Patient: Hello, doctor. In mid-December 2008, I felt a sudden rush of blood to my head (2 minutes) and nausea and dizziness when I was sleeping at night, and went to the hospital a few days later. I was diagnosed with lacunar cerebral infarction by brain CT and carotid ultrasound, and was given tensin for half a month, and took nimodipine and vitamin E nicotinate. There was some relief, and now I feel that my head is a little heavy. The doctor recommended blood lipid and blood glucose tests after the review, and found that all of them were abnormal. Liver function was normal. Lipids: CHO 6.74 (3.1-5.7); LDL-C 5.1 (1.27-4.13) The doctor prescribed atorvastatin treatment. Blood glucose: fasting blood glucose 7.14 was measured last Monday; because of the fear that the results are not accurate once, several values were measured today, fasting blood glucose 7.48, glycated hemoglobin 7.4%; dry chemical blood glucose rapid quantification (finger blood) 7.8 after eating a burrito (1 tael). In addition, platelet aggregation test (ADP) was done, which was normal. I would like to ask Dr. Du if it is possible to confirm my diagnosis of diabetes. I used to be in good health, I have not had any diseases, I do not have the typical symptoms of diabetes, I weigh less than a hundred and four, and I am less than one meter six. The information says that you have to have a blood sugar higher than 7.1 before a meal and 11.1 two hours after a meal to be considered diabetic. But my postprandial blood glucose is not that high (the doctor said that the amount may not be enough and that I should eat 2 taels of rice to be accurate, so I deduce that the actual value should be higher but I don’t think it should reach 12). I myself also think that the two measurements are not the same part, and the standard before and after eating should be different, but the hospital report before and after the meal reference value is 3.9-6.1, as if it is not very scientific. In addition, if diabetes can be diagnosed as serious, can it be regulated by diet and exercise without taking medication? Or should I consider my other cardiovascular conditions and actively intervene with medication? Thank you, doctor. Reply: Hello! You can already be diagnosed with diabetes. Why? Because the diagnostic criteria for diabetes are such that one fasting glucose greater than 7 or random glucose greater than 11.1 can be diagnosed if you have symptoms of three or more, and two (fasting glucose greater than 7 or random glucose greater than 11.1) can be diagnosed if you have no symptoms. It is true that the normal values in the hospital only list the normal criteria for fasting blood glucose, and the postprandial ones are not listed, you are right to mention. The normal postprandial blood glucose should be less than 7.8 mmol/L. Since you have had two consecutive fasting blood glucose levels greater than 7 and your glycated hemoglobin is also significantly elevated, the diagnosis of diabetes should be established. It is not serious, but generally speaking, the function of pancreatic islet cells in the pancreas is only about 50% remaining when diabetes is found, especially in patients with rising fasting blood sugar. There are five carriages in diabetes treatment, the most important is diet and exercise therapy, and if the two can not be controlled, you should add drugs. I think that if you used to eat more and like sweets and fat body type, diet and exercise will be more effective for you. Other measures to lower blood lipids and blood pressure should be carried out together, blood sugar is only one of the risk factors for atherosclerosis (including cerebral infarction), and the other ones are also very important. Whether you need to add glucose-lowering drugs depends on how well you can control your blood sugar through diet and exercise. Generally, the risk of hypoglycemia is greater than the risk of hyperglycemia in people over 70 years old, so it is fine to control blood sugar below 7 and below 10 after meals, without pursuing to lower blood sugar to the normal range. However, if you take metformin or baixin, which do not cause hypoglycemia, the blood sugar can be controlled a little better and the wind of various complications can be further reduced, so you can consider using them. Patient: Hello doctor, thank you for your prompt reply, I feel much more relaxed after reading it. Yesterday, I took half a tablet of glimepiride and one of pioglitazone in the morning as recommended by the doctor at the hospital I visited, and ate a steamed bun and dumplings (2 taels in total) half an hour later, and my blood sugar was 8.8 two hours after the meal. Last night, I controlled my diet a bit, one bowl of rice and vegetables (1/3 less than usual). This morning, I took another fasting blood sugar (without eating and glucose-lowering drugs), and it was 6.7. I would like to ask you: 1. why I took the drugs yesterday, but my blood sugar was still higher after breakfast than after breakfast the day before (of course, I may have eaten slightly less breakfast the day before), and I can understand that I ate more high at lunch. The medication did not work. This morning’s 6.7 is still normal, does it mean that the medication is working again. I’m not sure how much time after taking the medication, such as a week or a month, the medication will take effect and my blood sugar should drop a little (I asked the community doctor today that it would take two or three days for it to take effect). 2. according to what you said, my fasting today is below 7 (7.1 and 7.48 of the previous days are not too high), and if I don’t eat too much after meals, I guess it can be within 10, so can I not take the medication? (There was nothing wrong with the body before, now a bunch of drugs look really headache). If you want to eat, it is true that the current doctor prescribed hypoglycemic drugs instructions I also read, all have the risk of hypoglycemia. I’m not sure if it’s necessary to switch to metformin and bupropion as you said (or if each hospital and doctor’s medication habits are different and the efficacy is similar).3. Do you think that lipid-lowering drugs are also very necessary at the moment, I started to eat atorvastatin yesterday, and I had a home remedy, but my doctor said it was not as good as the former. 4. In addition, I would like to ask whether the other drugs taken at the same time have any effect and whether they can be taken again. The first is that I read the instructions of one of the glucose-lowering drugs I was taking, because I was taking vitamin E niacin at the same time, and the instructions say that high doses of niacin can counteract the effects of glucose-lowering drugs, so there may be some effects. The second is that due to dizziness the doctor prescribed a clear brain and rejuvenation liquid, which is also a sweet-tasting liquid, and it takes 10 ml at a time, so can I take it again? 5. Can I eat fruits in addition to the controlled diet? Thank you very much, I’m sorry. Patient: Doctor, I have another idea to ask you: can I stop taking medicine, reduce the amount of sweets and fruits and the amount of meals, and strengthen my exercise, and then measure my blood sugar before and after meals in a week or two. If it is within the range you mentioned (7 before and 10 after meals), we can continue to maintain it without medication; if it is still not under control, we can control it with medication. Of course, the glycated hemoglobin may not be well controlled for a week or two, so check it again in three months. I also feel that the current slightly higher, older may also be normal, but as the gold standard for diagnosis of high glycosylated hemoglobin some of my dissatisfaction, the other pre- and post-meal I think I can control. I always feel that taking too much medicine is not good for my body. And the instructions for glucose-lowering drugs are written for diabetics who cannot be controlled by exercise and diet, I have not yet gone through exercise and diet control, how do I have to take drugs. Or, do I finish my current prescription (glimepiride and pioglitazone, about a month’s worth), and then test my pre- and post-meal glucose, and if it’s normal, stop the medication and supplement it with another four carts (I’ve read that you can’t stop eating, you have to keep eating) The old man may be a bit stubborn, and I’d like to hear your opinion. Reply: I’m sorry I haven’t answered your letter, one because I have a patient at home and I’m busy this time, and one because you have more questions and I have to find a bigger time slot to answer. You have been thinking a lot about your disease, and I wish I could talk to you face to face, because many issues cannot be clarified in one or two sentences. For example, you said that you have a question about what kind of glucose-lowering medication to use. There are 5-6 major classes of glucose-lowering drugs with different indications. On the one hand, it depends on the level of blood sugar, on the other hand, it depends on the presence of liver, kidney, heart and lung diseases. Your doctor recommended the use of the drug glimepiride belongs to the new generation of sulfonylurea hypoglycemic drugs, long-acting preparations, slow onset of action, the effect is quite mild, pioglitazone belongs to insulin sensitizer, generally to achieve the best effect of 3 weeks, but 5-7 days to gradually take effect. So your blood sugar is estimated to have dropped further than when you first took the medication. Of course, all medication must be in addition to diet control. If your blood glucose is not too high, you don’t need to take medication if you think you can reach the standard with basic treatment, but if not, you must supplement with medication. The glucose medication you are taking is quite good, so I guess the doctor prescribed it based on your blood sugar. If you do not have liver and kidney disease, chronic bronchitis, emphysema, heart failure, these (hypoxia) conditions should be preferred to metformin to help you reduce appetite, reduce weight naturally increases insulin sensitivity, lowering fasting and postprandial blood sugar. And Bystolic for postprandial blood sugar and eating starch situation, fasting blood sugar improvement is small. So it varies from person to person. For the problem of eating fruits, there are several principles: 1, do not eat fruits containing too much sugar; 2, water should be added between two meals, not immediately after the meal; 3, after blood sugar should be between 7-8mmol/l best; 4, after eating fruits the next meal should reduce the amount of staple foods with corresponding sugar. As for lipid-lowering drugs, statin lipid-lowering drugs are good, strictly speaking atorvastatin than simvastatin is not said to be particularly strong, are useful for lowering blood lipids, regulating vascular endothelial function, reducing atherosclerosis, anti-inflammatory, should be able to take whether to take the drug judgment is also simple to say, is the blood glucose standard, lipid standard, if not the drug can not meet the standard will have to use. Some patients with initial onset of diabetes first take some drugs when the blood sugar is high and at the same time start diet and exercise therapy, as time recedes will gradually reduce the amount of drugs and may not need to take drugs for a period of time blood sugar can be controlled, especially if you lose more weight blood sugar will drop accordingly, then eat the kind of drugs to choose a relatively mild. Patient: Thank you, doctor. I wish your family a speedy recovery. I hope to have the opportunity to consult with you in person. For people who do not have a disease to get a disease all of a sudden, it is true that there are more thoughts and some can not figure out. It was a headache to go to the hospital for registration, examination, payment and medication, and it was hard for me and my relatives to get into trouble. With your explanation, I feel much relieved. Thank you. Today, I went to the hospital for a review of the neurology department and took a quick postprandial blood glucose test on the way. I was worried that it had dropped too low. I ate about 2 taels of food in the morning, which is normal, and my post-prandial blood sugar should be about 5 before the meal. Although I currently have no obvious symptoms of hypoglycemia, but read some information said that if it is hypoglycemia also has damage to cerebrovascular, currently I have cerebrovascular disease, will not further aggravate it. If I aggravate my diabetes, which is not too serious, I will lose more than I gain if I aggravate a disease like cerebral infarction that I just found out. Therefore, I would like to ask you again whether it is necessary to choose a milder medicine now. At present I do not have liver or kidney disease, heart failure (hypoxia) and other diseases, chronic bronchitis may be a little (long-term smoking), emphysema do not know, do you think metformin is suitable? Many people say its side effects are a little bit bigger and not as good as some new drugs, but I know it is a classic old drug. Or is it necessary to adjust the dose? For example, can Van Sulpin take 1/4 tablet (a colleague of mine had eaten this way and she had significant hypoglycemic symptoms), I will also consider it, as long as the pre- and post-meal control is within the right range, the lower the dose of the drug, the better, do you think. Or do you want to take it again for a while and see what happens. I’d like to take up your time again, and add to the trouble. Reply: Hello! First of all, I would like to remind you that monitoring your blood sugar is never a once or twice thing. In the case that you ensure that eating activities and medication are very regular every day, the blood glucose changes will be relatively large in the case that you have just started treatment, and there will be different degrees of recovery of pancreatic function after the high blood glucose control, and the blood glucose will drop, but do not decide your next treatment with one blood glucose, and do not assume that your blood glucose is good all day with one meal. You should buy a blood glucose meter and find one day a week to continuously monitor your fasting and three post-meal blood glucose, so that you have some continuity and know your blood glucose for each meal to be more comprehensive. If you have already done so (it is best to bring your own blood glucose meter), indeed it is certainly better to have 6-7 all the time after meals, but the blood glucose of people over 70 years old should be relaxed to about 10 appropriately. It is important to prevent the serious harm caused by hypoglycemia. Therefore you can test your blood sugar several times and indeed 6-7 after meal, you can reduce glimepiride. If tapering to 1/4 tablet is still good, you can stop using it. Pioglitazone only is fine. Pioglitazone is very good, because there are some contraindications, plus health insurance only covers 50%, which limits its use, and you don’t have to change metformin. Because it is not used in combination with insulin hypoglycemia does not occur much, but also can lower blood lipids, blood pressure, reduce insulin resistance, is a very good drug. Patient: Thank you, Dr. Du. I just bought a blood glucose meter today and I’m going to do what you said, so can I monitor fasting, post-meal and bedtime blood glucose on the same day every week (e.g. Wednesday)? Or should I test several days in a row? Answer: Generally speaking, one day a week is better after the disease has stabilized, but if you have just adjusted your treatment plan, you have to measure several days in a row. Patient: Thank you. I’m going to start taking tests tomorrow and the day after. On the other hand, some people say we should measure 7 points before and after meals and at bedtime, do you think that is possible? (Of course, from the economic point of view, 5 points are more appropriate) Also, I read a book yesterday (edited by Yang Wenying of the Sino-Japanese Hospital), which mentioned that it is OK to control the blood sugar of the elderly at 7.8 before meals and 11.1 after meals, which is basically the same as what you said. I have been in this range for several times, but at that time, I took the medication because I thought the index was high after reading the range on the hospital report (reference value 3.9-6.1). In addition, the book also mentions that the treatment process of type 2 diabetes in the Chinese Diabetes Control Guidelines is: diet control exercise therapy for 2-3 months, and then oral hypoglycemic drugs if the control is not satisfactory. But the doctor who visited me at that time did not say this and then prescribed the medication, which did not seem to be in line. So I’m always considering (as you’ve expressed many times) whether my situation can be adjusted without medication and exercise and diet. If not, then take the medicine. But I’ve already started taking the medication, so if I stop taking the medication now and take the exercise and diet regimen and then see the results, do you think it’s still okay? Of course, if these drugs I am taking now help prevent diabetes, I still prefer to use the drugs, if not just the therapeutic effect, I am confident that I can control my blood sugar through my own non-drug efforts. By the way, there is a mention in the book of doing an oral glucose tolerance test, but the doctor did not ask me to do it, is this also the gold standard for diagnosis. Do I still need to do it. Al again, thank you. Patient: I wish you a happy Spring Festival. However, if you want to test your islet function, you can do a bun meal test: use 2 taels of dry buns instead of glucose, and take blood tests for insulin and C-peptide on an empty stomach and 0.5, 1, 2 and 3 hours after a meal to see your islet function. Pioglitazone is very effective in reversing diabetes, so you can continue to take it. Patient: Thank you. I won’t do the tolerance test then. At the moment, I feel a little hungry around 4:00 p.m. I don’t feel dizzy, but I just want to eat especially sweet food like tonkatsu, is it a symptom of low blood sugar? In addition, I would like to ask you how long I need to continue to observe my blood glucose control before I can reduce the dosage of Vasopin to 1/4 (mainly because I am afraid that my blood glucose will drop too low), and Vasopin does not have the protective effect of Ativan, right? Patient: Hello doctor, I’m sorry to bother you on this holiday. I would like to show you the results of my blood glucose monitoring in the past two days, and ask you to guide me on how to use the medication and diet. 23rd: 8:30 am, fasting before meal 5.3 (got up a little late) 11:00 am: 2 hours after breakfast 4.0 (breakfast is rolls and eggs, about 2 taels) 14:00 am: 2 hours after lunch 8.4 (lunch is vegetable stir-fry cake, about 3 or 4 taels; around 16:00 am, I felt hungry and ate a sugar-free snack) 20:00 am: 2 hours after dinner 9.3 (dinner is rice, vegetables and a little meat, about 3 or 4 taels) 24: 7:15 am, fasting before meal 5.7 10:50 am: two hours after breakfast 3.8 breakfast of rolls and eggs, about two taels) 14:15 am: two hours after lunch 7.0 (lunch of noodles and a few vegetables, about three taels, also drank a 200 ml bag of milk before meal) 17:45 am: before dinner 4.9 (no obvious hunger, because two hours after lunch blood sugar value I would like to know why my blood sugar was low two hours after breakfast on both days, is it because the drug Glimepiride reached its highest blood concentration (the half-life of the drug is two to three hours) and its efficacy was maximized? The drug’s half-life is three hours. Do I need to adjust the dosage or change the medication in this case? Thank you. Happy Chinese New Year! Patient: I forgot to mention that on the day of monitoring, I took half a tablet of Glimepiride and one tablet of Pioglitazone about half an hour before breakfast. Good luck again for the holidays. Re: I don’t know if the 2 taels you mentioned for breakfast is a staple food (starchy)? Glimepiride should not only cause low blood sugar after breakfast, you should pay attention to your exercise problem, do you have more activity after breakfast than at noon and evening? If you provide information in the future, you should add the exercise condition as well, otherwise I can’t judge it. If you decide to have a fixed amount of food at a certain meal and exercise after that meal, you can adjust the drug dosage if your blood sugar is consistently low or high. However, Glimepiride is a long-acting preparation and cannot be adjusted individually for each meal. Therefore, for the phenomenon of low blood sugar after breakfast, you are advised to increase the amount of main meals or reduce the amount of exercise to reduce hypoglycemia. Originally I wanted you to reduce glimepiride to a quarter, but seeing that your lunch and dinner and fasting are still not low, so don’t reduce it yet, but adjust your diet and exercise first. Your low after breakfast should not be a problem with the duration of action of glimepiride. Patient: Thank you. I have a habit of going out after breakfast from 9:00 to 11:00, taking a nap for about an hour after lunch and then reading the newspaper and doing some housework at home, watching TV after dinner, and basically not going out for exercise in the afternoon and evening. In general, my diet is relatively fixed. If I reduce the amount of medication to 1/3 tablet, do you think that the blood sugar will be a little higher after breakfast. Wouldn’t that make it a little more normal after breakfast. Reply: I suggest you reduce the amount of exercise after breakfast or add a meal in the middle of the activity, as long as there is no hypoglycemia I think you do not need to reduce the medication, because if you reduce the noon and evening will increase blood sugar.