The wards not only provide the necessary space for patients to receive treatment, but also facilitate socialization. With beds close to each other and some sharing a large bedside table, it only takes a very short time for new patients to get acquainted with the left and right clinics, and once they do, they are like old neighbors who have been there for decades, chatting about everything. The conversation covers a wide range of topics, from national events to pots and pans, but the words that appear most frequently in the conversation are, of course, doctors and medications. “I heard that which which doctor is very good, that who is cured by him. When you go to his number again someday to see, a hang can get.” “You say that several beds how so young to get such a disease, what can be done in the future ah?” “The doctor prescribed me this medicine is very good, blood sugar really lowered a lot, what is the name of this medicine, you wait for me to find the medicine box to show you.” When patients get together, they always like to ask each other what medicine they are using. Sometimes two people’s blood sugar situation is obviously similar, but the doctor prescribed a completely different medicine, why is this? The doctor usually prescribes medication to the patient based on what does not like to move Ms. Wang bed Ms. Wang likes to stay in the ward, not that she does not like to go out and walk with others, but she is particularly afraid of heat. Although it’s already autumn weather, Ms. Wang just went downstairs to see off her daughter who came to visit her and was all sweaty. Ms. Wang said that when she was young she was not afraid of heat, it is after retirement began to fat up, can not walk two steps on a sweat. And because it is too fat, more and more feel that when walking knees can not be strong. A few days ago, Ms. Wang because of poor blood sugar control, fasting blood sugar (11.3mmol/L) is too high from the clinic directly to the hospital, is currently taking the doctor prescribed metformin. After a few days of hospitalization, Ms. Wang’s blood sugar did come down, and the doctor told Ms. Wang that she would lose weight during a period of persistent treatment. Expert comment Metformin as a first-line clinical drugs, widely used in Europe and the United States and other countries, but not all patients in China are suitable for use. Metformin can inhibit the release of glycogen from the liver, reduce insulin resistance in the liver, and has a good effect on controlling fasting blood sugar. And after taking metformin, patients will lose weight, so it is very suitable for patients with high fasting blood sugar and obese body shape. ”Longevity” of Master Li Li is more than 40 years old, compared with those gray-haired old comrades in the ward, he can only be considered a “young”, but everyone loves to joke about him called “longevity “. Why “young” will be associated with longevity? Because Master Li is tall, but his body is not two meat, looks long and thin, so everyone called him “long and thin”, a long time into the “long life”. Master Li just stepped into the circle of diabetes for a few days, he was found to be suffering from diabetes during a medical checkup last month. Like Ms. Wang in front, Master Li is also fasting high blood sugar, but after hospitalization, doctors have been using sulfonylureas to treat him. After a period of treatment, Master Li’s blood sugar has not only stabilized some, his face is also a little meat. Expert commentary Sulfonylurea drugs control fasting blood glucose well, but the control of postprandial blood glucose is more general. Sulfonylureas control blood sugar by stimulating insulin release from pancreatic B cells, so patients receiving treatment must have a certain amount of pancreatic function. New patients like Master Li, whose pancreatic islet function is not severely damaged, can be treated with sulfonylureas. And sulfonylureas have the effect of weight gain, so the “long and thin” Master Li is more suitable for sulfonylurea treatment than the immobile Ms. Wang, who would otherwise be more immobile. It is also worth mentioning that many patients have heard that taking sulfonylureas can lead to hypoglycemia, mainly because of inappropriate dosage and not strictly following the contraindications. At present, the clinical application of extended-release tablets of sulfonylureas is long-lasting and calm, which effectively reduces the incidence of hypoglycemia. Therefore, we should not waste food because of choking, as long as they are used correctly, sulfonylureas can achieve good therapeutic effects. For newly diagnosed elderly type 2 diabetic patients with mainly elevated postprandial glucose, non-sulfonylurea pro-secretory agents can be used clinically. Non-sulfonylurea agonists promote insulin secretion mainly by closing the ATP-dependent potassium channels on the pancreatic B-cell membrane, and non-sulfonylurea agonists are more selective to the potassium channels on the pancreatic B-cells, thus their specificity is higher. The data obtained from clinical application of non-sulfonylurea pro-secretory agent, Repaglinide (benzoic acid derivative), showed that its ability to specifically promote early-phase insulin secretion allowed it to better coordinate the peak insulin secretion with the peak postprandial glucose rise. With similar glycemic control, the incidence of severe hypoglycemia was 60% lower in the group treated with Repaglinide than in the group treated with sulfonylurea. In addition, it has been shown that Repaglinide does not increase the risk of cardiovascular death. The girl’s heart of the grandmother Liu white hair grandmother is the South, not tall, hair in a bun, usually talk to everyone’s voice soft, whether it is after eating or drinking water, she will take out a small flower handkerchief to wipe her mouth, everyone likes her very much. However, when she talks to people, she sometimes suddenly runs to the toilet, and when she comes out, her cheeks are red. When people asked her what was wrong, she just said that her stomach was not feeling well lately and that she might have eaten something bad. Grandma Liu is old, her liver and kidney function is declining, and her postprandial blood sugar is not well controlled, so she was just admitted to the hospital a few days ago. The doctor gave her acarbose according to her condition, and her symptoms were relieved. The doctor said that acarbose is a common intestinal reaction, which can increase gas (easier to fart) and can also cause abdominal pain and diarrhea, and asked Grandma Liu to keep an eye on it. Now we know that this is the reason. However, every time Grandma Liu’s cheeks are red, just like a shy girl, so even though we all know it, we don’t point it out and just pretend that nothing happened. Expert review Acarbose is an alpha-glucosidase inhibitor, which competitively inhibits glucoside hydrolase in the intestinal tract, reducing the breakdown of polysaccharides and sucrose into glucose, slowing down the absorption of sugar, and therefore having the effect of lowering postprandial blood sugar. However, because of this, the absorption of sugar in the small intestine is slowed down, the residence time is prolonged, and the gas production by intestinal bacterial decomposition is increased, which may cause abdominal distension, abdominal pain and diarrhea, etc. When taking acarbose, start with a small dose and gradually increase the amount. Acarbose is mainly degraded in the intestinal tract or excreted in its original form with the feces, and is not metabolized by the liver and kidneys, and hardly enters the blood circulation, so it has almost no effect on the liver and kidneys. It is ideal for patients with weakened liver and kidney function and high postprandial blood sugar like Grandma Liu. But if pharmaceutical manufacturers can take into account the suffering of shy patients like Grandma Liu, and in the future develop a dosage form that can relieve the symptoms of exhaustion, I believe it will be welcomed by more patients.