"Sugar friends" fever to be alert to ketoacidosis, monitor blood glucose, urine routine should not stop abruptly

"In recent days, there has been a rapid increase in outpatient patients, most of them are sudden increases in blood sugar, and the proportion of ketoacidosis in patients is significantly higher than usual
.
This is related
to viral infection, high fever, and irregular diet and rest caused by high fever, as well as blind discontinuation of drugs.
”

Emergency patient surge: diabetic ketoacidosis raises concerns

Recently, there has been a large increase in emergency patients in hospitals, and a considerable number of them are because of fever that breaks the daily diet, life and medication rules, resulting in elevated blood sugar and diabetic ketoacidosis, and severe cases require hospitalization
.

Zhang Yajing, deputy chief physician of the Department of Metabolic Diseases, Zhu Xianyi Memorial Hospital of Tianjin Medical University, mentioned that only insulin in the human body is a hypoglycemic hormone, and when people have fever, infection, poor rest, and emotional excitement, the secretion of glycemic hormone in the body will increase, making blood sugar abnormally high, so do not suddenly stop hypoglycemic drugs during fever, and at the same time strengthen blood glucose monitoring, conditions can also go to the nearest hospital to detect urine routine
.
If blood sugar is high and ketones in the urine are abnormal, seek medical attention
in time.
In addition, during the infection of the new crown, sugar friends can also contact familiar doctors through the Internet hospital to obtain the condition and medication guidance
at any time.

What factors may predispose to diabetic ketoacidosis?

Dr.
Zhang Yajing mentioned that in recent days, the number of outpatients has increased rapidly, most of them are sudden increases in blood sugar, and the proportion of ketoacidosis in patients is significantly higher than that of daily life
.
This is related
to viral infection, high fever, and irregular diet and rest caused by high fever, as well as blind discontinuation of drugs.

Diabetic ketoacidosis is the most common acute complication of diabetic patients, which is due to the aggravation of diabetes, blood sugar is significantly increased, insulin secretion is insufficient, causing sugar, fat, protein metabolism disorders, ketone body production excessive caused by a series of serious consequences
.

Patients with type 1 diabetes have a tendency to spontaneous ketoacidosis, and patients with type 2 diabetes can develop ketoacidosis
under certain triggers.
The most common triggers are infections, including pneumonia and urinary tract infections, followed by sudden interruption or inappropriate reduction of hypoglycemic therapy
.

Recently, many diabetic patients have no appetite to eat after being infected with the new crown virus, and they only drink water and sleep, and then stop using hypoglycemic drugs
on their own.
Patients with type 1 diabetes and patients with type 2 diabetes with a long course of disease generally have poor islet function and need insulin supplementation or replacement therapy, no matter what the reason, should not suddenly interrupt the use of insulin and other hypoglycemic drugs, otherwise, it is very easy to have ketoacidosis
.

What should diabetics pay attention to during the pandemic?

Dr.
Zhang Yajing suggested that during the new crown condition, diabetic patients should eat regularly and drink enough water
.

Poor appetite can reduce staple food intake and eat small and frequent meals
if necessary.
At the same time, the amount of hypoglycemic drugs
can be appropriately reduced before the main meal.
If the patient has a poor appetite, basically does not eat for a day, but drinks a lot of water, a meal of preprandial short-acting hypoglycemic drugs (such as repaglinide, acarbose, voglibose, short-acting insulin, etc.
) can be temporarily discontinued
.

At the same time, it is necessary to strengthen blood glucose monitoring, do not blindly stop the drug, especially basal insulin (such as insulin glargine, insulin detemir, insulin degludec and other long-acting insulin) can not be stopped suddenly, otherwise it will increase fasting basal blood sugar, resulting in an increase
in blood sugar throughout the day.

What situations require timely medical attention?

Dr.
Zhang Yajing reminds sugar friends to be vigilant against ketoacidosis and seek medical attention
in time if the following situations occur.

First, blood sugar is persistently high
.
More than 14mmol/L should be highly vigilant for the occurrence
of diabetic ketoacidosis.

Second, urinalysis monitors for abnormal urine
ketones.
During diabetic patients infected with the new crown, it is best to check urine routine in primary hospitals to monitor urine ketones
.
Because some patients in the early stage of ketoacidosis do not have significant discomfort, only manifest as elevated
blood sugar.
Especially for patients taking SGLT2 inhibitor hypoglycemic drugs (such as dapagliflozin, canagliflozin, empagliflozin, etc.
), the drug itself has side effects that increase the risk of ketosis, and diabetic patients taking the drug are recommended to detect urine routine in time even if their blood sugar is normal during fever, and find ketosis to be treated early
.

Third, high blood sugar is accompanied by symptoms such as thirst, increased urine output, nausea, fatigue, and vomiting
.

Other reminders