“My life has not been affected by diabetes”
In the past 24 years, his condition has not deteriorated, but has become increasingly stable, with ideal blood sugar control and no signs of complications. In a few words, he said, “You can’t be blindly pessimistic about diabetes, and you shouldn’t be overconfident. After I was diagnosed with the disease, I kept in close contact with my doctor, studied the relevant theoretical knowledge carefully, and went to the hospital regularly for annual checkups to minimize complications.” It is also emphasized that some patients are nervous and afraid to go to the hospital, and do not cooperate closely with the doctor, which is most detrimental to the condition. Chen Shaohua, Department of Endocrinology, Shandong Province Qianfo Mountain Hospital
“Treating diabetes, one’s own mentality is most important. Diabetes should naturally be taken seriously, but one should not worry about everything with the disease in mind. Now, I am at peace with myself and eat a certain amount of staple foods and vegetables every day, and exercise some control over the calorie intake. I eat some low-sweet fruits between meals, but do not eat fruits with high sugar content, such as grapes and bananas, etc. Other than eating them sparingly, I can eat all other fruits. And, every week in the morning and afternoon I make sure to do 2 physical exercises, such as walking, climbing, etc., and no less than half an hour each time.” Eat on time, take medication, inject insulin, and live a regular life.
”What patients cannot lose is their confidence and perseverance. Many people get diabetes, they blame God, negative and pessimistic, think that once the disease, it will be a lifelong pain, but in fact, the discovery of diabetes is a thing to celebrate, because this can be early attention to the disease, the recovery of the possible chances are also greater, the health index is also higher, the less complications.”
Many diabetic patients once the disease, they will suffer from the loss, think that they usually eat too much too good cause, so they do not dare to eat anything, do not dare to go anywhere. This is the case with patient Ms. Lu. She is a housewife, since the detection of higher than normal blood glucose value, all day fear, do not dare to eat, daily to pumpkin, thin rice fruit, from time to time also engage in a small prescription, eat some fish scales and wild vegetables. Because of the fear of overwork, Ms. Lu did not even dare to do more housework, not to mention family and friends to meet for dinner. Day after day, year after year, Ms. Lu herself “imprisoned” up, life is not tasty.
In fact, there are not a few diabetic patients who are as cautious as Ms. Lu. The reporter interviewed 15 patients in Xuanwu Hospital, 13 of them had the same idea as Ms. Lu, and the other two had another attitude towards life. Mr. Zhou is one of the representatives. Since he found out that he had diabetes, he took insulin under the guidance of his doctor. Sure enough, his blood sugar came down, and Mr. Zhou was so pleased that he was able to accompany his clients to socialize and exchange glasses with confidence. He thought that as long as he took a shot of insulin before meals, he would have no worries about what to eat, which resulted in a major reduction in the effectiveness of treatment.
In Europe, self-management is emphasized, because diet, exercise, glucose-lowering drugs and blood glucose monitoring are not enough. In order for patients to better self-manage, Germany has established a diabetes awareness and health care network, and there are 24 clubs of varying sizes for diabetics in Lower Saxony. Cole, an official with the state’s Ministry of Health, told reporters that people with diabetes can sign up voluntarily, and each group has a designated diabetes advisor. Participants work as a group on activities such as one individual counseling visit, 12 group meetings, postcard messages, and monthly calls with the diabetes advisor. Some hospitals have also created “full-time” and “inpatient” diabetes self-management training schools for the public good. Cole said that diabetes self-management includes a deep understanding of the pathogenesis, process and treatment of diabetes; setting personal goals for diabetes control; appropriate nutritional management; making exercise a lifestyle; using effective medication; regularly testing blood sugar and urine sugar and better regulating blood sugar based on the results; preventing, monitoring and treating acute and chronic complications; and incorporating psychological adjustment into daily life. . Ms. Furman from Berlin said that patients are in great need of these practical, instructive and operational knowledge and skills training. She used to seriously lack self-management knowledge. After the training, she started to pay attention to daily diet, exercise, blood sugar monitoring and related treatment, and her condition is getting better and better controlled, and her quality of life is greatly improved. Top of the window
Professor Maternus, head of the German Diabetes Research Center, told reporters that each diabetic patient has his or her own characteristics, including the different stages the disease is in, the presence of complications or concomitant diseases, and different eating and living habits and physical conditions, and that patients should develop individualized treatment plans for different situations and changing conditions. Only with active self-management can we better understand our condition and illness and take the initiative to control the disease. Professor Maternus emphasizes that “patient self-control is essential to achieve successful treatment outcomes.”
The current low rate of diabetic patients receiving treatment is related to the insufficient dissemination of diabetes knowledge. Medication, diet, exercise, diabetes education and psychotherapy, and self-monitoring are called the “five horsemen” of diabetes treatment. Among them, diabetes education is at the core of these five factors. Because of the lack of knowledge about diabetes in China, many patients who could have been treated and controlled at an early stage have wasted a lot of money on medical care due to lack of knowledge.
Several items of diabetes self-management
1. Understanding the pathogenesis, process and treatment of diabetes
1. What is blood glucose? Blood sugar, which is the glucose contained in the blood, is the form in which sugar is transported in the body. One of the main sources of blood glucose is food, which, when ingested by the body, is broken down and absorbed through the digestive tract thus forming glucose. In addition, proteins, fats and lactic acid produced from muscles can be turned into glucose through the process of gluconeogenesis. The blood sugar during fasting comes mainly from glycogen stored in the liver. Blood glucose is metabolized by insulin secreted by pancreatic B cells into cells, releasing a large amount of energy to be used and consumed by all tissues of the body, especially the brain, kidneys, red blood cells, retina, etc. Glucose must be constantly supplied by blood. The blood glucose concentration in normal people may fluctuate to a certain extent due to emotions or diet, but fasting blood glucose is generally maintained between 4.4 and 6.7 mmol/L (80 to 120 mg/100 ml). High or low blood glucose levels can have certain effects on human health, some of which can be lifelong and fatal. 2. What is diabetes? Diabetes is an ancient disease. The earliest classical medical book in China, the Emperor’s Classic of Internal Medicine, contains a description of “thirst disorder”, which is a combination of wasting and thirst. According to modern medicine, diabetes is a lifelong disease with complex etiology and is a chronic systemic metabolic disease, whose basic physiological characteristic is the increase of blood glucose level, mainly caused by the relative or absolute insufficiency of insulin secretion or the decrease of insulin sensitivity of beta cells. When blood glucose is increased, there can be three more and one less, which means eating more, drinking more, urinating more and losing weight, but most patients have no obvious symptoms at the early stage and are only found to have elevated blood glucose during physical examination or when complications arise, thus delaying the time of treatment. Long-term elevated blood sugar will lead to multi-organ tissue damage and a series of complications, such as cardiovascular, cerebrovascular, renal, retinal and neurological lesions, etc. In serious cases, acute ketoacidosis, hyperosmolar coma and lactic acidosis may occur, which may even threaten life. 3. Elevated blood sugar does not necessarily mean that you have diabetes. High blood sugar is one of the main characteristics of diabetes, but you should not assume that you have diabetes just because your blood sugar level is higher than the normal range. There are many factors that can increase blood glucose levels without manifesting as diabetes. A transient increase in postprandial blood glucose can occur when liver glycogen reserves are reduced due to various liver diseases such as hepatitis and cirrhosis. The use of some drugs affecting glucose metabolism such as glucocorticoids, thiazide diuretics, tachyphylaxis, female oral contraceptives, niacin, aspirin, anti-inflammatory pain, etc. can cause a transient increase in blood glucose. After stopping the medication, blood sugar will return to normal soon. When moderate or strenuous physical activity is performed, glucose stored in the liver is released, causing blood glucose levels to rise. In addition, blood glucose levels rise significantly in the morning between 4:00 and 8:00 a.m. Pregnancy and menstruation can also raise blood glucose levels. 4. When can diabetes be diagnosed? The old diagnostic criteria for diabetes were established by the World Health Organization in 1980. In 1997, the American Diabetes Association submitted new diagnostic criteria for diabetes, which were reviewed and approved by a group of experts from the World Health Organization the following year, and the Chinese Diabetes Association recommended the adoption of these diagnostic criteria in the Chinese population in October 1999. Diabetes is diagnosed mainly on the basis of fasting, any time or oral glucose tolerance test (OGTT) 2 hours blood glucose value. Diabetes is diagnosed if one of the following conditions is met: ① diabetic symptoms + plasma glucose level ≥ 11.1 mmol/L (200 mg/dl) at any time; ② fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dl); ③ 2-hour blood glucose ≥ 11.1 mmol/L (200 mg/dl) in OGTT test. Among them, fasting blood glucose refers to the blood glucose value of at least 8 hours of fasting; any time refers to the blood glucose value at any time of the day, regardless of the time of the last meal or how much food was consumed; OGTT refers to the blood glucose value after 75g of glucose powder dissolved in water and the glucose water is drunk within 5 minutes in fasting state, usually tested 2 hours later. 5. How many types of diabetes are there? In July 1997, the World Health Organization revised the typing of diabetes based on a report submitted by the American Diabetes Association. The revised etiology of diabetes mellitus is divided into four major categories, namely diabetes mellitus type 1, diabetes mellitus type 2, other specific types of diabetes mellitus and gestational diabetes mellitus. About 80% of diabetes mellitus is type 2 diabetes, and what we call diabetes mellitus in daily life generally refers to type 2 diabetes. Most of the patients with type 2 diabetes are over 40 years old, most of them have a slow onset, most of them are normal or obese, and the symptoms of “three more, one less” are not obvious, and they have a history of 5 to 10 years when they are diagnosed. The symptoms of type 1 diabetes are more obvious, and the insulin level in the body is low. The typical clinical symptoms of diabetes include thirst, excessive drinking, polyuria, polyphagia and weight loss, often referred to as the “three more and one less”. The presence of typical symptoms often prompts the patient to seek medical attention and to discover diabetes through clinical examination. The typical symptoms of type 1 diabetes are often very typical at the onset of the disease, while type 2 diabetes has few or no symptoms at first, or some atypical symptoms. For example, fatigue and fatigue; loss of vision and blurred vision; itchy skin; frequent numbness or tingling in the hands and feet; very slow wound healing; frequent or recurrent infections; impotence in men and abnormal vaginal dryness in women; easy hunger; nausea and vomiting. Because these symptoms can also be present in other diseases, the correct diagnosis of diabetes is often delayed. 7. Is diabetes related to eating sugar The sugar referred to here is the general term for carbohydrates, and sugar is divided into polysaccharides, disaccharides, and monosaccharides. The starch in our diet, such as rice, buns, noodles, bread, cookies, yams, pumpkin, etc., is polysaccharide. Although polysaccharide starch is not sweet, it is broken down into monosaccharides, mainly glucose, by the action of amylase. Glucose can be absorbed and used by the body, but its absorption and use requires the help of insulin. If you eat too much starchy or sugary food, combined with little physical exercise and lack of sufficient energy consumption, the body’s insulin is unable to help the excess sugar absorption and utilization, there is a risk that the blood glucose will rise and even filter out through the kidneys to become urine sugar, thus causing the onset of diabetes. 8. Risk factors for the development of diabetes The causes of diabetes are not fully understood, but the following factors may increase the risk of developing diabetes. (1) having relatives, especially first-degree relatives, with diabetes; (2) eating too much without moderation and over-nutrition; (3) being obese or overweight, especially those with a body mass index [BMI = weight (kg)/height (m) squared] greater than 25, in addition to abdominal obesity is also an important risk factor; (4) hypertension, hyperlipidemia and early coronary heart disease; (5) having a history of increased glucose in pregnancy or (5) those who have a history of gestational hyperglycemia or huge childbirth and multiple abortions; (6) those who are 40 years old or older. The prevalence of diabetes is significantly higher in middle-aged and older people than in younger people, according to domestic and international data. 30. What are the characteristics of geriatric diabetes mellitus? Most of them are type 2 diabetes. Most of them have a slow onset and usually do not have any symptoms in the early stage. Most elderly diabetics do not have the typical symptoms of “three more, one less” and are prone to complications of heart, brain, liver and kidney disease. Older patients with diabetes also need to control their blood sugar through diet, physical activity and exercise, and oral hypoglycemic drugs. If medication is needed, strong and long-lasting glucose-lowering drugs should be avoided. Some patients need blood pressure and lipid-lowering treatment at the same time as glucose-lowering, and the liver and kidney functions of the elderly should be paid attention to when using medication. When the efficacy of oral hypoglycemic drugs is reduced or there are obvious comorbidities, it is advisable to switch to insulin as soon as possible. The current low rate of treatment for diabetes is related to the lack of awareness of diabetes. Drug therapy, diet therapy, exercise therapy, diabetes education and psychotherapy, and self-monitoring are called the “five horses” of diabetes treatment. Among them, diabetes education is at the core of these five factors. Because of the lack of knowledge about diabetes in China, many patients who could have been treated and controlled well at an early stage have wasted a lot of money on medical care due to lack of knowledge.
2. setting personal diabetes control goals.
The control goals set by the Western Pacific Regional Type 2 Diabetes Policy Group in 2002 include
Control targets
Good
fair
Poor
Blood glucose (mmol/L)
Glycosylated hemoglobin (%)
Blood pressure (mmHg)
Body mass index (BMI) (kg/m2)
Total cholesterol (mmol/L)
Triglycerides (mmol/L)
Fasting
Non-fasting
Male
Female
(mmol/L)
(mmol/L)
4.4-6.1
4.4-8.0