The first diagnosis of diabetes is hospitalization, systematic assessment and comprehensive treatment; regular checkups, understanding the condition and strengthening control Medication, the best plan is individualized; protect the pancreas, don’t refuse to take insulin Diet therapy, balanced diet and three fixed; exercise therapy, exercise according to the ability and persistence Chinese medicine, correct choice to avoid blind obedience; Taoism and temperament, the best way to enjoy life. The first diagnosis of diabetes, a few worries a few worries? Engineer Zhang felt very confused: usually life is very careful, there is no discomfort, 57 years old he should be retired in two years, but this spring unit physical examination was diagnosed with type 2 diabetes. Old Zhang this chagrin ah, people often say that diabetics are not “three more (more food, more drink, more urine) a less (wasting)” well, why I do not have any symptoms, weight for more than 10 years without change, the last three years of physical examination of blood sugar, urine sugar are “normal”, this year all of a sudden found The doctor was cautiously The medical doctor carefully educated me on diet, exercise and so on for half a day, is diabetes a very dangerous disease? …… engineer, who has always been a good thinker, had a head full of questions. Similar to engineer Zhang’s situation in the first diagnosis of diabetic patients, this article focuses on the relevant knowledge for the majority of first diagnosis of diabetes and the need to understand the knowledge of diabetes prevention and treatment of patients and family members for reference. The diagnosis of type 2 diabetes is earlier than in the past due to the advancement of medical technology, physical examination and the popularity of fast glucose meters. type 2 diabetic patients, especially older patients with type 2 diabetes, such as the aforementioned engineer Zhang, can be diagnosed without any symptoms. It is usually detected during a physical examination or when the patient is examined for other diseases. In normal people, the glomerular filtrate contains a certain amount of glucose, but most of it is reabsorbed into the blood by the renal tubules, so the urine of normal people only contains a very small amount of glucose, which is not detected by the general routine examination, so the urine is negative for glucose. Because there is a certain limit to the ability of the renal tubules to absorb glucose. When the blood sugar exceeds this limit, some glucose in the glomerular filtrate cannot be absorbed and is excreted with the urine to produce diabetes. In normal people, urinary glucose can be detected when blood glucose exceeds 8.9-10.0 mmol/L. This blood glucose level is called the renal glucose threshold, or renal glucose threshold. In the elderly and diabetic nephropathy patients often blood sugar more than 10.0mmol / L, or even 11.1 ~ 16.7mmol / L, but does not appear diabetes, which is due to the renal sugar threshold, on the contrary, in pregnancy or renal diabetes patients, blood sugar is lower than 8.9mmol / L, but diabetes, which is due to the lowering of the renal sugar threshold. In the elderly, due to the increased renal sugar threshold, even when the blood glucose is very high, there is no diabetes, so some do not have the symptoms of excessive drinking, urination and eating, and are often found only after many years of diabetes. Some patients are not asymptomatic, but some symptoms are overlooked. For example, patients’ families and patients themselves think that eating a lot means having a good appetite and is a sign of good health. They are often diagnosed because of some complications of diabetes such as loss of vision, itchy skin, boils, carbuncles, edema, proteinuria, foot ulcers, impotence, periodontitis, etc. When they wait for a hospital visit and are examined, they are found to have diabetes and hyperglycemia. There are even a considerable number of cases that are misdiagnosed. Second, prevention and prevention, advocate early diagnosis and early treatment China’s famous diabetes expert, academician of the Chinese Academy of Engineering, Professor Kun-san wants to introduce in the preface of “China’s Type 2 Diabetes Prevention and Treatment Guide”: the prevalence of diabetes in China was 1% in the early 80s, but increased to 2.6% in 2002. At present, the prevalence of diabetes in Shanghai, Beijing, Guangzhou and other major cities has reached about 8%. In other words, one out of every 12 adults has diabetes. There are at least 26 million people with diabetes in China, and a similar number of candidates with elevated blood sugar who have not yet reached the diabetes diagnosis threshold. According to the International Diabetes Federation (IDF), there will be 1.01 million new cases of diabetes in China each year, which means 2,767 new cases of diabetes every day, or 115 new cases of diabetes every hour. Experts in the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes jointly believe that there may be multiple reasons for the dramatic increase in the prevalence of diabetes. The first is genetic. The Chinese may be a susceptible population for diabetes, and the prevalence of Chinese in wealthy countries is above 10%, significantly higher than the local Caucasian population, suggesting the existence of this possibility. Secondly, environmental factors, due to the rapid development of China’s economy, the improvement of living standards caused a change in dietary structure, the source of calories, proteins and fats in the diet from plant-based to animal-based, with an excess of total calories, as well as an unhealthy and unscientific lifestyle pattern, including ignorance of diabetes, excessive calorie intake and reduced physical activity leading to obesity. Also social aging is an important cause, with life expectancy in China reaching 71 years for men and 74 years for women, while type 2 diabetes is an age-related disease with a higher prevalence at older ages. These factors together have led to an increase in the incidence of diabetes. Diabetes is so harmful that the prevalence of chronic complications of diabetes in China has reached a fairly high level, with about 25,000 people going blind from diabetes and about 100,000 dying from it each year. Among the patients with chronic complications of diabetes, about 1/3 of them have hypertension, cardiovascular disease, eye and nephropathy, and more than half of them have neuropathy. In particular, cardiovascular complications have the highest rate of disability and death and are the most harmful. As for the prevention strategy of diabetes complications, our government and academic organizations advocate early prevention, early diagnosis and early treatment. People with one of the following conditions should have their blood and urine glucose tested regularly and be alert to diabetes: (1) family history of diabetes and over 40 years of age; (2) obese people over 40 years of age, especially those whose weight exceeds 20% of the standard weight; (3) skin infections such as folliculitis, boils and carbuncles that do not heal repeatedly; (4) women with a history of delivery of huge children; (5) people with recurrent vulvar itching and urinary tract infections; (6) people who have recently lost weight for unknown reasons; (7) people who have frequent reactive hypoglycemia; and (8) people who have a history of diabetes. (7) those with frequent reactive hypoglycemia; (8) those with decreased vision; (9) those with multiple miscarriages, stillbirths, and excessive amniotic fluid; (10) those with unexplained body surface ulcers. Pay attention to the traces of early complications of diabetes mellitus for early diagnosis to prevent transmission: ① Early diabetic nephropathy: Mild increase in blood pressure may occur in stage III. The presence of persistent microalbuminuria (UAER persisting at 20-200 μg/min or 30-300 mg/d) is the hallmark of this stage, but routine urine laboratory tests remain negative for protein. ②Early diabetic retinopathy: blurred vision or fly sign in early stage. Early diabetic peripheral neuropathy: abnormal proprioception, position, vibration and temperature sensation in the distal extremities, ataxia, unstable walking like stepping on cotton, ankylosis, or glove and glove-like sensation in the distal extremities, and also deep dull pain and spasm-like pain. Atrophy and weakness of small muscle groups between fingers and toes. Early diabetic heart disease: the clinical manifestation is often chronic stable angina, with two of the following symptoms can be diagnosed: a. chest discomfort with colic, tightness, pressure or heaviness, not knife or needle-like pain; b. retrosternal pain can radiate to the neck, epigastrium or left shoulder and arm; c. chest pain lasts for a few minutes; d. chest pain is often triggered by exertion or emotional excitement; e. chest pain is relieved by rest or sublingual nitroglycerin e. Chest pain is relieved within 30 seconds to several minutes with rest or sublingual nitroglycerin tablets. ⑤ Early diabetic cerebrovascular disease: the first symptom is mostly weakness of a limb when waking up, limited voluntary activity, and decreased muscle strength. There may be significant relief in a relatively short period of time. a. Cerebral ischemia: High blood sugar in the early morning, blood concentration, and also blood pressure is often high in the morning, preferably between 4 a.m. and 9 a.m. b. Cerebral hemorrhage: Acute headache after strenuous exercise, alcoholism, and emotional excitement. Frequent headache. Third, the first diagnosis of hospitalization, systematic assessment of comprehensive treatment Hospitalization is the best way to quickly control, systematically assess the condition and develop a comprehensive treatment plan. It is best to hospitalize patients with first diagnosis of diabetes. The purpose of this is twofold: ① As far as the patient is concerned, hospitalization can provide comprehensive knowledge of diabetes prevention and treatment. Through the lectures and teachings of doctors, nurses and dieticians, patients can learn diet control, exercise therapy, blood glucose and other metabolic index control, and understand the knowledge of diabetes and its complications prevention and treatment through the limited hospitalization time. ②For diabetologists, through comprehensive and purposeful examination in hospital, they can comprehensively assess the pancreatic function and metabolic level of the first-time patients, and promptly detect risk factors for complications or early diagnosis and treatment of complications. Diabetes is a metabolic disorder syndrome that can cause damage to multiple organs such as the heart, brain, kidneys, eyes and nerves. Therefore, when you go to the hospital to see a diabetic, in addition to a clear diagnosis, you should further clarify whether the combination of hypertension, hyperlipidemia, obesity and other metabolic disorders, the presence of various acute and chronic complications caused by diabetes, and the severity of the disease. Once these problems are clearly identified, the purpose of our visit will be achieved and a comprehensive basis for future systematic treatment will be provided. Hospitalization is necessary in the following cases: ①Diabetes combined with acute metabolic complications, such as ketoacidosis, hyperosmolar non-ketotic coma, lactic acidosis. (2) Diabetes mellitus combined with serious chronic complications, such as diabetic foot, diabetic nephropathy and renal insufficiency, etc. (iii) Diabetes combined with serious infection. (4) Diabetes mellitus combined with pregnancy and childbirth; (5) Diabetes mellitus combined with severe stress conditions, such as myocardial infarction, stroke, etc. ⑥Diabetes mellitus with serious trauma or other diseases requiring major surgery. Regular checkups to understand the condition and strengthen the control Checkups are to better control the condition and determine individualized treatment goals. The following physical and laboratory examinations should be performed at the first consultation: ① Physical examination: height, weight, body mass index (BMI), waist circumference, blood pressure and dorsalis pedis artery pulsation. ②Laboratory tests: fasting blood glucose, postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL cholesterol, LDL cholesterol, urine routine, liver function and kidney function. ③Special tests: fundus examination, electrocardiogram and neuropathy-related tests. If conditions allow, urine microalbumin should be tested. Set the initial goals to be achieved and the measures that should be taken: advise the patient to perform appropriate physical exercise, develop a diet plan, reduce weight and require certain goals to be achieved within a specified time frame. Patients are advised to quit smoking, perform self-monitoring of blood glucose and keep records. At the doctor’s follow-up visit, the diabetic record booklet is reviewed and the laboratory results including fasting and postprandial glucose, HbA1c, and the implementation of the diet and exercise regimen are analyzed and discussed. Determine the next steps to be achieved and the next step in the treatment plan. In order to systematically understand the changes in the disease and the comorbidities/complications at the time of illness, some of the following tests are optional according to the recommendations of diabetes experts: Tests related to diagnosis and typing: (1) Blood glucose: fasting and 2 hours postprandial blood glucose. A fasting blood glucose ≥7.0mmol/ l (126mg/ dl) and/or 2 hours postprandial blood glucose ≥11.1mmol/ l (200mg/ dl) can be diagnosed as diabetes mellitus. (2) Oral glucose tolerance test (OGTT test): It is an important test to diagnose “impaired glucose regulation” and diabetes mellitus. (3) Islet function: It includes insulin release test (IRT) and C-peptide release test (CPRT). It is used to understand the degree of islet failure and to help determine the clinical classification of diabetes mellitus. Tests reflecting the average level of blood glucose control: (1) Glycosylated hemoglobin (HbA1c), with a normal value of 4-6%, reflects the overall blood glucose level in the past 2-3 months. (2) Glycosylated serum protein (GSP): it is the combination of albumin and glucose in plasma, which can reflect the total blood glucose level in the past 2-3 weeks. Tests related to metabolic disorders and complications: (1) Urine routine: including urine sugar, urine ketone bodies, urine protein, white blood cells and other indicators, indirectly reflecting the blood sugar level and complications. (2) Blood lipid: diabetic patients are often combined with lipid metabolism disorders, and lipid-regulating drugs should be reasonably selected according to the test results to correct the abnormal lipid metabolism. (3) Blood pressure and blood viscosity: high blood pressure, high blood lipids, high blood viscosity and high blood glucose are the four invisible killers of diabetic patients, which must be noted at the initial diagnosis. Complications/comorbidities related tests: ①Body mass index (BMI). It can be used as a reference to calculate daily caloric intake to guide clinical selection of medication. ②Liver and kidney function. To understand the disease and guide the safe use of medication. ③Ophthalmic examination. To facilitate early detection of diabetic retinopathy. ④Neurological examination. To detect diabetic peripheral neuropathy at an early stage. ⑤ Electrocardiogram and cardiac ultrasound. To understand the presence of coronary artery disease and cardiac insufficiency. ⑥Lower limb vascular ultrasound and angiography. To find out whether there is arteriosclerosis or stenosis in the lower limbs. (7) Chest X-ray. To determine whether tuberculosis or lung infection is also combined. (8) Bone density examination. To find out whether there is osteoporosis. After the diagnosis of diabetes, in order to monitor the changes of the disease, according to the “China Type 2 Diabetes Prevention and Control Guidelines”, it is recommended that the frequency of examination should be arranged as follows: ① Blood glucose (fasting and after meal), weight, blood pressure, glycosylated hemoglobin and urine routine must be measured at each visit. ②Quarterly check eye (visual acuity and fundus), foot (dorsalis pedis artery pulsation, neuropathy), weight, blood pressure, glycated hemoglobin, and urine routine. ③Every year, eyes, feet, weight and body mass index, blood pressure, glycosylated hemoglobin, urine routine, urine albumin, blood lipids (cholesterol/high/low density lipoprotein cholesterol, triglycerides), creatinine/urea nitrogen, liver function, electrocardiogram. If conditions allow, urine microalbumin should be tested.