How to treat diabetes?
Long-term adherence to standardized treatment is the most important, including: control of diet, adhere to the appropriate amount of exercise and exercise, reasonable use of drugs.
First, the control of diet is especially important for diabetic patients, which can reduce weight, improve metabolic disorders such as blood sugar and blood lipid, and reduce the dose of hypoglycemic drugs.
(1) Calculate total calories Check the table or simple formula to obtain ideal weight according to gender, age and height (ideal weight kg=height cm-105), and then calculate total calories according to ideal weight and work nature, with reference to original living habits, etc. Adults at rest should be given 25-30kcal per kilogram of ideal body weight per day, with appropriate adjustment according to the degree of physical work. Pregnant women, lactating mothers, children, malnourished people with diabetes examination or those with wasting diseases should increase as appropriate. The recovery weight of obese people should be reduced as appropriate, and the recovery weight should be reduced as appropriate.
(2) Nutrient content Sugar accounts for about 50-60% of the total calories, advocating the use of coarse grains, noodles and a certain amount of mixed grains, avoiding glucose, sucrose, honey and their products. Protein content generally does not exceed 15%, with renal insufficiency, protein intake is reduced (according to medical advice), fat about 30%, control cholesterol intake, not more than 300mg/day.
(3) Reasonable distribution Each gram of sugar and protein (4kcal), each gram of fat (9kcal), after converting the calories into food to develop recipes, and arrange them according to the living habits, disease and medication. The amount of food in the morning, midday and evening can be distributed according to 1:2:2, or 1:1:1.
(4) Follow-up The above is only the principle estimation, obese people should further reduce their diet if their weight does not decrease under the premise of appropriate measures; lean patients whose weight increases, their diet plan should also be adjusted to avoid continued weight gain.
Second, physical exercise is as important as diet control and drug therapy.
Moderate physical exercise can reduce body weight and improve insulin sensitivity (i.e., insulin can lower more blood sugar per unit amount). Patients with cardiac and cerebral system diseases or severe microvascular lesions should arrange exercise according to the situation.
Third, drug treatment
1. Commonly used oral drugs include: insulin secretagogues, biguanides, α-glucosidase inhibitors, glitazones, etc.
(1)Pro-insulin secretagogues
Sulfonylureas (glibenclamide, glipizide, gliclazide, glipizide, glimepiride)
Non-sulfonylurea pro-insulin secretagogues: Repaglinide, nateglinide
(2)Biguanides Metformin, Phenelzine
(3) α-glucosidase inhibitors: Bystolic, Carboplatin
(4) Cetazolidinedione Pioglitazone, rosiglitazone
2.Insulin
Classification by source
(1) Animal insulin: extracted from the pancreas of pigs and cows, both have the same efficacy, but compared with human insulin, pig insulin has one amino acid difference, and bovine insulin has three amino acid differences, and thus is prone to antibody production.
(2) Semi-synthetic human insulin: The 30th alanine of porcine insulin is replaced by the same threonine as human insulin, which is semi-synthetic human insulin.
(3) Biosynthetic human insulin (the most commonly used insulin in clinical practice at this stage): High-purity biosynthetic human insulin obtained by using bioengineering technology, whose amino acid sequence and biological activity are identical to human insulin.
Classification according to the duration of drug effect
1.Ultra-short-acting: it takes effect 15 minutes after injection, and the peak concentration is 1~2 hours.
2.Short-acting (fast-acting): it takes effect 30 minutes after injection, with peak concentration of 2~4 hours and lasts for 5~8 hours.
3.Medium-acting (low fisetin zinc insulin): it takes effect 2~4 hours after injection, with peak concentration of 6~12 hours and lasts 24~28 hours.
4.Long-acting (zinc insulin with fisetin): it takes effect 4~6 hours after injection, with peak concentration of 4~20 hours and lasts 24~36 hours.
5.Pre-mix: that is, short-acting and medium-acting pre-mixed, can be injected at once, and the onset of action is fast (30 minutes), and lasts up to 16~20 hours.