Diabetes mellitus is an endocrine, metabolic disease whose etiology is not yet clear, but is known to be mainly characterized by the common feature of hyperglycemia due to impaired secretion and action of insulin, and its incidence has been increasing year by year in the middle-aged and elderly groups in recent years. Basic research data on diabetes shows that diabetes is a genetically determined systemic chronic metabolic disease, but it is not the diabetes itself that is inherited, but the susceptibility to diabetes, which must be triggered by environmental factors to develop. The main clinical types of diabetes (which are closely related to the choice of treatment measures and prognosis) include insulin-dependent diabetes, also called type 1 diabetes, and non-insulin-dependent diabetes, or type 2 diabetes. Relatively few diabetics have the former (about 5%). This type is an autoimmune disease, and environmental factors that trigger the disease include.
(1) Specific drugs or chemicals.
(2) Certain food components in the diet.
(3) Viruses. Type 2 diabetes is the most common type (about 90%) and is triggered by factors such as obesity, reduced physical activity, and stressful conditions (e.g., infection, surgery).
1. Clinical manifestations
Typical diabetes mellitus is characterized by the symptoms of “three more and one less”, such as excessive drinking, excessive urination, excessive eating and weight loss (or mainly fatigue). Chinese medicine calls diabetes mellitus as thirst disorder. Some patients (especially type 1 patients) may present as ketoacidosis or coma; some patients (especially type 2 patients) may not feel any obvious discomfort and only find increased blood glucose when they have a health checkup.
Long-term diabetes control without attention can cause serious complications, such as cardiovascular disease, diabetic nephropathy, fundus disease, cataract or limb necrosis, peripheral neuropathy, sexual dysfunction, etc.
2.Diagnostic criteria
The new diagnostic criteria of the World Health Organization (WHO) in 1999 are
(1) Fasting blood glucose ≥7.0mmol/L (126mg/dl), measured at least twice.
(2) 2 hours after meal (2H) blood glucose ≥ 11.1 mmol/L (200mg/dl), even if the patient has no symptoms, diabetes can also be diagnosed.
3.Treatment principles
There are 5 basic principles for the treatment of diabetes mellitus, namely
(1) diet control.
(2) physical exercise.
(3) Regular blood glucose measurement.
(4) medication.
(5) receiving education on diabetes prevention and treatment.
Dietary control is the basis for the treatment of all types of diabetes, and clinicians usually calculate the standard of eating for patients according to a simple formula, see the appendix of this book “Principles of Dietary Treatment of Diabetes”.
Medications are divided into two categories: oral medications and injectable insulin therapy. Oral hypoglycemic drugs can be classified into two simplified categories, namely, oral hypoglycemic drugs that directly depend on the function of pancreatic beta cells. Among them, the first group of drugs refers to all insulin-producing agents, including the commonly used euglycemics, damacell (glipizide), mepyridamole (glipizide), glucophage, glimepiride, and nandrolone (regeneron and nateglinide). The second group of drugs includes the biguanide class of glucagon and gevalt (metformin), the alpha-glucokinase receptor blockers bactrim and bexin, and the thiazolidinedione class of specific insulin sensitizers such as vindia (rosiglitazone).
The selection of oral hypoglycemic drugs should pay attention to the following principles.
(i) Liver and kidney function and insulin and peptide levels need to be measured first.
②The medication should be started with small doses and single flavored drugs, and the dosage or variety of drugs should be increased according to the change of blood sugar.
③Glucose-lowering drugs with similar effects should not be used overlappingly.
④The amount of each drug should not exceed 6 tablets per day.
⑤ When oral medications are not satisfactory for blood sugar control or produce side effects, injectable insulin should be used instead.
Indications for insulin.
Broadly speaking, insulin therapy should be taken in the following cases.
(i) Those who belong to type 1 diabetes mellitus.
②those who use sulfonylurea oral hypoglycemic drugs with poor results
③When accompanied by infection, surgery, trauma, etc.
④Patients with recurrent ketoacidosis
⑤ those with concomitant liver and kidney function impairment
(6) Those who are allergic to oral hypoglycemic drugs.
However, regardless of whether insulin or hypoglycemic drugs are used, they should be used according to medical advice and not at will, because the most fatal complication of these drugs is hypoglycemic reaction. When the blood sugar falls below 3mmol/L, it will seriously affect the uptake and use of energy by the brain’s nerve tissue, causing nerve cell damage and abnormal function, resulting in coma and even death. Common hypoglycemic reactions include dizziness, sweating, panic, general weakness, blackness in front of the eyes, etc. Do not panic when you encounter this situation, and look for a little sugar cube or sugar water as soon as possible to relieve it. If hypoglycemic reactions occur frequently during taking the medicine, it means that there is something wrong with the dose of the medicine, and it is time to ask the physician to adjust it.