The five aspects of modern diabetes treatment, namely diet, exercise, medication, blood glucose monitoring and diabetes education, are known as the five horses of diabetes treatment. Among them, diet, exercise and medication play a direct role in treatment, while blood glucose monitoring and education are important means to ensure that these three elements function correctly.
I. Diabetes education
The importance and necessity of diabetes education is determined by the nature of diabetes itself. Diabetes is a common disease, a lifelong disease, and a systemic disease. Without the close cooperation of patients and their families, it is difficult to achieve good results by the efforts of doctors alone. In order to achieve satisfactory results in diabetes treatment, patients and their families need to be educated about diabetes. The aims of the National Diabetes Federation (IDF) regarding diabetes education include: 1. All people with diabetes have the right to receive diabetes education for better treatment of diabetes and better health; 2. The work of diabetes educators is important in improving the prognosis of patients with diabetes; 3. Diabetes education helps to reduce and delay the onset and development of chronic complications of diabetes; 4. The IDF has initiated an assessment of the needs and important issues in diabetes education in all regions of the world and has developed a work plan to conduct research on diabetes education.
Self-monitoring of blood glucose
Self-monitoring of blood glucose (SMBG) is one of the most important advances in the management of patients with diabetes in the last decade and represents an important technological advance. Through a small, portable and easily calibrated blood glucose meter, a drop of blood is placed on a test strip, and the meter can quickly display the blood glucose value digitally, providing dynamic data for diabetic patients and health care providers to frequently observe and record blood glucose levels, which greatly benefits the treatment and management of diabetic patients. In the beginning, SMBG was mainly used for: 1. those who are under intensive treatment; 2. those who have gestational diabetes or diabetes combined with pregnancy; 3. those who have unstable condition and are prone to ketoacidosis and hypoglycemia; 4. those who have abnormal renal glucose threshold. Its application has been gradually expanded, and the use of glucose self-monitoring systems for the diagnosis of diabetes mellitus is usually not advocated, except for the initial screening in epidemiological surveys done on large groups of people. In addition, it should be noted that the accuracy (ability to obtain correct data) and precision (ability to reproduce results) of blood glucose self-monitors are affected by various factors, and attention should be paid to the training and quality control of users.
III. Diet therapy
Diet therapy is the basic measure of diabetes treatment. Regardless of the type of diabetes, the severity of the disease and the type of medication applied, diet therapy should be used to reduce the pancreatic islet burden and lower the excessive blood sugar to improve the symptoms. The principle of diabetic diet therapy is to reasonably control the total calories and the proportion of food components.
1. Total calories Reasonable total calories is the primary principle of diabetic diet control, which should be determined according to diabetes typology, disease, age, height, weight and labor intensity. The rough calculation of ideal weight (kg) for adults is: height (cm) – 105 or [height (cm) – 100] × 0.9.
The calorie requirement of adult diabetes (see table) Body type calorie requirement Body type bed rest light physical labor medium physical labor heavy physical labor normal (standard weight) low weight and wasting overweight and obese children need total calories: 1000kcal/d at the age of 1 year, after that add 100 kcal/d for each additional year, to adolescence according to the adult requirement.
2, food composition (1) carbohydrates: should account for about 55% of the total calories, the daily intake is controlled at 250, about 300g of food. fpg>11.1mmol/L and overweight, obese people, should be controlled at 130-200g/d, about 150-250g of food. food should choose whole wheat products and mixed grains containing more plant fiber, such as oatmeal, black bread, buckwheat, corn, millet, etc. corn, millet, etc.
(2) Fat: It should not exceed 30% of the total calories, and the daily intake should be controlled at 0.6~1g/kg, and <40g/d for overweight and obese people. reduce the intake of saturated fatty acids, which should be less than 10% of the total calories, and increase the proportion of unsaturated fatty acids appropriately. Olive oil, tea seed oil, corn oil and sunflower oil rich in linoleic acid can prevent the formation of atheromatous plaque. Fish oil can reduce triglycerides, lower blood pressure, anticoagulation, and help anti-atherosclerosis.
(3) Protein: It should account for 20% of the total calories, about 0.8~1.2g/kg per day for adults, and can be increased to 1.5g/(kg.) for children, pregnant women, lactating mothers and those with combined wasting diseases. Obese people should limit the total calories and fat to lose weight, it is appropriate to increase the proportion of protein, which can account for 25% of the total calories. Milk, eggs, fish, poultry, beef and lean meat are rich in animal protein. Those with combined diabetic nephropathy and impaired kidney function should be given high-quality protein, such as milk, eggs, chicken, beef, and the daily intake should not exceed 0.8g/kg.
(4) Food fiber: adults should consume 20~35g of food fiber. foods rich in soluble food fiber include wheat, beans, fruits, vegetables, kelp, nori, which form soy acid, pectic acid and algae gum respectively in the intestine, which can delay the absorption of carbohydrates, reduce pancreatic load, improve glucose metabolism, and reduce cholesterol and LDL cholesterol. Insoluble fiber exists in the outer skin of coarse grains, legumes and cereal seeds and plant stems and leaves rich in cellulose, hemicellulose and lignin, which can increase the volume of stool, increase intestinal motility, and prevent constipation.
It should also be supplemented with adequate vitamins, inorganic salts and trace elements, as well as with a reasonable meal distribution. The purpose is to help patients restore and maintain normal blood sugar levels; maintain proper lipid levels to reduce the occurrence of cardiovascular and cerebrovascular diseases; maintain normal body weight to ensure the growth and development of adolescents and the nutritional needs of pregnant women and lactating mothers; achieve nutritional balance, improve the nutritional status of the body, and enhance the resistance of the body. In terms of food selection, the pagoda concept recommended by the Chinese Nutrition Society is vigorously promoted. In conclusion, diet therapy needs to follow the principle of individualization, and medical personnel, nutritionists, patients and their families should cooperate closely.
IV. Exercise therapy
Regular exercise can bring many beneficial effects to patients with type 2 diabetes, including: 1) reducing body fat content, especially abdominal fat content, and improving the ability of muscles to use glucose; 2) improving insulin sensitivity, lowering plasma insulin levels, and improving glucose metabolism; 3) delaying the onset of type 2 diabetes in high-risk groups; 4) reducing LDL and triglyceride concentrations in the body, and Increase HDL concentration, improve fibrinolytic activity and reduce the chance of thrombosis, thus reducing the risk of developing cardiovascular disease. However, inappropriate exercise may have some adverse consequences for patients with long duration of disease, especially the elderly, such as cardiovascular problems that may cause myocardial ischemia or even infarction, microvascular problems that may cause retinal hemorrhage and urinary protein, and metabolic problems that may cause hypoglycemia, hyperglycemia or ketosis. Therefore, the patient should be evaluated before developing an exercise program, including: 1) medical history and physical examination 2) review of diet and medication; 3) foot examination; 4) fundus examination; 5) neurological examination; 6) overview of cardiovascular risk factors, body posture and glycemic control; 7) measurement of pulse, blood pressure, electrocardiogram during exercise and upright blood pressure, blood glucose and urinary albumin excretion rate after exercise. According to the assessment, practical exercise methods, frequency, intensity and duration of each exercise will be formulated, and other treatments will be adjusted accordingly according to the changes of some biochemical indicators during exercise, so that patients will be more willing to consciously adhere to regular aerobic exercise for a long time, and can be combined with household chores.
V. Drug treatment type
The drug treatment of diabetes includes oral hypoglycemic drugs and insulin treatment. type 2 diabetes can be treated in an acute stepwise manner according to the characteristics of the disease, i.e., first with diet therapy and physical exercise; if the patient has seriously implemented a healthy lifestyle for 2~3 months and the blood glucose level still does not reach the standard, then use an oral hypoglycemic drug and further combine oral hypoglycemic drugs or combined oral hypoglycemic drug box according to the needs of the disease insulin; if the insulin requirement exceeds 30U per day, an additional oral drug is used to reduce insulin resistance.
In recent years, the changes in the viewpoint of diabetes drug treatment are mainly manifested in the importance of controlling postprandial hyperglycemia and the combined application of two or even three drugs with different mechanisms of action and different duration of action, in order to better improve the disorder of glucose metabolism, reduce the side effects of drugs and delay the occurrence of complications. At present, the main oral hypoglycemic drugs for the clinical treatment of type 2 diabetes are: sulfonylureas, biguanides, α-glucosidase inhibitors, thiazolidinediones, and new insulin promoters are developed successively.
The above five aspects are the basic methods of diabetes treatment, and each method is complementary to each other and cannot be abandoned, so that patients can get the best treatment by taking comprehensive measures.