Key Points in Focus Blood glucose is influenced by many factors. The causes of elevated blood glucose can vary, and may be a single factor or multiple factors. In the face of a specific patient, we must analyze the situation on a case-by-case basis, find the right cause, and prescribe the right medicine.
Whether in the clinic or in the diabetes education class, one of the most frequently asked questions from diabetic patients is why their blood glucose keeps not coming down. The answer to this question is rather complicated. There are many factors affecting blood glucose, including diet, exercise, psychology, medication, monitoring and other aspects, which are different for each patient, and are summarized as follows.
1. Inappropriate diet treatment.
Diet therapy is the basis of diabetes treatment, whether type 1 diabetes or type 2 diabetes, regardless of whether the disease is mild or severe, whether or not the use of hypoglycemic drugs, all need diet therapy. Diet therapy helps to reduce the burden on the pancreas, lower blood sugar, reduce the dosage of glucose-lowering drugs and control body weight. For patients with mildly elevated blood sugar, diet therapy alone can bring blood sugar back to normal; on the contrary, if you do not pay attention to diet control, it is difficult to keep blood sugar normal even with good medication.
However, diet therapy is never the same as “starvation therapy” or “severe partial diet”. Diet therapy is to arrange the quantity (total calories) and quality (the ratio of various nutrients) of diet in a scientific and reasonable way, which can meet the body’s nutritional needs and help control blood sugar and weight.
2, insufficient exercise.
Exercise itself is a process of energy consumption, and regular aerobic exercise can promote the utilization of glucose by body tissues; exercise is also conducive to reducing body weight, improving insulin resistance and enhancing the efficacy of glucose-lowering drugs; in addition, exercise helps to relieve tension, maintain psychological balance and reduce blood sugar fluctuations, so scientific and reasonable exercise helps to control blood sugar.
3, adverse emotions.
Psychological factors have a great influence on blood sugar, and emotional changes such as tension, anxiety, exasperation, insomnia, great joy and sadness, and overexcitement will cause an increase in the secretion of glucagon in the body and a decrease in insulin release, resulting in an increase in blood sugar, therefore, it is important to learn to control and adjust one’s emotions. In addition, irregular life and excessive fatigue can also cause blood sugar fluctuations.
4, improper selection of drugs.
The medication for diabetic patients should be individualized, and the medication should be selected reasonably for each patient’s type of diabetes, pancreatic function status, age, fatness and thinness, the presence of complications and the characteristics of the blood sugar spectrum throughout the day. In the case of type 2 diabetes, for those who are obese and have insulin resistance, the use of biguanides and thiazolidinediones is appropriate; for those who are lean or of normal weight and have insufficient insulin secretion, the use of sulfonylureas is appropriate; for those who have postprandial hyperglycemia, the use of alpha-glucosidase inhibitors and glinides is appropriate.
Some patients are misled by false advertisements and choose Chinese patent medicines or health care products with inaccurate effect of sugar-lowering to replace western medicines for sugar-lowering, resulting in high blood sugar due to improper drug selection.
5. Insufficient or excessive medication.
Both insufficient or overdose of medicine can lead to the increase of blood sugar. Insufficient medication leads to blood sugar does not fall, it is easy to understand, and will not repeat. What needs to be alerted is the latter situation, the excessive dosage of hypoglycemic drugs, the blood sugar drops too fast and too low, which can cause the secretion of glucagon in the body to increase and make the blood sugar rebound higher. At this time, if you continue to increase the dosage, blood sugar will rebound higher.
For patients with elevated fasting blood sugar, we must first find out whether it is “insufficient dosage of hypoglycemic drugs” or “rebound hyperglycemia after hypoglycemia”, and if it belongs to the latter case, the dosage of hypoglycemic drugs should be appropriately reduced rather than increased at night.
6, intermittent medication.
Many patients often forget or omit to take medication due to work tension, business trips, etc., resulting in elevated blood sugar. Many patients use drug treatment, blood sugar down to normal after the unauthorized discontinuation of drugs, wait until the blood sugar back up to very high, and then according to the original dose of hypoglycemic drugs will be difficult to achieve control goals. At present, diabetes can not be completely cured, so you need to adhere to long-term treatment, do not eat eat stop.
7, incorrect drug usage.
There are many different types of glucose-lowering drugs and their usage varies. If they are used improperly, they will get half the result with twice the effort. For example, sulfonylurea hypoglycemic drugs are best taken half an hour before meals, so that the peak effect of the drug and the postprandial blood sugar peak exactly synchronized, so that the best effect of lowering sugar; Acarbose (Bystolic) is the main role of delaying the absorption of sugar, should be chewed with the first mouthful of rice, taking drugs on an empty stomach does not have any effect. For example, depending on the half-life of the drug, some drugs need to be taken three times a day, while others can be taken once a day.
Glipizide (sugar), glipizide (Mepida) and other hypoglycemic drugs are short-acting preparations, which should be taken 3 times a day before meals. If taken orally 1 or 2 times a day, it is difficult to satisfactorily control blood sugar throughout the day; while glipizide (Ruiyin), glimepiride (Amoxicillin) and other drugs are long-acting preparations, which can be taken once a day.
8.Inappropriate combination of drugs.
Single drug therapy can be effective at the beginning of the stage, but after several years of use, there is often a decrease in the effectiveness of the drug, blood sugar gradually increased phenomenon, at this time should be timely use of the combination of drug program. The principle of combined medication is to use two or more drugs with different mechanisms of action to synergistically play the role of lowering blood sugar and delaying the occurrence of complications.
However, some patients combine the same type of hypoglycemic drugs, such as glibenclamide (euglycemia) and glipizide (Mepida), which will not enhance the hypoglycemic effect, but will increase the adverse effects of drugs.
9. Islet failure.
Many glucose-lowering drugs can only work if the patient still has some islet function. This is why some glucose-lowering drugs [mainly glibenclamide (euglycemia), glipizide (Mepida) and other sulfonylureas] are effective at the beginning, but after a period of application, the effect gradually decreases or even fails completely.
Because such drugs mainly through the stimulation of pancreatic islet b-cell secretion of insulin to play a hypoglycemic effect, when the patient’s pancreatic islet function has completely failed, such drugs will not be effective.
10. Insulin resistance.
Insulin resistance can be simply understood as the body’s insensitivity to insulin. When patients have insulin resistance, it will greatly weaken the glucose-lowering effect of insulin and cause an increase in blood sugar.
In overweight or obese patients with type 2 diabetes, especially in the early stages of the disease, the reason for their elevated blood glucose is mostly due to insensitivity to insulin, rather than insufficient insulin secretion. The first choice of treatment for such patients is not insulin-producing drugs or insulin, but drugs with insulin-sensitizing effects such as biguanides and thiazolidinediones should be chosen to improve the control of blood glucose by eliminating insulin resistance.
11. The presence of glucose-raising factors.
It mainly includes two situations.
(1) Taking drugs with glucose-raising effect, such as glucocorticoids, b-blockers (such as propranolol, i.e., Jinan), thiazide diuretics (such as hydrochlorothiazide, i.e., dihydrokethionine), estrogen, thyroid hormone, etc.
(2) combined with certain endocrine diseases, such as acromegaly, Cushing’s disease, etc.
12. Stress state.
Stress conditions such as cold and fever, serious infection, trauma, surgery, acute myocardial infarction or stroke, or women in pregnancy or menstruation can increase the secretion of glucagon in the body, weakening the hypoglycemic effect of insulin, leading to high blood sugar and even inducing ketoacidosis.
13, the influence of climate factors.
It is clinically found that the blood glucose of diabetic patients is affected by the seasons and changes. Cold stimulation can increase the secretion of glucagon, thus increasing blood glucose and aggravating the disease. Hot and sweaty in summer, attention should be paid to replenish water, otherwise blood concentration will also raise blood sugar.
14. Unrecognized type 1 diabetes.
Type 1 diabetes occurs mainly in children, but at present, it seems that type 1 diabetes (LADA type diabetes) with adult onset is not uncommon. Because some of its symptoms are quite similar to type 2 diabetes (such as late onset, insidious onset, and effective for oral hypoglycemic therapy at the beginning of the disease course), coupled with the fact that the examination of pancreatic b-cell autoantibodies is not yet popular, it is often misdiagnosed as type 2 diabetes.
Since the pancreatic islet function of these patients fails quickly, the efficacy of oral hypoglycemic drugs will not be maintained for a long time, and insulin therapy should be given as early as possible.
15. Unfavorable blood glucose monitoring.
Self-monitoring of blood glucose (SMBG) is very important for blood glucose control, but its result depends on the quality of the blood glucose meter and the operation level of the user. An inaccurate test result often misguides treatment adjustment, leading to high blood glucose or hypoglycemia.
Blood glucose control is a “system project”, and any one of the problems will affect the control of blood glucose. Only when doctors and patients cooperate, analyze together, find out the causes and deal with the symptoms, can blood sugar be satisfactorily controlled.