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Recently, Shelley Duvall, an American actress who starred in the movie "The Shining", passed away in her sleep at her home in Blanco, Texas, at the age of 75. It is reported that Shelley Duvall died of complications from diabetes. As a common chronic disease, how harmful are the complications of diabetes?

Diabetic nephropathy is one of the leading causes of death

Diabetic nephropathy is a chronic kidney injury caused by diabetes and is one of the main causes of death among diabetic patients. Hong Tianpei, director of the Department of Endocrinology at the Third Affiliated Hospital of Peking University, believes that diabetic nephropathy can generally be divided into the high glomerular filtration rate stage, the normal white blood cell stage, and the high glomerular filtration rate stage.ProteinuriaThe main symptoms are foamy urine,Edema, anemia, etc.

Standardized screening is the most effective tool for early detection and diagnosis of diabetic nephropathy. Hong Tianpei introduced that the main clinical detection method is to evaluate through the ratio of urine microalbumin to urine creatinine (UACR). UACR detection can avoid the possible missed diagnosis caused by relying solely on albuminuria detection, reduce the patient's reduced quality of life due to disease progression and the payment pressure for disease diagnosis and treatment. Patients can use UACR for rapid screening at the time of initial diagnosis of diabetes, early initial screening, assessment and timely grasp of the progress of diabetic nephropathy, and increase the effectiveness of diagnosis and treatment.

According to the relevant guidelines issued by the Diabetes Branch of the Chinese Medical Association, patients with type 2 diabetes should undergo kidney disease screening from the date of clinical diagnosis, at least once a year. Patients with type 1 diabetes who have been diagnosed for more than 5 years should also undergo kidney disease screening at least once a year to facilitate early detection, early intervention, and maximize benefits. Hong Tianpei reminded that once a patient is diagnosed with diabetic nephropathy, comprehensive management such as personalized lifestyle intervention and customized drug therapy should be carried out according to the stage of the disease.

These three acute complications need to be watched out for

Diabetes itself does not necessarily cause serious harm to the human body, but if the patient's blood sugar is not well controlled, it is easy to cause complications. The Guangdong Health Commission once issued a document to remind that diabetic ketoacidosis, lactic acidosis, and diabetic hyperosmolar hyperglycemic state are the three most common acute complications of diabetes.

Ketoacidosis is one of the most common acute complications of diabetes.insulinWhen blood sugar levels are too high, the body begins to break down fat to produceKetone bodiesIf ketone bodies accumulate too much, the blood pH will drop, causing ketoacidosis, which is mainly manifested by a rotten apple smell in the breath, dehydration and shock.Impaired consciousness。

If blood sugar is not well controlled, patients are also prone to lactic acidosis. Once lactic acidosis occurs, the mortality rate of patients is as high as over 50%. In addition to the symptoms of the primary disease, lactic acidosis has an acute onset, with symptoms such as deep and large breathing, confusion, drowsiness, coma, and sometimes accompanied by nausea, vomiting, and abdominal pain, but no signs of cyanosis or shock.

Hyperosmolar hyperglycemic state of diabetes also requires vigilance. The onset of hyperosmolar hyperglycemic state is generally insidious, with a mortality rate of more than 40%. Occasionally, it has an acute onset. Most patients take 1-2 weeks from onset to clinical manifestations, and 30%-40% of patients have no history of diabetes. Clinical manifestations often begin with symptoms such as thirst, polyuria, and fatigue. Symptoms of polyphagia are not obvious, and may even manifest as anorexia.

Pay attention to fundus lesions and foot ulcers

"As a chronic progressive disease, diabetic complications can affect multiple organ systems throughout the body. Concurrent fundus diseases include hemorrhage, proliferation andMaculaDME is a serious complication and the main cause of vision loss. According to Dai Hong, director of the Department of Ophthalmology at Beijing Hospital, about one-third of diabetic patients have diabetic retinopathy (DR), and about one-third of them will develop diabetic macular edema (DME).

The occurrence of diabetic macular edema is closely related to the course of diabetes and the severity of retinopathy. The longer the disease lasts, the more severe the lesions are, and the more likely it is to develop DME. "In general, diabetic macular edema is caused by long-term unstable blood sugar levels, which damages the retinal vascular system, that is, it increases the permeability of the blood-retinal system, making the blood-retinal permeability stronger, and the accumulated fluid (permeate) enters the macula, thus causing diabetic macular edema." Dai Hong explained.

Dai Hong pointed out that diabetic macular edema can cause severe vision loss, which is mainly manifested in dark spots in the central area of ​​​​the visual field (that is, patchy blurred vision), difficulty in seeing details clearly, changes in the shape of objects, which appear larger or smaller than the actual shape, and straight lines appearing wavy or broken in certain parts of the visual field.

In addition, "diabetic foot, commonly known as 'rotten feet', is one of the most serious and complex complications of diabetes." Guo Xian, deputy chief physician of the peripheral vascular department of Beijing Xuanwu Hospital of Traditional Chinese Medicine, said that as the disease progresses, patients will develop peripheral nerve and peripheral vascular lesions, and the feet are the "hardest hit area" of microcirculation involvement. Patients will experience uncomfortable symptoms of cold feet, accompanied by insensitivity of sensory nerves.

Guo Xian pointed out that the feet are afraid of cold, and need to increase the external temperature to improve the symptoms. The temperature perception becomes dull, so even when the temperature is very high, the patient still feels that it is "not hot enough", so he will increase the bathing temperature indefinitely, prolong the bathing time, and increase the risk of burns. In addition, the patient's local ischemic lesions are prone to local ulceration, necrosis, and even amputation after burns.

Beijing News reporter Zhang Zhaohui

Proofread by Wu Xingfa