If you are diagnosed with type 2 diabetes and your doctor prescribes a bunch of medications without asking, you are advised to change hospitals. This is because the “diagnose – prescribe – go” “assembly line” is hardly effective for diabetes. The concept of diabetes treatment has changed a lot in recent years, and the most fundamental thing is to promote ‘individualized treatment’, we have to develop treatment plans, blood sugar control goals and even testing frequency according to the specific situation of the patient.
At present, in the field of type 2 diabetes treatment, stepwise therapy (i.e. from diet and exercise control to single drug oral, then combined oral and finally insulin) and insulin intensive therapy are more common, which is better or worse? It varies from person to person.
Although it varies from person to person, the first step is to clarify the patient’s specific situation, including weight, lifestyle, blood glucose level, as well as the function of important organs and complications; then recommend the appropriate form of diet and exercise for the patient; and then choose a reasonable medication, including oral hypoglycemic drugs or insulin. My basic principle is not to choose medication when diet and exercise can be controlled, and not to choose insulin when oral medication can be controlled.
In this principle, I always emphasize individualized treatment, for example, for newly diagnosed type 2 diabetic patients whose fasting and postprandial glucose are not very high, especially for obese patients, we advocate diet control and exercise therapy first, because the main problem of these patients is insulin resistance rather than insulin deficiency, and their insulin resistance will be reduced when they lose weight through diet control and exercise, and there are many Many patients will have their insulin resistance reduced after losing weight through diet control and exercise, and their blood glucose will drop to normal level after losing weight, and diabetes will not occur after a few years, so these patients are suitable for using ‘step therapy’; however, when first diagnosed type 2 diabetes patients visit the clinic, the ‘three more and one less’ (drinking more, eating more, urinating more, but losing weight) symptoms are very obvious. ) symptoms are very obvious, fasting blood glucose and postprandial blood glucose are significantly elevated, and intensive treatment with insulin is essential for those with high glycosylated hemoglobin (HbA1c).”
Continuously elevated blood glucose, on the one hand, makes pancreatic B cells exhausted, on the other hand, affects the sensitivity of peripheral tissues to insulin, making the peripheral tissues more insulin resistant, resulting in a vicious cycle of glucose metabolism in the body, which is called “high glucose toxicity”. High glucose toxicity is both a result of B-cell hypofunction and a cause of its deterioration. Intensive insulin therapy is a method of using exogenous insulin therapy to mimic the normal human physiological insulin secretion pattern as much as possible to achieve the ideal blood glucose level. The concept of immediate initiation of insulin intensive therapy in first-episode type 2 diabetes was first proposed by foreign scholars 10 years ago. This idea broke with previous traditional treatment thinking and proposed that for some patients with significantly elevated blood glucose in first-episode type 2 diabetes, a period of intensive insulin therapy should be initiated. The benefits of this treatment plan have been validated in a large number of subsequent clinical trials and in the clinical practice of clinicians.
In addition, there are many aspects that need to be considered on an “individual basis”, such as whether the patient is fat or thin? For example, does the patient have high fasting blood sugar or high postprandial blood sugar? Then, we need to see if the patient’s pancreatic function is good. Are the liver and kidneys functioning well? All these determine how to choose the medication.
What is the range of blood glucose control through treatment? It still varies from person to person. For young and middle-aged people, it is important to control blood sugar strictly and try to reach normal level to reduce the incidence of diabetes complications. It is more important to control all risk factors, including blood pressure, blood lipids, blood glucose and weight, etc.
Exercise therapy also plays an important role in the treatment of type 2 diabetes. Exercise can increase insulin sensitivity, improve blood glucose control, help to reduce weight and improve cardiovascular function. However, exercise should also vary from person to person. In general, light and moderate physical activities such as brisk walking, Tai Chi, dancing, jogging, swimming, etc. are suitable, and it is appropriate to exercise 3-4 times a week for 20-30 minutes each time. However, patients with various acute infections, cardiac insufficiency, arrhythmias, severe diabetic nephropathy, diabetic foot, severe fundus lesions, recent thrombosis, and significantly higher blood pressure are not suitable for exercise.
The choice of drugs “personality” also full drug therapy, is currently the most used and the most effective treatment of diabetes. Each drug has a different target.
First, look at oral hypoglycemic drugs:. Insulin promoters are divided into sulfonylureas and non-sulfonylurea promoters, both of which can promote insulin secretion and lower blood sugar, and are suitable for patients with good pancreatic B-cell function, the latter of which can also effectively simulate the normal human insulin secretion pattern, with the common side effect of hypoglycemia; biguanides are the first-line drugs recommended in diabetes treatment guidelines, which can help reduce body weight and increase insulin sensitivity, and are especially suitable for obese diabetic patients. It is especially suitable for obese diabetic patients, and its main side effect is gastrointestinal reactions. Insulin sensitizers can increase the sensitivity of insulin action and help patients to use insulin better, but the main side effects are edema and weight gain; glucosidase inhibitors can slow down the digestion of food and the absorption of glucose in the small intestine, helping to lower postprandial blood sugar. However, these drugs only work on carbohydrates and have no efficacy on fats and proteins, and their main side effects are bloating and increased gastrointestinal exhaustion.
Then look at insulin and insulin analogues, which can bring the blood sugar of patients with severe hyperglycemia under ideal control. There used to be short-acting insulin, premixed insulin and medium-acting insulin in the clinic, and in recent years insulin analogs have emerged, which not only control blood sugar better but also reduce the risk of hypoglycemia. “However, patients who inject insulin should pay attention to self-glucose testing to avoid the occurrence of hypoglycemia, and in addition, insulin can increase body weight, and it is better to combine with metformin in obese patients.”
In addition, some new drugs for GLP-1 (glucagon-like peptide-1) will soon land in China, these drugs have the advantages of glucose-dependent stimulation of insulin secretion, effective lowering of blood sugar, low incidence of hypoglycemia, and no weight gain, which is a new choice for patients with type 2 diabetes.
In the face of so many “personalized” drugs, those patients who buy their own drugs to lower sugar, really have to sweat for them.
Dietary Control: “Mix and Match”
Regardless of the type of treatment taken, diet control is necessary. Some patients find it very painful and difficult to adhere to, but in fact, it is not difficult to master the method.
”The postprandial blood glucose is an important indicator of diabetes control, which is closely related to diabetic macroangiopathy, microangiopathy, retinopathy and cardiovascular disease, and controlling postprandial blood glucose is a difficult problem for diabetics. We generally use the glycemic index to indicate the effect of food on blood sugar, and if we mix and match foods with high glycemic index and low glycemic index, we can completely control the post-meal blood sugar.” He recommends several ways to mix and match foods that reduce the glycemic index of meals.
Main and side dishes: main food with side dishes, such as rice alone, its glycemic index is 83.2, while rice mixed with fish, mixed food glycemic index is only 37, down by a large margin.
Coarse and fine with: coarse food glycemic index is generally lower than fine food, coarse and fine food mix can slow down the magnitude of post-prandial blood sugar rise caused by fine food, thus reducing the meal glycemic index.
Increase fiber: Dietary fiber can slow down the post-prandial blood glucose rise, such as adding vegetables when cooking breakfast noodles is better than eating noodles alone, because vegetables contain a lot of dietary fiber.
In addition, we recommend some foods with low glycemic index: cereals (barley, wheat, oats, buckwheat, black rice, corn, etc.), dairy (milk, low-fat milk powder, etc.), roots and tubers (konjac, taro, etc.), legumes (soybeans, green beans, peas, lentils, etc.), fruits (oranges, apples, cherries, poppy peaches, grapefruit, etc.).
Related stem cell therapies are still in the research stage Currently, there are some “unusual” alternative treatments to the “main theme” of type 2 diabetes treatment, such as surgery and stem cell therapy. For diabetics who need to fight a “constant battle”, these types of treatments have some appeal.
In this regard, the so-called surgical treatment of diabetes refers to the use of gastric diversion surgery (GBP) to treat type 2 diabetes, which was originally a bariatric surgery, and in 1982, some doctors discovered by chance that in the surgical treatment of morbid obesity, patients with combined type 2 diabetes who underwent bariatric surgery lost significant weight and had a rapid return to normal blood sugar. Since then, many scholars have studied the mechanism and some hospitals, including some in China, have carried out such surgery. However, there is no authoritative report on whether this surgery, which destroys the normal digestive system of the human body, will have long-term adverse effects on the digestive absorption and nutritional status of the patient, and what the treatment effect will be.
”My personal opinion is that the choice of surgical treatment must be cautious, and particularly obese people such as those with a BMI greater than 35 can be considered.”
Stem cell therapy for diabetes has also been a hot topic in recent years. There are two methods of stem cell transplantation: autologous bone marrow stem cell transplantation and autologous peripheral blood stem cell transplantation. In China, autologous peripheral blood stem cell transplantation is generally used, in which stem cells are mobilized to peripheral blood through drugs, and then stem cells are separated through a blood cell separator, and the stem cell suspension extracted in advance is injected into the pancreas through an arterial catheter, so that it differentiates into islet-like cells in the pancreas and secretes insulin to treat The purpose of this method is to treat diabetes. Compared with allogeneic islet cell transplantation, this method does not have the problem of immune rejection and is relatively less expensive. However, it is still in the research stage and there is no reliable data on long-term efficacy, so it cannot be used as a routine treatment for diabetes.
Sixty percent of male diabetic patients have sexual dysfunction in the national academic conference on endocrinology held some time ago, announced a set of data: China has about 40 million diabetic patients, another 40 million pre-diabetic people; in the general population, the incidence of male sexual dysfunction is 10%, in the diabetic population, the incidence of male sexual dysfunction is 30% to 60%.
Could diabetes be causing male sexual dysfunction? “It is extremely rare for adults to have low sexual function due to diabetes, perhaps not even 5%. Most sexual dysfunction in diabetic patients is not due to male hormonal problems, but rather to psychological factors, which may also be related to vascular lesions. Usually, diabetic patients are neither taken seriously nor embarrassed to talk about it when they visit their doctors. In fact, patients with diabetic sexual dysfunction should be diagnosed early and let their doctors help choose the right therapy, which is significant for improving the quality of life.”