Type 1 diabetes ketoacidosis

　　The causes of type 1 diabetic ketoacidosis include the following: 1. Type 1 diabetes causes a deficiency of insulin in the body. When there is an insufficient amount of insulin, it leads to a disorder in glucose metabolism, the acceleration of fat decomposition, a reduction in the uptake of glucose by adipose tissue, and a decrease in the removal of triglycerides from the plasma. This results in a reduction in fat synthesis and a decrease in the activity of lipoprotein lipase, leading to an increase in the concentration of free fatty acids and triglycerides in the blood.

　　Type 1 diabetic ketoacidosis is caused by further deficiency of insulin, with a higher concentration of free fatty acids in the blood. The liver absorbs fatty acids, but due to the obstruction of reesterification, fatty acids and other enzymes generate fatty acyl coenzyme A, which is further oxidized to produce acetyl coenzyme A. Acetyl coenzyme A is then condensed into acetic acid, which is converted into acetone and β-hydroxybutyric acid (acetic acid, acetone, and β-hydroxybutyric acid are collectively known as ketone bodies). When the production of ketone bodies exceeds the body's ability to utilize and excrete them, a large accumulation of unused ketone bodies forms ketoacidosis.

　　In addition to the insufficient amount of insulin in the body, the increase of various endogenous hormones that antagonize insulin, such as glucagon, cortisol, and growth hormone, also plays a certain role in the pathogenesis of type 1 diabetic ketoacidosis.

　　During the treatment process of type 1 diabetic ketoacidosis, many complications may occur, which may be due to the development or deterioration of the disease itself, or due to inappropriate treatment.

　　1. Shock

　　Shock is one of the complications that are relatively easy to occur with this disease. Diabetic patients have polyuria inherently, and during diabetic ketoacidosis, the reabsorption of potassium and sodium ions is difficult, which makes polyuria even more severe, leading to severe dehydration of the body. Without timely fluid replacement, shock is more likely to occur; when fluid replacement is excessive or too rapid, it can cause heart failure, leading to shock; when insulin is used in high doses to lower blood glucose levels, either the blood glucose level drops too quickly or blood glucose is not controlled, and a rapid rise in blood glucose levels within the body can also lead to shock or even sudden death.

　　2, Hypoglycemia

　　Hypoglycemia reactions are also common, often due to excessive insulin, not eating after insulin injection, or excessive glucose consumption after intense physical activity. It is important to promptly measure blood glucose, urine glucose, and ketones, especially blood glucose 3-4 hours after meals and during sleep, to observe blood glucose changes at any time, adjust insulin doses, and pay special attention to eating on time after insulin injection, avoiding intense physical activity to prevent hypoglycemia.

　　3, Cerebral edema

　　The occurrence of cerebral edema is generally due to the use of insulin and diabetic patients not replenishing fluids in a timely manner after polyuria, leading to rapid decreases in blood glucose and sodium, causing rapid decreases in plasma osmotic pressure, and water molecules entering brain cells and interstitial spaces. Rapid correction of acidosis, with a leftward shift of the oxygen dissociation curve, can lead to hypoxia of the central nervous system, thereby also promoting the occurrence of cerebral edema. Cerebral edema patients have high intracranial pressure, are prone to projectile vomiting, and once it occurs, relevant examinations should be completed immediately to avoid delaying the condition.

　　4, Hypokalemia

　　Hypokalemia also occurs frequently in clinical practice. Due to excessive fluid replacement, potassium has not been replenished, and monitoring of blood potassium levels has not been sufficient. Therefore, during treatment, especially during fluid replacement, it is important to 'replenish potassium when urine is present,' and to do a good job of monitoring blood potassium levels to prevent hypokalemia.

　　5, Infection

　　Infections and their complications are also more likely to occur, and infection is one of the triggering factors for diabetic ketoacidosis. Diabetic patients are more susceptible to infections due to decreased body resistance, and in severe infections, it is difficult to control the condition, leading to complications such as sepsis and disseminated intravascular coagulation, which can be life-threatening and affect the prognosis. Therefore, in clinical treatment, it is necessary to actively control the occurrence and development of infections.

　　The clinical manifestations of type 1 diabetic ketoacidosis include not only the symptoms of diabetes itself but also symptoms caused by triggering factors such as infection and trauma. In the early stage of ketoacidosis, symptoms such as polyuria, polydipsia, thirst, fatigue, and weight loss, which are originally diabetic symptoms, may worsen or appear for the first time.

　　When diabetic ketoacidosis progresses to acidosis, the condition rapidly deteriorates, and gastrointestinal symptoms appear, including decreased appetite, nausea, and vomiting. Some patients may also experience abdominal pain (which is sometimes misdiagnosed as acute abdomen). Changes in respiration occur due to acidosis, with deeper and faster breathing when the blood pH is below 7.2 to facilitate acid excretion; when the blood pH is below 7.0, the respiratory center is suppressed, and some patients exhale acetone, leading to a fruity, acetone-like odor, flushed cheeks, and cherry-red lips. Patients may show drowsiness, headache, and dizziness; symptoms of dehydration and shock may appear, such as reduced urine output, dry skin, and sunken eyes when dehydration reaches 5% of body weight. In the later stage, patients may suffer severe dehydration and reduced urine output, with dry mucous membranes and decreased elasticity, and their mental state may worsen, leading to irritability, drowsiness, delayed reactions, and coma. The cause of coma is often excessive acetoacetate, cerebral hypoxia, and increased plasma osmotic pressure due to dehydration; circulatory failure may occur, with clinical manifestations including increased heart rate, weak pulse, decreased blood pressure and body temperature, and shock, as well as renal insufficiency. Inadequate treatment or severe cases can be life-threatening, leading to death.

　　The clinical manifestations of type 1 diabetic ketoacidosis are diverse. It is especially emphasized that not all of the above clinical manifestations may occur, and it may only appear one or a few. If you have type 1 diabetes and experience the above symptoms, it is recommended that you go for a check-up to prevent the deterioration of the condition and the threat to life!

　　Type 1 diabetic ketoacidosis is an acute and severe complication of type 1 diabetes, which can even be life-threatening. Therefore, the prevention of type 1 diabetes is very important. The main prevention work is to start from the etiology and triggers.

　　Controlling blood sugar is a very important preventive measure for the occurrence of diabetic ketoacidosis. Blood sugar should be tested daily, and records should be kept. Adjust the dosage of insulin in a timely manner according to specific conditions (diet, physical activity, etc.), especially for insulin-dependent diabetic patients. It is strictly forbidden to reduce the dosage or discontinue medication arbitrarily. Strictly implement dietary therapy and do not eat excessive fat. Especially during various social events, dietary control should not be relaxed to prevent excessive intake and lead to increased blood sugar and worsening of the condition.

　　Preventing triggers is also a key work in preventing the occurrence of type 1 diabetic ketoacidosis, especially acute infections and infectious diseases. Precautions should be taken during the peak season of seasonal influenza, especially in the hot summer. Remember that diseases come from the mouth, and in winter, pay attention to keeping warm and preventing influenza. Once infection occurs, it should be treated actively, and the disease should not be delayed.

　　Patients with type 1 diabetes should try to avoid surgery to prevent accidents. In case of trauma, fracture, acute myocardial infarction, or cerebrovascular accidents, timely hospital treatment should be sought. During pregnancy, especially during delivery, a high degree of vigilance should be maintained for the occurrence of diabetic ketoacidosis. Regular hospital visits should be made, and any abnormalities should be handled promptly.

　　Active prevention and treatment of complications such as shock, heart and kidney failure, cerebral edema, and DIC, and provide good and detailed nursing care. Observe and record the changes in the condition on time every day.

　　Ketoacidosis is one of the acute complications of diabetes, caused by severe insulin deficiency in the body. The diagnosis of diabetic ketoacidosis is not difficult, and routine blood and urine tests can provide sufficient diagnostic evidence. The following is the introduction of the diagnosis and laboratory examination of diabetic ketoacidosis by experts.

　　1. Blood routine

　　The leukocyte count in the blood of patients with diabetic ketoacidosis type 1 is often increased, and it can reach (15～30)×109/L even without infection, and the increase in neutrophils is more obvious. The mechanism of blood count increase is not yet clear. Infection is one of the triggers of the disease, and blood routine cannot be solely relied on. Infection factors should also be considered when blood count increases.

　　2, Blood sugar

　　Monitoring blood sugar levels is a necessary examination for every diabetic patient. The blood sugar levels of patients with type 1 diabetes mellitus and ketosis are usually between 16.65～27.76mmol/L, and sometimes can reach 36.1～55.5mmol/L or higher. When the blood sugar level is >36.1mmol/L, it is often accompanied by hyperosmolar coma.

　　3, Blood lipids

　　In the early stage of type 1 diabetes mellitus and ketosis, free fatty acids in the blood often significantly increase, reaching up to 4 times the highest value of free fatty acids in normal blood, about 2500μmol/L; triglycerides and cholesterol also often increase significantly, among which triglycerides can reach above 11.29mmoL/L. After insulin injection treatment, they can return to normal values.

　　4, Blood ketones

　　The blood ketone bodies of patients with type 1 diabetes mellitus and ketosis are elevated, often strongly positive, usually above 0.48mmol/L, and can exceed 4.8mmol/L in severe cases.

　　5, Urine

　　When the renal function of patients with type 1 diabetes mellitus and ketosis is normal, urine glucose and ketone bodies are often strongly positive, and there may be proteinuria and cast urine. The sodium, potassium, calcium, and chloride ions in the urine increase. When severe renal insufficiency occurs and the threshold increases, urine glucose and ketone bodies decrease or even disappear.

　　6, Electrolytes

　　① Blood sodium: The blood sodium levels of most patients with type 1 diabetes mellitus and ketosis are below the normal value, generally below 135mmol/L, and a few patients are within the normal range. A small number of patients may have an increase.

　　② Blood potassium: Due to osmotic diuresis and the excretion of ketone bodies in the form of K salts in large quantities through the kidneys, patients with type 1 diabetes mellitus and ketosis often have nausea and vomiting due to decreased food intake, which further aggravates the potassium deficiency in the body, resulting in decreased blood potassium levels. However, after the urine output decreases, it can be normal or elevated. In addition, type 1 diabetes mellitus and ketosis often accompany phosphorus and magnesium deficiency.

　　7, Other

　　The blood urea nitrogen and creatinine levels of patients with type 1 diabetes mellitus and ketosis are often elevated, plasma osmolality can slightly increase, and CO2 binding capacity decreases. The mild range is 13.5～18.0mmol/L, and the severe range is below 9.0mmol/L. According to the specific condition of the patient, B-ultrasound, electrocardiogram, and other examinations can be selected.

　　Patients with type 1 diabetes mellitus and ketosis should actively control their dietary habits in life. Good dietary habits are also a simple and effective method for controlling diabetic ketoacidosis.

　　Patients with type 1 diabetes mellitus and ketosis should control their diet and reduce calorie intake. Eat less high-fat, high-starch foods with high calorie and sugar content, such as white sugar, brown sugar, dessert pastries, ice cream, and chocolate.

　　Maintain a light diet, consume foods with a low glycemic index such as coarse grains and onions, and under the condition of controllable blood sugar, some low-sugar fruits such as apples and star fruits can be selectively eaten. Eat less fruit with high sugar content such as bananas, lychees, jujubes, persimmons, and try to avoid them as much as possible.

　　Try not to drink carbohydrate and alcohol drinks.

　　Especially recommend that patients with type 1 diabetes ketoacidosis eat more soybeans and soy products. In traditional Chinese medicine, soybeans have the effects of invigorating the spleen and middle energizer, clearing heat and detoxifying, invigorating Qi, etc., which can be used to alleviate symptoms such as indigestion and edema in this disease; soybeans themselves are rich in soluble fiber and pancreatic enzyme inhibitors, which can effectively reduce cholesterol and reduce the fat content in the body's organs and blood.

　　In life, blood sugar monitoring should also be done well, seek medical attention at any time when abnormalities are found, follow medical advice, and pay attention to the details of daily diet and life.

　　Type 1 diabetes ketoacidosis is an acute and severe complication of diabetes. When the sugar metabolism is disordered to the extent that fat metabolism is disordered, and the concentration of ketone bodies in plasma exceeds the normal value, it forms ketoacidosis, with a large accumulation of ketone bodies leading to metabolic acidosis, which is called diabetic ketoacidosis in Western medicine. Type 1 diabetes ketoacidosis has symptoms such as severe dehydration, a fruity smell in the breath, increased blood sugar, and coma in the later stage. The characteristics of traditional Chinese medicine treatment are mainly symptomatic treatment based on dialectics, with regulation as the main method. The specific dialectical treatment is as follows:

　　1. Dry lips and mouth, thirsty, frequent urination, constipation, feverishness and restlessness, nausea and vomiting, dizziness and dizziness, fatigue and lack of strength, numbness of the limbs. The tongue is red and deep with little fur or yellow and dry fur, the pulse is wiry and rapid or thin and rapid.

　　Treatment Prescription:竹叶石膏汤合黄连解毒汤.

　　Effect: Clear heat, nourish Yin, detoxify and reverse.

　　2. Dry mouth and tongue, dry and withered skin, pale complexion, cold limbs, indifferent or unconscious expression, shortness of breath, continuous. The tongue is pale and dark without fluid, and the pulse is deep and weak.

　　Treatment Prescription: Sheng Mai Drink combined with Shen Fu Decoction.

　　Effect: Invigorate Qi and save Yin, reinforce Yang and retain the essence.

　　3. Dry mouth and slight thirst, nausea and vomiting,_{^{Loss of appetite}}Urine is short and red, drowsy, and in severe cases, the patient may be unconscious, the face is flushed, the body is hot, there is bad breath, the breathing sound is high and long, and the limbs are rigid. The tongue is red and deep, the fur is yellow and greasy and dry, or the fur is black, and the pulse is slippery and rapid.

　　Treatment Prescription: An Gong Niu Huang Pill with modifications.

　　Effect: Clear heat and transform turbidity, eliminate phlegm and open orifices.

　　4. The patient is thirsty and drinks a lot, urinates a lot, loses weight, eats a lot and feels hungry, is tired and lacks strength, the mouth and tongue are dark red, the tongue fur is thin and yellow, and the pulse is rapid.

　　Treatment Prescription: White Tiger Decoction combined with Yu Nu Jian Decoction.

　　Effect: Clear heat and cool the lungs and stomach, generate fluid and relieve thirst.