Different types of hypoglycemic drugs have their own characteristics, and the conditions of diabetics vary. In the treatment of diabetes, there are the following seven matters worthy of your attention. When the blood sugar level of diabetic patients is close to normal, it is necessary to take “fine glucose-lowering” measures, including guiding patients to adopt a more strict diet and exercise plan, closer blood sugar monitoring and more skillful use of glucose-lowering drugs. In the selection of glucose-lowering drugs, the closer the mode of action is to the physiological pattern of blood glucose control, the more it can help people safely approach the goal of normal blood glucose. In addition, it is necessary to strengthen the follow-up of treating diabetic patients, on the one hand, to measure blood glucose in order to control blood glucose up to the standard, and to regularly measure glycated hemoglobin and formulate the treatment plan of hypoglycemic drugs; on the other hand, to detect complications or related problems as early as possible, including weight, body mass index, blood pressure, dorsal foot artery pulsation, blood lipids, fundus of the eyes, liver and kidney function, urinary routine, urine protein, electrocardiogram, etc. Second, be alert to hypoglycemia For non-diabetic patients, the diagnostic criteria for hypoglycemia is blood glucose <2. 8 mmol/L; while diabetic patients receiving medication with blood glucose levels ≤3. 9 mmol/L are in the category of hypoglycemia. Diabetic patients are often accompanied by autonomic dysfunction, which affects the body's ability to regulate the feedback of hypoglycemia and increases the risk of severe hypoglycemia. The clinical manifestations of hypoglycemia are related to the blood glucose level and the rate of blood glucose decrease, and can be manifested as sympathetic excitation (palpitations, anxiety, sweating, hunger, etc.) and central nervous symptoms (mental changes, cognitive impairment, convulsions and coma). When hypoglycemia occurs in elderly patients, it can often be manifested as abnormal behavior or other atypical symptoms; nighttime hypoglycemia is often not dealt with in time because it is difficult to be detected; after some patients repeatedly have hypoglycemia, it can be manifested as hypoglycemic coma without aura symptoms. 1.Glucose-lowering drugs that can cause hypoglycemia mainly include insulin, sulfonylurea and non-sulfonylurea insulinotropic agents and GLP-1 agonists. Other types of hypoglycemic drugs alone generally do not cause hypoglycemia, but when used in combination with the above-mentioned drugs can also increase the risk of hypoglycemia. 2. Possible triggers of hypoglycemia and countermeasures ① Insulin or insulin promoter: observe whether it is caused by drug overdose and adjust the dose carefully; ② Failure to eat on time or eating too little: patients should eat regularly and quantitatively, and if the amount of meals decreases, the dose of drugs should be reduced accordingly, and should be prepared in advance when there is a possibility of missing meals; ③ Increased exercise: additional carbohydrate intake should be increased before exercise; ④ Alcohol can directly lead to hypoglycemia: alcohol abuse and drinking alcohol on an empty stomach should be avoided. 3. Treatment of hypoglycemia Diabetic patients should routinely spare carbohydrate-based foods for timely consumption. If the blood sugar is ≤3.9mmol/L, it is necessary to supplement glucose or sugar-containing food; severe hypoglycemia needs to be given intravenous glucose injection according to the patient's consciousness and blood sugar condition. Third, bear in mind the side effects and adverse reactions of various drugs Fourth, monitor body weight Some clinical studies have confirmed that metformin is equivalent to obese or non-obese people, and acarbose shows good effect on type 2 diabetes that cannot be controlled by diet therapy, and can be used regardless of obese or non-obese people. Therefore, metformin and acarbose can be preferred for obese diabetic patients; sulfonylureas should be preferred for non-obese diabetic patients. For non-obese patients with poor insulin reserve function, when hypoglycemic drugs cannot control blood sugar well, insulin therapy should be used in time. Fifth, choose the appropriate time to take meals and food have different degrees of influence on the absorption, bioavailability and efficacy of oral hypoglycemic drugs. Therefore, different glucose-lowering drugs should be taken at different times. 1, 0.5 hours before meals: drugs suitable for taking before meals are toluenesulfonylurea, glibenclamide, glipizide, riglinide, etc. These drugs have a rapid onset of action and are well absorbed when taken on an empty stomach or during meals, and their absorption can be affected by postprandial administration (especially fatty meals), resulting in delayed plasma peak time and half-life, thus advocating pre-meal administration. 2. During meals: Acarbose and voglibose should be swallowed with the first two meals, which can reduce the stimulation of the gastrointestinal tract, reduce adverse reactions, increase patient compliance, and adjust the dose according to individual conditions, and glimepiride should be taken at breakfast or the first meal. 3. 0.5 - 1 hour after meal: Drugs whose food has little effect on drug absorption and metabolism can be taken orally after meals, such as rosiglitazone; for those with gastrointestinal discomfort, metformin can be taken after meals. Six, try to avoid drugs that can affect blood sugar metabolism and induce diabetes 1, adrenal glucocorticoids: such as prednisone, prednisolone, methylprednisolone, hydrocortisone, dexamethasone, etc., can regulate glucose metabolism, in the medium and long term application of a variety of metabolic abnormalities, including hyperglycemia. 2, thyroid hormone: levothyroxine sodium, iodoserine sodium can make insulin levels fall, and it is appropriate to increase the dose of insulin and oral hypoglycemic drugs after diabetic patients take them. 3, diuretics: can inhibit insulin release, reduce glucose tolerance, increase blood sugar or positive urine sugar, such as furosemide, hydrochlorothiazide. Long-term use of diuretics can aggravate the original elevated blood sugar and have an increased risk of new onset diabetes. 4, non-steroidal anti-inflammatory drugs: aspirin, indomethacin, etc. can occasionally cause hyperglycemia. 5, antipsychotics: clozapine, olanzapine, quetiapine, risperidone, chlorpromazine, etc. can cause abnormal glucose regulation, including inducing or aggravating the original diabetes and leading to diabetic ketoacidosis. 6, antineoplastic drugs: trastuzumab, rituximab can cause hyperglycemia. 7, beta receptor antagonists: can mask the hypoglycemic response, but also can lead to peripheral vasoconstriction, so that patients with existing peripheral vascular disease produce vasospasm or aggravate intermittent claudication. In the absence of other indications, such as combined angina pectoris or myocardial infarction, beta receptor antagonists are generally not preferred for the treatment of hypertensive patients with combined diabetes mellitus. In addition, non-selective β-receptor antagonists may prevent patients from normalizing blood glucose after transient hypoglycemia after insulin application, reduce insulin sensitivity, aggravate insulin resistance, and aggravate peripheral vasoconstriction and lesions. VII. Treatment concept should be active According to the patient's pancreatic β-cell function, pharmacological treatment or combined treatment can be applied as early as possible, which can simultaneously improve impaired β-cell function and reduce tissue resistance to insulin. In addition, weight reduction and lipid regulation are often effective; comprehensive intervention of risk factors such as blood pressure control and antiplatelet also have an important role in the treatment of diabetic patients.