Primary prevention: Establish a correct diet concept and adopt a reasonable lifestyle. Although diabetes has some genetic factors, the key factors are life factors and environmental factors. Excessive calorie intake, overnutrition, obesity and lack of exercise are the important causes of the disease. Proper calorie intake, low salt, low sugar, low fat, high fiber and adequate vitamins are the best dietary combinations.
Secondary prevention regularly measures blood sugar to find asymptomatic diabetes as soon as possible. Blood sugar measurement should be included in the routine physical examination of middle-aged and elderly people, even if it is normal once, it should be measured regularly. Anyone with signs of diabetes, such as abnormal skin sensation, sexual dysfunction, poor eyesight, polyuria, cataract, etc. , should be measured in time and carefully identified, so as to diagnose as soon as possible and win valuable time for early treatment.
The tertiary prevention of diabetes is easy to be complicated with other chronic diseases, and most patients are life-threatening because of complications. Therefore, it is necessary to strengthen the monitoring of chronic complications of diabetes, so as to find and prevent them early, but the curative effect is often poor in the late stage. Early diagnosis and early treatment can often prevent the occurrence of complications and make patients live a near-normal life for a long time.
Diabetes treatment 2: dietotherapy;
Food is the most important thing for people. People don't have to exercise every day, but they must eat every day. Diet has a direct impact on diabetes, so controlling diet is very important for the treatment of diabetes. Traditional Chinese medicine believes that thirst quenching is mostly caused by excessive drinking, which damages the spleen and stomach, dereliction of duty in transportation, loss of grain and body fluid, indulgence of yin loss and changes yin deficiency into dryness and heat. For example, Huangdi Neijing said: "If this fat beauty comes from this, this person is sweet and fat, the fat person is hot inside, and the sweet person is full, then the gas overflows and the thirst is quenched." "Jing Yue Quan Shu" said: "The disease of quenching thirst is the beginning of the disease, all because of the change of fat and sweetness, and the injury of wine and color is due to the illness of the rich, and the poor are rare." It is pointed out that obese and rich people suffer from this disease, which is consistent with the understanding of the etiology of diabetes in modern medicine. Due to the secretion of insulin, the level of blood sugar is closely related to the quantity and variety of food intake. Therefore, dietotherapy is the basis of treating various types of diabetes. No matter what type of diabetes, the severity of the disease or whether there are complications, and what drugs are used, we should strictly control our diet and stick to it for a long time.
As early as 1950s, Chinese and foreign treatment programs were mainly based on low-carbohydrate, high-fat and high-protein diets. According to clinical practice, this diet structure is not conducive to the islet function of diabetic patients, while high-fat diet will aggravate the vascular disease of diabetic patients, and high-protein diet will increase the incidence of diabetic nephropathy. At present, medical experts advocate high carbohydrate content, reducing fat ratio and controlling protein's diet structure, which has a good effect on improving blood sugar tolerance. The specific contents of dietotherapy are as follows:
1, regular quantitative diet:
According to age, sex, occupation and standard weight [(body length-100)×0.9], the daily total calorie demand was estimated. Men need about 5% more calories every day than women. However, different ages require different calories. Generally, the number of calories required per kilogram of body weight is teenagers > middle-aged people > elderly people >, and the average height is 5%~ 10% per kilogram of body weight/day. And different manual workers consume different amounts of energy every day. Light manual workers consume 30 ~ 35 kilocalories per kilogram of body weight every day; Moderate manual workers consume 35~40kcal calories per kilogram of body weight every day; Heavy manual workers need more than 40 kilocalories per kilogram of body weight every day. Generally speaking, pregnant women, nursing mothers, malnourished people and consumptive diseases should be increased as appropriate, and obese people should be reduced as appropriate, so that the weight of patients can be kept at about 5% of normal weight, and the condition can often be satisfactorily controlled.
2. Reasonably adjust the proportion of the three major nutrients:
The proportion of sugar, fat and protein in the diet should be reasonably arranged and adjusted. It not only achieves the purpose of treating diseases, but also meets the physiological needs of human body. At present, the American Diabetes Association (ADA) advocates that carbohydrates in the diet of diabetic patients should account for 55% ~ 60% of the total calories; The intake of protein should not exceed 15% of the total daily calories. 0.8~ 1.2g per kg body weight per day is appropriate. Teenagers and pregnant women, lactating women or patients with special occupations and other complications can increase to about 1.5g; The daily total fat intake should not exceed 30% of the total calories, and the daily weight should be 0.6 ~1g. For obese patients, especially those with hyperlipidemia or arteriosclerosis, the fat intake should be adjusted according to the specific situation.
3, diet calculation and calorie calculation:
There are three kinds of nutrients that provide heat energy for the body: protein, fat and carbohydrate. Among them, carbohydrate and protein can provide 4 kilocalories (1 kilocalorie = 4. 184 kilojoules) per gram of calories, and fat can provide 9 kilocalories (37.74 kilojoules) per gram of calories. According to their own labor intensity, diabetics can allocate the total calories (kilocalories) required by each person per day according to the proportion of carbohydrates accounting for 69%, protein accounting for 65,438+05% and fat accounting for 25%, and calculate the heat energy supplied by various components. Then, according to the calorie production of 9 kilocalories per gram of fat, 4 kilocalories per gram of carbohydrates and protein, we can convert the body weight needed to supply different nutrients to patients, which can be three or four meals a day. The calorie distribution of three meals is 65438+ 0/5 for breakfast, 2/5 for lunch and 2/5 for dinner. The calorie distribution of four meals is breakfast 1/7, and the other three meals are 2/7. For example, a moderate manual worker with a weight of 60kg and an adult diabetic with a normal body shape have a total calorie of 2,400 kcal per kg of body weight every day, which is distributed according to the above ratio, that is, 1440kcal comes from carbohydrates, 360kcal comes from protein and 600kcal comes from fat. To provide these calories, you need to supply 360 grams of carbohydrates, 90 grams of protein and 66 grams of fat.
We emphasize that the method of controlling calories through diet does not require diabetic patients to calculate mechanically every day. Instead, after mastering this calculation method, calculate it again every once in a while or when the weight changes greatly, and make a diet plan for the next stage, instead of eating less sweets and greasy food. Dietary choices should be both principled and diverse.
Diabetes treatment Ⅳ: drug treatment;
For those patients with serious illness, exercise and diet alone may not be able to control their illness. At this time, you need to cooperate with drug treatment. The following is an introduction of some commonly used drugs. It is recommended that patients use it under the guidance of a doctor.
First, western medicine:
1, sulfonylurea:
One of the earliest oral hypoglycemic agents, which has developed to the third generation, is still the first-line drug for type 2 diabetes. It mainly works by stimulating insulin secretion. Taking medicine half an hour before meals has the best effect.
2, biguanides:
A veteran of oral hypoglycemic drugs. The hypoglycemic effect is positive and does not induce hypoglycemia. It has cardiovascular protective effects other than hypoglycemic effects, such as lipid regulation and anti-platelet aggregation, but it is not recommended for patients with severe heart, liver, lung and kidney dysfunction. In order to reduce the gastrointestinal side effects of biguanides, it is generally recommended to take them after meals.
3. Glucosidase inhibitors:
By inhibiting glycosidase on the surface of intestinal mucosal epithelial cells, the absorption of carbohydrates can be delayed (just like artificially causing "eating less and eating more meals"), thus reducing postprandial blood sugar, so it is suitable for those patients who simply increase postprandial blood sugar. Take it before meals or with the first meal, and the meal must contain certain carbohydrates (such as rice and flour). ) to play an effective role.
4, thiazolidinedione:
So far, the latest oral hypoglycemic drugs. As an insulin sensitizer, it can reduce blood sugar by increasing the sensitivity of peripheral tissues to insulin and improving insulin resistance, and can improve various cardiovascular risk factors related to low insulin resistance. Pay close attention to liver function when using such drugs.
5. Methyl methylamine benzoic acid derivatives:
Non-sulfonylurea insulin secretagogue developed in recent years is also known as postprandial blood glucose regulator because of its rapid onset, short action time and effective effect on postprandial blood glucose. Take it before meals.
Second, insulin.
There are many types of insulin, and the common classification methods mainly include:
1, classified by action time:
Short-acting insulin: the most commonly used common insulin, a colorless and transparent liquid, takes effect 20-30 minutes after subcutaneous injection, with a peak of 2-4 hours and a duration of 5-8 hours.
Medium-acting insulin: also known as low-refined protein zinc insulin, it is milky white turbid liquid, with onset time of 1.5~4 hours, peak action of 6~ 10 hour and duration of about 12~ 14 hour.
Long-acting insulin: also known as refined protein zinc insulin, it is also a milky turbid liquid, with the onset time of 3-4 hours, the peak of action 14-20 hours and the duration of about 24-36 hours.
Premixed insulin: In order to meet the further needs, the short-acting preparation and the medium-acting preparation (R and N) of imported insulin are mixed in different proportions to make premixed insulin with the action time between them.
2, according to the source classification:
Bovine insulin: extracted from bovine pancreas, there are three kinds of amino acids in its molecular structure that are different from human insulin, and the curative effect is slightly poor, so it is prone to allergy or insulin resistance. The only advantage of animal insulin is its low price. Patients can easily afford it.
Porcine insulin: extracted from pig pancreas, only one amino acid in the molecule is different from human insulin, so the curative effect is better than bovine insulin with less side effects. At present, domestic insulin mostly belongs to pig insulin.
Human insulin: human insulin is not extracted from human pancreas, but is produced by genetic engineering, with higher purity, fewer side effects, but more expensive. The imported insulin is human insulin. Recently, China has gradually begun to be able to produce human insulin.
3, according to the insulin concentration classification:
Uranium -40: 40 unit/ml.
U- 100: 100 unit/ml, usually used for insulin pens.
Domestic insulin 40 units/ml,
Foreign insulin has both. Before using a syringe to extract insulin, patients must find out which concentration of insulin they are using, otherwise the consequences will be very serious.
Different concentrations of insulin have different uses:
U-40 is used for routine injection.
U- 100 is mainly used for insulin pen.
The third type of diabetes treatment: exercise therapy;
Exercise therapy is an effective method to prevent and treat diseases by physical exercise according to patients' functional status and disease characteristics, to enhance the body's resistance, and to help patients overcome diseases and restore health. The benefits that exercise brings to the body will be elaborated in the following exercise methods. In the treatment of diabetes, exercise therapy is an important part, especially for the elderly and obese patients. Chinese medicine has long recognized the importance of exercise in the rehabilitation of diabetes. The Etiology in Sui Dynasty and Foreign Taiwan Secret in Tang Dynasty both recorded the physical exercise therapy for diabetes. Since then, doctors have discussed it.
By the middle of the18th century, some famous foreign medical scientists also began to advocate proper physical activity for diabetic patients, and listed physical activity, diet control and insulin injection as three magic weapons to treat diabetes. Some patients with mild diabetes can recover as long as they insist on physical exercise combined with diet control.
A, swimming exercise method:
1. The health benefits of swimming:
Swimming, like many sports, not only has a certain therapeutic effect on many chronic diseases, but also has its unique therapeutic value. The main reasons are as follows:
(l) Swimming is an exercise in a good natural environment where sunshine, air and cold water are combined, so that all the curative effects of sunshine bath, air bath and cold water bath are concentrated on people.
(2) Swimming is a systemic exercise, so its treatment of diseases is also a comprehensive and systematic treatment. Swimming can enhance the function of human nervous system, improve blood circulation, improve digestion and absorption of nutrients, thus enhancing physical fitness, enhancing resistance to diseases and achieving good therapeutic effects.
(3) Swimming can enhance the functions of human organs and systems. Through swimming, patients with chronic diseases can enhance the functions of underdeveloped organs and systems, restore and enhance the functions of weak organs and systems, and thus treat diseases.
(4) Swimming exercise can not only cultivate sentiment, temper will, and cultivate the spirit of fighting against nature, but also enable patients to establish confidence in overcoming diseases and overcome negative psychology of fear and worry about diseases, so it is very conducive to healthy rehabilitation and treatment of diseases.
2. Master the swimming exercise:
Swimming, like other physical exercises that people engage in, can only achieve the purpose of each exercise by scientifically mastering the amount of exercise, without being overtired or having adverse reactions to the body.
How to master the amount of exercise scientifically when swimming?
There are many ways to master the amount of exercise in swimming, but for ordinary swimmers, the simplest way is to measure the amount of exercise according to the change of swimmer's pulse.
The quiet pulse frequency of normal people in China is 60-80 times per minute. People who often take part in swimming exercises have a slow and quiet pulse frequency of 50-60 times per minute; The rate of contacts after exercise is low. For ordinary swimmers, the pulse frequency reaches 120- 140 times per minute after each swimming, and the amount of exercise this time is a lot of exercise; If the pulse frequency is 90- 1 10 times per minute, it is moderate exercise; After swimming, the pulse changes little, and the number of increases is within 10, which belongs to a small amount of exercise.
When choosing the amount of exercise for swimming exercise, it should vary from person to person and do what you can. Ordinary swimmers, even young and strong people, should not exercise more than twice a week; Middle-aged people should exercise moderately and should not do swimming with too much exercise; Old people are most suitable for swimming with small, medium to small amount of exercise.
Second, jogging exercise method:
Running is a convenient and flexible exercise method. Xian Yi, suitable for all ages, is increasingly becoming one of the means for people to keep fit and prevent diseases.
1. Running and fitness:
(1) Exercise and protect your heart. Persisting in running can increase oxygen uptake, enhance myocardial contractility, increase coronary blood flow and prevent coronary atherosclerosis.
(2) Promoting blood circulation to remove blood stasis and improving circulation. When running, the main muscles of lower limbs contract and relax alternately, which effectively drives venous blood to return, which can reduce the congestion of veins and pelvic cavity of lower limbs and prevent venous thrombosis. A lot of running exercise can also improve the activity of fibrinolytic enzyme in blood and prevent thrombosis.
(3) Promote metabolism and control weight. Weight control is an important principle to keep healthy. Because running can promote metabolism, consume a lot of blood sugar and reduce fat accumulation, it is an effective "prescription" for treating diabetes and obesity.
(4) Improve lipid metabolism and prevent arteriosclerosis. If the serum cholesterol and blood lipid are too high, the blood lipid can be reduced after running exercise, which is helpful to prevent and treat arteriosclerosis and coronary heart disease.
(5) Enhance physical fitness and prolong life. Life lies in exercise. The more people exercise, the stronger their adaptability to the outside world.
2. Running fitness method:
Fitness running should strictly control the amount of exercise. The factors that determine the amount of exercise are distance speed, interval time, daily exercise times, exercise days per week, etc. The infirm who start running can jog for a short distance, starting from 50m and gradually increasing to100m,150m and 200m. The speed is generally100m/30s-100m/40s.
(1) Jogging: It is a typical fitness run, and the distance starts from1000 m. After adaptation, increase 1000 m every week or every two weeks, generally increase to 3000-6000 m, and the speed can be controlled at 6-8 minutes 1000 m.
(2) Running exercise: Run for 30 seconds, walk for 60 seconds, and reduce the burden on the heart. Repeat this for 20-30 times, with a total time of 30-45 minutes. This kind of running is suitable for people with poor cardiopulmonary function.
Running times: short-distance jogging and running exercises can be 1 time every day or 1 time every other day; Old people can run/kloc-0 every 2-3 days for 20-30 minutes each time.
It's best to run with your own breath. You can inhale two or three steps forward and exhale after two or three steps. When running, it will be more comfortable to swing your arms back and forth and slightly outward. Lean your upper body forward slightly and try to relax your muscles. Generally, it is better to land on your toes.
3. Precautions:
(1) Master the indications and contraindications of running. Healthy middle-aged and elderly people can prevent coronary heart disease, hypertension and hyperlipidemia and control their weight; Patients with mild diabetes, with moderate or weak physical strength, can do running in order to strengthen their physique and improve their cardiopulmonary function.
Patients with liver cirrhosis, unstable tuberculosis, arthritis affecting their own functions, severe diabetes, hyperthyroidism, severe anemia and bleeding tendency, cardiovascular diseases such as valvular disease, myocardial infarction and frequent angina pectoris are not suitable for running.
(2) Avoid running immediately after meals or in very cold, hot, humid and windy weather.
(3) Running exercise should be gradual. Start from a short distance slowly, do what you can, have spare capacity to run, don't be too tired and don't overload your heart.
(4) It is best to run in the morning. You can do exercises first and then run. Running before going to bed is generally not advisable.
Three, walking exercise method:
(1) Ordinary walking method: Take slow (60-70 steps/minute) or medium (80-90 steps/minute) walking for 30-60 minutes each time, which can be used for general health care.
(2) Fast walking: Walk 5000-7000 meters per hour for 30-60 minutes each time, which is used by ordinary middle-aged and elderly people to lose weight. The maximum heart rate should be controlled below 120 beats/min.
When you feel depressed and can't get excited about anything, you might as well walk for more than ten minutes to restore your psychological balance.
(3) Quantitative walking method (also called medical walking): walk 100m on the road with a slope of 30 degrees, and then gradually increase to 2000m on the road with a slope of 50 degrees, or walk 15min on the road with a slope of 30 -50 degrees, and then walk 15min on the flat ground. The method is suitable for patients with diabetes, chronic cardiovascular diseases and obesity.
(4) Walking with swinging arm: When walking, the arm swings back and forth forcibly, which can improve the activity of shoulder and chest, and is suitable for patients with chronic respiratory diseases.
(5) Walking by rubbing the abdomen: Massage the abdomen while walking, which is suitable for the prevention and treatment of indigestion and chronic gastrointestinal diseases.
(6) Walking in light rain: Walking in rain is more beneficial than walking in sunny days. Rain can not only purify the polluted air, but also has the functions of calming the nerves, regulating qi and lowering blood pressure. Walking in the drizzle can also help to eliminate the depressed mood brought by rainy weather to the human body and make people feel relaxed and happy. The drizzle is like a natural cold bath, massaging the face, scalp and skin, making people feel refreshed and bored.
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