Patient's question:
Main symptoms: Have type 1 diabetes, some parts of the body get boils in the summer. Onset time: 2007. Test results: Type 1 diabetesDoctor's answer:
At onset, there is initially polyuria, polydipsia, and thirst without obvious hyperphagia, or even a decrease in appetite. However, because the patient does not develop severe ketosis or acidosis, there are no gastrointestinal symptoms, and the condition is often overlooked, leading to delayed medical attention. This results in significant loss of electrolytes and dehydration due to osmotic diuresis, causing severe dehydration and even shock by the time the patient seeks medical care, without the deep breathing seen in acidosis. As the condition progresses, dehydration gradually worsens, potentially exceeding 12% of body weight, leading to decreased urine output or anuria. Subsequently, a series of neurological symptoms may appear—lethargy, hallucinations, disorientation, hemianopia, convulsions, or hemiplegia—and ultimately coma. Severe infections, gastric distension, myocardial infarction, arrhythmias, heart failure, renal failure, cerebral edema, thrombosis, and disseminated intravascular coagulation may also develop.When hyperosmolar coma occurs, the onset of the disease is generally slower than in diabetic ketoacidosis, often worsening symptoms. In the initial days or weeks, symptoms include increased urine output but minimal fluid intake, fatigue, dizziness, and anorexia. As the condition worsens, dehydration becomes increasingly severe, manifesting as agitation, confusion, sluggishness, apathy, and ultimately coma. The patient’s skin becomes dry and inelastic, the heart rate increases, blood pressure drops, and urine output decreases. These symptoms are often misdiagnosed as cerebrovascular disease or other neurological disorders. Laboratory tests reveal extremely high blood glucose levels, typically above 33.6 mmol/L, positive urine glucose, and negative or weakly negative urine ketones. Blood osmolarity is elevated, exceeding 33 mmol/L.