In general, people who are obese (pimple-like body shape, increased total body fat or relatively or absolutely increased intra-abdominal body fat), people with high blood lipids, people with reduced physical activity and/or increased energy intake, low birth weight children and middle-aged and elderly people, etc., are more likely to develop diabetes. People who are prone to heartburn, sweating, and hunger after eating sweets for breakfast are prone to diabetes, and if your parents have diabetes, you have a genetic susceptibility. Patients in this category should control their weight, exercise, limit calories, and be aware of the caloric and glycemic index of various foods. Diabetes is a disorder of blood glucose metabolism, which is caused by absolute or relative insufficiency of insulin. Relative insufficiency means that sometimes the amount of insulin is not small, but the tissues are not sensitive to insulin, or there is a delay in the peak of insulin secretion, and blood glucose does not match insulin; the amount of insulin secreted by patients in the early stage is more than normal, and the body appears to have a large amount of insulin required to lower the same blood glucose, which means that the insulin The sensitivity of insulin has been reduced, insulin resistance has appeared, and disorders of blood glucose metabolism have occurred. Based on this, a good glucose-lowering drug is to change the secretion rhythm of the pancreas, reduce insulin resistance, and slow down the absorption of blood sugar. At present, oral hypoglycemic drugs include: pro-insulin secretion by pancreatic β-cells; sulfonylureas, non-sulfonylureas; sulfonylureas: mainly improve the defective secretion function of B-cells, divided into: the first generation: methylphenidate (D860) chlorosulfonylurea; the second generation: glibenclamide (euglycemia) (no longer used) glipizide (Disa Mepida Rexin), gliclazide (Damacell), glipizide (Glucophage) Gliporide (Glucophage); third generation: Glimepiride (Amoxicillin) and non-sulfonylurea insulin pro-secretory agents Reglanet (Vulaid, Novaluron), Naglinide (Tangli, Tangri, Dampin, Zifu, Wansuxin), etc.; these drugs require good pancreatic beta-cell function, will increase body weight, higher incidence of hypoglycemic events, most drugs require multiple doses, some have certain effects on cardiac function Some of them have some effect on heart function and do not have clear pancreatic β-cell protection. Most need to be taken before meals. Diabetic patients on sulfonylureas attenuate ST-segment elevation on ECG in the event of moderate myocardial infarction, an effect that may delay the diagnosis of ST-segment elevation in these patients and thus delay treatment. Biguanides: metformin, gevalt, these drugs mainly reduce hepatic glucose output, inhibit glycogen isogenesis, increase muscle glucose uptake and utilization of glucose, delay glucose uptake, correct receptor and post-receptor defects, improve tissue sensitivity to insulin; reduce plasma insulin concentration, reduce hyperinsulinemia; also have the ability to inhibit sodium absorption, inhibit sympathetic nerve activity, thus improving the patient’s blood It also has the ability to inhibit sodium absorption, inhibit sympathetic nerve activity, thus improving patients’ blood kinetics and reducing the load on the cardiovascular system; inhibit the activity of type I fibrinogen activator inhibitor, reduce platelet adhesion and aggregation; anti-microvascular thrombosis and anti-microvascular glycation; have a hypolipidemic effect independent of glucose lowering; therefore, the status of these drugs among oral hypoglycemic agents is increasing. However, it should be used with caution in cases of pre-existing renal insufficiency: serum creatinine levels above 15 mg/L (men) or 14 mg/L (women), acute and chronic metabolic acidosis (including ketoacidosis), chronic cardiac insufficiency, hypersensitivity to metformin hydrochloride, radiological examination with parenteral iodinated contrast agents, and hepatic insufficiency, avoid alcohol, monitor renal function (creatinine clearance), and is not recommended in pregnant women. Use. Long-term users may have B12 deficiency. Glucosidase inhibitors: such as Bactrim (acarbose) and voglibose, inhibit glucoamylase and disaccharidase, reduce the absorption of polysaccharides into monosaccharides, and therefore are ineffective in increasing blood glucose caused by oral monosaccharides. And it needs to be chewed and mixed with starch for good effect. Insulin sensitizers: thiazolidinediones: Troglitazone (hepatotoxic, eliminated in 1999), Rosiglitazone, Pioglitazone, Ciglitazone, Englitazone These drugs can specifically activate the peroxisome proliferator Activation of the PPARγ nuclear receptor regulates the transcription of many insulin-responsive genes, thereby enhancing the effects of insulin. It can cause headache, weakness, diarrhea, and in combination with sulfonylureas and insulin, weight gain in some patients with hypoglycemia can occur. It can aggravate edema, can cause anemia and erythrocytopenia. Some lead to cardiovascular accidents, and some have a risk of bladder cancer. DPP-4 enzyme inhibitors, reduce the metabolism of GLP1 to play a role in lowering glucose is blood glucose dependent, such as Genovel, Gavril, Anritzer and other drugs, there is an islet repair effect, a relatively new type of hypoglycemic drugs. There are also insulin analogs, etc., but they are mostly self-paying. The goal of treatment for Caucasians – to improve insulin resistance – is the main goal, and for Japanese/Chinese people treatment needs to target insulin secretion defects mainly. For people with delayed peak insulin secretion, insulin promoters can be given to take before meals to synchronize insulin with peak blood glucose, and taking medication before meals this means not wanting to eat without medication, otherwise they are prone to hypoglycemia. For patients with insulin resistance, insulin sensitizers are needed, as well as drugs that reduce the absorption and utilization of food sugar and drugs that reduce the transport of glycogen from the liver to the blood and drugs that enhance the tissue utilization of sugar in several ways. Insulin: As the disease progresses, the damage of pancreatic islet function worsens, or the body has complications or stressful events, such as infection, trauma, etc., causing high blood sugar, due to the toxic effect of high blood sugar or metabolic memory test also need to use insulin to control blood sugar, so that oral drugs can easily be effective, so this type of patients need insulin replacement therapy. There are various types of insulins, such as long-acting, medium-acting, short-acting, premixed and enteral insulin. Insulin is prone to hypoglycemia, especially short-acting insulin, and the principle of “take it before meals, do not take it without eating, eat more, eat less” should be followed. If it is not because of weight or inconvenience, it is good to use insulin as early as possible. Whether insulin is dependent or not has nothing to do with whether insulin has been used or not, but is determined by the needs of the body. Many people are afraid of insulin dependence after using insulin, which is a wrong view. We do not recommend the combined application of similar drugs. Doctors should ask patients when prescribing drugs, and it is necessary for patients to inform doctors about the drugs they use. It is common for patients to take several sulfonylureas at the same time in clinical practice. Attention to the assessment of the patient’s islet function is important for drug selection. Blood glucose is related to food, activity level, emotion, liver function and medication, and to stabilize blood glucose we need to coordinate these aspects. Therefore, first of all, we need to set the amount of activity for a day, just like refueling a car, determine the mileage to be traveled to decide how much fuel to add, mileage is the amount of activity, and fuel means how many calories of food to be fed. As long as the total calories are determined, the food content can be switched. Out also take snacks or sugar, to prevent the occurrence of hypoglycemia, such as feeling weak heart, limbs, cold sweat, cold limbs, dizziness, hand tremors, hunger may be hypoglycemia. Some people who are taking drugs like Betalac may have atypical hypoglycemia and may induce hypoglycemic hypertension or even coma, which should be noted. Diabetes is different at different times, in different conditions and at different ages, so it is important to manage yourself well and check your glycosylated hemoglobin regularly at the hospital (once every three months). Diabetes is damaging to both micro and large blood vessels, pay attention to the protection of the kidneys, and it is generally recommended that if such patients have hypertension, all should prefer ACEI or ARB class antihypertensive drugs. Diabetic patients should learn to manage themselves, consulting an endocrinologist is necessary to not let their blood sugar fluctuate too much. It is worth noting that for elderly patients, those with combined serious disorders or those with little survival period, blood glucose should not be too low, too low will accelerate death and reduce the quality of survival.