Mechanism: Elevated blood sugar leads to an increase in blood osmotic pressure, which stimulates the osmotic pressure receptors of the hypothalamus, causing excitement in the thirst center and producing a feeling of thirst, thereby prompting the patient to drink a large amount of water.

Manifestations: Patients often feel dry mouth, and the amount of water they drink increases significantly. The amount of water they drink every day can far exceed the normal level, and frequent drinking still cannot relieve thirst.

Mechanism: Insulin is relatively or absolutely insufficient, body cells cannot effectively use glucose to obtain energy, the body is in a state of energy deficiency, and the brain receives hunger signals, leading to increased appetite.

Symptoms: The food intake is significantly increased than before, and one always feels hungry, and will feel hungry again soon after eating, may eat frequently, and has a strong appetite for various foods.

Mechanism: Blood sugar is too high and exceeds the renal glucose threshold. The glucose filtered out by the glomerulus cannot be completely reabsorbed by the renal tubules, forming osmotic diuresis, resulting in increased urine output.

Manifestations: The frequency of urination increases, especially at night. The urine output is also larger than normal. The color of urine is generally lighter and may be accompanied by foam.

Mechanism: The body cannot fully utilize glucose and instead breaks down fat and protein to provide energy, resulting in a reduction in fat and muscle mass. At the same time, because blood sugar is excreted in the urine, some calories are also taken away.

Performance: Without deliberate dieting or increased exercise, weight gradually decreases, the body gradually becomes thinner, and muscle strength may also weaken.

Nausea and vomiting: Nausea and vomiting may occur in the early stage. This is caused by the accumulation of ketone bodies in the body, which stimulates the gastrointestinal tract. The vomitus is mostly gastric contents. Frequent vomiting can lead to dehydration and electrolyte imbalance.

Exhaled breath smells like rotten apples: This is one of the typical symptoms of DKA because ketones (mainly acetoacetate) in the body are excreted through the respiratory tract, producing a special smell.

Abdominal pain (some patients): Some patients may experience abdominal pain with varying degrees of pain, mostly persistent dull pain, which may be misdiagnosed as acute abdomen. The reasons may be related to stimulation of the celiac plexus by ketone bodies, electrolyte imbalance, etc.

Dehydration symptoms (dry skin, sunken eyeballs, etc.): As the disease progresses, dehydration symptoms gradually worsen, manifesting as dry skin, loss of elasticity, sunken eyeballs, obvious dry mouth, and a possible drop in blood pressure.

Consciousness disorder (from drowsiness to coma): Severe DKA can lead to changes in the patient's state of consciousness, which may appear as drowsiness and listlessness in the early stages. As the condition worsens, the patient may enter a coma.

Severe dehydration symptoms (more obvious than DKA): Due to extremely elevated blood sugar and more severe osmotic diuresis, patients have prominent dehydration symptoms, such as dry and wrinkled skin, sunken eye sockets, chapped lips and tongue, significant drop in blood pressure, and may even suffer from shock.

Neuropsychiatric symptoms (hallucinations, aphasia, etc.): Patients may experience neuropsychiatric symptoms such as confusion, hallucinations, aphasia, and limb twitching. This is because the hypertonic state causes dehydration of brain cells and causes nervous system dysfunction.

Exacerbation of existing diabetes symptoms (polydipsia, polyuria, etc.): Before the occurrence of HHS, patients may already have symptoms of diabetes. At this time, these symptoms will be significantly aggravated. For example, polydipsia and polyuria will become more significant, and urine output may increase significantly.

Cardiovascular disease (coronary heart disease, etc.): Angina pectoris may occur, manifesting as squeezing pain in the precordium area, which may radiate to the left shoulder and inner side of the left arm. The pain generally lasts for 3-5 minutes; myocardial infarction may also occur, with more severe pain. It lasts longer and is accompanied by symptoms such as difficulty breathing and profuse sweating.

Cerebrovascular disease (cerebral infarction, cerebral hemorrhage): Cerebral infarction may present symptoms such as weakness, numbness, slurred speech, and skewed mouth corners on one side of the limb; cerebral hemorrhage usually presents with sudden severe headache, vomiting, and disturbance of consciousness, and the condition is often more severe. Urgent and more serious.

Peripheral vascular disease (arteriosclerosis obliterans of the lower limbs, etc.): intermittent claudication in the lower limbs, that is, pain and numbness in the lower limbs after walking for a certain distance, which can be relieved after resting, but symptoms reappear after continuing to walk; in severe cases, the skin of the lower limbs may feel cold. , the pulse of the dorsalis pedis artery weakens or disappears, and ulcers and gangrene of the lower limbs may even occur.

Diabetic nephropathy: Microalbuminuria may occur in the early stage, and routine urine examination may reveal positive proteinuria; as the disease progresses, large amounts of proteinuria may occur, leading to edema, which gradually spreads from the eyelids and lower limbs to the whole body; in the late stage, it may develop into renal failure. Symptoms such as nausea, vomiting, anemia, oliguria or anuria may occur.

Diabetic retinopathy: There may be no obvious symptoms in the early stage, or only mild vision loss and blurred vision; as the disease progresses, dark shadows (floaters) and visual field defects may appear in front of the eyes; in severe cases, it may lead to retinal detachment and blindness. .

Peripheral neuropathy: Mainly manifested by symmetrical sensory abnormalities of the limbs, such as numbness, tingling, and burning sensations, which usually start from the distal end of the lower limbs and gradually develop upward; hypoesthesia may also occur, insensitivity to stimuli such as temperature and pain, and it is easy to Burns, trauma, etc. occur.

Autonomic neuropathy: Gastroparesis may occur if the digestive system is involved, manifesting as early satiety, nausea, vomiting, bloating, alternating constipation or diarrhea after eating; orthostatic hypotension may occur if the cardiovascular system is involved, that is, when changing from a supine or squatting position When standing up suddenly, dizziness, amaurosis, palpitation, or even syncope may occur; urinary disorders involving the genitourinary system may occur, such as frequent urination, urgency, urinary incontinence or urinary retention, and men may experience erectile dysfunction.

Sulfonylureas: such as glyburide, gliclazide, glipizide, etc., stimulate pancreatic beta cells to secrete insulin and are suitable for patients with type 2 diabetes, especially those with preserved pancreatic islet function. Common adverse reactions include hypoglycemia, weight gain, etc.

Meglitinides: such as repaglinide and nateglinide, their mechanism of action is similar to that of sulfonylureas, but they have a faster onset of action and a shorter duration of action. They are mainly used to control postprandial blood sugar, and the risk of hypoglycemia is relatively low. .

Biguanides: Metformin is currently the most widely used biguanide drug. It lowers blood sugar by reducing hepatic glucose output and improving peripheral insulin resistance. It is the first-line drug for the treatment of type 2 diabetes, especially for obese or overweight patients. Common adverse reactions include gastrointestinal reactions, such as nausea, vomiting, diarrhea, etc.

α-Glycosidase inhibitors: such as acarbose and voglibose, inhibit the absorption of carbohydrates in the upper part of the small intestine and reduce postprandial blood sugar peaks. They are suitable for patients with carbohydrates as the main food component or postprandial blood sugar increases. obvious patient. The main adverse reactions are gastrointestinal flatulence and increased flatulence.

Thiazolidinediones: such as rosiglitazone and pioglitazone, increase the sensitivity of target cells to the action of insulin and are suitable for patients with type 2 diabetes who have significant insulin resistance. However, this type of drug may increase weight and edema, and should be used with caution in patients at risk of heart failure.

DPP-4 inhibitors: such as sitagliptin, saxagliptin, vildagliptin, etc., increase endogenous glucagon-like peptide-1 (GLP-1) levels by inhibiting DPP-4 enzyme activity. Promote insulin secretion, inhibit glucagon secretion, lower blood sugar, lower risk of hypoglycemia, and have less impact on body weight.

SGLT-2 inhibitors: such as dapagliflozin, empagliflozin, canagliflozin, etc., inhibit the reabsorption of glucose by the renal tubules, promote urinary glucose excretion, thereby lowering blood sugar, and at the same time have certain effects on blood pressure and weight loss. , reduce the risk of cardiovascular events, etc., but may increase the risk of genitourinary system infections. Pay attention to drinking more water and keeping the vulva clean.

Indications: Type 1 diabetes patients; Type 2 diabetes patients with poor blood sugar control after treatment with diet, exercise and oral hypoglycemic drugs; acute complications of diabetes (such as diabetic ketoacidosis, hyperosmolar hyperglycemic state); severe and chronic diabetes Complications (such as diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, etc.); gestational diabetes; stress states such as surgery, trauma, and infection.

Insulin type: According to the action time, it is divided into short-acting insulin, intermediate-acting insulin, long-acting insulin and premixed insulin. Short-acting insulin has a quick onset of action and a short action time, and is mainly used to control postprandial blood sugar; intermediate-acting insulin has a longer action time and can provide basal insulin levels; long-acting insulin can last for about 24 hours and can better simulate physiological physiology. Basal insulin secretion; premixed insulin is a mixture of short-acting insulin and intermediate-acting insulin in a certain proportion, taking into account fasting and postprandial blood sugar control.

Instructions for use: Insulin is generally injected subcutaneously. The insulin dose and injection time can be adjusted according to the patient's blood sugar condition, diet and exercise. During the use of insulin, blood sugar needs to be monitored closely to prevent hypoglycemia.