Metabolic syndrome care measures

There is no one-size-fits-all standard answer to the core care of metabolic syndrome. The clinically recognized optimal logic is "stratified intervention, individualized adaptation, priority control of reversible risk factors, and gradual correction of metabolic disorders of glucose, lipids, blood pressure, and weight." All measures must first match the patient's living habits, tolerance, and subjective wishes. Compliance with forced application of standardized programs is often less than 30%.

When I was following up at a community chronic disease station two years ago, I met a 42-year-old long-distance truck driver, Brother Zhang. He was 172cm tall and weighed almost 180cm, with a waist circumference of 96cm. During the physical examination, his blood pressure was 148/96, his fasting blood sugar was 6.9, and his triglycerides were twice as high as those of him, which is typical of metabolic syndrome. At the beginning, he was given a unified education manual from the National Health Commission, which told him to eat no more than 5 grams of salt a day and exercise 150 minutes of moderate-intensity exercise every week. He turned around and threw the manual in the car - he was running long distances, sitting for 12 hours a day, and eating packed lunches from the service area. How could the conditions be as per the standard? Later, we changed the plan for him and asked him to replace all the iced black tea in the car with sugar-free oolong tea, pick out the fat meat in the lunch box and not eat it. Every time he stopped at the service area to unload the goods, he walked around the car twice and stood on tiptoe 30 times. Don’t underestimate this three-to-five-minute activity. The cumulative effect is really obvious. When we checked again three months later, he had lost 8 pounds, his blood sugar and blood pressure had returned to the critical value, and his triglycerides had dropped by more than half.

Speaking of this, we have to mention the two factions of clinical debate about dietary intervention. One faction advocates a low GI diet, which means trying to choose foods with a low glycemic index, such as replacing white rice and white noodles with brown rice and oats. This is suitable for patients who usually eat a lot of staple food and do not like to eat red meat. For example, many aunts in the South who eat white rice every day have a high degree of compliance with this method.； The other group recommends a low-carbohydrate diet, which appropriately reduces the intake of refined carbohydrates and increases the proportion of high-quality protein and fat. It is suitable for middle-aged men who usually socialize a lot, drink alcohol and eat barbecue every day. The effects of weight control and triglyceride reduction will be more rapid. However, no matter which school you are in, we do not recommend extreme diet plans in clinical practice, such as a ketogenic diet that does not eat carbohydrates at all. Many people develop ketosis and electrolyte disorders after trying it, which in turn increases the metabolic burden and makes the gain outweigh the loss. When I give advice to patients, I usually don’t say, “You must not eat this.” Instead, I say, “You can eat this, but just control the amount you eat each time.” For example, for a girl who loves milk tea, it’s okay to drink the full-sugar version once a week. Just don’t drink it every day.

In addition to the issue of food, the differences in exercise plans are actually even greater. There was a study in a top publication two years ago that said that fragmented short-term exercise every day, such as 10 minutes each time, which is enough for 30 minutes a day, has about the same metabolic effect as 30 minutes of continuous exercise. It is suitable for office workers who have no time to exercise and mothers who need to take care of their children. ； However, some endocrinology experts believe that moderate-intensity exercise for more than 30 minutes is more effective in improving insulin sensitivity and is more suitable for patients with elevated blood sugar and obvious abdominal obesity. When I give advice to patients, I usually ask them about their usual time schedule first. If they sit for 10 hours a day like Brother Zhang, I recommend fragmented exercise to them. If they are retired uncles and aunts who have nothing to do at home, I suggest them to go out for half an hour of square dancing and Tai Chi every night. If their joints are not good, they can sit on a chair and do leg lifts. Don’t force them to run. Injuring their knees will be more troublesome.

Many people think that metabolic syndrome means being fat. As long as you keep your mouth shut and move your legs, you don't need to take medicine. This is actually a big misunderstanding. If your blood pressure has exceeded 150/90, your fasting blood sugar has exceeded 7.0 for two consecutive weeks, and your triglycerides have exceeded more than three times, lifestyle intervention alone will be too slow to take effect and can easily lead to other complications. Different doctors have different habits regarding the choice of medication. Some doctors prefer to prescribe metformin to patients with obvious insulin resistance first to improve glucose metabolism. Some doctors will give priority to prescribing antihypertensive and lipid-lowering drugs to reduce cardiovascular and cerebrovascular risks first. In fact, there is no absolute right or wrong. It all depends on which indicator of the patient's abnormality is more obvious. You don’t have to put too much burden on yourself when monitoring. If your blood sugar is stable, you can test it twice a week on an empty stomach and twice after meals. If your blood pressure is stable, you can test it once a week. If you prick your finger every day and measure your blood pressure every day, it will make you anxious and your metabolism will be worse.

There is another influencing factor that many people don’t take seriously, which is emotional state. Nowadays, research in psychosomatic medicine has long confirmed that people who are chronically anxious and stressed will have elevated cortisol levels, which directly leads to abdominal obesity and elevated blood sugar. The impact is much greater than eating hot pot. I met a 50-year-old aunt before. She was very nervous after she was diagnosed with metabolic syndrome. She didn't dare to eat this or that. She cooked vegetables every day. She lost 10 pounds in three months, but her blood sugar increased instead and she still suffered from insomnia. Later, when we talked with her, we found out that she was worried about having diabetes or stroke every day and couldn't sleep well. Later, we told her that she could eat her favorite braised pork once a week, just eat 2 pieces at a time, and go to the park to dance with her old sisters more often, instead of staring at the numbers every day. When we checked again after two months, her blood sugar was normal, and she slept well.

To be honest, metabolic syndrome care is never about doing math problems, and there is no need to figure out precise numerical values. The core is to find a method that you can stick to for a long time. Don't make yourself miserable just to meet the standards, which is counterproductive. After all, the ultimate goal of nursing is to make your life more comfortable, not to be a "health robot" that can only eat boiled vegetables.