Diabetes can occur at any age, but the average prevalence rate of the elderly over 60 years old is 4.05%.
Diabetic ketoacidosis is a critical state of diabetes, which is caused by a serious shortage of insulin. The patient's blood sugar is abnormally high, dehydrated, and quickly enters coma, shock and respiratory failure. The mortality rate was 10%.
(a) ketoacidosis is a critical condition of diabetes:
When various incentives aggravate diabetes, the decomposition of fat in the human body is accelerated and fatty acids are produced by fat decomposition. A large number of fatty acids are oxidized by the liver to produce ketone bodies, which is β? A general term for hydroxybutyric acid, acetoacetic acid and acetone. Under normal circumstances, there are very few ketone bodies in blood, 2 mg/100 ml blood, and ketone bodies can not be detected in urine. In ketoacidosis, the ketone body in blood rises as high as 50 mg/100 ml, which is called ketonemia; The appearance of ketone bodies in urine is called ketonuria. Ketone is mainly composed of acidic substances, which consumes a lot of alkali in the body and gradually causes metabolic acidosis. When ketoacidosis occurs, the symptoms of diabetes are aggravated and accompanied by ketoacidosis.
(2) The inducement of diabetic ketoacidosis:
1, improper treatment of diabetes, improper interruption or reduction of insulin treatment; Sudden withdrawal or insufficient dosage of hypoglycemic agents; Diabetes without formal treatment.
2, infected with diabetes complicated with pneumonia, urinary tract infection, gangrene and other infections.
3, improper diet, overeating or improper eating (cleaning) caused vomiting and diarrhea.
4, other serious trauma or after surgery. Pregnancy and childbirth.
(3) Clinical manifestations of diabetic ketoacidosis:
1, extreme thirst, polydipsia, polyuria, general weakness, etc.
2. The condition deteriorated rapidly, with loss of appetite, nausea, vomiting, abdominal pain and abdominal distension. Severe abdominal pain is often misdiagnosed as acute abdomen. When ketoacidosis improved, abdominal pain quickly disappeared.
3, mental and respiratory symptoms headache, lethargy, irritability, deep and heavy breathing, can have rotten apple flavor when exhaling, high ketone body concentration is heavy.
Dehydration symptoms are caused by polyuria and vomiting and diarrhea. The patient's skin is dry, the elasticity is poor, the eyeball is sunken and indifferent, and he soon enters a coma. Shock manifestations such as weak pulse, low blood pressure and chills in limbs appear due to dehydration. Some patients have a fever with a temperature of 38 ~ 39℃.
5, check the orange to check urine sugar? ~? , urine ketone body positive; The blood sugar is obviously increased, most of them are 300 ~ 600 mg/ 100 ml blood (16.7 mmol ~ 33.3 mmol/L blood), and a few of them can reach 1000 mg/ 100 ml blood (55.5 mmol/L blood). Increased blood ketone bodies. Other laboratory tests may be abnormal, such as an increase in white blood cell count and a decrease in sodium, chlorine and potassium ions in the blood.
6. Pay attention to distinguish it from coma caused by other situations. Diabetic patients suddenly appear in coma at home, which may be caused by ketoacidosis, and the other may be hypoglycemia coma. Usually, when the blood sugar is lower than 50 mg/100 ml of blood (2.8 mmol/L of blood), they are pale, sweating and unconscious, but they have breathing and heartbeat. The patient woke up soon after being injected with glucose. When the family can't distinguish between these two kinds of coma, they should be sent to the hospital for examination before treatment.
(4) Rescue measures:
(1) Use insulin. This is the key to rescue treatment. It must be applied under the guidance of a hospital or a doctor. According to the condition, subcutaneous or intravenous injection or intravenous drip of ordinary insulin. Generally, 12 ~ 20 units can be injected subcutaneously as appropriate, and then 4 ~ 8 units can be injected intravenously every hour. Most of them were under control within 24 hours. At this time, other hypoglycemic drugs should be stopped.
(2) correct dehydration. If you can take it orally, try to drink water orally. Coma patients should be given intravenous rehydration, and 3000 ~ 6000 ml can be infused within 24 hours, and those with heart disease or poor renal function should be reduced as appropriate.
(3) The coma patient lies on the side of his head, and the vomit shall be removed in time to keep the respiratory tract unobstructed and the oral cavity clean. People who lack oxygen should take oxygen, and if infection occurs, appropriate antibiotics should be used.
(4) Record the patient's in-and-out quantity in detail, such as water intake, food intake, vomiting, urine volume and stool volume, and report to the doctor to provide basis for diagnosis and treatment.
(5) Diabetic ketoacidosis is complicated, serious and developing rapidly. Various laboratory tests should be carried out before and after treatment to adjust the dosage, infusion amount and type of insulin. It is best to send the patient to the hospital for emergency treatment to avoid serious consequences.
The proportion of diabetic patients suffering from erectile dysfunction (ED) is above 50%.