Diabetes Care Education

There is no one-size-fits-all unified plan for diabetes care. The core is the three-dimensional combination of "individualized lifestyle control + standardized medical follow-up + early screening of complications." Any care recommendations that are divorced from the patient's age, disease course, pancreatic islet function, and daily habits are essentially invalid guidance.

Last week, I met Uncle Zhang, a 62-year-old man who had been diagnosed with type 2 diabetes for three years. Last month, he heard an old man who danced with him saying that "you can stop taking hypoglycemic drugs by eating whole grains every time." So he stopped taking all his medicines when he got home and ate buckwheat noodles and steamed sweet potatoes three times a day. He didn't even dare to touch white rice. As a result, he came for a review last week and found that his fasting blood sugar had soared to 11.2mmol/L, and his urine ketones were two plus signs, which almost caused ketoacidosis. Do you think he didn't control his sugar seriously? Of course not, I just stepped on the most common pitfall of "copying common solutions".

Nowadays, the debate about diet in the diabetic circle has never stopped. Many scholars in the field of endocrinology in Europe and the United States recommend a very low-carbohydrate diet. The daily carbohydrate intake should be controlled within 10% of the total calories. It can indeed quickly reduce blood sugar in the short term and even allow some newly diagnosed diabetics to achieve "clinical remission." However, our domestic guidelines actually recommend warmer temperatures. In the mixed dietary pattern of He and her, carbohydrates account for about 50% of the total calories. The reason is also very practical: Chinese people’s eating habits are mainly based on grains, and it is difficult to adhere to extreme low-carbon diets for a long time. Many people endure it for several months, or they can’t help but experience a rebound in blood sugar due to excessive carbon consumption, or they suffer from fatigue, hair loss, and menstrual disorders in women. In fact, the gains outweigh the gains. I used to manage a 23-year-old patient who was newly diagnosed with diabetes. When he was first diagnosed, he ate boiled vegetables every day. He lost 22 pounds in three months, but his glycosylated hemoglobin was stuck at 7.2%. Later, I adjusted his plan and allowed him to eat sukiyaki twice a week. He chose a clear soup base, boiled lean beef and green leafy vegetables, and changed his staple food to half a piece of corn. He persisted for half a year, and his glycosylation dropped to 6.1%, and his overall condition improved a lot.

Many people get confused when they hear that they need to take insulin, thinking that "if you take it, you can't stop it." This statement actually depends on the situation: if you are a diabetic with extremely high blood sugar when first diagnosed, short-term intensive treatment with insulin for 2 weeks to 3 months can actually give the pancreatic beta cells a "holiday." Many people can stop taking the medicine later and control their blood sugar by eating and exercising alone.； But if the disease has lasted for more than 10 years and the pancreatic islet function has declined to less than 30% of normal, then you really need to use insulin for a long time to control blood sugar. This is not "addiction", but your body is indeed lacking this thing, just like calcium deficiency, you need to supplement calcium. There is nothing to be afraid of. GLP-1 drugs have become very popular in the past two years. Many people with diabetes want to prescribe them for weight loss regardless of whether they have indications. Here is another thing to mention: This type of drug is first recommended to people with type 2 diabetes who are combined with obesity and high cardiovascular risk factors. Patients who are not obese and do not have cardiovascular risks do not need to blindly follow the trend. Many people continue to feel nausea and vomiting after taking it, which in turn affects their normal diet.

Don’t think that everything will be fine if you measure your fingertip blood sugar every day at home. Fingertip blood sugar only measures the blood sugar value at a certain moment. If you want to know the average blood sugar level in the past 2-3 months, you still have to check your glycated hemoglobin every three months. I met a 58-year-old aunt in the past two years. She usually tested her fasting blood sugar at home at around 6mmol/L. She felt that her control was very good. She didn’t even bother to do the annual routine physical examination. Later, she felt that her eyes were blurry and she came to check. She already had microaneurysms in the fundus. Fortunately, she was discovered early and the laser did not affect her vision. If it had been delayed for another year or two, she would have probably gone blind. There are also many people with diabetes who think, "If I don't feel uncomfortable, I don't need to check for complications." In fact, kidney damage and fundus damage of diabetes do not have any symptoms in the early stage. By the time you have foamy urine and blurred vision, it is often in the middle stage, and reversal is much more difficult. Therefore, you should check urine microalbumin, fundus, blood lipids, and electrocardiogram at least once a year. This money really cannot be saved.

There are many opinions on when is the most appropriate time to exercise. Some people say that fasting exercise is effective in burning fat and significantly lowering blood sugar. Others say that fasting exercise can easily induce hypoglycemia, which is dangerous. In fact, both of these statements are correct, but they are suitable for different people: If you have a short duration of disease, good pancreatic islet function, and have never had hypoglycemia, you can try walking briskly for 30 minutes on an empty stomach in the morning. The effect of sugar control is indeed good. ； But if you usually take insulin or take sulfonylurea hypoglycemic drugs such as glimepiride, it is best to wait an hour after eating before moving. Remember to carry two pieces of fruit candy in your pocket. If you have symptoms of hypoglycemia such as panic, trembling hands, or cold sweats, take one quickly and don't carry it.

To be honest, many people with diabetes feel that the sky is falling when they are first diagnosed, and they feel that they cannot eat or do this or do that in the future. In fact, it is really unnecessary. Diabetes care never requires you to be an ascetic, nor do you need to copy the "perfect sugar control recipes" on the Internet. As long as you find a rhythm that suits you, occasionally eat a bite of your favorite cream cake, drink half a cup of milk tea, and make slight adjustments to your subsequent diet, there will be no big problem at all. After all, sugar control is a lifelong matter, and the best plan is the one that can be adhered to for a long time.