1, safe hypoglycemia, prevent hypoglycemia: all drugs for the treatment of diabetes, both for hyperglycemia hypoglycemia effect, but also hypoglycemia side effects. Prevention of hypoglycemia is the key to the safe selection of oral hypoglycemic drugs. Hypoglycemia is commonly seen in the treatment of diabetic patients and is the most common adverse reaction, which can directly lead to cardiovascular and cerebrovascular accidents and even life-threatening. It has been emphasized that “a single episode of severe medically induced hypoglycemia or resulting cardiovascular event may offset the benefits of a lifetime of maintaining blood glucose in the normal range.”
The Working Group on Hypoglycemia states that patients with diabetes should be treated as hypoglycemic as long as their blood glucose value is ≤3.9 mmol/L, regardless of fasting status.
Common symptoms of hypoglycemia: only obvious hunger and slight sweating in mild hypoglycemia, heartbeat, hand trembling, heavy sweating, pale or turning blue, dizziness and even coma in more severe hypoglycemia.
How to prevent and control hypoglycemia? Firstly, medication should be taken in conjunction with meals. Secondly, when hypoglycemia occurs, it should be dealt with in time. Generally, you can eat a few cookies, bread slices or a small amount of peanuts when you have mild hypoglycemia, but you should not eat sweet food. If there is serious hypoglycemia or even dizziness, you should eat sweet food (candy, sugar water, etc.) in time to rapidly raise blood sugar to avoid coma and go to the hospital in time.
2. The key words of safe glucose lowering: achieve the standard, safe, early and comprehensive: Achieve the standard: it is to make HbA1c≤6.5%, but the principle of individualization must be observed, that is, individualized achievement. The HbA1c target value is recommended by different diabetes treatment guidelines, the ADA guidelines recommend 7%, while the International Diabetes Federation (IDF), EASD and China’s newly released 2007 edition of the Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes all recommend 6.5%. The ADVANCE study set 6.5% as the target value for glucose reduction, providing strong evidence-based evidence. Diabetes is a heterogeneous, progressive disease with diverse etiologies, and clinicians must take into account the different circumstances of each patient to develop individualized glucose-lowering goals and protocols.
Opinions on the target glucose lowering values: ① For the ADA’s target glucose lowering value of HbA1c<7.0% for adults, individualized adjustments should be made according to the patient's pathophysiology, age, duration of diabetes, lifestyle, comorbidities, combined medications, hypoglycemia and pregnancy; ② For some patients, on the basis of the actual situation and the ability to avoid hypoglycemia and other adverse events as much as possible, the HbA1c to near normal values (e.g. 6.5%); ③ For patients whose strict glucose lowering may lead to hypoglycemia, shorten life expectancy or cause disabling complications, a lenient glucose lowering target is used. Safety: It is to avoid hypoglycemia. The current expert view, hypoglycemic events are seriously harmful, and glucose lowering emphasizes intensification on the basis of safety. In intensive glucose-lowering therapy, the occurrence of hypoglycemic events is an important aspect of our concern because repeated hypoglycemic events in diabetic patients can lead to derangement of the autoregulatory system and thus increase the risk of fatal myocardial infarction. Myocardial blood glucose utilization is reduced in diabetic patients compared to non-diabetic patients. Once hypoglycemia occurs, it can easily lead to acute myocardial infarction, and the defect in glucose metabolism and fatty acid metabolic response after myocardial infarction increases the risk of death. For example, an intensive hypoglycemic regimen based on acarbose tablets, regeneronide tablets and nateglinide tablets can effectively lower blood glucose on a safe basis and reduce the risk of cardiovascular and cerebrovascular events. Hypoglycemia relies on self-glucose management: If a person with diabetes has a blood glucose meter, he or she should first test fingertip blood glucose when mild hypoglycemic symptoms occur. Hypoglycemia symptoms may manifest completely differently in different people. Hypoglycemia can occur frequently, and the longer it lasts, the more severely brain function is impaired. If the patient fails to perceive autonomic symptoms, such as sweating, trembling, palpitations, etc., it may turn into coma or convulsions, which is called asymptomatic hypoglycemia. This kind of hypoglycemia is easy to be delayed in diagnosis and treatment, and the consequences can be serious or even life-threatening. About 30% of patients can develop asymptomatic hypoglycemia. To prevent hypoglycemia, we should monitor blood sugar regularly, apply hypoglycemic drugs reasonably, make blood sugar reach the standard safely, and go to hospital in time when hypoglycemia occurs. Early and comprehensive: It means to control a variety of risk factors that elevate blood glucose and produce complications, and improve long-term regression. Diabetes is often combined with a variety of cardiovascular risk factors, such as hypertension, hyperlipidemia, obesity, etc. These independent risk factors interact with each other and influence each other, increasing the risk of cardiovascular events. To improve cardiovascular outcomes in patients with diabetes, a comprehensive focus on these risk factors is needed in addition to glucose reduction. This comprehensive approach to intervention provides further benefit if it is initiated early, with prevention taking precedence. In patients with newly diagnosed type 2 diabetes, early intensive glycemic intervention does significantly reduce distant myocardial infarction and all-cause mortality. This has increased our focus on the importance of early and comprehensive management strategies in the management of diabetes. In patients with a certain duration of type 2 diabetes, it is beneficial to choose an appropriate safe glucose-lowering regimen to achieve the target. Combined glucose-lowering and antihypertensive therapy can provide further significant benefits to diabetic patients, not only in microvascular terms, but also in terms of reduced risk of cardiovascular death and all-cause mortality. In patients with existing cardiovascular disease, more attention should be paid to the control of other cardiovascular risk factors, such as blood pressure and lipids, with the aim of minimizing macrovascular events and prolonging patient life.