In recent years, with the rapid development of China’s economy, the improvement of human living standards resulting in changes in dietary structure, as well as the formation of a sedentary lifestyle, the number of patients with abnormal glucose tolerance and diabetes in China has increased appallingly, with the total number occupying one-third of the global diabetic patients, bringing a heavy economic burden to China. Therefore, it is especially important to understand diabetes correctly and take active measures to prevent and treat it. Lulu Chen, Department of Endocrinology, Wuhan Union Medical College Hospital
One of the diagnostic criteria of diabetes is fasting blood glucose (fasting state means no food for at least 8 hours) ≥ 7.0mmol/L. When this criterion is reached, we can diagnose diabetes. When fasting blood glucose is between 6.1mmol/L and 7.0mmol/L, we call it impaired fasting blood glucose, and impaired fasting blood glucose is in the pre-diabetes stage, and proper control can delay or avoid the development of diabetes. In fact, when fasting blood glucose reaches 5.6mmol/L, we should consider it as a warning signal and monitor blood glucose level regularly.
So, what further tests do we need to do for abnormal fasting blood glucose found at the first time of physical examination?
First, because blood glucose is affected by many factors, we cannot diagnose diabetes by just one blood glucose measurement result, we need to recheck blood glucose several times.
Second, two-hour post-prandial blood glucose, according to the data, among the newly diagnosed diabetes in China, the simple post-prandial blood glucose elevation accounts for 50%, if only fasting blood glucose is measured, many patients will be missed.
Third, glycated hemoglobin (HbA1c), according to which we can assess the average fluctuation level of blood glucose in the past 2-3 months.
Fourth, oral glucose tolerance test (OGTT) is the current gold standard for the diagnosis of diabetes. Two hours after taking sugar, blood glucose ≥ 11.1 mmol/L or fasting blood glucose ≥ 7.0 mmol/L can determine diabetes, and the measurement of insulin secretion curve can assess the function of the pancreas and distinguish the type of diabetes to see if oral medication or insulin therapy is needed.
Fifth, for high fasting glucose or possible type 2 diabetes, routine urine examination should be done to determine whether there is ketosis or renal impairment.
Sixth, lipid liver and kidney function, type 2 diabetes is often accompanied by hyperlipidemia, control of lipid can significantly reduce the occurrence of vascular complications, and determine the liver and kidney function, if the liver and kidney function is not good, the use of drugs will be different;.
Seventh, the detection of blood pressure. High blood pressure accelerates damage to the heart, brain and kidneys, and properly controlled blood pressure can delay damage to these organs.
Finally, in case of type 2 diabetes, the presence of chronic complications such as diabetic retinopathy and peripheral vascular neuropathy should be evaluated at the same time. Timely treatment can significantly improve the quality of life and avoid the occurrence of tragic events such as blindness and amputation.
According to the above tests, patients who can be diagnosed with impaired fasting glucose or diabetes, what measures should be taken to monitor and control blood glucose to slow down the progress of the disease?
First of all, for those with poor blood sugar control, we ask to monitor blood sugar 4-7 times a day, including fasting, pre-meal, two hours after meal and bedtime blood sugar, until the blood sugar reaches the standard and then monitor 1-2 days a week. When the fasting blood glucose value fluctuates above and below 7.0mmol/L, we often suggest controlling blood glucose through reasonable diet and exercise, the specific plan is individualized, and the general principle is to control the total energy intake and distribute various nutrients in a reasonable and balanced way. The calories provided by fat in food should not exceed 30% of the total calories, and high-calorie diet such as fatty meat should be avoided or limited; the calories provided by carbohydrates should account for 55% – 60% of the total calories, more vegetables and fruits, and control rice and steamed buns and other staple foods; the calories provided by protein should account for 15% – 20% of the total calories, such as eggs, fish, lean meat, and evenly distributed among three meals. Following the above principles, each person can develop a diet plan that meets his or her needs by monitoring blood sugar. Exercise therapy should be carried out under the guidance of doctors, mainly for mild to moderate type 2 diabetic patients with fasting blood sugar <16.7mmol/L, especially overweight or obese people and stable type 1 diabetic patients, the timing of exercise is one hour after meals, and a small amount of fruit can be eaten after exercise to supplement the energy consumption during exercise and prevent the occurrence of post-exercise hypoglycemia. For fasting blood sugar ≥ 16.7mmol/L, obvious hypoglycemia or large blood sugar fluctuations, acute complications of diabetes (such as ketosis) and serious heart and kidney and other chronic complications of patients should not exercise for the time being. The frequency and duration of exercise is at least 150 minutes per week, for example, 30 minutes at a time five days a week, and the intensity of each exercise should not be too high to avoid hypoglycemia. It is recommended to quit smoking and limit alcohol. For those who still cannot control blood sugar better with lifestyle interventions, medication needs to be started.
While diabetes is becoming increasingly prevalent in China, people’s knowledge of diabetes is limited, and like the frustrations encountered in life, it can only be treated correctly if it is properly understood. We communicate with you on several common problems.
1. Can I rule out diabetes if my fasting blood sugar is normal?
No, you can’t. Data show that among the newly diagnosed diabetes in China, the proportion of high postprandial glucose alone accounts for nearly 50%, and if only fasting glucose is measured, a large proportion of patients will be missed. Therefore, diabetes can only be ruled out when both fasting and two-hour postprandial blood glucose are normal.
2. No urine sugar, it is not diabetes?
Diabetic patients with high blood glucose, glucose flow through the kidneys can not be completely absorbed by the kidneys, glucose will be leaked from the kidneys, with urine, which is what we call urine sugar. When the kidney function is normal, we can judge whether the blood sugar is very high according to the presence of urine sugar, so the absence of urine sugar does not exclude diabetes.
3. Once a diabetic patient starts insulin therapy, you need to rely on insulin for life?
In the clinic we often encounter such patients, afraid of lifelong dependence on insulin, even if the blood sugar is very high also refused to use insulin therapy, so we have the heart to do nothing. In fact, for newly diagnosed patients with fasting blood glucose greater than 13 mmol/L, we often recommend treating them with insulin for a period of time first, so that the pancreatic B cells can rest and recover their function to some extent, and then hopefully change to oral medication after 2-3 months. Even if insulin therapy needs to be continued there is nothing to fear, we advocate that the earlier insulin is used the better, and there is no need to avoid it as a poisonous snake and beast.
In the clinic, we will meet people with different life backgrounds and different cultural levels, and the questions they ask will be very strange and representative, which most people have questions about.
1. eat pumpkin, bitter melon can reduce sugar?
At present, there is no domestic report proving that pumpkin has the effect of lowering blood sugar, although there are reports indicating that the bitter melon peptide in bitter melon has a certain hypoglycemic effect, but there are also reports indicating that the bitter melon peptide will be degraded by pepsin and pancreatin in the stomach and lose its hypoglycemic effect, so it cannot be used as a single drug to control blood sugar. But bitter melon as a vegetable, eating more is also good for diabetics.
2. Why is diabetes detected when you don’t feel anything?
What we have heard of diabetics eat more, drink more, urinate more symptoms, is very typical of diabetics, but these typical symptoms in diabetics is not common, a considerable number of people do not have any symptoms, only in the physical examination found high blood sugar, this time do not ignore their condition, to timely to diabetes referral department to avoid delaying the disease.
3. Is diabetes caused by eating too much sugar?
No, it is not. Normal people’s blood sugar is normal because the body’s pancreatic B cells can release enough insulin to bring blood sugar down to normal, and diabetic patients are more or less damaged pancreatic function, the release of insulin is not enough to bring blood sugar down to normal, so there is a high blood sugar, eat more sugar will cause diabetes this statement is obviously not true.
Finally, we give some advice to diabetics.
For patients with no symptoms but high blood glucose found during physical examination, they should seek timely medical attention and perform lifestyle interventions and medication. If left unattended, complications such as numbness and pain in the limbs, blurred vision, and impaired kidney function will gradually appear, which are difficult to reverse once they appear and seriously reduce the quality of life. For patients who have been diagnosed and treated, strict monitoring of blood glucose, taking medication as prescribed, and regular visits to keep blood glucose within the target range can delay the occurrence of various complications. Do not believe in the “experience” of non-professionals, accept individualized professional treatment, and do not “rush to the doctor”.