Diabetes care observation points

First of all, we should pay close attention to the rationality of blood sugar fluctuations, and simultaneously screen for hidden signals of early complications. We should also include the patient's life compliance and emotional state into the observation dimension - if one of the three is missing, care will be easily compromised.

A while ago, I took care of Uncle Zhang, a 62-year-old retired teacher. He measured his fasting blood sugar at home strictly according to the requirements. Every time, he was between 6.3-6.5mmol/L. He was complacent and said that his control was better than that of young people. However, when he came for a routine review, his blood sugar rose to above 12 two hours after measuring meals for three consecutive days. He also said that he has been feeling nervous and shaking at mealtimes recently. Sometimes he just eats a biscuit when he sweats, and does not think about hypoglycemia at all. Here we have to mention two ideas for sugar control that have been controversial in the endocrinology community: one school advocates strict compliance with the standard, especially for type 2 diabetes patients under 50 years old and without underlying diseases. Try to reduce fasting to 4.4-6.1mmol/L, and do not exceed 7.8mmol/L 2 hours after meals, which can delay the occurrence of complications to the greatest extent. ； The other group is specifically aimed at elderly patients and patients with a history of coronary heart disease/cerebral infarction, and advocates relaxing the threshold for glucose control. Fasting 7-8mmol/L and postprandial no more than 11mmol/L are considered qualified. After all, the risk of myocardial infarction and insufficient blood supply to the brain caused by severe hypoglycemia is much more urgent than that of hyperglycemia. There is no need to stick to the standard. When we usually observe blood sugar, we should not just look at a single value. It is best to also ask about the diet and exercise status of the previous three days. If you walked five kilometers the night before, it is normal for the fasting blood sugar to be a little lower the next day. There is no need to panic to adjust the medicine.

Don’t think that everything will be fine once your blood sugar is under control. Signs of many complications appear earlier than blood sugar fluctuations. Last month, there was an aunt who has been suffering from diabetes for 12 years. Her blood sugar is usually as stable as an alarm clock. When she came for a follow-up check-up, she casually mentioned, "My feet have been numb recently, and wearing slippers feels like a layer of thick socks." We quickly did an electromyogram and found that it was already the early stage of peripheral neuropathy. Fortunately, we intervened early and did not develop to the point of ulcerating my feet. During daily observation, you really need to pay more attention to small details: for example, does the patient always rub his eyes and say that things feel blurry, does he say that there is too much foam when urinating, and does he scratch his arms and legs until his arms and legs are scratched and complain that his body is itchy. Many people think of these as "little problems of old age", but they are actually early signs of diabetic retinopathy, kidney disease, and skin diseases. If you wait until the pain, swelling, and sight are gone before you intervene, most of them are already irreversible. My own habit is that every time I test the blood sugar of people with diabetes, I take a look at their feet to see if there are any small cuts on their feet or if the skin is dark and flaky. Many elderly people have poor eyesight and don’t even know if their feet are broken. They wait until they are infected and suffer the consequences of old age.

It’s also interesting to say that many patients’ blood sugar fluctuates high and low. It’s not the wrong medicine at all, but a problem with their daily compliance. There used to be a 70-year-old aunt. Every time she came to the hospital for a follow-up check, her blood sugar was very low. When she went home, she would test it by herself and it would always rise to over 10. Later, she was given a dynamic blood glucose monitor for three days before the secret was revealed. Her daughter was not allowed to eat candied dates, so she secretly ate two candied dates every day while her daughter was at work. She also took an extra half tablet of hypoglycemic pills on her own initiative, which just brought her blood sugar back to the normal range. Little did she know that this kind of high and low fluctuations would do more damage to blood vessels than sustained high blood sugar. When observing compliance, don’t just ask, “Have you taken your medicine on time?” Most people will say “Yes.” Instead, it’s better to ask sideways, “Have you attended a wedding banquet recently?” ”“Have you ever found it troublesome to take medicine and forgotten it once or twice recently?" You can even look at the medicine box he brought. If you have been prescribed medicine for a month and only half of the box is left, it is most likely that you did not take it on time. Some family members were too anxious and would test the patient's blood sugar seven or eight times a day and not allow him to touch anything sweet, which made the patient depressed. There used to be a 12-year-old type 1 diabetic whose parents were very strict and wouldn't even let him eat fruit. As a result, he secretly bought lollipops at school and hid them in his schoolbag to eat, and his blood sugar fluctuated like a roller coaster. Later, we communicated with the parents that it is okay to eat a small piece of ice cream occasionally, and just calculate the calories and reduce the staple food by two bites. However, the blood sugar has stabilized a lot, and the child has become much more cheerful.

In fact, there is really no universal standard for diabetes care. Some people’s blood sugar explodes after one bite of watermelon, while others feel nothing happens after eating half a piece. The core is to observe more and check more. Don’t get stuck on the values ​​​​in the book, and don’t let go of those inconspicuous small abnormalities. This is better than anything else.