First, classify health risks.
1, the trend of diabetes aggravation.
The patient has been diagnosed with type 2 diabetes for 2 years, and the fasting blood glucose measurement result is 12.56mmol/L, indicating that blood glucose control is not ideal, and fructosamine is 4, which exceeds the highest value of 2.5 (fructosamine reflects the blood glucose level of the body 1 ~ 2 weeks before the test).
Diabetes can lead to many diseases:
Renal damage: due to hyperglycemia, hypertension and hyperlipidemia, glomerular microcirculation filtration pressure is abnormally increased, which promotes the occurrence and development of diabetic nephropathy. Early manifestations are proteinuria and edema, and late renal failure is the main cause of death in type 2 diabetes.
Cause infection: urinary system diseases complicated with infection are mutually causal and must be treated at the same time. Common infections include respiratory tract infection and tuberculosis, urinary tract infection and skin infection.
Acidosis: Weak acid acidosis is a common hazard of type 2 diabetes. The patient has a history of heart, liver and kidney diseases, or shock, infection, hypoxia, drinking alcohol and taking a lot of Jiangtangling. Symptoms are not specific and the mortality rate is high.
Complications: Hypertonic syndrome of diabetes mostly occurs in middle-aged and elderly people, and half of them have a history of diabetes. Clinical manifestations include severe dehydration, which can sometimes be misdiagnosed as cerebrovascular accident due to clinical manifestations such as hemiplegia and coma.
2. Kidney damage
In the test results, the high value of urinary microalbumin is 93.7, and the detection values of creatinine and uric acid are intermediate values;
The determination of urinary microalbumin reflects early nephropathy and renal injury. Pathological increase is seen in diabetic nephropathy, hypertension and preeclampsia. Early urinary microalbumin is an early signal and precursor of nephropathy, and renal damage is in a reversible period. If treated in time, the development of nephropathy can be reversed.
The detection of microalbuminuria can be used as a renal function index of systemic or local inflammatory reaction, such as early renal disease caused by urinary tract infection. Predictors of complications of acute pancreatitis: those who take drugs that affect renal function can also detect microalbuminuria, which is convenient for early observation of renal function and early measures.
3. weight.
Body mass index = weight/height squared (m), and the patient's body mass index is 23.7, which belongs to the normal range. Combined with age, diet preference and exercise, it can be inferred that visceral fat has accumulated, and there will be obvious fat at the waist after long-term desk work.
According to age, weight, height and other information, as well as the life rhythm and unhealthy mode of most modern people, with the growth of age, the metabolic rate of the body decreases, and it is easy to accumulate too much fat in the waist and abdomen, and visceral fat is easy to exceed the standard. This can be improved by losing weight and fat in the later stage.
4, dyslipidemia
The triglyceride of patients was 1.79, and the highest value of trend test was 2.2.
There are two main sources of triglycerides in human plasma:
① Exogenous: Fat ingested from food is absorbed by intestinal mucosa under the action of bile acid and lipase, and triglycerides are synthesized in intestinal mucosal epithelial cells.
② Endogenous: The triglyceride synthesized by oneself in the body is mainly in the liver, followed by adipose tissue.
Triglyceride is one of the risk factors of cardiovascular disease in human body, and its increase indicates the greater the probability of cardiovascular disease.
The total cholesterol is 6.0, which has exceeded the highest detection value of 5.2;
Total cholesterol refers to the sum of cholesterol contained in all lipoproteins in blood. The level of total cholesterol in human body mainly depends on genetic factors and lifestyle. The sources of cholesterol are exogenous and endogenous.
Exogenous cholesterol comes from foods rich in cholesterol; Endogenous cholesterol is synthesized by the human body itself, mainly in the liver. The liver is the main organ for synthesis and storage. Cholesterol is an important raw material for the synthesis of adrenocortical hormone, sex hormone, bile acid and vitamin D, and it is also the main component of cell membrane. Its serum concentration can be used as an index of lipid metabolism.
Apolipoprotein A 1 is 1.25, which tends to be the lowest reference value1.2;
Apolipoprotein A 1 is a good lipoprotein, which can prevent coronary heart disease and arteriosclerosis. The biggest feature is that the higher the ratio, the better, indicating that there is no problem with the body's own fat metabolism.
Apolipoprotein B was 1.2, which exceeded the reference maximum1.1;
Apolipoprotein B exists on the surface of low-density lipoprotein (LDL), and cells recognize and ingest LDL mainly by recognizing apolipoprotein B. Therefore, when apolipoprotein B rises, even if the LDL level is normal, it can increase the incidence of coronary heart disease.
The high-density lipoprotein cholesterol (HDL-C) is 1.39, which tends to the highest reference value, indicating that the body's metabolic function is acceptable and it is a scavenger in blood vessels.
High density lipoprotein cholesterol is mainly synthesized by the liver and small intestine, and is the smallest lipoprotein. Its main function is to transport excess cholesterol from extrahepatic tissues to the liver for metabolism, so as to prevent excessive accumulation of cholesterol in these tissues. It can prevent arteriosclerosis and reduce the mortality of coronary heart disease.
Low density lipoprotein cholesterol 3.9 1:
Low density lipoprotein (LDL) is the main atherogenic lipoprotein in all serum lipoproteins. Is the garbage in the blood vessels, piled up in people's blood vessels.
5. Abnormal hypertension
Diabetic nephropathy is accompanied by hypertension, which occurs in parallel with microalbuminuria in type 1 diabetic nephropathy, but often occurs before diabetic nephropathy in type 2 diabetic nephropathy. Blood pressure control is closely related to the development of diabetic nephropathy. Long-term diabetes is often accompanied by fundus neuropathy, arteriosclerosis and heart, brain and kidney damage, and hypertension is also closely related to these diseases; The probability of vascular injury and sclerosis in patients with diabetic hypertension is twice as high as that in patients with simple hypertension, and cardiovascular disease is a risk factor for myocardial infarction and stroke.
In view of the fact that diabetic hypertension often coexists with other risk factors of cardiovascular and cerebrovascular diseases, such as hypercholesterolemia, obesity and diabetes. It synergistically increases the risk of cardiovascular disease. Long-term hypertension will maximize its harm. Persistent hypertension will damage the heart, brain, kidney and aorta, and eventually lead to serious complications such as cerebral hemorrhage, heart failure and renal failure, which will seriously affect health and even life.
6. Liver abnormalities
The total bile acid was 10.7, which exceeded the highest value of the reference value 10.
The change of total bile acid level can reflect the change of liver function. Once liver cells have pathological changes or intestinal and hepatic circulation disorders, total bile acids can increase.
Total bile acids are a group of metabolites of cholesterol in liver decomposition and enterohepatic circulation, and are the final products of cholesterol catabolism in liver, which are closely related to cholesterol absorption, metabolism and regulation.
The total bile acids in human body can be divided into primary bile acids and secondary bile acids. Primary bile acids take cholesterol as raw material and participate in the digestion and absorption of fat. After entering the duodenum through the biliary system, it is hydrolyzed by intestinal bacteria to generate secondary bile acids. When liver cells are diseased or blocked inside and outside the liver, bile acid metabolism is disturbed and returns to the blood, and serum total bile acid concentration increases. Therefore, the change of total bile acid level can sensitively reflect liver function.
Elevated serum total bile acids can be seen in all kinds of acute and chronic hepatitis, hepatitis B carriers or alcoholic hepatitis (TBA is more sensitive than all other liver function tests), and can also be seen in most extrahepatic bile duct obstruction, intrahepatic cholestasis, cirrhosis, obstructive jaundice, etc.
7. Gastrointestinal function
Combined with the medical history of diabetes, kidney damage, overweight, abnormal blood lipid/blood pressure/liver, impaired gastrointestinal function, and the information provided in the diet, it shows that the diet is unbalanced and tastes heavy; As a result of long-term diet, the gastrointestinal function of patients has been damaged and decreased to some extent. It is necessary to collect more detailed health data and determine the specific situation of stomach and digestive function.
II. Collection of required health data
1, health questionnaire: information such as water consumption, continuous exercise preference, dietary preference, dietary pattern, sleep status, mental health status, etc.
2. Diet evaluation: the diet structure and cooking methods of three meals a day.
3, the nature of the work, rhythm, environment, entertainment,
Three. Health management objectives
In a word, the patient's history of type 2 diabetes, kidney damage, overweight, abnormal blood lipid/blood pressure/liver, impaired gastrointestinal function, etc. It is suggested to continue to treat diabetes, reduce blood sugar level, slow down the disease and control related complications; At the same time, we should pay attention to the daily diet, adjust and improve the diet structure, gradually repair the gastrointestinal function, and establish a correct and healthy diet and lifestyle.
1, blood sugar control and management, realize blood pressure regulation/kidney conditioning.
Continue to take diabetes drugs according to the doctor's advice;
Stabilize blood sugar in an ideal range and monitor blood sugar changes in time;
Lifestyle changes:
? -Diet: Avoid a high protein diet.
? -Exercise: Long-term regular exercise to lose weight.
? -Need to quit smoking and drinking
? -Control the intake of salt, water and potassium, and avoid greasy diet.
Patients with type 2 diabetes are easily troubled by many diabetes-related diseases, such as blindness and renal failure leading to uremia. In addition, diabetes can also lead to physical disability, affecting patients' walking and daily life. As can be seen from the above, diabetes is extremely harmful.
2. Weight management
The patient's body mass index is 23.7, the standard weight is (163-100) * 0.9 = 56.7, and he is overweight by 6.3kg, so weight management is needed. In order to avoid losing weight too fast, causing damage to the body and internal organs and weight rebound, combined with the actual age, it can be done at a rate of 1 ~ 2 kg per week.
3, gastrointestinal tract repair
As the saying goes, the disease enters from the mouth, and the gastrointestinal tract is the largest immune organ in the body. If you have gastrointestinal diseases, you will not discuss other diseases that follow with your patients. The key lies in the adjustment of diet structure and living habits.
Long-term heavy taste, salty taste, sweet taste, meat and greasy food have caused unbalanced nutrition, and the damage to gastrointestinal tract is inevitable.
Fourth, conditioning procedures
1, diabetic diet:
Diet therapy is a treatment that all diabetic patients need to adhere to. Mild cases can achieve good results mainly through diet therapy, and moderate and severe patients must also apply physiotherapy and drug therapy reasonably on the basis of diet therapy. Only by controlling diet, oral hypoglycemic drugs or islets can play a good role. Otherwise, it is difficult to achieve good results in clinic by blindly relying on so-called new drugs and drugs and ignoring diet therapy.
The diet plan should be adjusted at any time according to the condition and mastered flexibly. Thin patients can relax appropriately to ensure the total calories. Obese patients must strictly control their diet and focus on a low-calorie fat diet to lose weight. For patients treated with insulin, we should pay attention to adding meals at 9 ~ 10, 3 ~ 4 pm or before going to bed as appropriate to prevent hypoglycemia. When manual labor or activities are long, attention should also be paid to appropriately increasing staple food or dinner.
Diabetes diet should scientifically arrange staple food and non-staple food, and not only attach importance to staple food but despise non-staple food. Although staple food is the main source of blood sugar and should be controlled, some protein and fat in non-staple food can also become blood sugar and become the source of blood sugar. In metabolism, 58% of protein and 10% of fat are converted into glucose. Eating too much of this kind of non-staple food will also make people fat, which is not good for their illness. Therefore, in addition to reasonable control of staple food, non-staple food should also be reasonably matched, otherwise the expected effect will not be achieved.
Three meanings:
Whole grains: buckwheat flour, corn flour and purple yam are rich in vitamin B, various trace elements and dietary fiber, and low-sugar and low-starch foods or coarse grains and vegetables are the staple foods.
Beans and bean products: Beans are rich in protein, inorganic salts and vitamins, and soybean oil contains unsaturated fatty acids, which can reduce serum cholesterol and triglycerides.
Bitter gourd, mulberry leaves, onions, mushrooms and grapefruit can all lower blood sugar and are the most ideal foods for diabetics. If it can be eaten for a long time, the effect of lowering blood sugar and preventing complications will be better.
Three is not desirable.
People with diabetes should also be alert to the "three inappropriateness" in their daily diet.
It is not advisable to eat all kinds of sugar, candied fruit, canned fruit, soft drinks, fruit juice, jam, ice cream, sweet biscuits, sweet bread and sugar-free cakes, sugar-free biscuits and sugar-free foods. These foods basically contain a lot of starch, because these foods have high sugar content and are prone to hyperglycemia.
It is not advisable to eat foods with high cholesterol and animal fat, such as animal brain, liver, heart, lung, waist, egg yolk, fat, butter, pig, cattle and sheep oil, etc. These foods are easy to raise blood lipids and easily cause atherosclerosis;
Drinking alcohol is not advisable. Alcohol can make blood sugar fluctuate. When drinking heavily on an empty stomach, severe hypoglycemia can occur, and drunkenness can often cover up the manifestations of hypoglycemia, which is difficult to find and very dangerous.
2. Dietary principles of daily meals
(1) High-quality carbohydrate source (i.e. staple food)
Choosing carbohydrates is very important, because carbohydrates will play an important role in healthy diet and disease prevention. Carbohydrate is the fuel of human body, and it is the fuel needed to make internal organs work. For example, the brain mainly uses it as an energy source. Most carbohydrates come from plants, grains, vegetables, fruits and beans.
There are three kinds of carbohydrates: sugar, starch and fiber. Carbohydrates in sugar and starch produce 4000 calories per gram, while fiber does not produce heat, so it cannot be absorbed. However, it can help the food in the digestive system move smoothly and slow down its absorption of heat. ?
High-fiber carbohydrates are digested slowly, so that the blood sugar level in the body will not rise too fast. In contrast, low-fiber carbohydrates are digested faster, so the blood sugar level in the body will rise rapidly. The rapid rise of blood sugar leads to the production of more insulin in the body, which is a hormone that can help regulate the blood sugar level in the body. Long-term health problems can lead to chronic diseases.
How much staple food to eat is calculated by fist, and it is appropriate to eat one fist for each meal.
What staple foods are eaten in the north and south are different, and most of them are divided into flour and rice and coarse grains. In addition to the rice and white flour you often eat, you also need to eat some of the following complex carbohydrate staple foods:
(1) whole grains: whole grains, such as black rice, brown rice, oats, buckwheat, quinoa, etc.
(2) Miscellaneous beans: including all kinds of red beans, mung beans, peas and broad beans.
(3) Potatoes and tubers: such as potatoes, yams, sweet potatoes and lotus roots. Usually, we all think of them as "vegetables". In fact, they contain more starch and can provide more energy for the body. At the same time, they are rich in dietary fiber and B vitamins, which can provide a stronger satiety.
(2) protein food.
Protein is the material basis of life. Without protein, there would be no life. Therefore, it is a substance closely related to life and various forms of life activities. Protein participates in every cell and all important parts of the body.
Protein is an essential nutrient for human body, so we should pay attention to the intake of high-protein food in our daily life.
How much should protein eat? It is recommended to eat1.1-1.2g/kg every day, which means to eat 83-90g of protein every day. These should be evenly distributed among the three meals, and the ratio can be 1: 1: 1.
Protein eats animal protein and plant protein. Because the types and proportions of amino acids contained in animal protein are more in line with human needs, the nutritional value of animal protein is higher than that of plant protein.
Animal protein: such as dairy products, livestock meat, poultry meat, eggs, fish, shrimp and other animal proteins;
Plant protein: beans such as soybeans, green beans and black beans, and dried fruits such as sesame seeds, melon seeds, walnuts, almonds and pine nuts.
Meat: donkey meat has the highest content of essential amino acids, which is 39.4%, while mutton, pork, beef and chicken are 37.2%, 38.3%, 39.0% and 33.5% respectively.
Eggs: An egg weighs about 50 grams, including 7 grams of protein.
Milk: The protein content of a glass of milk is about 2.8 ~ 3.4%. Adults can generally drink about 250 ~ 300ml of milk every day, which is an ordinary glass.
Fish: The protein content of most fish can reach 18%-20%, which is higher than the protein content of meat, poultry, eggs and milk. It is easy to digest and absorb, and the utilization rate is as high as 85%-90%.
Protein should adjust the uric acid value and avoid eating too many foods with high purine content, such as seafood and animal offal (please refer to the purine content table of food).
(3) Vegetable food
Vegetables can provide our bodies with essential vitamins, minerals and many phytonutrients, and they are low in calories, so they are foods with high nutritional density. It should be noted that its calories are very low, so every meal should be distributed with an appropriate amount of staple food and protein food, otherwise the calorie intake will be insufficient. Vegetables are a kind that needs to be supplemented at ordinary times, especially breakfast. Lack of vegetables in breakfast will reduce the body's ability to manage blood sugar and reduce the total intake of vegetables at the end of the day.
How many fresh vegetables and fruits to eat every day should be around 500g, evenly distributed in each meal; When choosing melons and fruits, we should pay attention to choosing fruits with low glycemic index to avoid rising blood sugar.
What vegetables do you eat every week? Eat 25 colors and rainbow colors. Vegetables and fruits can be diversified, and different colors are rich in vitamins and dietary fiber, which can provide different nutrition for the body's immune system.
(4) high-quality anti-inflammatory fat
Fat, commonly known as grease, consists of carbon, hydrogen and oxygen. It is not only an important part of human tissue, but also one of the main substances that provide heat. The fat in food is digested in the stomach and intestines, and most of it is converted into fat again after absorption. Mainly distributed in subcutaneous tissue, omentum, mesentery and kidney. The content of body fat often changes with nutritional status, energy consumption and other factors. Therefore, it is particularly important to choose high-quality fat.
Olive oil, linseed oil, fish oil, almond sauce, waist sauce, avocado and other fats are all relatively healthy fats, among which linseed oil also has the function of reducing fat.
There are almonds, walnuts, walnuts, cashews and peanut butter; They are an excellent source of healthy fat and contain a small amount of protein.
All fried foods: Because fried foods are high in fat.
Shortened butter made from butter and margarine, palm oil and coconut oil, and vegetable oil: they are not healthy sources of fat.
(5) Water consumption
Water is the source of life and the basic component of all living things. Animals and plants use water to maintain the most basic life activities. People can go without food for several days, but they can't go without water for a day. Therefore, water is the source of life, and water is also one of the most necessary nutrients for human beings.
About 50% ~ 70% of human body weight is water. Water content varies with age, sex and physical condition. Brain tissue contains about 85% water, and blood contains about 90% water, which is the main component of human cells and body fluids. About 50% of the total water in human body is intracellular fluid, and the other 50% is extracellular fluid, including intercellular fluid and plasma, so as to maintain the balance of environmental water and electrolyte in the body.
How much water do you drink? Water consumption of people who lose weight = weight kg * 40 ~ 50ml Drink 200ml after getting up in the morning, sip more water during the day, keep the rhythm of drinking less and drinking more, and drink a little water before going to bed.
What kind of water to drink? Boiled water is best.
2. Lifestyle intervention
(1) can increase moderate exercise, such as aerobic exercise and brisk walking. And increase the body's metabolism. For gout, strenuous exercise is not allowed;
(2) Increasing knowledge of chronic diseases and maintaining a healthy and positive attitude will play a guiding role in the treatment process.