I. Basic knowledge of diabetes
1. Current situation and characteristics: The prevalence is increasing rapidly: with the rapid development of social and economic development, the incidence of diabetes in China has shown a rapid growth trend, and it is predicted that by 2025, the number of people with diabetes will reach more than 50 million, currently ranking second in the world. There is a large reserve army: high-risk groups, people with blood glucose regulation disorders. Beijing-Shanghai community is over 30 years old 10%. Younger onset: Chinese children with diabetes 50% type 1, 50% type 2; children and adolescents with type 2 prevalence 2.5%.
2. Definition: The World Health Organization defines diabetes as a metabolic disease characterized by chronic elevation of blood glucose with insufficient insulin secretion, defective insulin action or both, resulting in disorders of carbohydrate, fat and protein metabolism caused by multiple etiologies.
3.Classification.
(1) Type 1 diabetes: destruction of pancreatic islet beta cells, causing absolute lack of insulin; depend on insulin to maintain life.
(2) Type 2 diabetes: insulin resistance and insulin secretion defects.
(3) Gestational diabetes mellitus.
(4) Other diabetes mellitus: hepatogenic diabetes mellitus, etc.
(4) Clinical manifestations: excessive drinking, polyphagia, polyuria, weight loss. The following symptoms should also be alerted to diabetes mellitus.
Repeated boils and carbuncles on the skin, wounds that do not heal, unexplained loss of sexual function in men, numbness in the lower limbs, and protein in the urine.
5. Diagnosis.
Diagnostic criteria for diabetes mellitus.
1. Diabetic symptoms (typical symptoms include polydipsia, polyuria and unexplained weight loss) plus
(1) random blood glucose ≥ 11.1mmol/L (200mg/dL).
(2) fasting blood glucose (fasting state means no calories eaten for at least 8 hours) ≥ 7.0mmol/L (126mg/dL)
(3) Glucose ≥ 11.1mmol/L (200mg/dL) 2 hours after glucose load.
(2) Those without diabetic symptoms need to repeat the examination on another day to clarify the diagnosis.
6.Complications.
(1) Acute complications.
Infection, ketoacidosis, hyperosmolar non-ketotic diabetic coma, lactic acidosis.
(2) Chronic complications.
Cerebrovascular disease, cardiovascular disease, lower limb vascular disease, diabetic foot, nephropathy, fundus disease: double vision, sensory nerve: pain, numbness, allergy; motor nerve: movement disorders, lesions involving the whole body.
Second, the treatment of diabetes five sets of carriages
1.Education and psychotherapy
Diabetes is a recognized physical and mental disease, which can cause negative emotions such as depression and anxiety, and negative emotions can aggravate diabetes, decrease insulin secretion → increase blood sugar, aggravate the disease and consequence complications. So get rid of negative emotions at the beginning of the disease as soon as possible, accept the fact of the disease, treat it actively and scientifically, and do not blindly fear insulin.
2.Diet therapy
(1) Reasonable control of total calorie intake.
(2) Balanced diet, balanced intake of various nutrients.
(3) Weighing diet, regular and quantitative meals.
(4) Small amount and multiple meals, 3-6 meals per day.
3.Exercise therapy
Reasonable exercise can help control blood sugar, reduce weight, enhance insulin sensitivity, reduce insulin resistance, improve blood lipid level and cardiovascular function, and contribute to disease prevention and psychological health.
4.Drug therapy
The common types of oral hypoglycemic drugs: the usage, maximum dose, indications, and side effects should be noted. Specialist consultation to determine.
1. Pro-secretory agents: sulfonylureas, non-sulfonylureas (such as Novaluron);
2. Biguanides: metformin
3.Insulin sensitizers.
4, glucosidase inhibitors (acarbose)
5, DPP-IV inhibitors.
Formulations of insulin: short-acting human insulin, intermediate-acting insulin, premixed human insulin, rapid-acting insulin
Precautions for insulin injection
Do not stop injecting insulin or change the type of insulin at will. Premixed insulin should be shaken well before injection. According to the onset of action of different insulins, arrange the injection and meal time reasonably, injecting Novalax 30 immediately eat, Novalax 30R,50R half an hour eat, for obese patients can delay the meal. Wash your hands before injection, disinfect the skin with 75% alcohol, exhaust 1U, do not sterilize the needle (protective film of silicon), otherwise it is easy to cause pain, do not use more than 6 times. Stay for 10 seconds for insulin injected within 10 units and pull out; stay for 20 seconds for insulin injected more than 15 units. Unopened insulin should be stored at 2-8°C, do not freeze. Insulin being used should be kept at room temperature, below 28°C, for 28 days, avoiding sunlight.
5.Diabetes monitoring.
Blood glucose: at least seven times every 1-2 weeks, before three meals, two hours after three meals and once before bedtime. Add 3AM blood glucose measurement if necessary.
Glycated hemoglobin: once every 2-3 months.
Urine microalbumin: once every 3-6 months.
Sensory threshold measurement: once every 6-12 months.
Weight: mandatory at the first visit and at least once every 3 months thereafter.
Urine routine/blood pressure: mandatory at first visit and at least once every 3 months thereafter, even if normal.
Blood lipids/blood viscosity: at least once a year, or once every 3 months if abnormal.
Liver function, kidney function, electrocardiogram, fundus of the eye: according to the condition.