Diabetes care fill-in-the-blank questions

There is no one-size-fits-all standard answer. The final judgment criterion is always the dynamic balance of the individual patient's blood sugar stability, complication prevention and control effect, and life quality satisfaction. Any standardized filling method that is divorced from the patient's individual situation can only score basic points.

To be honest, I have been working as a nurse in the Department of Endocrinology for almost 8 years. In the first three years, I scored perfect marks on these fill-in-the-blank questions. When I got to the clinic, I ran into several obstacles before I understood that the blanks on the paper are dead and the people are alive. Take the most commonly asked question: "Patients with type 2 diabetes should control their daily staple food intake within ____g." The standard answer memorized when I was in school was 250-400g, which is correct based on 4-6g per kilogram of body weight. Later, I met a 62-year-old retired high school teacher who had been taking sugar for 5 years. If he ate this amount, his blood sugar would always rise above 12 two hours after a meal, and he would always complain that he felt bloated after eating. Later, I tried with him for half a month, and reduced the staple food to 180g, half of which was replaced with mixed beans, and 300g of green leafy vegetables. After the meal, the blood sugar level was directly stable between 7.8-8.5, and the person was comfortable. There is also a school of low-carbohydrate diet in the industry, which believes that the staple food of people with diabetes is best controlled within 100g, and even the requirement of ketogenic diet is less than 50g. It is true that many young people with diabetes can control it well according to this method, and do not need to take medicine. However, when it comes to elderly patients with weak gastrointestinal function, they are likely to be hungry, dizzy, and prone to hypoglycemia, and they cannot persist for a long time. Therefore, if we really want to fill in this blank with a clinical answer, we can only "adjust individually based on the patient's weight, activity level, pancreatic islet function, and dietary tolerance, usually floating in the range of 100-400g."

Speaking of this, I am reminded of another frequently asked question in the nursing department's assessment last year: "Patients with diabetes should exercise ____ first, and the cumulative duration per week should not be less than ____ minutes." At that time, half of the new nurses filled out "aerobic exercise, 150." To be honest, it was correct according to the old guidelines, but in clinical practice, patients should be taught this way, and problems would arise if they were not fully covered. Last month I took care of a 71-year-old man who had synovitis in his knees for many years. I heard from popular science that people with diabetes need to walk for 30 minutes a day. After walking for two weeks, his knees were so swollen that he could not go downstairs, and his blood sugar increased due to pain and stress. Later, I adjusted the plan for him. He sat on a chair and lifted 1kg dumbbells to practice his upper limbs for 20 minutes every day. He also walked in the community rehabilitation pool twice a week for 20 minutes each time. He didn’t have to run or jump. His blood sugar was very stable and his knees no longer hurt. Now more and more guidelines are mentioning that elderly people with diabetes who have sarcopenia must increase strength training, otherwise they will lose muscle mass quickly, insulin sensitivity will become worse and worse, and blood sugar will only get worse and worse. There is no "preferred" exercise that can make patients willing to persist for a long time, does it without discomfort, and does not affect blood sugar. This is the best exercise.

There is another fill-in-the-blank question that has troubled many people: "The glycated hemoglobin control target should be less than ____%." Many people just fill in 7. Of course, it is fine for healthy adults with diabetes. Young people with no complications and no history of hypoglycemia can even rely on the 6.5% target. However, if it is changed to the elderly over 80 years old, with coronary heart disease, and frequent asymptomatic hypoglycemia, if the control is forced to be below 7%, big trouble may happen. This happened to me last year, and my family members were very concerned about it. They kept an eye on the old man's blood sugar every day, even if he had to eat an extra mouthful of food, and forced his glycation to be controlled from 8.2% to 6.3%. As a result, the old man fainted at home due to hypoglycemia in the middle of the night. When he was sent to the emergency room, his blood sugar was only 2.1, which was almost dangerous. Later, the goal was relaxed to 8%, but he was stable and stable without going to the hospital for more than half a year.

Last time, an old sugar lover joked with me, saying that you are like a chameleon in your care. Last year, when you asked me how much staple food I should eat, I said 2 taels, and you were right. This year, I asked you 2 taels, and you said you could eat half a tael more. I was very happy at the time, saying that you have been dancing in the square every morning for the past six months, and your muscles have gained 2 pounds, and your pancreatic islet function is better than before. What's wrong with eating more? After hearing this, he slapped his thigh and laughed, saying that it turns out this question changes with my body.

Isn't that right? Nowadays, both domestic and foreign guidelines are changing the previously fixed values ​​in the direction of individualized adjustments. To put it bluntly, the diabetes care paper has never been a test of whether you are familiar with the standard answers. It is a test of whether you can treat the patient in front of you as a living person, rather than a case that needs to be standardized. If you fill in the wrong blanks on the paper, you can correct it. If you choose the wrong care plan for the patient, it will be the patient who suffers.