As we all know, type 2 diabetes is known as the “disease of the rich”, but some people say that diabetes is the “disease of the poor”. In fact, to say that type 2 diabetes is a “disease of wealth” or a “disease of poverty” reflects only one aspect of the pathogenesis of diabetes, but from the perspective of self-care awareness, diet structure or lifestyle, diabetes is a kind of The “disease of ignorance”. In this class we will look at each of the following aspects First, introduction to diabetes and related you check . Second, the current status of diabetes . Third, the treatment of diabetes .
Diabetes occurs by different mechanisms and can be divided into type 1, type 2, gestational diabetes and special types of diabetes, of which 95% of people belong to type 2 diabetes.
We know that the typical symptoms of diabetes are “three more and one less”: drinking more, urinating more, eating more and losing weight. Other symptoms include fatigue, blurred vision, itchy skin, wounds that don’t heal easily, and itchy hands and feet. But in fact, the vast majority of people with type 2 diabetes do not have any of the three symptoms at the beginning of the disease, or even none of them.
Common chronic complications of diabetes.
Diabetic nephropathy is a common cause of chronic renal failure and has a high prevalence in the Asia-Pacific region. a retrospective analysis of domestic inpatients in 2001 showed that the prevalence of type 2 diabetes complicated by nephropathy was 34.7%.
Diabetic retinopathy is the leading cause of blindness in the adult population. Approximately 20-40% of adult patients with type 2 diabetes develop retinopathy and 8% have severe vision loss.
The diabetic foot is one of the most serious and most expensive chronic complications of diabetes to treat, and can lead to amputation in severe cases. The relative risk of lower extremity amputation in diabetic patients is 40 times greater than in non-diabetic patients. Approximately 85% of amputations are triggered by foot ulcers, and about 15% of diabetics will develop foot ulcers during their lifetime.
Diabetic peripheral neuropathy is the most common chronic complication of diabetes, and 60% to 90% of diabetic patients have combined peripheral neuropathy. Early symptoms of diabetic peripheral neuropathy are mainly sensory disorders, with symmetrical pain and abnormal sensation, more common in the lower extremities than in the upper extremities, and abnormal sensation such as numbness, ant walking, insect crawling, heat, electric shock-like sensation, and sock- and glove-like sensation.
The “China Heart Survey” study found that diabetes is an important concomitant disease of coronary heart disease, and the complication of coronary heart disease in diabetic patients is 2 to 3 times higher than in the general population.
Important tests for diabetes: glycated hemoglobin, urine and kidney function, and sensory threshold. In addition to blood glucose, which can reflect the blood glucose level in the body, there is another important indicator, glycosylated hemoglobin, which can reflect the average blood glucose level for 2-3 months and is the “golden indicator” for evaluating blood glucose control. Why can glycated hemoglobin reflect the average blood glucose level for 2-3 months? Because the combination of blood glucose and hemoglobin to form glycated hemoglobin (HbA1C) is an irreversible reaction, and is proportional to the blood glucose concentration, and remains for about 120 days, so it can reflect the average level of blood glucose for 2-3 months. Therefore, glycosylated hemoglobin should be monitored every 3 months, and every 6 months after reaching the treatment target, and the control target level is less than 7%. Each 1% decrease in glycosylated hemoglobin can reduce diabetes-related mortality by 21%, total mortality by 14%, the incidence of myocardial infarction by 14%, and the incidence of stroke by 12%.
Urine renal function test, or urine microalbumin test, microalbuminuria refers to the presence of trace amounts of albumin in the urine. Albumin is a normal protein in the blood, but only a very small amount of albumin appears in the urine under physiological conditions. It reflects abnormal leakage of protein from the kidneys, and an increase in urinary microalbumin is mostly seen in diabetic nephropathy, hypertension, and pre-eclampsia of pregnancy, and is an early and sensitive indicator of kidney injury. Patients with type 2 diabetes who present with microalbuminuria are at high risk of developing serious renal complications, and once microalbuminuria progresses to proteinuria, further reduction of renal function will be inevitable. Therefore, effective screening for microalbuminuria in diabetic patients is necessary to decide early on appropriate therapeutic measures to slow down this progressive process. Therefore for the general population: annual testing and for diabetics and patients with increased urinary microalbumin: 3-monthly testing can have a positive effect on the prevention and early treatment of kidney disease.
Diabetic peripheral neuropathy (DPN): refers to the symptoms and or signs associated with peripheral nerve dysfunction in diabetic patients when other causes are excluded
Diagnostic criteria for diabetic peripheral neuropathy.
1, clear history of diabetes mellitus
2, neuropathy at or after the diagnosis of diabetes mellitus
3. Clinical signs and symptoms consistent with the manifestations of DPN
4.DPN is diagnosed if 2 or more of the following 5 tests are abnormal
(1) Abnormal temperature sensation;
(2) nylon wire examination, reduced or absent sensation in the foot
(3) Abnormal vibration sensation;
(4) Loss of ankle reflex
(5) Two or more nerve conduction velocities (NCV) are slowed down
(6) Exclude other pathologies (e.g. cervical and lumbar spine pathology, cerebral infarction, Guillain-Barre syndrome, etc.)
Digital Vibratory Sensory Threshold Checker is the most advanced medical instrument to quantitatively check the threshold of vibratory sensation in various parts of the human body. It is mainly used for the early diagnosis of sensory abnormalities caused by nerve damage diseases (diabetes, neurotoxic diseases, neuritis, male and female neurogenic diseases, etc.), especially in the assessment of diabetic neuropathy, diabetic foot ulcer risk assessment, deep sensory disorder diagnosis, pre and post sensory nerve changes and progression assessment. Early screening for diabetic peripheral neuropathy (DPN).
Current status of diabetes: The prevalence of diabetes has increased significantly in China in the last 30 years. The prevalence of diabetes has become more serious in the last decade. Since 1993, the number of diabetes cases has been increasing every year, and by 2008, the number of cases rose more than seven times in 15 years. According to recent survey results, it is estimated that there are 43.1 million rural diabetics and 49.3 million urban diabetics in China. This number is another 6.5 times higher than in 2008! We may have become the country with the largest number of people with diabetes. In fact, it is not only our country, the number of diabetic patients worldwide is also growing. In the 1990s there were 100 million diabetic patients worldwide, in 2007 this number rose to 246 million, and it is expected that by 2025 the number of diabetic patients worldwide will reach 380 million! Since the first epidemiological survey of diabetes in China in 1980, the prevalence of diabetes in China has increased from less than 1% at that time to about 10%, becoming the third most serious chronic disease threatening people’s health after cardiovascular and cerebrovascular diseases and tumors. The increasing prevalence of diabetes, the high incidence of complications, the heavy economic burden and the enormous mental stress have also brought significant impact on individuals and society.
Although the current state of medicine is limited, diabetes is still an incurable disease that requires lifelong treatment. But you don’t have to worry, diabetes can be prevented and controlled. Through the integrated management of the “five horses” and good metabolic control of blood glucose, lipids and blood pressure, you can completely control diabetes, avoid acute complications and prevent chronic complications, so that you can have a good life as normal people.
Comprehensive treatment of diabetes: There are five horses in the treatment of diabetes, of which diabetes education is the horse that leads the way, monitoring is the horse that discerns the way, and diet, exercise, and medication are the horses that pull the cart.
Diabetes education is the core of comprehensive diabetes management. The importance of diabetes education is evident in the international and domestic guidelines that call for the management of diabetes education for patients with diabetes. Active diabetes education can help you gain scientific health knowledge, change your poor lifestyle and improve your ability to self-manage diabetes, including learning scientific diet and exercise, proper blood glucose monitoring, standardized insulin injection, foot care and so on. The principles of scientific prevention and treatment of diabetes are: early diagnosis, early treatment, early achievement of the standard, and early benefit.
Blood glucose monitoring is one of the important tools in diabetes management, which can effectively monitor the changes of your condition and treatment effect, so as to facilitate timely adjustment of your treatment plan, thus effectively delaying the occurrence and development of complications and enhancing your confidence in overcoming the disease. The main monitoring indicators include glycosylated hemoglobin, blood glucose, urine sugar, etc. As a diabetic patient, you should understand that the most important indicator for long-term blood glucose control is glycosylated hemoglobin. Glycosylated hemoglobin is an important basis for your clinician to decide whether you need to change your treatment plan. Its normal value is 4% to 6%, and the control goal is less than 6.5%. Glycosylated hemoglobin reflects your average blood glucose level for the 2 to 3 months prior to the blood draw. However, glycosylated hemoglobin is not a substitute for daily blood glucose monitoring because blood glucose monitoring is used to guide adjustments to your daily treatment regimen, while glycosylated hemoglobin does not reflect immediate blood glucose levels. Self-monitoring of blood glucose is an important measure to guide you to meet your blood glucose control standards and to check whether you are at risk of hypoglycemia. Fingertip capillary blood glucose monitoring is the ideal method, with a control target of 4.4 to 6.1 mmol/L fasting 4.4 to 6.1 mmol/L non-fasting. There is some research evidence that self-monitoring of blood glucose is beneficial in improving blood glucose control. If your blood glucose control is poor or your condition is critical, you should monitor 4-7 times a day until your condition is stable and your blood glucose is under control; when your condition is stable or you have reached the goal of blood glucose control, you can monitor 1 to 2 days a week, 4-7 times a day. Blood glucose monitoring time: before meal – 2h after meal – before bed – at night – usual – exercise – other conditions (e.g., trying a new diet, not being able to eat regularly, mood swings, self-consciousness, etc.). If self-monitoring of blood glucose is not possible due to conditions, then self-monitoring of urine glucose can also be performed.
Regardless of the type of diabetes you have, diet and nutritional therapy is one of the most important components of diabetes treatment and is the foundation of all treatment.
Some patients with type 2 diabetes, if diagnosed early, can achieve significant results with diet and exercise alone in mild cases.
Conversely, if diet and nutritional therapy are not given adequate attention, your diabetes is unlikely to be well controlled.
Poor diet and habits may also lead to the development or exacerbation of associated cardiovascular risk factors, such as hypertension, dyslipidemia and obesity. The principles of nutritional therapy: reasonable control of total caloric intake; balanced diet with a balanced intake of various nutrients; weighed diet with regular meals.
Regular physical activity is very important for everyone, but for patients with diabetes, it is even more important for the management of your disease. Exercise can increase insulin sensitivity, improve blood sugar control, contribute to weight loss, reduce the risk of cardiovascular disease, help you lose weight and improve your mental health. One study showed that diabetic patients who exercised regularly for 12 to 14 years had a significantly lower mortality rate.
Indications for exercise: Stable type 2 diabetes; overweight type 2 diabetes; stable type 1 diabetes; stable gestational diabetes.
Exercise: You can choose low to moderate intensity aerobic exercise according to your age, physical condition, hobbies and environmental conditions. Low-intensity exercises include: shopping, walking, doing exercises, tai chi, qigong, etc.; medium-intensity exercises include: brisk walking, tai chi, cycling, golf and gardening activities, etc.; higher-intensity exercises include: dancing, aerobic fitness, jogging, swimming, cycling uphill, etc.
Exercise frequency and duration: at least 150 minutes per week, spread over 5 days, about 30 minutes per exercise.
Exercise intensity: Diabetic patients should maintain a heart rate (beats/minute) when exercising = 170 age Timing of exercise.
You should start exercising about 1 hour after eating your first meal, because blood sugar is higher at this time and hypoglycemia is less likely to occur during exercise. Please remember: never do exercise on an empty stomach. Other: The exercise time you choose should be relatively fixed, such as doing exercise after dinner or after breakfast each time, in order to facilitate stable blood sugar control; in addition, do not exercise in large or small amounts, so as not to cause obvious fluctuations in blood sugar. There are many exercise programs for sugar lovers, so choose the right one for you according to your physical condition. But no matter which exercise you choose, you should keep in mind the general principle of exercise, which is gradual, measured and persistent.
Medication is an important weapon to lower sugar. When diet and exercise cannot control blood sugar, medication will be needed to help.
After the above-mentioned five-driver treatment and self-emotional adjustment, what kind of standard should the blood sugar of diabetic patients reach?
The control goal of diabetes glycosylated hemoglobin >7.5%, or fasting blood glucose >7.0mmol/L, or postprandial blood glucose >10.0mmol/L are not well controlled and need to be managed more.
The immediate goal of urinary disease treatment is to control diabetes and prevent acute metabolic complications, and the long-term goal is to achieve the prevention of chronic complications through good metabolic control, improve the quality of life and prolong the life span of diabetic patients.