MindMap Gallery diabetes
Diabetes is a chronic disease with hyperglycemia as the main sign. It is mainly caused by a decrease in insulin secretion caused by pancreatic islet cell dysfunction, or the body is insensitive to the action of insulin (i.e., insulin resistance), or both, making glucose in the blood ineffective. be utilized and stored.
Edited at 2024-11-15 16:11:10呼吸功能不全是指由於外呼吸功能的嚴重障礙,以致動脈血氧分壓(PaO₂)低於正常範圍,或伴隨二氧化碳分壓(PaCO₂)升高的病理過程。
Respiratory insufficiency refers to a pathological process in which the partial pressure of arterial oxygen (PaO₂) is lower than the normal range or accompanied by an increase in the partial pressure of carbon dioxide (PaCO₂) due to severe impairment of external respiratory function.
現場施工及商務文件,詳細描述了工程項目從準備到竣工的各個階段和關鍵任務。有助於專案管理人員更能掌握專案進度和關鍵環節,確保專案順利進行。
呼吸功能不全是指由於外呼吸功能的嚴重障礙,以致動脈血氧分壓(PaO₂)低於正常範圍,或伴隨二氧化碳分壓(PaCO₂)升高的病理過程。
Respiratory insufficiency refers to a pathological process in which the partial pressure of arterial oxygen (PaO₂) is lower than the normal range or accompanied by an increase in the partial pressure of carbon dioxide (PaCO₂) due to severe impairment of external respiratory function.
現場施工及商務文件,詳細描述了工程項目從準備到竣工的各個階段和關鍵任務。有助於專案管理人員更能掌握專案進度和關鍵環節,確保專案順利進行。
diabetes
symptom
metabolic disorder symptoms
Drink more
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.
Eat more
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.
polyuria
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.
weight loss
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.
Symptoms related to acute complications
Diabetic ketoacidosis (DKA)
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.
Hyperosmolar Hyperglycemic Syndrome (HHS)
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.
Symptoms related to chronic complications
Macrovascular complications (cardiovascular, cerebrovascular, peripheral vascular)
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.
Microvascular complications (diabetic nephropathy, diabetic retinopathy)
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. .
Neuropathy (peripheral neuropathy, autonomic neuropathy)
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.
diagnostic criteria
Fasting blood glucose ≥7.0mmol/L.
Blood glucose ≥11.1mmol/L 2 hours after a meal.
Random blood sugar ≥11.1mmol/L, accompanied by symptoms of diabetes (polydipsia, polyphagia, polyuria, weight loss).
Glycated hemoglobin (HbA1c) ≥6.5%. (Note: If there are no typical symptoms of diabetes, you need to choose a date for re-examination to confirm)
prevention
healthy eating
Control total calories: Calculate the daily calories required based on age, gender, height, weight, and activity level, and reasonably distribute them to carbohydrates, proteins, and fats.
Carbohydrates: Choose high-fiber, low-GI (glycemic index) foods such as whole-wheat bread, oats, brown rice, beans, etc., and reduce your intake of refined grains and added sugars.
Protein: Eat an appropriate amount of high-quality protein, such as lean meat, fish, poultry, eggs, beans, dairy products, etc.
Fat: Control the intake of saturated fat and trans fat, and increase the intake of unsaturated fat, such as olive oil, fish oil, nuts, etc.
Eat more vegetables and fruits: Ensure that the daily intake of vegetables is no less than 500 grams and 200-350 grams of fruits. Choose seasonal fruits and pay attention to control the intake of fruits to avoid excessive blood sugar fluctuations.
Diet rules: Eat regular and quantitative meals, avoid overeating, and reduce the number of meals out.
Moderate exercise
Frequency of exercise: At least 150 minutes of moderate-intensity aerobic exercise per week, such as brisk walking, jogging, swimming, cycling, etc., which can be divided into 5 times, about 30 minutes each time; you can also perform appropriate strength training, such as weightlifting, push-ups, and sit-ups. Sit and wait, 2-3 times a week.
Exercise intensity: During moderate-intensity exercise, the heart rate generally reaches 50% - 70% of the maximum heart rate (maximum heart rate = 220 - age). You may sweat slightly during exercise, and you can speak but cannot sing.
Exercise time: Choose to exercise 1 - 2 hours after a meal and avoid exercising on an empty stomach to avoid hypoglycemia.
Notes: Warm up before exercise and stretch and relax after exercise; wear appropriate sports equipment; carry candies or biscuits with you in case of hypoglycemia; if you have severe cardiovascular disease, retinopathy and other diabetic complications, Exercise needs to be done under the guidance of a doctor.
control weight
Calculate body mass index (BMI): BMI = weight (kg) ÷ height² (m²), normal range is 18.5 - 23.9. Keep your weight within a normal range through proper diet and exercise.
Waist circumference management: The waist circumference of men should be controlled within 90cm, and the waist circumference of women should be controlled within 85cm. Abdominal obesity is one of the important risk factors for diabetes, and reducing abdominal fat accumulation can help prevent diabetes.
Regular physical examination
Blood glucose testing: It is recommended for the general population to conduct fasting blood glucose and 2-hour postprandial blood glucose testing once a year; high-risk groups such as those with a family history of diabetes, obesity, hypertension, and hyperlipidemia should test blood glucose every six months to detect blood sugar abnormalities early and take timely measures. Interventions.
Other examinations: including blood pressure, blood lipids, liver function, kidney function, glycated hemoglobin, fundus examination, urine microalbumin, etc., to comprehensively understand the physical condition and promptly detect diabetic complications or other potential health problems.
treat
Diet therapy (same as healthy diet in prevention)
Exercise therapy (same as moderate exercise in prevention)
drug treatment
Oral hypoglycemic drugs
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.
Insulin treatment
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.
blood glucose monitoring
Monitoring frequency: determined based on patient condition and treatment plan. Generally speaking, patients who take insulin treatment or whose blood sugar control is unstable should monitor their blood sugar 4-7 times a day, including fasting blood sugar, blood sugar before three meals, blood sugar 2 hours after three meals, and blood sugar before bedtime; patients with stable blood sugar control, Blood glucose can be monitored 1 - 2 days a week.
Monitoring time points: Fasting blood sugar refers to blood sugar after fasting for at least 8 hours; 2-hour postprandial blood sugar is measured from the first bite of meal; random blood sugar refers to blood sugar testing at any time point.
Monitoring equipment: Commonly used blood glucose monitoring equipment include blood glucose meters and continuous glucose monitoring systems (CGM). The blood glucose meter is easy to operate and can quickly obtain blood sugar values; CGM can continuously monitor changes in interstitial fluid glucose concentration, provide more comprehensive blood sugar information, and help detect hidden hyperglycemia and hypoglycemia, especially suitable for patients with large blood sugar fluctuations and low blood sugar levels. Patients at higher risk for glycemic risk.
Significance of monitoring: Through blood sugar monitoring, we can understand blood sugar control, adjust treatment plans in a timely manner, and prevent the occurrence and development of diabetic complications; at the same time, blood sugar monitoring results can be used as a basis for patients to adjust their diet, exercise and drug treatment, and improve their self-management ability.
Diabetes Education and Psychological Support
Diabetes education: Popularize knowledge about the causes, symptoms, diagnosis, treatment, and complication prevention of diabetes to patients and their families, so that they can understand diabetes self-management methods, including diet control, exercise, drug use, blood sugar monitoring, etc., to improve the patient's Treatment compliance and self-management skills. Education can be provided by holding diabetes health lectures, distributing promotional materials, and one-on-one consultation and guidance.
Psychological support: Diabetes is a chronic disease. Patients may face long-term treatment, dietary restrictions, blood sugar fluctuations and other problems, and are prone to negative emotions such as anxiety, depression, fear, etc. These emotions may affect the patient's blood sugar control and quality of life. Therefore, it is necessary to pay attention to the patient's psychological state, provide psychological support and guidance, help the patient build confidence in overcoming the disease, and actively cooperate with treatment. Patients can be encouraged to join mutual aid organizations for diabetic patients, exchange experiences with other patients, share insights, and relieve psychological pressure.