If you ask me what I need most to succeed, the answer is accurate judgment; if you continue to ask where accurate judgment comes from, the answer is rich experience; if you then ask where rich experience comes from, the answer is “fighting monsters”. Wang Liang, Department of Osteoporosis and Orthopedics, 309th Hospital of the People’s Liberation Army
Yes, that’s right, “fighting monsters”. For the Department of Endocrinology, this “monster” is all kinds of diseases. Please take away the following experience from the “fighting monsters” along the way.
How to distinguish T2DM and LADA
T2DM, Type 2 Diabetic Mellitus, is type 2 diabetes.
LADA, Latent Autoimmune Diabetes in Adult, is late-onset (latent) autoimmune diabetes in adults.
Clinically, it is important to distinguish T2DM from LADA because both are not as early-onset as type 1 diabetes and both are more common in adults.
Some hospitals check IAA, GAD and ICA, so it is not too difficult to distinguish them. If not, they can be identified as follows
1. those with family history
2. people with initial wasting
3. first onset of ketosis
4. those who have the first onset of “three more and one less” symptoms
5. some patients who are obese at the onset but lose weight quickly
The above conditions support LADA.
Diabetes medication experience
1. The ratio of glucose to insulin for diabetic patients with normal blood glucose is usually 2-4 g:1 U. 2.
2. Combined medication to raise blood glucose: glucocorticoids, ACTH, glucagon, estrogen, oral contraceptives, thyroxine, adrenaline, thiazide diuretics, phenytoinamide.
3. Combination of drugs to lower blood sugar: ACEI, bromocriptan, clofibrate, ketoconazole, mebendazole, theophylline, octreotide.
How to identify diabetic pain
1. neurological: bilateral symmetry, light day and heavy night, pinprick-like or electric shock-like, normal skin temperature of lower limbs.
2. vascular: asymmetric, hypothermia, diminished dorsalis pedis artery pulsation, positive angiography
3. osteoporotic: low back pain is common, mild day and night, not easily ulcerated.
4. mixed: with more than one of the above characteristics.
Rules for insulin injection
1. Injection technique: subcutaneous tissue rather than muscle. Choose abdomen for short-acting insulin, thigh for long-acting insulin, and abdomen is better for premixing.
2. Selection: correct needle length and method. Choose an 8 mm long needle. 3.
3. How to operate: Pinch up the skin fold with two fingers, inject insulin in the center of the skin fold at an angle of 45 degrees to the skin fold, withdraw half of the needle, count to 5 seconds, withdraw the needle completely and release the skin fold.
If a single injection is greater than 40 U, divide it into two injections, and it is best to inject the same site more than 1 month apart.
Why fasting blood sugar is high
1. Insufficient insulin dosage at night.
2. Dawn phenomenon, that is, good control of blood glucose at night and no hypoglycemia, but hyperglycemia only occurs in a short period of time before dawn, the mechanism may be due to increased secretion of cortisol, growth hormone, catecholamines and other insulin-resistant hormones.
3. Somogyi phenomenon: Hypoglycemia had occurred, but the hypoglycemia was not detected during sleep, and the reactive hyperglycemia occurred after hypoglycemia. Clinically, monitoring blood glucose at 2 and 4 o’clock at night can identify the cause of high fasting blood glucose in patients.
If it is 1 and 2, the patient may be dosed with pre-dinner insulin appropriately, or given medium-acting insulin subcutaneously or metformin orally at bedtime.
If 3, reduce the dose of insulin before dinner accordingly or reduce the patient’s meal before bedtime.
Study notes again 1 basket?
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