From the ‘death in bed’ to see the harm of hypoglycemia The introduction of insulin has fundamentally changed the fate of diabetics, making thousands of type one diabetics not only alive, but many of them can live as long as non-diabetics. But while happy, doctors encountered some strange things —- Some patients who used insulin and had normal blood sugar were found one morning to have died inexplicably. After careful investigation it was realized that these people died from hypoglycemia. I have seen a patient who has been using insulin for years, who went to a banquet with insulin injections, ‘got drunk’ without thinking that it was hypoglycemia, and then sent to the hospital overnight and died a ‘vegetable’! There are often people who get so drunk that fatal hypoglycemia sneaks up on them that night! Blood sugar control is not the lower the better About 50% of diabetic patients are found to have macrovascular disease before diabetes is diagnosed. In other words, high blood sugar can already greatly increase the risk of cardiovascular events even before a diabetes diagnosis is reached. Foreign studies have shown that a glycosylated hemoglobin (HbA1C) above 6.2% is associated with a significantly increased risk of cardiovascular events. Moreover, even when blood glucose is in the normal range, the risk of cardiovascular events increases as blood glucose rises. So, is it better to control blood sugar as low as possible? Foreign studies have been conducted on this issue, and it was found that the mortality rate increased in patients with long duration of disease and cardiovascular complications who had strict blood glucose control. The reason is that the stricter the blood sugar control, the higher the incidence of hypoglycemia, and hypoglycemia stimulates the release of glucose and blood pressure hormones, which can cause the heart rate to accelerate and systolic blood pressure to rise, which is enough to cause angina pectoris and even myocardial infarction in patients with coronary heart disease. Therefore, it is not better to lower blood sugar as low as possible, but to maintain it within the appropriate range. Especially for elderly patients, the standard should be relaxed. If you can’t resolve hypoglycemia, you’d rather not meet the standard! This is because hypoglycemia is more dangerous than hyperglycemia for the elderly. Relaxed glycemic control goals are appropriate for patients who have had hypoglycemia, have limited life expectancy, and have co-morbidities that do not lend themselves to strict control. There is a difference between leniency and strictness in glucose lowering treatment: it is ideal to maintain glycosylated hemoglobin at 6.5%-7.5% or lower, but it is difficult not to cause hypoglycemia; it is impossible to achieve “normal blood sugar” within 24 hours without hypoglycemia. Therefore, it is recommended that patients should keep their blood glucose at 6-7mmol/L before meals and less than 9mmol/L after meals for most of the day, and it is acceptable to be higher than this value for a short time; they should try to prevent their blood glucose concentration from falling below 4mmol/L. (In elderly people, it is even required that the non-postprandial blood glucose is not less than 5.5mmol/L.) A 65-year-old diabetic patient can lower his blood glucose from 8% to 7% without any change in quality of life and no increase in cardiovascular events. change, cardiovascular events will not increase, there will be no reduction in deaths, only a little benefit to the microvasculature, which can easily produce negative results. Elderly patients should not compare their blood glucose lowering treatment with young people. Some elderly people worry about their blood glucose value every day. In fact, getting his blood sugar to 5.5% will harm him. He will risk hypoglycemia every day. Therefore, we need to relax the standard for the elderly, >65 years old with 7% is fine. Those with a short life expectancy can have a blood sugar of 8%. For those who have no children around and have bad eyes, they just need not to have ketoacidosis. Hypoglycemia may not appear exactly the same for different people. It is true that hunger, panic and sweating are mostly seen in the first episode of hypoglycemia. But hunger is not the same as hypoglycemia. Many diabetic patients with hunger do not have low blood sugar and may have high blood sugar. Therefore, it is necessary to monitor blood glucose in time when you feel hungry, but the fact that the blood glucose measured is not low does not negate the fact that hypoglycemia has occurred. This is because the low blood sugar may have rebounded into high blood sugar when you measured it. Patients whose blood sugar drops too fast or too much in a short period of time may also have symptoms of hypoglycemia such as panic, sweating, hand trembling and hunger, but at that time their blood sugar is not low either. The symptoms can be different for the same hypoglycemia. Clinical observation shows that the clinical manifestations of diabetic patients of different ages are not exactly the same when hypoglycemia occurs. The symptoms of hypoglycemia occurring in adults are often more typical, mainly manifesting as sympathetic excitement symptoms, such as hunger, panic, hand trembling, sweating and weakness of limbs. In contrast, hypoglycemia occurring in the elderly can often manifest as drowsiness, impaired consciousness, hemiparesis, epileptic convulsions, coma, etc., which can easily be misdiagnosed as “acute stroke”. Some hypoglycemia is easy to recognize, but many hypoglycemia is “hidden”. Some hypoglycemia has no obvious symptoms. It is called “asymptomatic hypoglycemia”, which is mostly found in elderly diabetic patients and those who have frequent hypoglycemia for a long period of time, and patients with this problem must strengthen blood sugar monitoring. Pay special attention to the strange manifestations of hypoglycemia. Because hypoglycemia is actually a malfunction of brain function. This cannot be detected by measuring blood sugar alone! We also find that certain patients say they have headaches and chills during hypoglycemic episodes. Some people just have slurred speech. He can hear people talking, knows what they mean but cannot answer, and tries to answer but his mouth won’t listen to him. Family members can see that the patient is irritable, walks around ignoring people, and is in a blurred state of consciousness. What’s more peculiar is that some patients may fight with others, have paroxysmal atrial fibrillation, or just feel the numbness of their tongue during hypoglycemic episodes. …… Here is an old Chinese saying: the signs of suspicion should not be ignored. Hypoglycemia is important to prevent For hypoglycemia, prevention is better than cure, and it is better to avoid it. To this end, it is important to: eat regularly, be moderately active, use hypoglycemic medication wisely, monitor blood sugar, carry candy with you, and see your doctor regularly to adjust your treatment plan. The opinion of the European Diabetes Research Association is particularly worth our attention: (1) In early diabetic patients, the risk of cardiovascular disease is low, so in these cases the goal of glycemic control is close to the normal range. (2) In patients with longer disease duration and older age, it is also necessary to consider whether to use anti-hyperglycemic drugs or hypoglycemic drugs to minimize hypoglycemia, especially severe hypoglycemia, because the cardiovascular status of these people can no longer afford to be ‘tested’ by hypoglycemia. ‘. Special attention should be paid to reducing cardiovascular risk. Patients on sulfonylurea hypoglycemic drugs or insulin injections are always hungry, especially seven to ten days after starting the medication. Blood sugar drops significantly or even below normal, and hunger becomes more and more pronounced. It is called ‘drug hypoglycemia’. When this kind of hypoglycemia occurs, you can add a small amount of meals, usually one-third of two buns or three or four cookies is enough. Patients should be taught to find the “peaks” and “valleys” of blood sugar and adjust their insulin dosage once or twice a week. People who inject insulin should also remember to prepare a meal before taking the medication to avoid hypoglycemia. Once symptoms of hypoglycemia occur, take prompt action and consult an endocrinologist to find the cause of hypoglycemia. It is important to reduce the dose of the medication or maybe even to stop this kind of medication and change it to one that does not induce hypoglycemia. So when you are hungry all the time, you should think that you have taken too much medicine! When this happens, all should be treated as hypoglycemia and eat some candy quickly. Those with severe hypoglycemia or even coma should be given first aid or even hospitalized for resuscitation to get out of it.