Metabolic Syndrome Care Plan

Abandon the erroneous idea of ​​"one-size-fits-all hard control indicators" and adopt a three-dimensional framework of "individualized lifestyle intervention as the core, drug symptomatic management and control as an auxiliary, and psychological adjustment throughout the entire process." The priority of the intervention plan's persistence is much higher than the speed of forcibly lowering blood sugar, blood lipids, weight and other indicators in the short term.

Don't tell me, Lao Zhou, a 42-year-old Internet programmer who just received a diagnosis last week, fell into the trap of "hard control indicators". He is 1.75 meters tall and weighs 182 kilograms. The physical examination showed that fasting blood sugar was 6.8mmol/L, triglyceride was 3.2mmol/L, and systolic blood pressure was 146mmHg. It was just enough for three of the four diagnostic items of abdominal obesity, hyperglycemia, hypertension, and dyslipidemia to confirm the diagnosis of metabolic syndrome. He searched for nursing guidelines on the Internet, ate boiled vegetables every day, and forced himself to run 5 kilometers after get off work. However, he only persisted for 10 days when he fainted downstairs due to hypoglycemia and low potassium. When he was taken to the emergency room, his blood pressure soared to 160, which was higher than before.

In fact, there have been two different voices regarding intervention for metabolic syndrome in the field of endocrinology. One group is the "indicator-first group", which follows the requirements of the old European and American guidelines and believes that the body weight must be reduced by more than 7% within 3 months, and fasting blood sugar and triglycerides should be brought down to the normal range in order to avoid the subsequent development of diabetes and coronary heart disease. The other school is the "adherence-first school" that has become more and more recognized in the past three years. It believes that metabolic syndrome is essentially a problem caused by long-term bad living habits and cannot be cured by short-term extreme intervention. It is first necessary to find a plan that the patient can tolerate and can adhere to for a long time. Even if the index drops a little slower, it is better than rushing for quick success, damaging the body and giving up intervention completely.

I have been in the clinic for 8 years, and have managed at least four to five hundred patients with metabolic syndrome. To be honest, I really don’t have to worry about which side to follow, and I can adjust it as needed. Let’s just talk about Lao Zhou. The plan I changed for him didn’t mention the requirements of “boiled vegetables” and “daily exercise” at all: for dinner, replace the original 2 bowls of white rice with half a portion of brown rice and add a fistful of stir-fried vegetables. His favorite braised pork sausage can be eaten once a week, with a maximum of 3 pieces at a time. ； There is no need to take time to go to the gym. Instead of taking the subway after get off work, ride a shared bicycle. It only takes 20 minutes to ride home. If you can do it 3 times a week, you will meet the standard. In the past two months, he came for a review and his weight slowly dropped by 8 pounds. His fasting blood sugar was stable at 6.1mmol/L, and his triglycerides dropped to 1.8mmol/L. He said that now he doesn't feel like he is "treating a disease" at all, and he has no burden at all.

Oh, by the way, many patients asked me if they should completely quit sugar and oil as soon as they were diagnosed. In fact, this point is still controversial in the nutrition circle. There used to be a 62-year-old Aunt Zhang who loved to eat sweet and sour pork ribs all her life. After she was diagnosed, she heard others say she should give up sugar. She didn't dare to touch a bite. She sighed at home every day. She suffered from insomnia for almost a month, and her blood pressure rose from 140 to 158. Later, I set a rule for her that she can eat sweet and sour pork ribs once a week, with a maximum of 2 pieces at a time, and she can use zero-calorie sugar instead of white sugar. As a result, my aunt's mood improved immediately and she slept soundly. During the next month's review, her blood pressure dropped to 135. After all, long-term emotional stress will increase cortisol, which will in turn aggravate metabolic disorders. Rather than forcing patients to completely quit their favorite foods and causing an emotional breakdown, it is better to leave a little "opening", which will make it easier to persist in the long term.

Let’s talk about the medication issue that everyone is most troubled with. At present, there is no completely unified standard in clinical practice for the delineation of "medication first or lifestyle intervention first". For example, if the triglyceride threshold exceeds 5.6mmol/L, some guidelines say that fibrate drugs must be taken immediately to avoid inducing acute pancreatitis. However, some schools of thought believe that if the patient has no history of pancreatitis and his daily diet is indeed ridiculously oily, he can also try a very low-fat diet for 2 weeks first. If he can reduce it, he does not need to take medicine. I met a 28-year-old young man a while ago, and his triglyceride was found to be 6.1mmol/L. He usually eats takeout and drinks milk tea every day, so I asked him to stop milk tea first and choose stir-fried vegetables instead of fried ones. I checked again after 2 weeks and found that the triglyceride dropped directly to 2.3mmol/L. There is really no need to take medicine. But if you have a history of pancreatitis, or if the indicators still cannot be lowered after adjusting your diet, then you have to take medicine when you need it. Don’t force yourself to take it, and don’t think that you can just take medicine as much as you want. Medicine is always a supplement and is not a trap for you.

Another point that is easily overlooked is psychological adjustment. Many patients panic as soon as they are diagnosed. They feel that they are about to suffer from diabetes or myocardial infarction. They stare at the scale and blood glucose meter every day. They are so stressed that they overeat and fall into a vicious cycle. When I follow up patients now, I don’t even ask about the indicators at the beginning. I always talk about common things first, such as asking if Lao Zhou is busy with projects recently and if he has time to take his son to play football. ； Ask Aunt Zhang if she has learned any new songs during square dancing recently. Instead, they will take the initiative to tell me what they have eaten recently, whether they have exercised, and how their indicators are. To put it bluntly, nursing is not about controlling whether patients are allowed to eat or move. It is about helping them embed intervention plans into their original lives without having to "reinvent the wheel."

In fact, the care of metabolic syndrome is, to put it bluntly, like charging an old mobile phone. You know that it only supports 10W slow charging, so don’t force on the 65W fast charging head. In the short term, it may seem to charge quickly, but in fact it will damage the battery and cause it to lose power again after a short time. The best care plan is to be slower, more steady, and stick to the plan.