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| What are the treatments for diabetes? |
General treatment
1.Education
To educate people with diabetes to understand the basics of diabetes, to build confidence in the fight against disease, how to control diabetes, and to control the health benefits of diabetes. Develop appropriate treatment options based on the characteristics of each diabetic patient.
2.Self-monitoring blood sugar
With the gradual popularization of small and fast blood glucose meters, patients can adjust the dose of hypoglycemic drugs at any time according to blood sugar levels. Type 1 diabetes is monitored at least 4 times a day (pre-meal) when intensively treated, and 8 times before blood glucose is unstable (before, after, at night, before bedtime and at 3:00 am). Fasting blood glucose should be controlled below 7.2 mmol/L during intensive therapy, blood glucose less than 10 mmol/L two hours after meal, and HbA1c less than 7%. The frequency of self-monitoring blood glucose in patients with type 2 diabetes can be appropriately reduced.
2. Drug treatment
a. oral medication
(1) sulfonylurea drugs Type 2 DM patients after diet control, exercise, weight loss and other treatment, the effect is not satisfied, sulfonylurea drugs can be used. Because the mechanism of hypoglycemic is mainly to stimulate insulin secretion, it is better for patients with certain islet function. For some diabetic patients with younger onset and less fat, they also have a certain effect in the early stage. However, when using sulfonylureas for obese people, special attention should be paid to diet control to gradually reduce body weight, which is better combined with biguanide or α-glucosidase inhibitor hypoglycemic agents. The following conditions are contraindications: First, severe liver and kidney dysfunction; second, severe infection, temporary change to insulin during trauma and major surgery; third, diabetic ketosis, ketoacidosis, temporary conversion to insulin therapy Fourth, pregnant women with diabetes, pregnancy hyperglycemia has a teratogenic effect on the fetus, the incidence of premature birth, stillbirth is high, so the blood sugar should be strictly controlled, the fasting blood glucose should be controlled below 105 mg / deciliter (5.8 mmol / liter), meal After 2 hours, the blood sugar control is below 120 mg / dl (6.7 mmol / liter), but the control of blood sugar is not suitable for oral hypoglycemic agents; the fifth is allergic to sulfonylureas or obvious adverse reactions.
(2) biguanide hypoglycemic agents The main mechanism of blood sugar lowering is to increase the utilization of glucose by peripheral tissues, increase the anaerobic glycolysis of glucose, reduce the absorption of glucose by the gastrointestinal tract, and reduce body weight.
- Indications for obesity type 2 diabetes, those who are not satisfied with dietary treatment alone; type 2 diabetes with sulfonylurea alone is not effective, can be combined with bismuth drugs; type 1 diabetes with insulin treatment is unstable, with sputum Drugs can reduce the dose of insulin; when the secondary failure of type 2 diabetes is changed to insulin, a biguanide can be added to reduce the amount of insulin.
- Contraindications for severe liver, kidney, heart, lung disease, wasting disease, malnutrition, hypoxic disease; diabetic ketosis, ketoacidosis; suspension of sputum with severe infection, surgery, trauma and other stressful conditions Class drugs, switched to insulin therapy; pregnancy.
- Adverse reactions One is the gastrointestinal reaction. The most common manifestations are nausea, vomiting, loss of appetite, abdominal pain, and diarrhea, with an incidence of up to 20%. To avoid these adverse reactions, take the medicine during or after meals. The second is headache, dizziness, and metallic taste. The third is lactic acidosis, which is more common in long-term, large-scale application of hypoglycemic, accompanied by liver and kidney dysfunction, hypoxic diseases, acute infections, gastrointestinal diseases, and less chance of acidosis caused by hypoglycemic tablets.
(3) α-glucosidase inhibitors Both type 1 and type 2 diabetes can be used, and can be used in combination with sulfonylureas, biguanides or insulin. 1 vgregliose was taken orally immediately before the meal. 2 Acarbose is taken orally immediately before a meal. The main adverse reactions were: abdominal pain, flatulence, diarrhea, and increased anal exhaust.
(4) Insulin sensitizers have the effect of enhancing insulin and improving glucose metabolism. It can be used alone or in combination with sulfonylureas, biguanides or insulin. Those with liver disease or cardiac dysfunction should not be applied.
(5) Glinide-like insulin secretagogue 1 repaglinide is a rapid insulin-promoting agent. It is taken orally immediately before a meal, and it is served every time the main meal is served. 2 Nateglinide acts like repaglinide.
b. insulin therapy
Insulin preparations are animal insulin, human insulin and insulin analogs. According to the action time, it is divided into short-acting, medium-acting and long-acting insulin, and has been made into a mixed preparation, such as Novo Ling 30R, and Yulin 70/30.
(1) Type 1 diabetes requires insulin therapy. Non-intensive treatments were injected 2 to 3 times a day, and intensive treatment was injected 3 to 4 times a day, or with an insulin pump. The dose needs to be adjusted frequently.
(2) Type 2 diabetes patients who have failed oral hypoglycemic agents first adopt the combination therapy method. The method is that the original oral hypoglycemic agent is unchanged, and the intermediate-acting insulin or long-acting insulin analog is injected at 10:00 pm before going to bed, generally every The adjustment was performed once every 3 days for the purpose of fasting blood glucose to 4.9 to 8.0 mmol/L. Ineffective patients discontinued oral hypoglycemic agents and switched to insulin injection twice a day.
The biggest adverse reaction to insulin therapy is hypoglycemia.
c. Exercise therapy
Increased physical activity can improve the body's sensitivity to insulin, reduce body weight, reduce body fat, enhance physical strength, improve work ability and quality of life. The intensity and duration of exercise should be based on the overall health of the patient, finding the amount of exercise appropriate for the patient and the item of interest to the patient. Sports can be varied, such as walking, brisk walking, aerobics, dancing, tai chi, running, swimming, etc.
d. Dietary therapy
Dietary therapy is the basis of all types of diabetes treatment, and some patients with mild diabetes can control their condition with diet alone.
1.Total heat
The total calorie requirement is determined by a combination of factors such as the patient's age, gender, height, weight, physical activity, and condition. First, to calculate the standard weight of each person, you can refer to the following formula: standard weight (kg) = height (cm) - 105 or standard weight (kg) = [height (cm) - 100] × 0.9; female standard weight should Then subtract 2kg. It can also be obtained by looking up the table according to age, gender and height. After calculating the standard weight, the calorie requirement per kilogram of standard body weight is estimated based on each individual's daily physical activity.
After calculating the amount of calorie required per day based on the standard weight, it is also adjusted according to other conditions of the patient. Children, adolescence, lactation, malnutrition, weight loss, and chronic wasting diseases should increase total calories as appropriate. Obese people should strictly limit the total calorie and fat content, and give a low-calorie diet. The total calorie per day does not exceed 1500 kcal, which is generally reduced by 0.5-1.0 kg per month. When the standard weight is approached, calculate the total daily amount according to the above method. Heat. In addition, older people need less calories than younger ones, and adult women need less calories than men.
2. Carbohydrate
Carbohydrates produce 4 kcal per gram of calories, which is the main source of calories. It is believed that carbohydrates should account for 55% to 65% of the total calories of the diet, which can be calculated by the following formula:
According to the living habits of our people, we can enter the main food (rice or noodles) 250 ~ 400g, can be made as follows: the rest of the daily staple food 200 ~ 250g, mild physical labor 250 ~ 300g, moderate manual labor 300 ~ 400g, Heavy manual workers are 400g or more.
3. Protein
Protein produces 4 kilocalories per gram of calories. It accounts for 12% to 15% of total heat. The amount of protein required is about 1 g per kilogram of body weight in adults. In children, pregnant women, lactating women, malnutrition, weight loss, and consumptive diseases should be increased to 1.5 ~ 2.0g per kilogram of body weight. People with diabetic nephropathy should reduce their protein intake by 0.8g per kilogram of body weight. If renal insufficiency is present, high-quality protein should be ingested and the intake should be further reduced to 0.6g per kilogram of body weight.
4. Fat
The energy of fat is higher, producing 9 kilocalories per gram of calories. About 25% of total calories, generally no more than 30%, 0.8-1g per kilogram of body weight per day. Animal fats mainly contain saturated fatty acids. Vegetable oil contains more unsaturated fatty acids, and diabetic patients are more susceptible to atherosclerosis. Vegetable oil should be used.
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