Regular check-ups for diabetic patients are important to help monitor the progression of the disease, provide a basis for the use of medications, increase their efficacy and reduce adverse effects (hypoglycemia, etc.). If the examination reveals complications they can be treated promptly.
Blood pressure, pulse, weight and waist and hip circumference should be measured at least once a week. Blood glucose and urine routine, especially urine sugar, urine protein and urine ketone body should be checked at least once a month. Glycated hemoglobin status, which should be checked every two to three months. Urine microalbumin, which should be checked every six months to a year. Eye condition (should include fundus examination), checked every six months to a year. Liver function, kidney function, and lipid profile every six months.
Patients can record the results of the above examinations with the date of examination, and also record the conscious symptoms, the amount of food and calories eaten at each meal, work activities, and the occurrence of hypoglycemic reactions. All these will provide important reference information for the doctor to formulate further treatment plan.
Urine glucose test
It is a simple, easy and inexpensive method to monitor the control status of diabetes, and is still used by most patients in China. There are two main methods.
Spot’s reagent method: This method has been used potentially for a long time, but because of its cumbersome operation method and the shortcomings that sometimes the user will be burned or scalded, fewer and fewer people are using it now.
Urine sugar test paper method: At present, there are many kinds of urine sugar test paper for sale in China, and its determination method is similar: 1.
1, first put the urine sugar test paper into the container with urine.
2, immediately remove, wait a moment.
3, within 30 seconds with the test paper packet of different urine sugar try colorimetric, in order to determine the amount of urine sugar.
4.The result is indicated by “+”.
Although urine sugar determination is easy and simple, there are many drawbacks.
Only when the blood sugar exceeds the renal sugar threshold (180mg/dl), it can be filtered out from the kidney and excreted in the urine, but when measured on an empty stomach, the urine sugar is negative although the blood sugar control has not reached the requirement.
Urine glucose is only helpful when controlling high blood glucose, but has almost no value when low blood glucose.
Urine glucose test strips are semi-quantitative and not as accurate as blood glucose.
An increase in urine sugar reflects the level of blood sugar a few hours ago and does not reflect the blood sugar situation at that time.
In cases of neuropathy, prostatitis, and renal diabetes, the urine of a diabetic patient cannot be completely emptied, and the urine sugar measured at this time will include sugar that has been filtered out earlier, thus causing misunderstandings when determining the results.
Urine glucose measurement is also influenced by how many factors.
(1) Altered renal glucose thresholds in renal insufficiency, the elderly and pregnant patients, etc., when urine glucose is not representative of actual blood glucose levels.
(2) Sometimes urine glucose can also be elevated in non-diabetic cases, such as certain kidney diseases, heavy eating, exercise, etc.
(3)Urinary tract infection. Urine sugar is also not representative of blood sugar when women are menstruating, pregnant, etc.
(4) Certain drugs with reducing properties can also discolor the urine sugar test paper, causing the illusion of high urine sugar. For example, vitamin C, salicylates, etc.
Normal range of blood sugar
Blood sugar means glucose in the blood, and various other sugars, such as fructose, disaccharide and polysaccharide can only be called blood sugar after they are converted into glucose into the blood. The normal human blood sugar concentration is likewise in stability and balance. Once the balance is disturbed, such as an abnormally high blood sugar, it comes back to diabetes.
The normal range of blood glucose is between 3.9 and 6.1 mmol/L in fasting and less than 7.8 mmol/L 2 hours after meal, and the body can adjust its blood glucose level to stay within this range under normal circumstances. However, in the case of disease, blood glucose exceeding (above or below) the normal range can cause hyperglycemia or hypoglycemia.
Hyperglycemia: Blood sugar elevated above the normal range.
Hypoglycemia: Blood glucose is too low above the normal range.
When blood glucose is significantly elevated to a certain degree (such as fasting blood glucose over 7.0mmol/L or 2 hours after meal blood glucose over 11.1mmol/L), it both meets the diagnostic criteria of diabetes and is called diabetes.
If the blood glucose is mildly elevated, although it has exceeded the normal range, but still does not reach the diagnostic standard of diabetes, such as fasting blood glucose between 6.2-7.0mmol/L and 2 hours after meal blood glucose between 7.8-11.1mmol/L, it is an excessive state, called hypoglycemic tolerance (IGT), in a sense, is a kind of danger signal of diabetes. Early attention can prevent it from developing into diabetes.
It is important to remind patients that hypoglycemia is as harmful as hyperglycemia, and hypoglycemia can cause various hypoglycemic reactions and even coma, which will endanger life. Therefore, during the treatment of diabetes, in addition to preventing the danger of elevated blood sugar, it is important to pay attention to the danger of hypoglycemia.
The effect of blood sugar on the human body
Blood sugar refers to the glucose contained in the blood, and the blood sugar value indicates the concentration of glucose in the blood. Sugar is carbohydrate, and normal level of blood sugar is extremely important for the physiological functions of human tissues and organs. Normal blood glucose fluctuates in a certain range, with fasting blood glucose of 3.4-6.2 mmol/L (60-110 mg/dL) and blood glucose not exceeding 7.8 mmol/L (140 mg/dL) 2 hours after a meal. Glucose is necessary for the human body, but too high or too low blood sugar will have certain effects on the human body, some of which are even lifelong and fatal, so maintaining the proper blood sugar concentration is what the body needs. The following will talk about the effects of high blood sugar and low blood sugar on the human body.
(A) High blood sugar
Is high blood sugar good for the human body? It should be said that short-time and transient hyperglycemia is not seriously harmful to the human body. Transient hyperglycemia can occur when the human body is under stress or emotional excitement or high tension, or when a large amount of sugar is consumed at one time, and then the blood sugar level will gradually return to normal under various regulation of the body. Long-term hyperglycemic state is commonly found in diabetes mellitus, which is a systemic metabolic disorder caused by absolute or relative deficiency of insulin in the blood and reduced sensitivity of target cells to insulin. Long-term hyperglycemic state can cause pathological changes in various organs and tissues of the body, commonly
(1) High blood glucose concentration in the blood, but lack of insulin, blood glucose cannot enter the target cells to be utilized, lack of glucose in tissue cells, and accelerated fat and protein decomposition.
(2) Extensive capillary wall thickening and lumen thinning throughout the body, red blood cells cannot easily pass through, and tissue cells are hypoxic.
(3) The kidneys show glomerulosclerosis and renal papillary necrosis.
(4) Retinal capillaries in the fundus of the eye appear as microangiomas, fundus hemorrhage, exudation, etc.
(5) Degeneration of nerve cells and segmental demyelinating lesions of nerve fibers.
(6) Multiple atherosclerosis in the heart, brain and lower extremities. Hyperglycemia is often accompanied by hyperlipidemia, and atherosclerosis of coronary arteries, cerebral vessels and lower limbs occurs earlier and more severely than normal people.
The above pathological changes will cause a variety of diabetic comorbidities in the body, thus affecting the quality of life of the patient and causing disability and death in serious cases. Therefore, diabetic patients should be treated promptly.
(II) Hypoglycemia
Hypoglycemia is a sudden drop of blood sugar to below 2.8 mmol/L (50 mg/dL) caused by a variety of reasons.
It produces a syndrome characterized by sympathetic hyperexcitation and brain dysfunction. Due to the rapid drop of blood sugar, patients often have hunger, nausea, vomiting, weakness, powerlessness, nervousness, anxiety, palpitation, cold sweat, pale face, hand and foot tremor, etc.; when blood sugar further drops, patients may appear mental trance, drowsiness, convulsions, coma; long-term and serious hypoglycemia can cause brain damage, such as coma for more than 6 hours, which can cause irrecoverable brain damage, and then cause death.
The most common cause of hypoglycemia is the overdose or improper use of insulin and sulfonylureas in diabetic patients; elderly diabetic patients are prone to hypoglycemic reactions before lunch or dinner, even if their condition is stable and untreated.
For the prevention of hypoglycemia, firstly, we should eat within 30 minutes after insulin injection, and when the activity increases, we should add a small amount of meals in time, and we should pay attention to eating on time when we go out to work, and patients who take sulfonylurea hypoglycemic drugs should also add meals in time; secondly, patients who inject mixed insulin should pay special attention to eating dinner on time and eating more staple food or eggs and dried tofu before going to bed; thirdly, we should carry some sugar cubes, cookies Third, carry with you some candy bars, biscuits, etc. for application in case of hypoglycemic reaction.
When the acute attack of hypoglycemia occurs.
1. For patients with mild reaction and sober mind, use 25-50 grams of white sugar or brown sugar and wash it down with warm water or drink other sugar-containing drinks; for those who are a little heavy, eat 25 grams of steamed buns, bread or cookies, or 1-2 pieces of fruits, and the reaction will disappear after 10 minutes in general.
2, hypoglycemic reaction is heavy, and the mind is not very clear, you can put white sugar or brown sugar in the patient’s mouth, make it dissolve and swallow; or mix it into syrup and feed it slowly. If the sugar is still not awake for 10 minutes, it should be sent to a nearby hospital immediately for rescue.
3.For the patient who is in a hypoglycemic coma, 50% glucose 40ml should be injected intravenously immediately, and oxygen should be given, which will be effective soon, or hyperglycemia 1mg should be injected intramuscularly, and the consciousness should be awake within 15 minutes. After waking up, the patient must be given sugar water, etc. to prevent the next reactive hypoglycemia.
What is the significance of fructosamine measurement?
Fructosamine is a substance formed by the protein in plasma during the non-enzymatic glycation of glucose. Since the half-life of plasma protein is 17 days, fructosamine reflects the blood glucose level within 1-3 weeks.
The determination of fructosamine is fast and inexpensive, and it is an indicator to evaluate the control of diabetes, especially for brittle diabetes and gestational diabetes with large fluctuations of blood glucose, and it is more practical to know the average blood glucose level. However, fructosamine is affected by each meal, so it cannot be used to directly guide the daily dosage of insulin and oral hypoglycemic drugs. The normal value of serum fructosamine is 2.13 ± 0.24 mmol/L, and the plasma fructosamine is 0.3 mmol/L lower than the serum.
Does a positive urine sugar mean that I have diabetes?
In diabetes, urine sugar is positive, but positive urine sugar does not necessarily mean diabetes. There are many reasons for a positive urine sugar test.
1, after eating diabetes A few normal people after ingesting a large amount of carbohydrates, due to excessive absorption of sugar in the small intestine, blood glucose concentration rises above the renal sugar threshold and diabetes, known as tonic diabetes.
2, renal diabetes nephritis, nephropathy and other kidney diseases due to reduced renal tubular reabsorption of sugar, the renal sugar threshold is low, although the blood sugar is normal and diabetes. A small number of pregnant women also have a temporary reduction in the renal glucose threshold and diabetes.
3, neurogenic diabetes See in cerebral hemorrhage, brain tumors, skull fractures, traumatic brain injury, anesthesia, etc. These diseases sometimes have temporary hyperglycemia, accompanied by diabetes, with the remission of the disease blood sugar back to normal, urine sugar turned negative.
4, non-glucose urine, such as lactosuria, seen in lactating women, pregnant women and young infants; fructose and pentose urine, occasionally seen after eating a lot of fruit, is a very rare congenital disorders.
5. False-positive urine sugar After taking a large amount of vitamin C, vincristine, remifentan, aspirin and other drugs can cause a false-positive reaction of urine sugar.
Once a patient finds a positive urine sugar, he or she should go to the hospital and have fasting glucose, postprandial glucose and, in some cases, a glucose tolerance test done. The doctor will determine whether the positive urine sugar is caused by diabetes or by other causes based on these materials.
How often should you have your blood glucose monitored?
This will be up to you and your diabetic doctor to decide. However, studies have shown a very significant correlation between the number of daily blood glucose monitoring sessions and strict blood glucose control, including the famous Diabetes Control and Complications Trial (DCCT) in the United States. This means that the more often you can monitor your blood glucose levels, the tighter the blood glucose control you can achieve.
People with type 1 diabetes will have very large fluctuations in blood glucose levels throughout the day. If you are on intensive therapy to get your blood glucose levels as close to normal as possible, you will need to have your blood glucose monitored 4-5 times a day: before each meal and at bedtime, and at least one day a week at midnight (3 a.m.). If you are not currently on intensive therapy, and your treatment is aimed only at preventing excessive increases in blood glucose levels and acute complications of diabetes caused by hyperglycemia (ketoacidosis), then you will only need to have your blood glucose monitored twice a day. However, you should be aware that previous studies have found that blood glucose control tends to deteriorate in patients with diabetes when blood glucose is monitored less than four times a day, and that this deterioration in blood glucose control increases the risk of serious diabetes complications in patients with diabetes. When deciding how often to self-monitor your blood glucose, the relevant diabetes professional organizations have recommended that every person with type 1 diabetes should self-monitor their blood glucose at least once before each meal. This is essential for people with type 1 diabetes to determine their insulin dose, and to determine their dietary intake.
Compared to people with type 1 diabetes, blood glucose levels in people with type 2 diabetes are usually more stable throughout the day and less likely to fluctuate significantly, so self-monitoring is not as frequent in people with type 2 diabetes as it is in people with type 1 diabetes. However, it is important to note that people with type 2 diabetes do not feel any discomfort even when their blood glucose levels are high, and this unrecognized hyperglycemic state can cause serious problems for these patients as well. Many human factors determine the frequency of glucose self-monitoring in type 2 diabetes, such as patient awareness and affordability of glucose self-monitoring. When you feel uncomfortable, self-monitoring may tell you what’s wrong. As a person with type 2 diabetes, you need to be aware that some people with type 2 diabetes think they can guess their blood glucose levels by how they feel, but numerous studies have found that almost no one can accurately guess their blood glucose levels. You will need to monitor your blood glucose more frequently when your diet and exercise levels change, or when you have a cold, fever, or other illness, or if you are under stress.
What is glycated hemoglobin?
You may have heard of the term glycosylated hemoglobin (HbA1c) test when you go to the hospital, or you may have had it done, but you may not have a good understanding of what it really means. Glycated hemoglobin actually refers to hemoglobin (or hematocrit) that has been glycated by glucose. By measuring the amount of glycated hemoglobin (HbA1c) in the blood, you can tell how well a person with diabetes has controlled his or her diabetes over the past few months. Why is it necessary to measure glycosylated hemoglobin periodically? While the daily blood glucose measurement of a diabetic patient only reflects the change in blood glucose at the time of the test, the measurement of glycosylated hemoglobin provides a picture of the overall blood glucose control over the past 2-3 months. Experts suggest that if a diabetic patient’s blood glucose control has reached the standard and is relatively stable, he/she should undergo glycated hemoglobin testing at least twice a year; while for those who need to change their treatment plan or whose blood glucose control status is unstable, glycated hemoglobin should be measured once every three months.
The red blood cells in the human blood contain hemoglobin, which is often referred to as hematocrit. When glucose in the blood comes into contact with hemoglobin, the two will cross-link together, thus forming what we now call glycated hemoglobin, which some people refer to as glycosylated hemoglobin, and when the concentration of glucose in the blood is high, the amount of glycated hemoglobin formed in the human body is relatively high. The life span of human red blood cells is generally 120 days (3 months), and the amount of glycosylated hemoglobin in the blood remains relatively unchanged until the human red blood cells die, so it appears that the glycosylated hemoglobin level in the blood changes every 120 days. Thus, the glycosylated hemoglobin level reflects the average blood glucose level over the past 2-3 months. Glycosylated hemoglobin measurements are expressed as a percentage. The glycosylated hemoglobin (HbA1c) level in non-diabetic individuals is 4-5.5%. Many studies have found that diabetics who can lower their HbA1c levels below 8.1% will have a much lower incidence of diabetic complications.
How can glycosylated hemoglobin (HbA1c) measurements help patients manage their diabetes? If you measure your blood glucose level only before breakfast every day, i.e. fasting blood glucose level, and find that it is 130 mg/dl, which is within the normal safe range, but when you take a glycosylated hemoglobin measurement and find that it is 11%, this means that your average blood glucose level has been close to 270 mg/dl for the past 2-3 months, which means that you are at risk of developing future diabetes complications This means that your average blood glucose level has been close to 270 mg/dl for the past 2-3 months, suggesting that you are at risk for future complications of diabetes. The glycosylated hemoglobin results suggest that although your blood glucose before breakfast is satisfactory, your blood glucose levels at other times of the day are severely over the limit, so your diet, exercise and medication need to be re-evaluated and adjusted accordingly, and your blood glucose levels need to be measured more frequently than at present.
When should a patient be monitored for urinary ketones?
Early detection of urinary ketosis can prevent diabetic ketoacidosis, which can be measured with urine test strips. Urine ketone bodies should be monitored in the following cases.
①Glucose greater than 270mg/dl;
②Glucose greater than 240mg/dl with symptoms of hyperglycemia;
③During any illness, such as fever, gastroenteritis, etc;
④When hungry or fasting;
⑤ Pregnancy, especially when accompanied by pregnancy vomiting;
(6) Any time you feel unwell.
If urine test reveals weakly positive urine ketone bodies and no other discomfort, drink plenty of water and monitor continuously. If urine ketone body continues to be positive or accompanied by dry mouth, weakness, vomiting, vomiting and other symptoms, you should immediately go to the hospital for consultation
Precautions for urine glucose monitoring.
The advantages of urine glucose monitoring methods are that they are simple, quick, not damaging to people, and inexpensive. However, because
① Urine glucose is affected by many factors and is prone to errors and cannot accurately reflect the blood glucose level;
② Only when the blood sugar is above 1Ommol/L, the urine sugar can respond, so it cannot monitor the occurrence of hypoglycemia;
③ Urine glucose is more delayed than blood glucose, for example, if urine is kept 2 hours after meal, the urine glucose result reflects the blood glucose level about 1 hour after meal.
Women with kidney disease or pregnant are not suitable for monitoring urine glucose due to changes in the renal glucose threshold; patients using insulin therapy need to detect possible hypoglycemic reactions and are not suitable for monitoring urine glucose; people taking high doses of vitamin C and aspirin and other drugs are not suitable for monitoring urine glucose because it may affect the results of urine glucose testing.
How to test fasting glucose and 2 hours postprandial glucose
Some diabetic patients have normal fasting blood glucose but significantly higher postprandial blood glucose, so clinically it is necessary to test fasting blood glucose and postprandial blood glucose when you are not sure whether the patient has diabetes.
At present, there are three main methods to detect blood glucose as follows.
1.Venous blood sampling to determine blood glucose. Take 1.5~2ml of venous blood and put it into a special blood glucose tube.
2ml of venous blood into a special test tube for blood glucose and then shake it well and send it for testing, the whole process takes about 2 hours. The advantage of this method is that the measured blood glucose value is accurate, but the disadvantage is that the waiting time is long and the patient cannot monitor blood glucose at home by himself.
2. Microvascular blood (finger, earlobe, toe) rapid blood glucose measurement. This method uses a needle to prick the finger, earlobe or toe, squeezes out a very small amount of blood, drops it on the end of a specific blood glucose test paper, and then inserts the end of the paper into the pocket blood glucose detector, and after 1 minute, the instrument can display the blood glucose value. This method is simple, rapid, no need to draw blood, and the patient is willing to accept it, and it is especially useful to test blood glucose several times when there is an emergency. Its disadvantage is that it is easily disturbed by external factors and the result is not stable enough.
3.Glucose test paper to measure blood glucose. After pricking the finger, earlobe or toe with a needle, attach the blood glucose test paper to the blood, observe the color change, and then compare it with the standard color to find out the color that is similar to it, and then get the blood glucose value. This method is simple and easy to use, but the measured blood glucose value is not accurate enough.
The above three methods are most commonly used in 1 and 2. When testing blood glucose, the influence of external factors on blood glucose should also be taken into account, and generally the intravenous blood glucose value should prevail.
Routine examination of diabetes mellitus
I. Blood test.
1.Glucose
(1), fasting blood glucose: It is best to draw blood at 6~8 am, and make sure to sleep well the first night. Because anxiety and insomnia can affect the blood glucose level.
(2), Pre-meal blood glucose: Blood is drawn before Chinese food and dinner for monitoring the condition during treatment.
(3), Random blood glucose: Any time of the day when blood glucose is suspected to fluctuate, it can be checked.
2.Glucose tolerance test, also called OGTT test: there are two kinds of oral and intravenous. This test is needed when blood sugar is higher than normal and does not meet the criteria for diagnosing diabetes. The patient needs to go to do it on an empty stomach, and the doctor will tell you more about the details.
3.Glycosylated hemoglobin (HbAlc): It can reflect the average blood sugar level in the 2 months before blood collection, and is the most effective and reliable indicator to reflect good or bad blood sugar control.
4.Insulin and C-peptide release test: It requires patients to draw blood several times for examination after taking oral glucose. It is convenient for the doctor to diagnose which type of diabetes you have and the specific medication.
2. Fluid tests.
Urine routine: It is better to urinate for the first time in the morning, and it is better to take the middle urine. Observe the presence of protein, ketone bodies, urine sugar in the urine, as well as the presence of urinary tract infection manifestations.