The onset age is relatively young, and most of them are

2.2 Diabetes

Common in middle-aged and elderly people, the incidence of obesity is high, often accompanied by hypertension, dyslipidemia, arteriosclerosis and other diseases. If the onset is hidden, there are no symptoms in the early stage, or only mild fatigue and thirst, and the blood sugar increase is not obvious, the diagnosis can only be made by glucose tolerance test. The serum insulin level is normal or increased in the early stage and low in the late stage. treat cordially

At present, diabetes cannot be cured, but it can be controlled by various treatment methods. It mainly includes five aspects: diabetes patient education, blood sugar self-monitoring, diet therapy, exercise therapy and drug therapy.

(1) General treatment

1. Education

It is necessary to educate diabetic patients to understand the basic knowledge of diabetes, establish confidence in overcoming the disease, how to control diabetes, and control the benefits of diabetes to health. According to the characteristics of each diabetic patient's condition, formulate appropriate treatment plans.

2. Self-monitoring blood sugar

With the gradual popularization of small rapid blood glucose meters, patients can adjust the dosage of hypoglycemic agents at any time according to their blood glucose levels. 1 type diabetes mellitus's blood sugar is monitored at least 4 times a day (before meals), and 8 times when blood sugar is unstable (before meals, after meals, before going to bed at night and at 3 am). During intensive treatment, fasting blood glucose should be controlled below 7.2 mmol/L, 2 hours after meal blood glucose should be less than 10mmol/L, and HbA 1c should be less than 7%. The frequency of self-monitoring blood sugar in patients with type 2 diabetes can be reduced appropriately.

(2) drug therapy

1. Oral drug therapy

(1) sulfonylureas can be used for patients with type 2 diabetes who are not satisfied with the curative effect after diet control and exercise to lose weight. Because the hypoglycemic mechanism is mainly to stimulate insulin secretion, it is better for people with certain islet function. It also has certain curative effect on some diabetic patients with younger onset age and not fat in the early stage. However, obese people should pay special attention to diet control when using sulfonylureas, so as to gradually reduce their weight, and it is best to use them in combination with biguanides or α -glucosidase inhibitors. The following conditions are contraindications: 1. Severe hepatic and renal insufficiency; Second, during the period of serious infection, trauma and major surgery, insulin treatment was temporarily switched; Three, diabetic ketosis and ketoacidosis, temporary use of insulin treatment; Fourth, pregnant women with diabetes have abnormal effects on the fetus, and the incidence of premature delivery and stillbirth is high. Therefore, blood sugar should be strictly controlled. Fasting blood glucose should be controlled below 105 mg/dl (5.8 mmol/l) and 2 hours after meals should be controlled below 120 mg/dl (6.7 mmol/l), but it is not appropriate to control blood glucose. Fifth, allergic to sulfonylurea drugs or have obvious adverse reactions.

(2) The main hypoglycemic mechanism of biguanides is to increase the utilization of glucose in peripheral tissues, increase anaerobic glycolysis of glucose, reduce the absorption of glucose in gastrointestinal tract and lose weight. ① Obese type 2 diabetes with indications, the effect of simple diet is not ideal; The effect of sulfonylureas alone in type 2 diabetes mellitus is not good, and biguanides can be added; 1 type diabetes mellitus is unstable when treated with insulin, and the dosage of insulin can be reduced by using biguanides. When the secondary failure of type 2 diabetes turns to insulin therapy, biguanides can be added to reduce the dosage of insulin. 2 contraindications: severe liver, kidney, heart and lung diseases, wasting diseases, malnutrition and hypoxic diseases; Diabetic ketosis and ketoacidosis; When accompanied by serious infection, surgery, trauma and other stress States, stop using biguanides and switch to insulin therapy; Pregnant. ③ The first adverse reaction was gastrointestinal reaction. The most common manifestations are nausea, vomiting, loss of appetite, abdominal pain and diarrhea, and the incidence rate can reach 20%. In order to avoid these adverse reactions, you should take 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 and large-scale application of Jiangtangling, accompanied by liver and kidney dysfunction, hypoxic diseases, acute infections and gastrointestinal diseases. Jiangtang tablets are less likely to cause acidosis.

(3) α -glucosidase inhibitor 1 and type 2 diabetes can be used, which can be combined with sulfonylureas, biguanides or insulin. ① Bexin (voglibose) should be taken orally immediately before meals. ② Take white sugar and carbopol (acarbose) orally immediately before meals. The main adverse reactions were abdominal pain, flatulence, diarrhea and increased anal exhaust.

(4) Insulin sensitizer can enhance insulin and improve glucose metabolism. It can be used alone or in combination with sulfonylureas, biguanides or insulin. Not suitable for patients with liver disease or cardiac insufficiency.

(5) glinide insulin secretagogue ① Repaglinide (Novolone) is a rapid insulin secretagogue, which is taken orally immediately before meals and every main meal. ② The effect of nateglinide (Li Tang) is similar to that of repaglinide.

2. Insulin therapy

Insulin preparations include animal insulin, human insulin and insulin analogues. According to the action time, it is divided into short-acting, medium-acting and long-acting insulin, and has been made into mixed preparations, such as Novolin 30R and Youbilin 70/30.

(1) 1 type diabetes requires insulin treatment. Non-intensive treatment patients are injected 2 ~ 3 times a day, intensive treatment patients are injected 3 ~ 4 times a day, or treated with insulin pump. The dosage needs to be adjusted frequently.

(2) Combined treatment for type 2 diabetic patients who failed to take oral hypoglycemic agents. The method is to keep the original dose of oral hypoglycemic agents unchanged, inject medium-acting insulin or long-acting insulin analogues at 10: 00 before going to bed at night, and generally adjust 1 time every three days, in order to reduce the fasting blood sugar to 4.9 ~ 8.0 mmol/L. Those who fail to take oral hypoglycemic agents should stop taking oral hypoglycemic agents and inject insulin twice a day.

The biggest adverse reaction of insulin therapy is hypoglycemia.

(3) Exercise therapy

Increasing physical activity can improve the body's sensitivity to insulin, lose weight, reduce body fat, enhance physical strength, improve work ability and quality of life. The intensity and duration of exercise should be determined according to the overall health status of patients, so as to find the appropriate amount of exercise and the items that patients are interested in. There are various forms of exercise, such as walking, brisk walking, aerobics, dancing, playing Tai Ji Chuan, running and swimming.

(4) Diet therapy

Diet therapy is the basis of various types of diabetes treatment, and some patients with mild diabetes can control their condition only through diet therapy.