Diabetic limb vasculopathy is one of the most common chronic complications of diabetes mellitus, which belongs to the category of “pulse paralysis” and “gangrene” in Chinese medicine. With the improvement of living standard and the aging of society, diabetes and its vascular complications are increasing exponentially. 22%-46% of diabetic patients suffer from complications of limb vasculopathy, which is one of the main causes of disability and death of diabetic patients and is extremely harmful to human health.
Currently, both Chinese and Western medicine emphasize the importance of prevention of diabetic limb vasculopathy. The following is the tertiary prevention of diabetic limb vasculopathy from three aspects.
First, prevention before the disease
Since ancient times, Chinese medicine has emphasized the prevention idea of “not treating the disease before it happens”. Therefore, the prevention of diabetic limb vasculopathy, the first is the prevention of diabetes, mainly from the following five aspects: 1.
1, diet: diet structure and dietary habits of unreasonable is the main environmental factors leading to the occurrence of type 2 diabetes, especially sweet or long-term consumption of refined rice, refined flour, high fat, high calories, high protein, not only easily cause obesity and is a recognized risk factor for diabetes. Therefore, in addition to paying attention to the reasonable proportion of nutrients in the daily diet, we should limit the total calories and fat, and increase the intake of grains and vegetables, so as to help reduce the risk of diabetes.
2, exercise: appropriate physical exercise is a basic method to prevent diabetes, it can improve the sensitivity of insulin and glucose utilization, thus reducing the risk of diabetes. British research found that 30min of moderate intensity exercise every day can reduce the risk of developing type 2 diabetes by 58% and reduce weight by 5%-7%.
3, psychological factors: diabetes is recognized as one of the physical and mental diseases, mental tension is an important factor in the occurrence of diabetes. Long-term excessive mental tension can make the body endocrine metabolism disorder, causing blood sugar rise. As the elderly are susceptible to a variety of adverse factors, mental and psychological problems, which is not conducive to the prevention of diabetes. Therefore, the elderly eliminate or reduce the psychological pressure, maintain a good state of mind, to prevent diabetes has a positive significance.
4. Sleep: People who do not get enough sleep or sleep excessively are prone to diabetes. The results of a recent study show that people who sleep less than 6 hours and more than 8 hours a day are 1-3 times more likely to develop diabetes than those who sleep 6-8 hours. The reason for this is that the former secrete more insulin and are less sensitive to insulin. Researchers point out that when the body loses the ability to regulate the body’s blood sugar response to insulin, blood sugar levels will rise, which in turn leads to diabetes.
5, obesity: overweight and obesity (especially abdominal obesity) is one of the main risk factors for type 2 diabetes, the risk of diabetes can increase with the growth of weight. Obesity can cause insulin resistance, reduced glucose tolerance, and thus the occurrence of diabetes. 80%-90% of type 2 diabetes patients with overweight or obesity. Obesity, however, is a controllable and correctable factor that can be improved by, for example, a healthy diet and proper exercise. Therefore, weight control can prevent diabetes.
At present, the best way to prevent diabetes is to maintain a healthy lifestyle: scientific and reasonable diet, regular and moderate physical exercise, weight control, minimize mental stress and ensure adequate sleep.
Second, the disease has been prevented from changing
For high-risk groups, fasting blood glucose or (and) postprandial blood glucose should be checked regularly to achieve early diagnosis, and once diabetes is detected, early treatment, mainly active control of blood glucose, and active prevention of various risk factors for diabetic limb vasculopathy to prevent the occurrence of diabetic vascular complications.
1, diet: for diabetic patients who have been diagnosed, diet therapy should be used as the preferred method of blood sugar control. Diet avoid sweet food, less pasta, more grains and vegetables. Strictly in accordance with the diabetic diet, for the control of blood sugar has a positive significance, thereby delaying the occurrence of diabetic limb vascular disease.
2, exercise: for patients with insignificant increase in blood sugar, on the basis of diet therapy, with appropriate exercise therapy, generally can better control blood sugar, and has a positive effect on the prevention of obesity.
3, mental: mental tension can make blood sugar rise. Therefore, diabetic patients should maintain mental comfort and emotional stability, which is necessary for blood sugar control.
4.Drugs: Strict control of blood sugar is the basis for preventing diabetic vascular complications. When poorly controlled by diet and exercise and other non-drugs, oral hypoglycemic drugs or insulin therapy should be chosen according to the condition to control fasting blood glucose at 5-7mmol/L and reduce the process of atherosclerosis of lower limbs in diabetic patients, so as to effectively reduce the occurrence of lower limb arterial lesions. Due to the presence of abnormalities in lipid and lipoprotein metabolism in diabetic patients, mainly hypercholesterolemia, hyper- and low-density lipoproteinemia and reduced high-density lipoprotein. Studies have confirmed that disorders of lipid metabolism are the most important pathogenic factors or risk factors for the development of atherosclerosis. Therefore, in the active control of blood sugar at the same time to correct lipid metabolism disorders.
5.Sleep: Diabetic patients should develop reasonable sleep habits and ensure sufficient sleep, which has an important role in the control of morning fasting blood sugar.
6, general protection: develop good hygiene habits, diabetic patients should check the feet every day, keep the feet clean, loose and appropriate footwear; strengthen labor protection, develop a good walking and standing posture, avoid foot injury; avoid infection and cold, prevent frostbite; for ingrown nails, corns and calluses, blisters, injuries and fungal infections properly handled.
Third, after the disease to prevent disability
Once diabetic patients have lower limb arteriopathy, they should pay great attention to the patients, actively carry out the correct specialist treatment, use the holistic treatment of Chinese and Western medicine to improve blood circulation and microcirculation, prevent the aggravation of the disease, and at the same time pay attention to the protection of the affected limb, so as not to cause amputation or even complications of cardiovascular, cerebral and renal vascular disease and endanger life, and improve the quality of life of patients.
1, active control of blood sugar: is the most basic measures to prevent and control diabetic limb vasculopathy. Use diet therapy, exercise therapy, spiritual therapy, drug therapy (oral hypoglycemic drugs or insulin therapy), so that fasting blood sugar control at 5-7mmol/L, blood sugar is not easy to fall too low, so as to avoid hypoglycemic reaction.
2.Therapeutic internal herbal medicine: According to the four diagnoses, overall identification, local identification according to the local condition of the affected limb, combining overall identification and local identification internal herbal medicine, giving full play to the overall advantages of Chinese medicine in treating diabetic limb vascular lesions, delaying the process of lesions, preventing the aggravation of the disease, avoiding the occurrence of limb gangrene injury and loss of limbs or even life, and improving the quality of life of patients.
3, drug intravenous injection therapy: This is an important therapy for treating diabetic limb vasculopathy and preventing it from becoming evidence. The application of blood circulation and blood stasis Chinese medicine intravenous drip, with thrombolytic, anticoagulant, fibrinolytic, vasodilator and other drugs, or the application of arterial injection therapy of the affected limb, can be faster to improve blood circulation and microcirculation, preserving the limb.
4, with appropriate external therapy: external therapy is a unique therapy of traditional medicine in China, which is effective in peripheral vascular diseases. The early stage of diabetic complications of lower limb vascular lesions with appropriate external therapies, such as drug fumigation therapy, can improve the symptoms of the affected limbs. The use of drug fumigation should avoid scalding, so as not to increase the metabolism of the tissue and cause gangrene of the limb.
5, if the limb ulcer necrosis, in addition to active control of blood sugar and anti-infection, but also with aseptic change: according to the situation of the sore surface selection of drugs, such as infection oozing obvious, available Qingda saline gauze, while the systemic application of antibiotics to prevent infection; infection control, the sore surface necrotic tissue more, can be used to rhubarb oil gauze, to get rid of rotten tissue; infection control, blood circulation improved, sore surface buds fresh If the infection is controlled, blood circulation is improved, and the sore surface is fresh, the oil gauze can be used to promote the growth of granulation and accelerate the healing of the sore surface.
6, surgical treatment: for diabetic limb vasculopathy in the early stage, the arterial blockage segment is not long, or when the complication of gangrene of the limb can be performed interventional therapy, which can improve the blood supply to the lower limb, which is conducive to the early healing of gangrene and significantly reduce the rate of amputation. When gangrene infection occurs in the limb, the infection should be actively controlled, and when the blood circulation improves, the gangrene infection is controlled and clear boundaries are formed, necrotomy or partial toe amputation is feasible to preserve the limb. However, in the advanced stage of vascular disease or after the failure of revascularization surgery, high level amputation is still required to save life.
7, diabetes complicating limb vascular disease: make patients fully aware of the importance of limb protection and avoid all damaging treatments, such as acupuncture, physiotherapy, cupping, baking, and indiscriminate use of plasters. A series of protective measures such as keeping the affected limb warm but avoiding hot water bags, avoiding trauma, and wearing loose and comfortable shoes and socks are particularly important. It is also necessary to quit bad habits, such as quitting smoking, etc.
8, causing long-term ischemic pain: so that the patient’s mobility is reduced and affects sleep, emotional depression frustration or irritability, especially the amputation of limb disability on the patient caused by the great psychological impact. Therefore, psychological care for patients is very important, especially before and after amputation, which can reduce or eliminate the occurrence of postoperative phantom limb pain or residual limb pain, re-understand self-worth and improve the quality of life.