Measures to prevent infection in diabetes

Only based on long-term and stable blood sugar control, hierarchical protection based on one's own comorbidities, and avoiding blind application of general health guidelines, can the risk of infection be truly reduced. Don’t believe in any “one-size-fits-all” protection list. What works for others may not work for you.

Let’s talk about the core blood sugar control first. When I was doing follow-up work for chronic diseases in the community, I met Aunt Zhang, who has been living with diabetes for 12 years. Last winter, everyone around her was fine. She first got severe pneumonia. I checked that her glycosylated hemoglobin was 1.2 higher than usual during that period. She ate a few extra pieces of sugar rice cakes during the New Year. Her blood sugar fluctuated continuously for a week, and the immunity of the respiratory mucosa directly dropped by a notch. There are currently two different tendencies in the academic community regarding the goals of sugar control: the strict group believes that as long as adult sugar users have no history of hypoglycemia and their glycation is stable below 7%, the phagocytic ability of immune cells can be restored to more than 80% of that of ordinary people, and the risk of infection will be reduced by about 40%. Right; the loose group prefers elderly people with diabetes who are over 75 years old and have underlying cardiovascular and cerebrovascular diseases. They feel that it is perfectly fine to relax glycation to 7.5%-8%. There is no need to force blood sugar to cause hypoglycemia, which will cause the immunity to drop off a cliff in a short period of time. Both statements are supported by large sample clinical data. Which one to choose, you have to discuss with your follow-up doctor, and don’t adjust the medicine randomly.

Many people think that if sugar control is done well, everything will be fine. This is not true. Infections among people with diabetes mostly arise from small details that you don’t even pay attention to. Last week, a 19-year-old man was admitted to the outpatient clinic. When he cut his toenails, he cut a cut the size of a grain of millet. He put on a waterproof band-aid and left it alone. Within a week, the entire foot was swollen to purple. He was diagnosed with cellulitis. If he came two days later, there would be a risk of amputation. He suffers from neuropathy in his lower limbs, and his pain is several times weaker than that of ordinary people. He did not feel pain at all after the wound was broken. In addition, in a high-sugar environment, bacteria reproduce at 2-3 times that of ordinary people, so a small problem suddenly turned into a big trouble. There are also different opinions on the treatment of small wounds: most surgeons recommend that as long as the skin of people with diabetes is damaged, no matter how small it is, they should go to a regular hospital for disinfection and dressing change. After all, the infection progresses too fast, and people with diabetes may not be able to handle small wounds that ordinary people can handle; but many people who do long-term home follow-up Colleagues will also mention that as long as your blood sugar is stable at 6-8 on an empty stomach and 8-10 after a meal, the diameter of the wound is less than 1cm, and there is no obvious redness, swelling or pus, you can use iodine at home twice a day and don't put on an airtight band-aid. There is no need to go to the hospital, which will increase the risk of cross-infection.

Oh, by the way, there is another source of infection that 80% of people with diabetes don’t pay attention to: the oral cavity. Many people with diabetes think that they have bleeding gums and bad breath all year round because they are suffering from internal heat. In fact, high sugar can reduce the resistance of periodontal tissue. The prevalence of periodontitis is three times that of ordinary people. Chronic periodontal infection not only causes blood sugar to rise and fall, but also spreads along the blood circulation, increasing the risk of pneumonia and urinary tract infections. A 62-year-old patient I treated last year had recurring urinary tract infections that could not be cured. Three different antibiotics were used, but to no avail. In the end, repeated tests revealed that he had severe periodontitis. After the periodontal problem was resolved, the urinary tract infection cleared up on its own without taking any medicine.

As for the respiratory infection protection that everyone is most concerned about, there is actually no need to overdo it. I met a 28-year-old type 1 diabetic before. He had very good blood sugar control. He wore an N95 wherever he went to prevent the flu. His face was so sweaty in the summer that a boil broke out and then became infected. Instead, he was hospitalized for a week. There are also different voices regarding respiratory protection: Infectious diseases doctors will recommend that all patients with diabetes wear N95 when going to closed places during the peak season of influenza and COVID-19, and try to avoid going to crowded places. However, some colleagues in the endocrinology department believe that young patients with diabetes who have no underlying comorbidities and long-term stable blood sugar do not need to be so strict. Appropriate exposure to a small amount of pathogens can build their own immunity. As long as they wear a mask when going to high-risk places such as hospitals and stations, ordinary medical masks are completely sufficient when going to a neighborhood supermarket or the like.

Finally, let me mention the most common trap for everyone: don’t blindly take so-called “immunity-enhancing” health products. Last month, a patient heard from a live broadcast that propolis and high-concentration vitamin C can prevent infection. He bought more than 3,000 yuan of goods at once, and after half a month of eating, his blood sugar soared to 11. Instead, he caught a cold and fever. You said it was a loss or not. The controversy about supplements has never stopped: some nutritionists recommend that people with diabetes take a daily supplement of 100 mg of vitamin C and 200 IU of vitamin D during the flu season to reduce the risk of infection; however, there are also a large number of studies showing that as long as you can eat 1 pound of vegetables, half a pound of low-sugar fruits, and get plenty of sunshine every day, these nutrients are enough, and additional supplements are of no use. On the contrary, many health products add invisible sugar, and eating them will actually increase blood sugar.

In fact, to put it bluntly, there is no universal formula for preventing infection for people with diabetes. Whether you are a newly diagnosed diabetic patient in your early twenties, an elderly person in your seventies or eighties with several underlying diseases, an office worker who sits in an office every day, or a salesperson who often travels outside, the appropriate protection methods will definitely be different. Don’t just try it on yourself one by one if you read something online about “X things people with diabetes must do to prevent infection”. If you are really unsure, ask the endocrinologist who follows you up, it’s more reliable than anything else.