1.What is diabetes?
The blood of a normal person contains a certain concentration of glucose, referred to as blood sugar, which is the main source of energy that provides people’s activities. When eating, the concentration of glucose in the blood rises. Under the action of insulin, the glucose in the blood enters into the cells, so that the concentration of glucose in the blood decreases and maintains it within a normal range. At the same time, the glucose that enters the cells undergoes a series of biochemical reactions to provide energy for people’s activities. Diabetes is a metabolic disease caused by the lack of insulin in the body or the inability of insulin to function effectively, which manifests itself as an increase in blood glucose concentration and diabetes.
The cause of diabetes is complex, but ultimately it is due to absolute or relative insulin deficiency or insulin resistance. Therefore, problems in any of the three steps – insulin production by B cells, insulin transport by the circulatory system, and insulin receipt and physiological effects by target cells – can cause diabetes.
The predisposing factors for diabetes are: infection, obesity, reduced physical activity, pregnancy and environmental factors.
2. Classification of diabetes mellitus
The causes of type 1 and type 2 diabetes are not completely clear, so we call them primary diabetes; other types of diabetes have special causes, such as impaired insulin synthesis caused by pancreatic diseases, or taking drugs that can raise blood glucose, or other endocrine causes. Gestational diabetes is a specific type of diabetes that is diagnosed during pregnancy.
3.Symptoms of diabetes mellitus
The symptoms of diabetes are varied at the beginning of the disease. It can have typical symptoms, or no symptoms, or symptoms that occur as a result of complications of diabetes, or diabetes that is discovered as a result of diagnosis and treatment of other diseases.
(1) The typical symptoms are fatigue, lethargy, increased urination, thirst, increased water intake, easy hunger, increased meal intake, but weight loss. In short, the symptoms are polyuria, polyphagia, polyphagia and weight loss, i.e. “three more and one less”.
(2) Those who are asymptomatic at the beginning of the disease are mostly non-insulin-dependent diabetics. The high blood glucose is often found during health checkups, and it is difficult to determine when the high blood glucose started.
(3) Some patients have sought medical attention for the development of diabetic complications and were only found to have diabetes upon examination. For example, a patient goes to the ophthalmology department for blurred vision, and a fundus examination reveals diabetic retinopathy, and then a blood glucose test confirms diabetes mellitus, which was already present at that time. Patients who visited internal medicine for anemia and swelling were examined and found to have diabetic nephropathy before treatment for diabetes was started. A female patient who sought treatment in gynecology for itchy vulva was examined and found to have diabetes, and her itchy vulva was caused by more urinary sugar.
(4) In acute myocardial infarction, cerebrovascular accident and other stressful conditions, temporary hyperglycemia can occur, not always with diabetes, and regular rechecking of blood glucose can determine whether one has diabetes. Not diabetes, then hyperglycemia will not persist.
4.Complications of diabetes
Diabetes itself does not affect the life expectancy of the patient. What really leads to fatal and disabling diseases are the complications of diabetes. Complications of diabetes include the following.
(1) Acute complications.
(1) Hypoglycemic coma.
(2) Hyperglycemic coma (ketoacidosis, non-ketotic hyperosmolar coma);
(3) Lactic acidosis.
(2) Chronic complications
①Vascular lesions, whether small, medium or large arteries, veins, capillaries can be involved, is the pathological basis of chronic complications. There are 40-80% of diabetic patients with hypertension. Atherosclerosis can involve all parts of the body, and the involvement of both lower limbs is called occlusive atherosclerosis. Diabetic foot-extremity jaundice is a serious vascular complication.
(ii) Cardiac lesions; there can be coronary heart disease, diabetic cardiomyopathy, hypertensive heart disease, microangiopathy and arrhythmia due to plant nerve dysfunction.
③Brain lesions; there can be subarachnoid hemorrhage, cerebral hemorrhage, cerebral thrombosis.
④Nephropathy: mainly diabetic glomerulosclerosis, hyperalgesia, pyelonephritis, etc.
⑤ Ocular lesions: 50% of blindness is related to diabetes. Retinopathy, cataract, glaucoma, refractive changes, and regulatory paralysis have a prevalence of 58%.
(vi) Neuropathy: It can involve any part of the nervous system, brain, spinal cord, vegetative nerves and peripheral neuropathy. Peripheral neuropathy is the most common, followed by paraplegia, urinary retention, hypohidrosis, nocturnal sweating, impotence, etc.
(7) Other: skin and muscle lesions, bone and joint lesions, oral cavity, ear and other lesions. Kidney: proteinuria, infection, renal failure, etc.
5.Diabetes diagnosis
(1) Patients with clear diabetic symptoms, such as: polyuria, polydipsia, polyphagia and rapid weight loss, and any time or fasting (at least 8~10 hours empty) blood sugar can be diagnosed as diabetes.
(2) If there are no clear symptoms, but fasting blood glucose, at least twice, can diagnose diabetes. Those with fasting blood glucose should do 75g oral glucose tolerance test. 75g oral glucose tolerance test for 2 hours blood glucose can diagnose diabetes.
(3) Impairment of fasting glucose (IFG): fasting glucose, at least twice, and 75 g oral glucose tolerance test 2 hours glucose.
(4) Impaired glucose tolerance (IGT): fasting blood glucose, 75 grams of oral glucose tolerance test 2 hours blood glucose ≥ 7, 8 but < 11.
6.Treatment of diabetes mellitus
(1) The goal of diabetes treatment.
To effectively treat diabetes, it is necessary to first clarify the goals of diabetes treatment, so as to choose the correct treatment method and achieve the desired therapeutic effect. The goals of diabetes treatment are mainly the following.
① Correct metabolic disorders such as hyperglycemia and hyperlipidemia, and promote normal metabolism of sugar, protein and fat.
② Relieve the symptoms caused by metabolic disorders such as hyperglycemia.
③Prevent acute complications such as ketoacidosis and prevent chronic pathologies such as cardiovascular, renal, eye and nervous system, prolong the life span of patients and reduce the morbidity and mortality rate.
④Obese people should actively lose weight to maintain normal weight, ensure normal growth and development of children and adolescents, ensure smooth delivery of pregnant women with diabetes and mothers with diabetes during pregnancy, maintain normal labor force of adults, and improve the quality of survival of elderly patients with diabetes.
(2) Diet therapy
Dietary control is very important to the treatment of diabetes. Patients with mild disease can completely rely on diet control to bring blood glucose levels up to standard. The level of blood glucose is closely related to the amount and type of food intake due to insulin secretion, so diet therapy is the basis of treatment for all types of diabetes. Regardless of the type of diabetes, the severity of the disease or the presence of complications, and the type of medication used, diet control should be strictly carried out and adhered to for a long time.
Prior to the 1950s, both Chinese and foreign treatment programs were based on a low-carbohydrate, high-fat, high-protein diet. According to clinical practice, this diet structure is not beneficial to the islet function of diabetic patients, while a high-fat diet can aggravate the vascular disease of diabetic patients, and a high-protein diet can increase the incidence of diabetic nephropathy. Currently, a diet structure with high carbohydrate amount, reduced fat ratio and controlled protein intake is advocated, which has a better effect on improving blood glucose tolerance. The specific elements of dietary therapy are as follows.
①Diet at regular intervals
The total daily calorie requirement is estimated according to age, sex, occupation and standard weight [(length – 100) × 0,9]. The daily calorie requirement for men is about 5% higher than that for women. The number of kilocalories required per kilogram of body weight generally varies from adolescents > middle-aged > elderly > with an average of 5-10% higher per kilogram of body weight per day. The daily energy consumption of different manual workers is also different. Light manual workers consume 30~35kcal per kilogram of body weight per day; medium manual workers consume 35~40kcal per kilogram of body weight per day; heavy manual workers need more than 40kcal per kilogram of body weight per day. Generally speaking, pregnant women, lactating mothers, malnourished people and people with wasting diseases should increase as appropriate, and obese people should reduce as appropriate, so that the patient’s weight can be kept at about 5% of normal weight, and the condition can often be satisfactorily controlled.
②Reasonable adjustment of the ratio of the three major nutrients
The ratio of sugar, fat and protein in the diet should be reasonably arranged and adjusted. Not only to achieve the purpose of treating the disease, but also to meet the physiological needs of the human body. At present, the American Diabetes Association (ADA) advocates that: carbohydrates in the diet of diabetic patients should account for 55%~60% of the total calories; protein intake should not exceed 15% of the total daily calories. A daily intake of 0.8~1.2g per kg of body weight is appropriate. The daily fat intake should not exceed 30% of the total calories, and 0.6~1g per kg of body weight per day is preferable. For obese patients, especially those with high blood lipids or arteriosclerosis, the fat intake should be adjusted according to specific conditions.
③ Diet calculation and calorie calculation
There are three kinds of nutrients that supply the body with heat energy: protein, fat and carbohydrate. Among them, carbohydrates and proteins can supply 4kcal (1kcal=4,184kj) per gram, and fats supply 9kcal (37,74kj) per gram. Diabetic patients can allocate the total calories (kcal) needed per person per day according to their labor intensity in the proportion of 69% for carbohydrates, 15% for proteins and 25% for fats to find out the caloric energy supplied by various components, and then convert the weight needed to supply different nutrients to the patient according to 9kcal per gram of fat and 4kcal per gram of carbohydrates and proteins, which can be used for three meals a day or Four meals a day. For example, for an adult diabetic patient with a normal body type and a medium working weight of 60kg, the total calories are 2400kcal per day based on 40kcal per kilogram of body weight, which is distributed in the above proportion, i.e. 1440kcal. Calories come from carbohydrates, 360kcal from proteins and 600kcal from fats. To provide these calories, 360g of carbohydrate, 90g of protein and 66g of fat should be supplied.
We emphasize that the method of calorie control through diet does not require diabetic patients to calculate mechanically every day, but should, after mastering this calculation method, calculate every time or when there is a substantial change in weight, and formulate the next stage of diet plan, while eating less sweets, greasy foods, and choosing diet both in principle but striving for variety.
(3) Exercise therapy
In the treatment of diabetes, exercise therapy is an important component, especially for elderly patients, obese patients more important. Some patients with mild diabetes can recover by simply adhering to physical exercise and combining it with dietary control.
①Swimming exercise method
Swimming exercise should be controlled scientifically. There are various ways to master the exercise volume of swimming exercise, but for ordinary swimmers, the easiest way to measure the size of the exercise volume is according to the change of the swimmer’s pulse. Normal people in China quiet pulse rate of 60-80 times per minute. People who often participate in swimming exercise, quiet pulse rate is slower, 50-60 times per minute; exercise people, the pulse rate is also lower. For ordinary swimmers, after each swim, the pulse rate reaches 120-140 times per minute, the exercise volume is large exercise volume; pulse rate of 90-110 times per minute, the exercise volume; after swimming exercise, the pulse rate does not change much, the increase in the number of times within 10, is small exercise volume.
When choosing the amount of exercise for swimming exercise, it should be different from person to person, according to the ability. Ordinary swimmers, even the young and strong, the weekly exercise of large volume, should not exceed 2 times; and middle-aged people are appropriate to the medium amount of exercise, do not or less exercise too much swimming exercise; the elderly is most suitable for small and medium small amount of exercise swimming exercise.
②Jogging exercise method
Running is a convenient and flexible exercise method, suitable for young and old, has increasingly become one of the means of people’s fitness and disease prevention. Fitness running should be strictly control the amount of exercise. Begin to practice running frail people can be short distance jogging, starting from 50 meters, gradually increased to 100 meters, 150 meters, 200 meters. The speed is generally 100 meters / 30 seconds – l00 meters / 40 seconds.
Slow long run: is a typical fitness run, the distance starts from 1000 meters. After adaptation, increase 1000 meters per week or every 2 weeks, generally can be increased to 3000-6000 meters, the speed can be mastered in 6-8 minutes to run 1000 meters.
Run line exercise: run for 30 seconds, walk for 60 seconds to reduce the burden on the heart, so repeatedly run line 20-30 times, the total time of 30-45 minutes. This kind of running exercise is suitable for those with poor cardiorespiratory function.
The number of times you run: short distance jogging and running exercises can be done once a day or once every other day; older people can run once every 2-3 days for 20-30 minutes each time.
The best footsteps to run with their own breathing, can run two or three steps forward to breathe in, and then run two or three steps after exhaling. When running, it is more comfortable to swing your arms back and forth and slightly outward, lean your upper body forward and try to relax your whole body muscles, generally with your toes on the ground. Running should be avoided immediately after meals, or in very cold, hot, humid and windy weather, preferably in the morning, can do exercises first and then run, before going to bed generally should not run.
③ Walking exercise method
Ordinary walking method: walk at a slow speed (60-70 steps / min) or medium speed (80-90 steps / min), 30-60 minutes each time, can be used for general health care.
Rapid walking method: walking 5000-7000 meters per hour, 30-60 minutes per exercise, used for general middle-aged and elderly people to enhance heart strength and reduce weight, the maximum heart rate should be controlled below 120 beats/minute.
Quantitative walking method (also known as medical walking): walk 100 meters on a 30-degree slope, and then gradually increase to 2000 meters on a 50-degree slope, or walk along a 30-degree – 50-degree slope for 15 minutes, followed by a 15-minute walk on flat ground. This method is suitable for patients with diabetes, chronic diseases of the cardiovascular system and obesity.
(4) Medication
For those patients with more severe disease, exercise alone and diet may not control the disease. This is when medication is needed in combination. The following is a description of some commonly used medications. Patients are advised to use them under the guidance of their doctors.
Sulfonylureas: One of the earliest oral hypoglycemic drugs used, now in its third generation, is still the first-line drug for type 2 diabetes in clinical practice. It mainly works by stimulating insulin secretion. It is recommended to take the drug half an hour before meal.
Biguanide: the oldest of oral hypoglycemic drugs. Glucose-lowering effect is sure, with cardiovascular protective effects other than glucose-lowering effect, such as lipid regulation and antiplatelet agglutination, but it is not recommended for patients with severe cardiac, hepatic, pulmonary and renal dysfunction. To alleviate the gastrointestinal side effects of biguanides, it is generally recommended to be taken after meals.
Glycosidase inhibitors: By inhibiting glycosidase on the surface of the epithelial cells of the small intestine mucosa, it delays the absorption of carbohydrates (like artificially causing “eating less and more”), thus lowering postprandial blood sugar. It should be taken immediately before a meal or with the first bite, and the meal must contain a certain amount of carbohydrates to be effective.
Thiazolidinedione: The newest oral hypoglycemic agent to date. It is an insulin sensitizer that lowers blood glucose by increasing the sensitivity of peripheral tissues to insulin, improving insulin resistance, and improving various cardiovascular risk factors associated with insulin hypo-resistance. During the application of these drugs, close attention should be paid to liver function.
Methylmethylaminobenzoic acid derivatives: Non-sulfonylurea insulin secretagogue developed in recent years, with fast onset of action and short duration of action, and effective and good effect on postprandial blood glucose, so it is also called mealtime blood glucose regulator. Take it before meal.
Insulin.
①Insulin-dependent diabetes mellitus requires continuous insulin therapy regardless of the presence or absence of ketoacidosis.
②If ketoacidosis occurs in non-insulin-dependent diabetic patients due to stress, infection, trauma, surgery, acute myocardial infarction, etc., temporary treatment with insulin is recommended until the stress reaction is eliminated and the condition improves, then it can be discontinued as appropriate.
③Patients with diabetes mellitus in pregnancy or gestational diabetes mellitus.
④Diabetic patients with vascular lesions, such as retinopathy, nephropathy or with neuropathy, cirrhosis of the liver, gangrene of the lower limbs, etc. should be treated with insulin.
⑤ Diabetic patients with significant weight loss, malnutrition and growth retardation should be treated with insulin; if accompanied by long-term wasting diseases such as tuberculosis, they should be treated with anti-TB.
(6) Secondary diabetes mellitus such as pituitary diabetes mellitus and pancreatogenic diabetes mellitus should be treated with insulin.
(7) Diabetes mellitus with hyperosmolar coma or lactic acidosis patients.
(8) Diabetic patients, who are not satisfactorily controlled by diet control and oral hypoglycemic drug treatment, can be treated with insulin.
(5) The control standard of blood sugar
How to control diabetes well? You can refer to the following table. Blood glucose control should be carried out under the guidance of clinicians, and the specific control index varies from person to person, so do not follow the chart.