The edema is a pathological symptom with excessive effusions in organizing intervals; the most common one in clinical is lower limb edema, For patients with diabetes, except for the minority reasons, the edema in lower limbs is mostly connected with various chronic complications of diabetes and it is a sign for many chronic complications. The following are the common complications:
1. Renal Insufficiency
Diabetic Nephropathy(DN) is the most common reason for the edema in lower limbs for the patients of diabetes. When there is a harm in kidney for diabetic patients, these symptoms of abundant leakage in urine protein, the decreasing filtration rate of glomerulus and the severe hypoproteinemia could result the edema in both legs, eyelid and face even in the whole body for the severe situation. The regular urinary inspection for patients could see the protein and cast. The rise on the index of renal function such as creatinine and urea nitrogen could be the signs.
2. The Heart Disease
The diabetes could easily trigger such cardiovascular disease as coronary heart disease, cardiomyopathy etc. For the severe cases, such symptoms as systemic congestion and the retention of water and sodium could be resulted by cardiac insufficiency, especially the right heart insufficiency, which could lead to the distention of jugular vein and hepatosplenomegaly and symmetry edema of both legs. These patients often accompanied by such cardiovascular symptoms as palpitate, frowsty bosom and shortness of breath and also the electrocardiogram ischemic changes, which could be the signs.
3. Surrounding Nerve Lesions
The diabetes neurological edema often sees in the part of both legs and it is connected with position and exercises. The edema is resulted by the dilatation of peripheral vessels and the congestion of both legs, which are caused by damage in vegetative nervous system, especially the sympathetic nerve; moreover, the increase in the permeability of the local blood capillary could also lead to the lower limbs edema. The edema caused by diabetes neurological lesion is often accompanied by the symptoms of acromegaly numb, pain, the drop in the feeling of in-socking, which could be used as the signs.
4. Vascular Disease in Lower Limbs
When there is a lesion in the vein of lower limbs, such as the deep venous thrombosis of the lower limbs and the insufficient close of the venous valve, venous hypertension could occur aroused by the obstruction of venous reflux. At this time, the edema in lower limbs could appear, and often in the presentation of unilateral edema.
5. Feet Infection
When there is a damage and infection in the skin of feet, local inflammatory reaction could also lead to edema. Besides, these patients are often accompanied by the acute inflammatory manifestations such as the rise in the temperature of local skin, rubefaction and pain etc.
6. Severe Malnutrition
For some diabetic patients, the situation that serious insufficient intake of the calorie and protein, caused by excessive dieting, lead to hypoalbuminemia and the edema in malnutrition.
7. Drug Factors
Some glucose-lowering and antihypertensive drugs could result the retention of sodium and water, which could lead to the edema in lower limbs. The glucose-lowering drugs include such as insulin, thiazolidinedione(for example, rosiglitazone and pioglitazone); and the antihypertensive drug include such as calcium antagonist(such as nifedipine and amlodipine). The common characteristic is that the edema occurs after the medication and disappears soon after the medications.
8. Hypothyroidism
For some diabetic patients, especially the old women patients, the hypothyroidism could arouse the mucous edema in the part of lower limbs or face with the characteristic of no pitting changes in the part of edema when pressed by fingers. Moreover, the patients with thyroid disease often have such accompanied symptoms as lacking of strength, drowsiness, sensation of chill, bradycardia, constipate. The test report of hypothyroidism(FT3、FT4) could be a sign.
9. Idiopathic Edema
For women diabetic patients, when there is any symptoms of edema in lower limbs, pay attention to rule out the possibility of “Idiopathic Edema”. This edema often occurs during the reproductive age and usually accompanied by neurosis. The occurrence of the edema is usually connected with the menstrual cycle. “upright position test in water” would help in the diagnosis of the idiopathic edema.
Others
For the diabetic patients, the edema in lower limbs would occur if there are any complications such as chronic liver disease, the manifestations of which include digestive function, fatigue weakness, hepatic face, liver palms, spider angioma and jaundice and abnormal liver function, etc. These symptoms could be signs together with the report of B ultrasonic examination for liver and gall.
In short, the reasons for diabetic edema are various. So, make the analysis and identify the causes according to the patients’ realistic situation, and then give them specific treatment.
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