Diabetes mellitus is a lifelong disease caused by the interaction of genetic and environmental factors in a group of abnormal metabolic syndromes with chronic hyperglycemia as a common feature. As the disease progresses, multi-system damage can occur leading to chronic progressive lesions of the eye, kidney, nerves, heart, blood vessels and other tissues, causing functional defects or even failure. Acute metabolic disorders such as ketoacidosis and hyperosmolar coma can occur in severe illness or stress, threatening life.
With the change of people’s living standard and lifestyle, the number of diabetic patients is increasing, for type 2 diabetes early through diet therapy and exercise therapy can maintain the stability of blood sugar, appropriate treatment and diet behavior habits, can reduce the disease, control the development of the disease, how to improve the self-monitoring and care prevention ability of diabetic patients, health education is extremely necessary and important, good health education can Good health education can fully mobilize the patient’s initiative, improve the patient’s quality of life, reduce the economic burden, and facilitate disease treatment and control.
The example of Zhou, a patient in bed 24 of the endocrinology department, is used for illustration. Zhou was diagnosed as type 2 diabetes mellitus and was hospitalized with “three more and one less” and poor glycemic control. The following health education and guidance were mainly done after admission.
Psychological care.
The patient in this bed had anxiety after admission. We should fully understand and analyze the reasons: on the one hand, he was not adapted to the hospital environment and rules and regulations after admission; on the other hand, he did not have a deep understanding of the disease and thought that diabetes was a lifelong disease that could not be cured, which was equivalent to suffering from an incurable disease, so he had negative pessimism, and then he felt pressure about the economic burden brought by long-term treatment.
In response to the patient’s situation, we firstly took the initiative to introduce the department and ward bed unit to the patient, introduced the attending physician and bed nurse, maintained a warm and amiable attitude, strengthened the admission education, made the patient familiar with the ward environment as soon as possible, reduced the sense of unfamiliarity, explained the significance of the rules and regulations to the patient’s disease recovery and safety, and explained the treatment process and methods to the patient;
Before each nursing operation, the purpose of the operation should be introduced, and the name of the drug should be explained when intravenous infusion, intramuscular injection or oral medication is given, so that the patient can understand the whole treatment situation and reduce the patient’s psychological resistance; secondly, the patient’s knowledge related to the disease should be educated at a fixed time every week to correct the patient’s misconceptions about diabetes, make it clear that diabetes is not an incurable disease, but can be predicted and treated, and provide timely feedback on the effect of treatment and recovery to Relieve their mental pressure, overcome psychological imbalance, build up confidence to overcome the disease, and actively cooperate with treatment and care to achieve the best results.
Promote communication between patients; teach patients and family members to master self-testing and care methods, emphasize the important role of diet and exercise in the treatment process, encourage patients to go outdoors and breathe fresh air, and encourage family members to give psychological support and understanding, while achieving the purpose of cooperating with treatment.
Diet management.
Diabetic diet is implemented to control blood sugar and balance nutrition. Diabetic diet follows the basic principles of “equal calorie exchange” and “two high and two low”, i.e. high protein, high fiber, high vitamin, low sugar and low fat. According to the patient’s condition, blood sugar, age, height, weight and labor intensity, we calculated and formulated the total daily calorie intake and the proportion of dietary structure for the patient.
①2100kcal per day, strictly limit sweet food, of which carbohydrates account for 55% of the total calories and are an important source of energy for the body, mainly noodles, steamed buns and rice, the total daily staple food should not exceed six taels (300g), distributed by 1/5,2/5,2/5, dry and wet, and advocate the consumption of coarse rice and noodles and a certain amount of mixed grains to enrich dietary fiber and vitamins and increase satiety Feelings;
②Protein accounts for about 15%, advocate refined protein, such as lean meat, fish and shrimp, eggs, soy products, etc;
③Fat accounts for 30% of total calories, of which the ratio of saturated fat, polyunsaturated fat and monounsaturated fat is 1:1:1, supplemented with vegetable oil and nuts, and less cholesterol-containing foods such as animal offal, egg yolk and fish and shrimp;
④ Eat more foods with high fiber content such as beans, vegetables, coarse grains, and fruits with low sugar content, which are good for smooth bowel movement, satiety, weight control, and delay and reduce the absorption of sugar in the gastrointestinal tract.
⑤ Encourage the consumption of various vegetables, especially green vegetables. For fruits, when the patient’s blood sugar is stable and fasting blood sugar concentration does not exceed 8mmol/L, he can eat pears, oranges, apples and other fruits with low sugar content between meals or before going to bed, and control them within four taels (200g) per day, without eating fruits with high sugar content such as dates, sugar cane, dried fruits and bananas, etc. Eating fruits are to be exchanged with staple foods for equal calories, and only one unit of fruits should be subtracted accordingly from one exchange A unit of fruit should be subtracted from a unit of staple food.
Exercise: appropriate exercise for diabetic patients is beneficial to the utilization of glucose, lower blood sugar, and can make patients feel comfortable and reduce stress and tension. Exercise principles: moderate, regular, individualized. Exercise aerobic exercise, walking jogging cycling radio exercise, tai chi are suitable for daily exercise, once a day, 20-30 minutes each time. During hospitalization, patients can choose to walk after 60-90 minutes after meals, more convenient and easy to operate.
When exercising, we need to pay attention to
① Before exercising, you need to assess your body and condition. You should not exercise when your blood glucose is higher than 14mmol/L, you should not exercise when you are fasting, and you should not eat after exercising after taking hypoglycemic drugs or injecting insulin to prevent hypoglycemia.
②Prevent accidents, it is advisable to exercise at a distance accompanied by family members, pay attention to hydration, carry candy with you, and even eat to relieve symptoms of hypoglycemia such as hunger, panic, cold sweat, dizziness, weakness of limbs and trembling when they occur. If discomfort occurs during exercise, exercise should be suspended; if chest pain and blurred vision occur, stop immediately and deal with it promptly.
Medication guidance.
1, the correct use of hypoglycemic drugs
For the control of blood sugar in diabetic patients, diabetes treatment, safety are important. Clinically used hypoglycemic drugs are divided into pro-insulin secretagogues (sulfonylureas and non-sulfonylureas), drugs to increase insulin sensitivity (biguanides), glucosidase inhibitors, etc.. Sulfonylureas such as glibenclamide are taken orally half an hour before breakfast and are prone to hypoglycemia and gastrointestinal reactions; biguanides such as metformin are prone to produce a metallic taste in the mouth, nausea, vomiting, and are taken during or after meals;
Alpha glucosidase inhibitors such as acarbose should be taken with the first meal. The dose of the drug should be adapted to the state of blood sugar control, and patients should not increase or decrease the dose, stop the drug, or change the drug at will. Adverse reactions during medication should be promptly notified to the doctor.
2.Insulin use care
①Patients should have a subcutaneous insulin infusion pump (bolus) installed to maintain the normal basal amount and additional amount before meals. MRI and other examinations should not be done in the mounted state.
②Patients need to inject their own insulin to control blood sugar and intensify treatment after discharge.
It is especially important to standardize insulin injection.
①Familiar with the name, dosage form, dose and duration of commonly used insulin.
②Storage of insulin, unopened in the refrigerator, 4-8℃; after opening, it can be stored at room temperature (below 28℃) for 28 days, avoiding overheating, overcooling and direct sunlight.
③Selection of injection site: subcutaneous injection, loose skin parts, absorption from fast to slow in order of abdomen, outer upper arm, outer thigh, buttocks. Rotate the sites frequently and do not inject more than 2 times within 75px in the same area within two weeks to prevent skin hardening and fat atrophy.
④Aseptic operation should be strictly observed during injection to prevent infection.
⑤ Thin skin areas should be injected by pinching up the skin, and abdominal injection should avoid the umbilicus, near the three horizontal fingers around the umbilicus.
⑥The needle should stay in the skin for more than 15 seconds after pushing the solution.
(7) The dose and time should not be adjusted arbitrarily, and food should be eaten within thirty minutes after the injection.
⑧Notify the doctor promptly if discomfort or allergy occurs during the injection.
Diabetes-related knowledge.
1.Diabetes diagnosis criteria: typical symptoms of diabetes mellitus (polydipsia, polyphagia, polyuria, unexplained weight loss) plus random blood glucose ≥ 11.1mmol/L or fasting blood glucose ≥ 7.0mmol/L or blood glucose ≥ 11.1mmol/L 2 hours after 75g glucose load.
2, diabetes complication prevention guidance: the development of diabetes will cause multi-organ lesions, and accompanied by a variety of acute chronic complications.
①Acute complications include hypoglycemic reaction, ketoacidosis, hyperosmolar coma, etc., which have rapid onset and high risk and can be life-threatening. Type 2 diabetic patients are prone to ketoacidosis under stressful conditions, which is caused by hyperglycemia, hyperketosis, ketonuria, dehydration, electrolyte disorders, and metabolic acidosis due to significant insulin deficiency.
The main symptoms are irritable thirst, excessive drinking, polyuria, increased nocturia, weight loss, fatigue, blurred vision, deep breathing, abdominal pain, nausea, vomiting, etc. Hyperosmolar coma is a serious complication with rapid increase in blood sugar, irritable thirst, dry skin, sunken eyes, low urine, closed urine, rapid heartbeat, low blood pressure and even shock, with varying degrees of impaired consciousness, coma and other symptoms. Once ketoacidosis or hyperosmolarity occurs, you must immediately go to the hospital to receive active treatment.
Chronic complications of diabetic foot is a combination of diabetic factors leading to neurovascular disease causing foot pain, deep skin ulcers and gangrene of the extremity, which is one of the main causes of disability and death in diabetic patients. Due to neuropathy, the skin of the affected limb is dry and sweatless, sensation is delayed or lost, deformities develop, peripheral vasculopathy occurs, the dorsalis pedis artery pulsation disappears, the skin temperature of the foot drops, resting with pain, intermittent claudication, ischemic resting pain, and eventually ulceration and gangrene.
In life, we should learn self-observation and care, actively control blood sugar, quit smoking, observe the foot skin color, temperature and humidity and the presence of skin lesions, edema, pain and abnormal sensation every day, massage and clean the foot and calf diligently, choose suitable shoes and socks, and avoid foot trauma.
Discharge guidance.
1, maintain a good mood, take the initiative to participate in interpersonal communication, cultivate hobbies and interests, maintain a happy mood, live a regular life, pay attention to personal hygiene, family members should cooperate with the patient’s treatment and self-healing, encourage and help patients to develop healthy habits of life and behavior.
2.To make patients and family members realize the importance of diet control in daily life, consciously comply with the treatment diet requirements after discharge, limit the intake of salt, fat and sugar, supplement with appropriate amount of protein, eat more vegetables, limit alcohol consumption (no more than one or two per day), and prohibit smoking.
3.Make exercise plan, adhere to exercise 20-30 minutes a day, gradually, in order not to fatigue.
4.Follow the doctor’s prescription, pay attention to the dosage, usage, time and efficacy of the medication, do not change the dosage or stop the medication on your own, review regularly to understand the condition control and adjust the medication in a timely manner. If there is any discomfort, consult the doctor in time, and inject insulin correctly and regularly.
5.Prevent complications Patients and family members are familiar with the main clinical manifestations, observation methods and management measures of acute diabetic complications, such as hypoglycemic reaction, ketoacidosis and hyperosmolar coma, and master the knowledge of preventive care of chronic complications of diabetic foot.
6. Regular follow-up, regular monitoring of blood glucose and lipids, weight measurement every 1-3 months, regular outpatient review every 3-6 months, and annual whole-body physical examination to keep abreast of changes in the condition and prevent the development of chronic complications.