Original title: Blood sugar fluctuates greatly in winter, and hyperglycemic crisis should not be underestimated.
One noon, a young man in his 20s came to the emergency room. For several days, he had repeated nausea and vomiting, thinking that he had a "cold stomach", but he didn't want to vomit anything he ate, and even walking became difficult.
*After an emergency blood glucose test at the end of his fingers, it was found that the patient's blood glucose was elevated beyond the range of the blood glucose meter. Doctors judged that he might be ketoacidosis, an acute complication of diabetes. Menstrual blood gas analysis, urine ketones and other auxiliary examinations confirmed the doctor's judgment. Fortunately, after a timely **, the patient turned his life around.
In winter, many people with diabetes experience seasonal blood sugar spikes. This is because when the weather is cold, the human body will secrete some stress hormones, such as adrenal hormones, thyroid hormones, etc., in order to maintain a normal body temperature, which will antagonize the action of insulin, resulting in a slight increase in blood sugar levels.
In addition, when the weather is cold, many people's eating habits will also change, such as sweets and meats with more fat content, in this case, the number of calories in the diet will increase, which will also lead to an increase in blood sugar levels. If the blood sugar level is mildly elevated, it can be slightly adjusted through diet and exercise, but some patients do not pay attention to blood sugar control, so they should be alert to hyperglycemic crisis.
Winter is the season of high incidence of diabetes and its complications.
As the third major killer of human health, diabetes mellitus is a group of metabolic diseases characterized by chronic elevated blood glucose levels caused by defects in insulin secretion and/or action in the body, which is the result of a combination of genetic factors and environmental factors.
As of 2021, there are 5There are 2.9 billion people living with diabetes, and it is estimated that by 2050, there will be 13100 million people with diabetes. There are not a few diabetic patients 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 with a high incidence of diabetes and its complications. According to the severity of the disease, it can be divided into two categories: acute and chronic. Acute complications include ketoacidosis, lactic acidosis, hyperglycemic 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 severe diabetic emergency. If left unprompted**, it can lead to multi-organ failure within 1 to 3 days and is the leading cause of death in people with diabetes.
To use a simple analogy, insulin is like a key to open the intracellular glucose channel, with which glucose can smoothly enter the cell to store and metabolize, convert into energy, and supply energy to the body. Without enough keys, glucose cannot enter the cells adequately for energy. At this point, blood sugar rises, and the body has to open up a second pathway, using the liver to break down fat for energy. At the same time, the body will give birth to the "three brothers" of ketone bodies - the eldest - hydroxybutyric acid, old diacetoacetic acid, and old triacetone. The eldest and second are acidic, depleting the remaining alkali and inducing ketoacidosis. When the acidic substances in the body continue to increase, there will be a series of reactions: osmotic diuresis and water loss, electrolyte imbalance, oxygen-carrying system disorder, peripheral circulatory failure, etc., and in severe cases, it can even lead to coma and death of the patient.
In short, when diabetic patients do not secrete enough insulin to meet the body's needs or insulin resistance occurs, the hypoglycemic effect decreases, blood sugar rises, and the body begins to break down fat and produce a large number of ketone bodies. Ketones are mostly waste products of the body, and metabolic acidosis occurs when the body's disposal capacity is exceeded.
Multiple factors induce ketoacidosis, and attention should be paid to the early warning symptoms of the disease.
In addition to temperature changes, what factors are likely to trigger ketoacidosis? Studies have found that type 1 diabetes has a tendency to spontaneous ketoacidosis, and it is often first detected with ketosis or ketoacidosis; Type 2 diabetes can also develop under certain triggers, and the common triggers are infection with various pathogens.
In addition, inappropriate insulin reduction or interruption; Improper diet such as alcoholism, high sugar and high fat; Stresses such as vomiting, diarrhea, trauma, surgery, acute myocardial infarction, cerebrovascular accident, pregnancy, childbirth, etc., are all predisposing factors for ketoacidosis.
Ketoacidosis is preceded by warning signs. Including diabetic patients and high-risk groups of diabetes, when symptoms such as polydipsia, polyphagia, polyuria, and fatigue occur; further loss of appetite, nausea, vomiting, abdominal pain, often accompanied by headache, irritability, drowsiness and other symptoms; Even when there are symptoms such as deep and rapid breathing, the smell of rotten apples in the exhalation, decreased urine output, dry mucous membranes, and increased heart rate, it is necessary to be alert to ketoacidosis.
Once the patient has the above symptoms, or even a drop in blood pressure, coma and other manifestations, diabetic patients and their families should know the first aid methods for ketoacidosis, such as monitoring blood sugar, drinking more water to replenish body fluids, insulin injection to lower blood sugar, etc., so as to take self-help measures in an emergency. At the same time, the patient should be sent to the doctor immediately to avoid delaying the condition.
Survive the winter smoothly and learn to "protect your family" in the cold season
Blood sugar is easy to fluctuate in winter, for diabetic patients and high-risk groups of diabetes, how to "protect their families" in the cold season?
Stick to regular exercise.
Proper exercise can help diabetics control their weight, improve insulin sensitivity, help control blood sugar, and help strengthen their immunity. For example, walking, jogging, swimming, etc., outdoor exercise should be avoided in the early morning and evening when it is cold, which is easy to induce cardiovascular and cerebrovascular diseases, and it is more suitable for exercise when the temperature rises at noon. Overexertion should be avoided during exercise to avoid aggravating the condition.
Arrange your diet wisely.
People with diabetes have to meet their nutritional needs while keeping their blood sugar levels under control. It is recommended to choose low-sugar, low-fat, high-fiber foods, such as vegetables, fruits, whole-grain bread, lean meats, etc., and avoid excessive sugar and fat. Mix protein, carbohydrates, and fats in the right proportions.
Monitor your blood sugar regularly.
People with diabetes should monitor their blood sugar regularly so that they can detect blood sugar fluctuations and take appropriate measures. If glycemic control is not satisfactory, you should seek medical attention promptly to adjust your ** regimen.
Avoid infection. Winter is the season of high incidence of various infectious diseases, and diabetic patients are more likely to be complicated by various infections, such as colds, pneumonia, urinary tract infections, etc. Drink plenty of water, pay attention to personal hygiene and protection, and wear more clothes and socks to keep out the cold to avoid infection and diabetic foot.
Stick to regular medications.
Diabetic patients need to adhere to regular medication for a long time, such as insulin, hypoglycemic drugs, etc. The drug should be used according to the advice of the doctor or pharmacist, and the dose should not be changed or discontinued at will, so as not to affect the effect of blood sugar control.
Be in a good frame of mind.
Mood swings can affect blood sugar stability and can lead to ketoacidosis. Therefore, diabetic patients should learn to control their emotions, maintain a positive and optimistic attitude, and avoid excessive excitement or depression.
Review regularly. Regular check-ups at the hospital so that complications can be detected and treated in a timely manner.
The author, Han Zhen, is an emergency and critical care physician at Pudong New Area People's Hospital).
*: Wen Wei Po.