At a young age, I got a chronic disease and had to use medicine for a lifetime, which is something that many people dare not imagine.
And adolescent boys and girls happen to be in the rebellious period, chronic diseases not only torment their bodies, but also bring trauma to the soul, there are thoughts of self-abandonment and even self-reliance.
Episode 7 of the medical documentary observation program "My White Coat" tells a sighing story.
At 13:12 p.m., Xiao Yue (pseudonym), a 16-year-old girl, was taken by ambulance to the emergency department of Shenzhen People's Hospital.
By the time she arrived at the hospital, Xiaoyue was completely unconscious, her pupils were dilated, and her blood pressure was very low, but she didn't know what the cause was.
The friend who sent Xiaoyue said: "She has diabetes and low blood sugar, and said she wanted to go to bed the night before, but she couldn't wake up at noon." (Note: When diabetics take excessive hypoglycemic drugs, exercise too much, and eat too little, they will consume too much glucose, produce too little, and induce hypoglycemia.) ）
The situation was so urgent that medical staff immediately took her to the rescue and resuscitation room.
In the rescue room, the doctor measured blood glucose and blood ketones for Xiaoyue, and the results showed "high" - so high that the instrument could not detect the specific number.
And she was cold, and even had ecchymosis on her body, indicating that she had been in shock (a large reduction in the amount of blood flowing in her body, causing tissue ischemia and hypoxia) for a period of time.
The normal blood pH of the human body is 7.35 to 7.45, and when the pH is less than 6.9, it is already severe acidosis. And the pH of Xiaoyue's blood was only 6.6!
Xu Ping, deputy chief physician of the emergency department, said that if the blood pH is too low, it may die at any time!
Why does a young girl in the flower season who is in good youth have diabetes? And what made her condition so critical?
Combined with the test results and medical history, the doctor judged that Xiaoyue was "diabetic ketoacidosis" caused by diabetes.
Whenever we finish eating and our blood sugar rises, the body secretes insulin, which helps lower blood sugar.
In people with type 1 diabetes, insulin is often not secreted enough, resulting in consistently high blood sugar. If the patient develops another acute infection, or if the use of hypoglycemic drugs is not standardized, insulin deficiency can be exacerbated.
Not only that, the glycemic hormone - glucagon also came out to "add oil to the fire", promote the decomposition of glycogen into glucose, and accelerate the decomposition of fat into glycerol and fatty acids.
Glycerol is metabolized and becomes glucose, while fatty acids are oxidized into acetone, acetoacetic acid, and β-hydroxybutyric acid. All three metabolites belong to the "ketone body".
Due to insulin deficiency, the body's ketone body and glucose accumulate excess, can not be consumed by tissues, can only enter the blood in large quantities, resulting in high blood sugar and high blood ketones.
Hyperglycemia can cause high permeability of body fluids, causing dehydration and electrolyte disturbances;
Ketone bodies accumulate in large quantities in the blood, forming ketosis -
Some acetone exhales from the lungs and has the "smell of rotten apples", while acetoacetic acid and β-hydroxybutyric acid are acidic substances that cause metabolic acidosis, resulting in damage to cardiovascular and cerebrovascular diseases, impaired oxygen use, and respiratory paralysis, causing serious complications [2]. This is where ketoacidosis comes from.
(Metabolic acidosis)
Ketoacidosis is the most common acute complication of type 1 diabetes mellitus, affecting organs throughout the body and, in severe cases, cerebral edema, respiratory failure, and heart failure, leading to death [1].
Note here that type 1 diabetes is not the same as type 2 diabetes.
Type 2 diabetes prefers obese middle-aged and elderly people. Type 1 diabetes begins in adolescence and childhood, and most patients are very thin.
Type 2 diabetes is generally not insulin secretion, but insulin "weakened.". Especially for people who smoke, are obese, and have a history of diabetes and urine, insulin has changed from a "workaholic" to an old fritter that "strikes", which is insulin resistance.
(Pathogenesis of type 2 diabetes mellitus)
Type 1 diabetes is a combination of genetic, environmental, viral infections and other factors, causing an autoimmune response, destroying the β cells of the islets, resulting in insufficient insulin secretion.
(Pathogenesis and typical symptoms of type 1 diabetes mellitus)
Therefore, people with type 2 diabetes do not necessarily need to take insulin, but people with type 1 diabetes must be treated with insulin for a long time, and one treatment is a lifetime.
People with type 1 diabetes must strictly control their diet, inject insulin on time, and prevent infections. If you are not careful, there will be serious complications such as hypoglycemia, ketoacidosis, diabetic nephropathy and so on.
Be wary of ketoacidosis even if you have no previous history of diabetes if you have the following symptoms [3]:
1. Unexplained loss of appetite, nausea, vomiting, abdominal pain;
2. Drink a lot of water, urinate a lot, and lose a lot of water in the body, resulting in poor skin elasticity and sagging orbit;
3. Decreased blood pressure, weak pulse, cold limbs, decreased body temperature;
4. The breathing deepens and accelerates, and the exhalation has a "rotten apple smell";
5. At the beginning, it will be dizzy, headache, irritability, and when the disease worsens, the expression is indifferent, unresponsive, drowsy, and comatose.
Image source: Stand Cool Helo
Suspect ketoacidosis, be sure to go to the hospital immediately.
Xiaoyue is a typical example, when sent to the hospital, blood glucose, blood ketone is very high, there is also "super acidosis", which is the most serious case of diabetic ketoacidosis, and may die at any time.
In fact, if she had controlled her blood sugar well before, there would be no such serious complications.
In addition, Chen Huaisheng, deputy chief physician of the Department of Critical Care Medicine, who rushed to the consultation, found that Xiao Yue had a black wound on her hand.
According to her friend, Xiaoyue once applied "anesthesia" (the specifics are unknown) on her hand, leaving a wound.
Dr. Chen suspected that this was "exudative peeling.". This shows that her high blood sugar has caused microvascular lesions, the elasticity of the skin and mucosa has decreased, the ability to regenerate cells has decreased, and even minor damage is difficult to repair, so there has been peeling and blisters.
After nearly 1 hour, after the efforts of medical staff, Xiaoyue's pupils retracted, his blood pressure increased, and his metabolic condition improved, temporarily out of danger to life.
After doing another head CT and excluding cerebral hemorrhage, at 3:20 p.m., Xiao Yue was sent to the intensive care unit (ICU) for further monitoring and treatment.
In late April, Xiaoyue finally recovered and was transferred to a lower hospital for further rehabilitation.
Xiao Yue's escape from death reflects the general plight of chronic patients in adolescents.
She is only 16 years old, according to the daily diet, insulin injections need parental supervision, how can it develop to such a serious point?
According to Xiaoyue's friends, Xiaoyue has dropped out of school and lives alone in a hotel, and the onset of the disease is still the first thing they discovered. After being sent to the hospital for more than an hour, Xiao Yue's brother hurried to the hospital.
It turned out that Xiao Yue had been hospitalized in the Third People's Hospital of Shenzhen City a few years ago.
When she learned that she was type 1 diabetic, she may have heard some negative situations from doctors and nurses, thinking that she would not live for more than two years, and began to give up on herself.
In fact, if she knows more about medical knowledge, she will know that although type 1 diabetes is urgent and sounds very scary, as long as the blood sugar is controlled, it is a "tiger in a cage" and does little harm to the human body.
Not to mention 2 years, even if you live to the life of a normal person, it is also possible.
However, due to the misunderstanding of the disease, Xiaoyue ran away from home many times, the family reported to the police three times, and her father was still hospitalized for this anger...
Like many Chinese parents, Xiaoyue's parents will do whatever it takes to treat their children's physical ailments, but ignore the trauma of her heart.
According to the survey, after adolescents and children have type 1 diabetes, depression and anxiety have increased significantly.
Poor psychological conditions make these children more reluctant to eat well and take medication regularly, affecting blood sugar control and falling into a vicious circle [4].
How can we lift our children's demons and let them face the disease correctly?
Parents are advised to start with these 5 small things:
1. Parents themselves should maintain a good attitude, try not to pass on negative emotions to their children, causing them guilt, self-blame and other psychological burdens.
2. Pay attention to the child's emotions, encourage them, and tell them that as long as they actively cooperate with the treatment, they can overcome the disease.
3. You can let your children participate in some group activities, join the "small sugar circle", let them know that there are many children like them, everyone can understand and support each other, share effective sugar control experience, and enhance children's confidence in treatment.
4. In order to supervise the child's diet and medication, parents often control excessively, causing them to rebel. Communicate with your child more, listen to their needs, and protect their health based on respect.
5. If you find that your child has a tendency to depression and anxiety, do not hide your illness and avoid medical treatment, and seek the help of a psychologist in time. Parents can also learn some child psychology and try to create a good family atmosphere [5].
In addition to psychological counseling, the most important thing for type 1 diabetes is to control blood sugar.
In the process of child treatment, parents should pay attention to the following 4 points:
1. Take medication on time and in quantity, follow the doctor's advice, check blood glucose regularly, and adjust the sugar control strategy in time.
2, exercise can help children control blood sugar, but it varies from person to person, find a suitable way to exercise. It should be noted that blood glucose should be measured before, during and after exercise, and exercise should be accompanied by adults who are familiar with the symptoms of hypoglycemia and have treatment experience.
3. In terms of diet, the needs of children of different ages and different amounts of exercise are different, and you can listen to the opinions of doctors and nutritionists to formulate the most appropriate diet plan.
4, parents do not always think that "the child is still small", all big package. It is necessary to let children correctly understand their own illness as soon as possible, learn to manage themselves, and encounter special situations before they can calmly cope with them [6].
Of course, the treatment of diabetes is a long road. Understanding these is only the foundation, but also requires patients and families to continue to learn and adhere to it for a long time.
Here I would like to say to the lost teenagers:
Sometimes, illness does not sentence life to death.
If a chronic disease will accompany you for the rest of your life, instead of struggling in pain and giving up on yourself, it is better to learn more about health and try to live in peace with the disease.
When you are not knocked down by the disease, but get back on your feet again and again, you will find that the world is really big, it is good to be alive, and life is so brilliant.
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
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