Chen Bo is a patient with a history of cirrhosis of the liver for several years, these days he often wakes up in the second half of the night when he has palpitations, cold sweat and other hypoglycemic reactions, and has to get up in the middle of the night to add meals to prevent hypoglycemia at night. Later, I went to the hospital for examination and found that Chen Bo's fasting blood glucose was normal, but the postprandial blood glucose checked many times was high, and the highest time was even as high as 14.6mmol/l. Chen Bo, who has no history of diabetes in the past, why is his blood sugar so high? Combined with Chen Bo's history of cirrhosis of the liver, the doctor considered that Chen Bo's glucose abnormalities belong to "hepatic diabetes", the doctor told Chen Bo that the liver is also an important sugar metabolism regulatory organ, when the liver lesions can also lead to impaired glucose tolerance, serious will be like Chen Bo, the development of diabetes, but this hepatic diabetes after active treatment, the prognosis is mostly more optimistic.
Expert Profile: Hu Chunling, female, chief physician, professor, director of internal medicine, director of comprehensive ward, master degree, as a member of the Critical Illness Medical Branch of guangdong Medical Association, a member of the Emergency Medicine Association of Guangdong Medical Association, a medical technology accident appraisal expert in Guangdong Province, mainly engaged in the diagnosis and treatment of common internal medicine diseases, pregnancy and internal medicine diseases. He specializes in the diagnosis and treatment of critical medical diseases, pregnancy complicated by diabetes, pregnancy with hyperthyroidism, pregnancy with hypothyroidism, pregnancy with kidney disease, and pregnancy with heart disease.
Do you know about hepatic diabetes?
Speaking of diabetes, many people are familiar with it, and people are accustomed to associating it with the pancreas, but in fact, in addition to the pancreas, there is an organ --- liver, which also plays an important role in maintaining the relative stability of blood sugar levels.
Hu Chunling, director of the Department of Internal Medicine of Guangdong Provincial Maternal and Child Health Hospital, pointed out that the liver not only plays an important role in gluconeogenesis and the synthesis, storage and release of glycogen, but also is a target organ involved in blood glucose regulation hormones, such as insulin, glucagon, somatostatin and other secretions are also directly through the portal vein into the liver. Once the liver lesion occurs, it is easy to cause glucose metabolism disorders, which in turn lead to abnormal glucose tolerance and eventually develop diabetes. Diabetes like this, caused by damage to the liver parenchyma, is called "hepatic diabetes."
Hepatic diabetes is also type 2 diabetes, but it is different from primary type 2 diabetes. Hepatic diabetes mellitus is clinically characterized by normal or low fasting blood glucose and a significant increase in postprandial blood glucose. Compared with the typical "three more and one less" (that is, more drinking, more eating, polyuria, weight loss) of primary diabetes mellitus, many hepatic diabetes mellitus in the clinic does not have typical "three more and one less" symptoms, only a few patients can have polyuria, thirst and other symptoms, they may be more likely to be covered by the symptoms and signs of primary liver disease, showing poor sodium, fatigue, nausea, bloating, etc., often need to be detected by blood glucose testing. As a result, many patients may just stare at the liver problem and ignore the blood sugar problem in the treatment.
Hepatic diabetes cannot be ignored
Hu Chunling reminded patients not to despise hepatic diabetes, "If hyperglycemia is not controlled, it will also lead to congestion of the patient's internal organs, which will increase the pressure of the portal vein and increase the chance of internal organ bleeding." Therefore, for hepatic diabetes, it cannot be ignored. Experts suggest that once diagnosed with hepatic diabetes, the following four problems need to be paid attention to.
First, actively treat liver disease. China is a high incidence of viral hepatitis, and hepatic diabetes is more secondary to chronic hepatitis, cirrhosis and other liver diseases, and the more serious the liver damage, the more severe the diabetes, therefore, should be actively treated for liver disease, liver disease damage is improved, diabetes will also improve. In the clinic, there are also some patients with hepatic diabetes, when they find themselves with diabetes, they just treat diabetes, which is also unreasonable, after all, liver disease is the real cause of hepatic diabetes, simple hypoglycemia is the treatment of symptoms, not the root cause, should be done to protect the liver, hypoglycemic two-pronged.
Second, use insulin as early as possible to control blood sugar. Compared with conventional diabetic patients, hepatic diabetes mellitus should pay attention to the effect of selected drugs on liver function and glucose metabolism function during treatment. It is generally recommended that insulin should be used as soon as possible for treatment, insulin can not only promote the storage of liver glycogen, reduce blood sugar, but also play an important role in the synthesis of proteins and lipid metabolism processes, in the selection of insulin is mainly short-acting insulin, if necessary, the combination of medium-acting insulin, short-acting insulin control postprandial blood glucose, moderate-acting insulin controls basal glycemic, while paying attention to real-time monitoring of patients' blood glucose levels in the treatment to reasonably adjust the dose of insulin, Oral hypoglycemic drugs are recommended in principle not to be used first, so as not to aggravate the damage of liver disease.
Third, dietary therapy. Dietary therapy is the underlying therapy for hepatic diabetes. The treatment of patients with liver disease generally requires high calories, if in order to control blood sugar and excessive restriction of diet, it can cause protein decomposition, affecting the repair of liver cells, therefore, for patients with hepatic diabetes, should be appropriately relaxed their intake of calories, diet should eat high protein, high fiber, low fat, easy to digest and other foods, such as eggs, fish, soy products, fruits, vegetables and so on.
Fourth, proper exercise. Appropriate exercise can improve the use and conversion of glucose by peripheral tissues, which is conducive to controlling blood sugar, therefore, for patients with hepatic diabetes, appropriate exercise is also needed, in the choice of exercise items, according to their own conditions and personal preferences, choose some moderate aerobic exercise.
In short, actively cooperate with the doctor's treatment plan, under the liver protection, hypoglycemic, diet therapy, exercise therapy, most patients with hepatic diabetes can still be cured. (Correspondents: Peng Wenbin, Lin Huifang)