A Reassessment of Diabetes 1999.1.5

A Reassessment of Diabetes 1999.1.5

1. Previously, it was believed that diabetic coma was always caused by ketoacidosis due to elevated ketone bodies and decreased CO2 binding capacity. However, in 1986, Dreccpvtela first described a non-ketotic diabetic coma, which is caused by elevated blood glucose and hyperosmolar plasma. Typically, blood glucose levels exceed 30 mmol/L, leading to increased blood viscosity, elevated osmotic pressure, and rising serum sodium levels. The preferred treatment is large-dose insulin.

2. Recent major discoveries show that diabetes can also cause specific microvascular diseases. It is generally believed that diabetes lasting more than 15 years can lead to such complications. These microvascular diseases are commonly referred to as arteriosclerosis and can affect coronary arteries, small arteries in the limbs, cerebral arteries, renal arteries, and retinal arteries. Consequently, diabetic patients may develop coronary heart disease, cerebral infarction, diabetic nephropathy, retinal lesions, and lower limb gangrene.

3. Recent findings also indicate that diabetic patients are particularly prone to neuropathy, including radiculitis and polyneuritis.

4. The essence of hepatic diabetes lies in liver dysfunction, which restricts the conversion of glycogen. As a result, blood glucose rises significantly, urine glucose becomes positive, while fasting blood glucose remains normal—this is what is known as hepatic diabetes. Treatment: avoid glucose and focus on protecting the liver; recovery will gradually follow as liver function improves.