The most typical clinical manifestation of diabetes mellitus is three more and one less, that is, polydipsia, polyphagia, but weight loss. But not all people with diabetes will have these symptoms. Recently, there was a patient in the outpatient clinic who just didn't have the typical symptoms of diabetes.
This is a 60-year-old female patient, who said that diabetes is a disease of wealth, which is caused by the improvement of people's living standards. The patient himself admits that since he retired, he is not so tired every day, he just thinks about how to eat more comfortably and have a better time, so he eats a little fish and meat every few days, and the patient likes to eat sweets very much. But it didn't take long for such a leisurely life for the patient to realize that something was wrong. Not two days ago, the patient had pins and needles in the abdomen for no reason. As the symptoms persisted, the patient went to the local hospital for examination. The local hospital diagnosed intestinal spasm and gave the patient intramuscular analgesics and oral pividinium bromide tablets**.
After three days**, the patient's abdominal pain was relieved. When the urine routine was performed at the local hospital, glucose+++ was found, indicating that the patient's high blood sugar had reached a very serious level. So I hurried to our hospital for treatment, and the patient's blood sugar was measured at 1273 mmol l, glycosylated hemoglobin 105%。It is understood that the patient has no obvious typical symptoms of diabetes from the onset of the disease to the present, such as thirst, polydipsia, polyphagia, polyuria, and weight loss. After communicating with the patient, it was decided to admit the patient for a comprehensive examination, and a comprehensive and effective plan was formulated.
Second, the patient's ** process.
Because the outpatient clinic only has a basic understanding of the patient's condition, after the patient is admitted to the hospital for a comprehensive consultation, the patient has suffered from "lumbar disc herniation" for 5 years, accompanied by numbness in the left toe, after giving acupuncture, massage, etc. in our hospital, the toe numbness symptoms are relieved for half a year, and there are still toe numbness symptoms after that, and the left foot occasionally has a feeling of stepping on cotton, understanding the patient's family history found that his parents had suffered from "diabetes", and he has a sister suffering from "diabetes" In the patient's physical examination, it was found that the patient's blood pressure was 129 77mmHg, height 163cm, weight 66kg, measured BMI 268。From the perspective of BMI, it is considered to be overweight, and a reasonable diet should be taken during hospitalization. At the same time, in the physical examination of the patient, it was found that the patient had no edema in both lower limbs, the dorsal pulse of both feet was normal, the temperature was normal, and no obvious pathological signs were found. After admission, the patient was given a random blood glucose of 1109 mmol l, the patient's glycosylated hemoglobin was shown as 72%。The current condition of the patient is first considered to be type 2 diabetes, and the patient is negative for insulin-related antibodies, which can rule out the diagnosis of type 1 diabetes. Therefore, the patients were given a low-salt and low-fat diabetic diet, and hypoglycemic drugs were given, and the relevant examinations and guidance programs were further improved. After a period of time, the patient's fasting blood sugar is stable at about 7mmol L, and the postprandial blood sugar has also decreased significantly. While adjusting the diet, exercise is one of the important ways to lower blood sugar, and patients should ensure that they have about 40 minutes of aerobic exercise each time while eating less sweets to increase the body's metabolism of sugar. A re-examination should be carried out every 1-2 months, focusing on the changes in the patient's blood glucose level and glycosylated hemoglobin level, which should generally be rechecked once every 3-6 months, mainly for blood glucose level, glucose content in urine, etc., and at the same time, the fundus should be examined to see if there is progression or other complications.
The biggest pain of diabetic patients is diet, and they can no longer enjoy the joy of desserts, but for the sake of their body, the diet should tend to be light, and the intake of fried foods should also be reduced. During hospitalization and after discharge, it is necessary to pay attention to control and be mentally prepared for long-term combat.
In addition to the typical manifestations of diabetes, the symptoms of diabetes mellitus are relatively rare, and a large proportion of patients are found to have diabetes due to physical examination or other reasons. Diabetes