I. Causes of fasting hyperglycemia and countermeasures
One of the causes: “Sumuji” phenomenon
Measures: Monitor blood glucose at night (especially in the early morning) to confirm that there was a hypoglycemic attack at night, which led to a rebound increase in fasting blood glucose the next day, which is the so-called “Sumuji” phenomenon. By appropriately reducing the dose of oral hypoglycemic drugs (or medium- and long-acting insulin before bedtime) before dinner to avoid the occurrence of nighttime hypoglycemia, fasting blood sugar can return to normal. Xu Jiang, Department of Internal Medicine, Qinhuangdao Orthopedic Hospital
Reason No. 2: Short maintenance time of drug effect or insufficient dose
Measures: Also monitor the blood sugar at night, after thoroughly excluding that the patient has had hypoglycemic episodes at night. You can choose medium- and long-acting oral hypoglycemic drugs, such as glimepiride, Damecam slow-release tablets, metformin slow-release tablets, etc., and take them orally before dinner; or choose medium- and long-acting insulins, such as Novolin N, glycine insulin (Lysine), etc., and inject them subcutaneously at night before bedtime, and adjust the dose according to the results of blood glucose monitoring as appropriate until the blood glucose is satisfactorily controlled.
Reason No. 3: The amount of extra meals at night is too large
Measures: The amount of extra meals should be appropriate and not a large number of extra meals. Note: The time of meal addition is very important, it should be chosen before the occurrence of hypoglycemia, generally chosen at about 10:00 pm before bedtime; if hypoglycemia occurs and then go to add meals, it will often eat a lot, which is not conducive to blood sugar control.
Reason No. 4: Poor sleep at night
Measures: keep emotionally stable, learn to relax, avoid excessive agitation, and use sedative and sleeping medication if necessary.
Second, the causes of postprandial hyperglycemia and countermeasures
One of the causes: Eating too much, or eating food with high glycemic index
Measures: Dietary control is the basis of diabetes treatment and should be adhered to in all cases, even for patients with medication. Adjustment methods are as follows
① control the amount of food eaten, each meal eat seven or eight minutes full can be (in general, no more than 2 taels).
②To reduce hunger between meals, try to choose staple foods with high dietary fiber content of coarse grains or whole grains, and take “eat less and more meals”.
③ thin rice, sticky porridge “glycemic index” is high, can significantly increase postprandial blood sugar, so diabetics try not to drink or drink less thin rice.
④ Eat less greasy food, because the fatty food contains high calories.
Reason No. 2: Improper medication, or incorrect usage, or insufficient amount of medication
Measures: Reasonable choice of drugs is very crucial to control postprandial blood sugar. Oral hypoglycemic drugs mainly used to reduce postprandial blood glucose can be chosen from glinides (such as Novaluron, Tangli), alpha-glucosidase inhibitors (such as Bactrim, Bexin), glucose suitability, etc., while insulin should be chosen from ultra-short-acting insulin analogues (such as Novaluron, Eugenol) or short-acting insulins (such as Novolin R, Eugenol R). In addition, the drug usage is also important, such as alpha-glucosidase inhibitor requires chewing with the first bite of meal and taking together, Novaluron requires taking immediately before meal, Novolin R requires subcutaneous injection half an hour before meal, and Novaluron requires subcutaneous injection immediately before meal. If the usage is not correct, the efficacy will be greatly reduced. Of course, if the drug selection and usage are no problem and blood sugar is still high, you can increase the amount of drugs or take the combination of drugs as appropriate.
Reason No. 3: Lack of proper exercise after meals
Measures: Appropriate exercise after meals can consume body heat and assist in reducing postprandial hyperglycemia. It is generally recommended to start exercising half an hour after meal, and aerobic exercise form should be chosen (such as jogging, brisk walking, etc.), and the intensity of exercise should not be too great, and the time should be mastered in 30~45 minutes. Note: Do not do intense anaerobic exercise, the latter can stimulate sympathetic excitation, but will raise blood sugar.
The causes and countermeasures of high blood sugar before and after meals
The causes of fasting blood glucose and postprandial blood glucose elevation were talked about before, mainly to facilitate the analysis of the causes. In fact, there are not too many cases of elevated fasting or postprandial blood glucose, and more often than not, both of them are high, or one of them is the main cause of elevation.
Fasting blood glucose and postprandial blood glucose affect each other. Fasting blood glucose reflects the basic blood glucose level, and postprandial blood glucose is a further increase above the basic level; in turn, poor control of postprandial blood glucose will also affect the preprandial blood glucose (or fasting blood glucose) of the next meal and make it increase.
For the treatment of high blood sugar both before and after meal, it is necessary to take both into consideration and prioritize. In addition to diet adjustment and moderate exercise, we advocate the combination of long- and short-acting drugs and combined drugs. Long-acting drugs (such as glimepiride, Damacell extended-release tablets, Novaline N, glargine insulin, etc.) are mainly used to control fasting blood glucose, while short-acting drugs (such as Novaluron, bactrim, Novaline, Novolac, etc.) are mainly used to control postprandial blood glucose.
In addition, it should be noted that stressful situations such as severe infections, high fever and surgical trauma can also cause significant increases in blood glucose, including fasting blood glucose and postprandial blood glucose. Therefore, patients with unsatisfactory blood glucose control must pay attention to exclude infection and other stressful factors, and deal with them in time.