Edema is a pathological phenomenon of excessive fluid accumulation in the interstitial spaces of tissues, and is most common clinically, especially in the lower extremities. Diabetic patients with lower limb edema, in addition to a few causes, mostly related to various chronic complications of diabetes, is a sign of many chronic complications. Commonly seen in the following cases.
1, diabetes complicating renal insufficiency
Diabetic nephropathy is the most common cause of lower extremity edema in diabetic patients. When renal damage occurs in diabetic patients, it causes bilateral lower limbs, eyelids and facial swelling due to large leakage of urinary protein, decreased glomerular filtration rate and severe hypoproteinemia, and generalized swelling can occur in severe cases. Patients can be distinguished by protein and tubular type in routine urine examination and elevated renal function indicators (such as creatinine and urea nitrogen).
2.Diabetes complicated by heart disease
In severe cases, cardiovascular diseases such as coronary artery disease and cardiomyopathy can be complicated by cardiac insufficiency (especially right heart insufficiency), which can lead to 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 can be distinguished.
3.Diabetes combined with peripheral neuropathy
Diabetic neuroedema is mostly seen in both lower limbs and is related to body position and activity. This is due to damage to the vegetative nerves (mainly sympathetic nerves), which causes peripheral vasodilatation and congestion, and edema due to venous stasis in both lower limbs; in addition, increased permeability of local capillaries caused by neurotrophic disorders can also lead to swelling of the lower limbs. Most of the edema caused by diabetic neuropathy is accompanied by numbness, pain, glove-like sensory loss and other symptoms, which can be distinguished.
4.Diabetes combined with lower limb vasculopathy
When patients have lesions in the veins of the lower limbs (such as deep vein thrombosis and venous valve closure insufficiency), resulting in venous return obstruction and venous hypertension, lower limb edema can occur, but often unilateral edema.
5.Diabetic combined foot infection
Patients with foot skin damage infection, local inflammatory reaction can also lead to edema, these patients are often accompanied by local skin temperature, skin redness, pain and other acute inflammatory manifestations.
6, diabetes combined with severe malnutrition
Some diabetic patients, due to long-term excessive dieting, calorie and protein intake is seriously insufficient, resulting in hypoproteinemic and malnutrition swelling.
7.Drug factors
Certain hypoglycemic drugs and antihypertensive drugs can cause water and sodium retention, leading to swelling of the lower limbs. 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 the edema occurs after the drug is used and disappears soon after stopping it.
8, diabetes combined with hypothyroidism
Some diabetic patients (especially elderly female patients) combined with hypothyroidism, the latter can cause lower limbs or facial mucinous edema, which is characterized by finger pressure on the edema site does not appear depressed changes. In addition, hypothyroid patients often have accompanying symptoms such as lethargy, drowsiness, coldness, bradycardia, constipation, etc., and can be differentiated by low thyroid function (FT3, FT4) on laboratory tests.
9, idiopathic edema
Female diabetic patients appear swollen lower limbs, we must pay attention to exclude “idiopathic edema”. This edema often occurs in the reproductive age, patients often accompanied by symptoms of neurosis, edema is often related to the menstrual cycle. A positive “standing water test” will help in the diagnosis of idiopathic edema edema.
10.Other
Lower limb edema may also occur in diabetic patients with chronic liver disease. Patients with chronic liver disease manifestations (such as weakness, liver disease face, liver palm, spider nevus, jaundice, etc.) and liver function abnormalities, combined with liver and biliary ultrasound examination can be distinguished.
In conclusion, the causes of diabetic edema are multifaceted and should be analyzed specifically in the context of the patient’s specific situation in order to identify the causes and give targeted treatment.