glucose and liver and kidney functions should be measured regularly to detect adverse drug reactions and hypoglycemia at an early stage. Pay attention to the early detection and treatment of diabetes and tuberculosis Patients with diabetes who are tuberculin negative should be vaccinated with BCG in a timely manner, especially for adolescent diabetics. Those who are tuberculin-positive should be treated with chemoprophylaxis. Diabetic patients should always pay attention to whether they have complications of tuberculosis. Diabetic patients should be alerted to complications of tuberculosis if they experience significant weight loss, repeated fluctuations in blood glucose, with significant weakness and other symptoms during treatment. If a patient develops respiratory symptoms such as cough, sputum production, low fever, etc., and sees improvement after two weeks with antimicrobials, further investigations such as chest X-ray, sputum smear antacid staining, etc. should also be performed. In order to detect TB as early as possible and treat it early. Patients with tuberculosis should also pay attention to whether they have complications of diabetes, and should routinely check blood sugar and urine glucose regularly for early detection of asymptomatic hidden diabetes. Patients with tuberculosis who have repeated skin boils and itching in the pubic area, or whose condition is still difficult to control with regular anti-tuberculosis treatment, should be alert to complications of diabetes and should go to the hospital for timely examination. In conclusion, with the progress of modern medicine and the continuous introduction of effective drugs, tuberculosis is already a disease that can be "treated and prevented", and it is not terrible to have diabetes complicated by tuberculosis. As long as each patient has a comprehensive understanding of these two diseases, correctly grasp the principles and methods of treatment, establish confidence in overcoming the disease, communicate with the doctor in a timely manner, under the guidance of the doctor's reasonable treatment, accept modern chemotherapy and management, you will be able to achieve very good treatment results.