One noon, a young man in his 20s came to the emergency room. In the past few days, he had repeated nausea and vomiting. He thought he had a "cold stomach", but he vomited everything he didn't want to eat, and even walking became difficult.
The nurse urgently tested his fingertip blood sugar and found that the patient's blood sugar increased beyond the monitoring range of the blood glucose meter. Doctors determined that he might be suffering from ketoacidosis, an acute complication of diabetes. Blood gas analysis, urine ketone body and other auxiliary examinations confirmed the doctor's judgment. Fortunately, after timely treatment, the patient was out of danger.
In winter, many diabetic patients will experience seasonal elevations in blood sugar. This is because when the weather is cold, in order to maintain normal body temperature, the human body will secrete some stress hormones, such as adrenal hormones, thyroid hormones, etc., which will antagonize the effects of insulin, causing blood sugar levels to rise slightly.
In addition, when the weather gets colder, many people's eating habits will also change, and they like to eat sweets and meats with high fat content. In this case, the number of calories in the diet will increase, which will also cause blood sugar levels to rise. rise. If the blood sugar level is slightly elevated, it can be slightly adjusted through diet, exercise, etc. However, some patients do not pay attention to blood sugar control, so they should be alert to hyperglycemic crisis.
Winter is the season with high incidence of diabetes and complications
Diabetes, as the third largest killer of human health, is a group of metabolic diseases characterized by chronic increase in blood sugar levels caused by defects in insulin secretion and/or action in the body. It is a multi-factorial disease involving genetic factors and environmental factors. The result of the combined action of several factors.
As of 2021, there are 529 million diabetic patients globally, and it is estimated that by 2050, there will be 1.31 billion diabetic patients worldwide. There are many patients with diabetes in China, and many patients do not even know they have diabetes when they develop the disease.
Seasonal changes affect blood sugar levels, and winter is also the season when diabetes and its complications are most common. According to the severity of onset, it can be divided into two categories: acute and chronic. Acute complications include ketoacidosis, lactic acidosis, hyperglycemia and hyperosmolar state, etc.; chronic complications include cardiovascular and cerebrovascular diseases, chronic renal insufficiency, diabetic retinopathy, diabetic peripheral neuropathy, etc.
Ketoacidosis is the most common and serious diabetic emergency. If not treated in time, it may lead to multiple organ failure within 1 to 3 days, which is the main cause of death in patients with diabetes.
To use a simple analogy, insulin is like the key that opens the glucose channel in the cell. With the key, glucose can smoothly enter the cell for storage and metabolism, and be converted into energy to provide energy for the body. Without enough keys, glucose cannot fully enter cells for metabolism. At this time, when blood sugar rises, the body has to open up a second path and use the liver to break down fat for energy. At the same time, the "three brothers" of ketone bodies will be produced in the body - the oldest beta-hydroxybutyrate, the oldest diacetoacetate, and the oldest three acetone. The oldest and second oldest ones are acidic and consume all the remaining alkali, thus inducing ketoacidosis. When acidic substances in the body continue to increase, a series of reactions will occur: osmotic diuresis and water loss, electrolyte disorders, oxygen-carrying system disorders, peripheral circulation failure, etc. In severe cases, it may even lead to coma and death.
In short, when a diabetic patient's insulin secretion is insufficient to meet the body's needs or insulin resistance occurs, the hypoglycemic effect decreases, blood sugar increases, and the body begins to break down fat and produce a large amount of ketone bodies. Ketone bodies are mostly body waste. When the body's disposal capacity is exceeded, metabolic acidosis occurs.
Multiple factors induce ketoacidosis, pay attention to disease warning symptoms
In addition to changes in temperature, what factors are likely to induce ketoacidosis? Studies have found that type 1 diabetes has a tendency to spontaneously develop ketoacidosis, and is often diagnosed with ketosis or ketoacidosis for the first time. Type 2 diabetes can also develop under certain triggers, and common triggers are various pathogenic infections.
In addition, improper reduction of insulin or interruption of treatment; improper diet such as alcoholism, high sugar and high fat; and various stresses such as vomiting, diarrhea, trauma, surgery, acute myocardial infarction, cerebrovascular accident, pregnancy, childbirth, etc., are all ketosis Predisposing factors for acidosis.
There are warning symptoms before ketoacidosis occurs. Including diabetic patients and people at high risk of diabetes, when symptoms such as polydipsia, polyphagia, polyuria, and fatigue occur; further symptoms such as loss of appetite, nausea, vomiting, and abdominal pain occur, often accompanied by symptoms such as headache, irritability, and lethargy; or even If you have symptoms such as deep and fast breathing, the smell of rotten apples in your breath, decreased urine output, dry skin and mucous membranes, and increased heart rate, you should be alert to the possibility of ketoacidosis.
Once a patient develops the above symptoms, or even drops in blood pressure, coma, etc., diabetic patients and their families should understand the first aid methods for ketoacidosis, such as monitoring blood sugar, drinking more water to replenish body fluids, injecting insulin to lower blood sugar, etc., so that they can respond in an emergency. Take self-rescue measures. At the same time, the patient should be sent to a doctor immediately to avoid delaying the condition.
Spend the winter smoothly and learn to “protect your family” during the cold weather
Blood sugar is prone to fluctuations in winter. For diabetics and people at high risk of diabetes, how can they “protect their health” during the cold weather?
Maintain regular exercise
Appropriate exercise can help diabetic patients control their weight, improve insulin sensitivity, control blood sugar, and enhance resistance. For example, walking, jogging, swimming, etc., you should avoid outdoor exercise in the early morning and evening when it is cold, as it can easily induce cardiovascular and cerebrovascular diseases. Exercise is more suitable when the temperature rises at noon. Overexertion should be avoided during exercise to avoid aggravating the condition.
Arrange your diet properly
People with diabetes must both meet nutritional needs and control blood sugar levels. It is recommended to choose low-sugar, low-fat, and high-fiber foods, such as vegetables, fruits, whole-wheat bread, lean meat, etc., to avoid excessive intake of sugar and fat. Properly mix protein, carbohydrate and fat intake ratios.
Monitor blood sugar regularly
Diabetic patients should monitor blood sugar regularly in order to detect blood sugar fluctuations in time and take appropriate measures. If blood sugar control is not ideal, you should seek medical advice promptly to adjust the treatment plan.
avoid infection
Winter is the peak season for various infectious diseases, and patients with diabetes are more likely to suffer from various infections, such as colds, pneumonia, urinary tract infections, etc. Drink plenty of water every day, pay attention to personal hygiene and protection, and wear more clothes and socks to keep out the cold to avoid infection and diabetic foot.
Adhere to regular medication
Diabetic patients need to take long-term and regular medication, such as insulin, hypoglycemic drugs, etc. Drugs should be used according to the recommendations of your doctor or pharmacist, and do not change the dosage or stop the drug at will, so as not to affect the blood sugar control effect.
keep a good attitude
Mood swings can affect blood sugar stability and may lead to ketoacidosis. Therefore, patients with diabetes should learn to control their emotions, maintain a positive and optimistic attitude, and avoid excessive excitement or depression.
Regular review
Go to the hospital for regular check-ups so that complications can be discovered and dealt with in a timely manner.
(The author Han Zhen is a doctor of emergency and critical care medicine at Pudong New Area People’s Hospital)
Source: Wen Wei Po