Metabolic syndrome nursing routine

Based on individualized lifestyle intervention, the management plan is layered to match abnormal indicators such as blood sugar, blood pressure, blood lipids, and weight, and takes into account psychological state adjustment and early screening of complications. The ultimate goal is to reduce the risk of long-term cardiovascular and cerebrovascular diseases, diabetes and other complications.

Last week, I met a 38-year-old Internet programmer in the clinic. His waist circumference was 105cm, his fasting blood sugar was 6.9mmol/L, his blood pressure was 145/92mmHg, and his triglycerides were 2 times higher than the normal value. He was still laughing while holding the report and said, "I just need to be fatter, just drink more tea." In fact, this situation already meets the diagnostic criteria of metabolic syndrome. Without intervention, the risk of myocardial infarction and cerebral infarction in the next five years will be 2-3 times higher than that of ordinary people.

When it comes to intervention, the first thing that comes to everyone's mind is definitely "shut up", but now the opinions on how to eat on the Internet are very noisy. Some say that we should completely cut off carbon dioxide, and some say that we should go vegetarian. After so many years of clinical practice, we can only say that each has its own pros and cons. For example, the extremely low-carbon diet, which has become very popular in recent years, accounts for less than 20% of the daily energy supply from carbohydrates. Many patients can lose 8-10 pounds in the first month of trying it, and their fasting blood sugar can also drop 1-2mmol/L. However, nearly 30% of those who adhere to it for more than 3 months will suffer from hair loss, irritability, and elevated uric acid. Some patients even have gallstones that directly induce biliary colic. On the contrary, according to the dietary guidelines for Chinese residents, carbohydrates account for about 50% of total energy, eat more whole grains, low GI foods, eat one pound of vegetables and half a pound of fruits every day, and eat an appropriate amount of meat, eggs, and milk. Although you may only lose 2-3 pounds in the first month, the advantage is that you can persist for a long time and have no side effects. Among the patients who have been followed up in our ward for 2 years, those who can adhere to this diet can maintain more than 80% of their indicators within the normal range. Oh, by the way, there is another pitfall that is easy to fall into. Many people think that "sugar-free" foods can be eaten casually. In fact, sugar-free biscuits and sugar-free cakes contain a lot of trans fatty acids and refined starch. Eating too much will still raise blood sugar and make the stomach grow. Last time, a patient ate sugar-free oatmeal bars every day, and his waist circumference increased by 2cm in a month. This pitfall was stepped on.

After figuring out the problem of eating, the next step is to "stretch your legs", but don't immediately apply for a fitness card for two or three years, especially for patients with abdominal obesity, who have a large base weight and run, jump, and climb stairs as soon as they start, which is very harmful to the knee joints. We usually give the most basic requirements to newly diagnosed patients: first, sit for an hour less every day, and stand for 5 minutes after every 40 minutes of sitting. Don’t collapse on the sofa and check your phone immediately after a meal. Standing and wandering for 15 minutes is fine. It is better if you can go downstairs and walk around the community for 20 minutes. There was a 52-year-old aunt who listened to the Internet and walked 15,000 steps a day. After walking for half a month, her knees hurt and she couldn't go downstairs. Later, she changed to doing Baduanjin for 20 minutes every morning and evening. She walked an extra 10 minutes to buy groceries. In 3 months, her waistline dropped by 4cm, and her blood pressure dropped from 140/90 to 130/80. It was much more effective than messing around before. Oh, by the way, patients with high blood pressure must check their blood pressure before exercising. If the systolic blood pressure exceeds 160mmHg, rest first and don't move forcefully, as this may lead to danger.

After adjusting both eating and moving, you have to know if it’s working, right? Regarding monitoring, there are two groups of patients. One group finds it too troublesome and only checks blood sugar and blood pressure once every six months. The other group is so anxious that they measure blood sugar 8 times a day and cannot sleep if it is slightly higher. Our general clinical advice is that in the first month after you have just adjusted your lifestyle or changed your medication, test fasting + 2-hour blood sugar after meals on 2 days a week, and measure blood pressure 3 times a week. Sit down for 5 minutes before each test, and take the average of the 2 measurements. Once the indicators are stable, one test every half a month is enough. You really don’t need to test yourself every day. If you experience dizziness, palpitation, or blurred vision, take a test at any time. If something is wrong, go to the hospital immediately. Don’t force yourself to do anything.

Many people don’t know that poor sleep and poor mood will actually worsen metabolism. We met a 29-year-old young man before who stayed up late playing games until two or three o'clock every day. His waist circumference was 102cm, and his blood sugar and blood lipids were high. When we asked him to adjust his diet, he said he was busy with work and had no time, so we first asked him to go to bed before 11 o'clock. He tried half-heartedly for a month. Without any deliberate dieting, his waist circumference dropped by 3cm, and his fasting blood sugar dropped from 6.8 to 6.1. There are also many patients who are very anxious after being diagnosed and feel that they will have to deal with medicine bottles for the rest of their lives. They will either go on an extreme diet or break the medicine bottle and ignore it. In fact, it is really unnecessary. Metabolic syndrome is reversible. As long as it is adjusted well, there is no need to take medicine. If you really can't adjust it, talk to a nurse or psychiatrist and don't hold it in yourself.

Finally, let’s talk about the issue of taking medicine that everyone is most concerned about. There are two extremes. One kind thinks that "the medicine is only three parts poisonous" and refuses to take it even if the indicators are ridiculously high. The other type thinks that taking the medicine will make everything fine, and continues to eat and drink indiscriminately and not exercise. Both of these are not advisable. Generally speaking, if you adjust your lifestyle for 3 months and the indicators are still not up to standard, you should consider medication. Today's anti-hyperglycemic, anti-hypertensive, and anti-lipid drugs are very safe. Taking them according to the doctor's instructions will basically not cause any major side effects. It is much better than forcing your blood vessels to slowly block. But don’t think that you don’t have to worry about your lifestyle after taking medicine. There was a patient who took lipid-lowering medicine and ate braised pork every day. After 3 months, his blood lipids were higher than before. He made this mistake.

After all, there are actually not so many rigid rules in the care of metabolic syndrome, and there is no need to follow other people's templates. After all, everyone's living habits and physical foundation are different, and what suits you is the best. There is no need to pursue all indicators to be reduced to normal at once. Adjust slowly. Even if you only lose 1 pound per month and only lose 1cm in waist circumference, it is still a good thing. If you persist for a long time, the benefits will be much higher than if you are eager for quick success and quick gains.