Diabetes

Diabetes is characterized by high blood glucose metabolic disorders. Hyperglycemia is due to insulin secretion or its biological effect caused by damage, or both. High blood sugar diabetes exist for a long time, leading to a variety of organizations, especially the eyes, kidneys, heart, blood vessels, nerve damage, chronic dysfunction.
Diabetes

Essential information

Diabetes Pathogeny

1 genetic factors
Type 1 or Type 2 diabetes mellitus There were significant genetic heterogeneity. The presence of diabetes familial tendency, 1/4 ~ 1/2 patients with a family history of diabetes. Clinical on at least 60 or more genetic syndrome may be associated with diabetes. Type 1 diabetes mellitus There are many DNA loci involved in the pathogenesis of DQ, the relationship between the polymorphisms of HLA gene in the most closely. stay Type 2 diabetes mellitus It has been found that many specific gene mutations, such as insulin gene, insulin receptor gene, glucokinase gene and mitochondrial gene etc..
2 environmental factors
Eating too much physical activity, obesity is reduced Type 2 diabetes mellitus The most important environmental factor, which has Type 2 diabetes mellitus The genetic susceptibility to individual morbidity. Type 1 diabetes mellitus In patients with immune system abnormalities in some viruses such as Coxsackie virus, Rubella The virus, the virus of parotid gland infection resulted in autoimmune reaction, the destruction of insulin beta cell.

Diabetes Clinical manifestation

1 polydipsia, polyuria, polyphagia and emaciation
Typical symptoms of severe hyperglycemia, in Type 1 diabetes mellitus . Occurrence of diabetic ketosis Acid poisoning When the symptoms are more obvious.
2 fatigue, obesity
In Type 2 diabetes mellitus . The pathogenesis of type 2 diabetes are often obese before, if not timely diagnosis, the weight will gradually decline.

Diabetes inspect

1 blood glucose
Is the only criteria for the diagnosis of diabetes. There are obvious symptoms, as long as a diagnosis of abnormal blood glucose values. Asymptomatic diabetes diagnosis needs two times of abnormal blood glucose value. Suspicious person need to do 75g glucose tolerance test.
2 urine
Often positive. The blood glucose concentration above the renal glucose threshold (160 ~ 180 mg / dl) when positive urine. Renal glucose threshold increased blood glucose to diabetes diagnosis can be even negative. Therefore, diastix diagnosis standard is not as.
3 urine ketone
Diabetic ketosis Acid poisoning When the urine ketone body positive.
4 glycosylated hemoglobin (HbA1c)
Is the product of glucose and hemoglobin of non enzymatic reaction with the reaction is not reversible, the level of HbA1c is stable, can reflect the average blood glucose level of blood in the first 2 months. Is to determine the state of the most valuable indicator of glycemic control.
5 glycosylated serum protein
Blood glucose and serum albumin non enzymatic reaction product combination, reflect the average blood glucose level of blood before 1 to 3 weeks.
6 serum levels of insulin and C peptide
Reflect the beta cell reserve function. Insulin in patients with type 2 diabetes mellitus or obesity serum normal or increased, with the development of disease, islet function drops gradually, decreased insulin secretion ability.
7 blood lipids
Common in patients with diabetes Dyslipidemia , especially in poor glycemic control when. Performance for the triglyceride, total cholesterol and low density lipoprotein cholesterol levels. High density lipoprotein cholesterol levels decreased.
8 immune index
Islet cell antibody (ICA), insulin autoantibodies (IAA) and glutamate decarboxylase (GAD) antibody Type 1 diabetes mellitus Three important indicators of humoral immune abnormalities, the GAD antibody positive rate is high, long duration, the Type 1 diabetes mellitus The diagnostic value of high. In type 1 diabetic first-degree relatives also have certain positive rate, prediction of type 1 diabetes significance.
9 urinary albumin excretion, RIA or ELISA method
Be sensitive detection of urinary albumin excretion, early diabetic nephropathy Urinary albumin increased slightly.

Diabetes Diagnosis

The diagnosis of diabetes is generally not difficult, fasting blood glucose greater than or equal to 7 mmol / L and / or two hour postprandial blood glucose greater than or equal to 11.1 mmol / l can be confirmed. After the diagnosis of diabetes type:
Type 1.1 diabetes mellitus
Age, mostly aged <30, sudden onset, polydipsia, polyuria, emaciation eating symptoms, high blood sugar levels, many patients with ketosis Acid poisoning As the first symptom, low serum levels of insulin and C peptide, ICA, IAA or GAD antibody positive. Single oral medicine is invalid, need to be treated with insulin.
Type 2.2 diabetes mellitus
Common in the elderly, high incidence of obesity, often accompanied by Hypertension , Dyslipidemia , Arteriosclerosis Other diseases. Insidious onset, early without any symptoms, or only mild fatigue, thirst, hyperglycemia is not obvious to a glucose tolerance test can be confirmed. The serum insulin level of normal or increased early, late low.

Diabetes differential diagnosis

1 liver disease
Cirrhosis Patients often have abnormal glucose metabolism, typically normal fasting glucose or low postprandial blood glucose rise rapidly. The duration of the elderly are also elevated fasting blood glucose.
2 chronic renal insufficiency
Can have mild abnormal glucose metabolism.
3 stress state
A lot of stress such as heart, cerebrovascular accident, acute infection, trauma, surgery may lead to blood glucose increase, the recovery stress factor is eliminated after 1 ~ 2 weeks.
4 kinds of endocrine diseases
as Acromegaly , Cushing syndrome , hyperthyroidism , pheochromocytoma , glucagonoma can cause secondary diabetes, hyperglycemia in addition, there are other features, not difficult to identify.

Diabetes Treatment

At present there is no cure for diabetes, but with a variety of treatments can control diabetes. Mainly includes 5 aspects: diabetes education, self monitoring of blood glucose, diet therapy, Exercise therapy And drug treatment.
(a) general treatment
1 Education
To understand the basic knowledge of diabetes education for patients with diabetes mellitus, establish the confidence to overcome the disease, how to control diabetes, good control of diabetes health benefits. Make the appropriate treatment according to the disease characteristics of the patients with diabetes each.
2 self monitoring of blood glucose
With the gradual popularization of small and fast blood glucose meter, the patient can be adjusted at any time according to the blood glucose level of hypoglycemic drug dose. Type 1 diabetes intensive treatment every day at least 4 times blood glucose monitoring (before meals), to monitor 8 times blood glucose instability (before and after meals, at bedtime and 3:00 a.m.). Intensive treatment of fasting blood glucose should be controlled at 7.2 mmol / liter, two hour postprandial blood glucose is less than 10mmol/L, HbA1c less than 7%. Self monitoring of blood glucose in patients with type 2 diabetes may be appropriate to reduce the frequency of.
(two) drug treatment
1 oral drug treatment
(1) sulfonylurea in type 2 DM patients with diet, exercise, weight loss after treatment, the curative effect is not satisfied by sulfonylureas. Because the hypoglycemic mechanism is mainly stimulated insulin secretion, so to have better effect of islet function. Some of the younger age at onset of diabetes, not body fat also have certain curative effect in the early stage. But the use of sulfonylureas on obesity, should pay special attention to diet control, the body weight decreased gradually, and glucosidase inhibitor antidiabetic biguanides or alpha combined with good. The following is a contraindication: one is severe liver and renal insufficiency; two patients with severe infection, trauma and during major surgery, temporary use of insulin treatment; three is the period of diabetic ketoacidosis, ketoacidosis, temporary use of insulin treatment; four diabetes in pregnant women, pregnancy hyperglycemia has teratogenic effects on the fetus, premature birth, stillbirth the high incidence, so we should strictly control the blood glucose, the blood glucose control at 105 mg / dl (5.8 mmol / L), 2 hour postprandial blood glucose control at 120 mg / dl (6.7 mmol / L), but the control of blood glucose should not use oral antidiabetic drugs; five of sulfonylurea drug allergy or obvious adverse reactions.
(2) biguanides hypoglycemic mechanism is mainly increased peripheral tissue glucose utilization, increase glucose anaerobic glycolysis, reduce the gastrointestinal absorption of glucose, reduce weight. The indications of obese type 2 diabetes with diet alone are not satisfied with the treatment; type 2 diabetes with sulfonylurea effect is not good, can add biguanides; type 1 diabetes treated with insulin, the condition is unstable, with biguanides can reduce the dose of insulin; type 2 diabetes secondary failure to insulin therapy, can be added with biguanides, can reduce the dosage of insulin. The contraindication of severe liver, kidney, heart and lung diseases, wasting disease, malnutrition, hypoxic diseases; diabetic ketosis and ketoacidosis; accompanied by severe infection, trauma, surgery, stress condition of suspended biguanides, switch to insulin therapy; pregnancy. The adverse reaction is a reaction of gastrointestinal tract. The most common symptoms were nausea, vomiting, loss of appetite, abdominal pain, diarrhea, the incidence rate of up to 20%. To avoid these adverse reactions, the medication should be in a meal or after meal. The two is a headache, dizziness, metallic taste. The three is lactic acidosis, in the long-term, a large number of applications Jiangtangling, accompanied by liver and kidney dysfunction, hypoxia disease, acute infection, gastrointestinal diseases, Melbine cause less chance of acid poisoning.
(3) alpha glucosidase inhibitor type 1 and type 2 diabetes can be used with sulfonylurea, biguanides and insulin combined with cyclophosphamide. Voglibose orally immediately before meals. The acarbose meal immediately before oral administration. The main adverse reactions are: abdominal pain, flatulence, diarrhea, anal exsufflation.
(4) insulin sensitizer can enhance insulin action, improve glucose metabolism. Can be used alone, can also be used to sulfonylurea, biguanides and insulin combined with. Have a liver disease or heart failure should not be used.
( 5) glinides insulin secretagogues of repaglinide for rapid insulin secretagogues, immediately before meals oral, every time when the main meal, not eating or. The nateglinide is similar to repaglinide.
2 insulin therapy
Insulin preparation animal insulin, human insulin and insulin analogues. According to the effect of time is divided into short acting and long-acting insulin, in effect, and has made a mixture, such as Novolin 30R, Humulin 70/30.
(1) type 1 diabetes need insulin treatment. Non intensive therapy daily injections of 2 ~ 3 times, intensive therapy daily injections of 3 ~ 4 times, or the use of insulin pump therapy. Often need to adjust the dose.
(2) type 2 diabetes oral hypoglycemic drugs by combined treatment failure, the original method for oral hypoglycemic drugs in the same dose, before going to bed late 10: 00 injection of insulin or long-acting insulin analogues, generally every 3 days to adjust 1 times, for the purpose of fasting blood glucose reduced to 4.9 ~ 8 mm mol / L invalid discontinuation of oral antidiabetic drugs, instead of taking insulin injections 2 times a day.
The biggest adverse reaction of insulin treatment for hypoglycemia.
(three) exercise therapy
Increased physical activity can improve the body's sensitivity to insulin, reduce weight, reduce body fat, enhance physical strength, improve the ability to work and quality of life. The intensity and duration of exercise should be based on the overall health status of patients to find a suitable amount of exercise, the patient and the patient is interested in the project. The movement form is various, such as walking, brisk walking, aerobics, dancing, jogging, swimming, Tai Chi etc..
(four) diet therapy
Diet therapy is the basis of various types of diabetes treatment, part of the light of diabetic patients can control the disease with single treatment diet.
1 of total calories
Required amount of total calories according to age and gender, height, weight, physical activity, disease and other factors to determine. First of all to calculate each person's standard weight, can refer to the following formula: standard weight = height (kg) (CM) or -105 (kg) n height standard weight (CM) -100] * 0.9; female standard weight should be minus 2kg. Can also be based on age, gender, height, look it up in a table. Calculate the standard weight according to each person of daily physical activity to estimate the energy required per kg standard weight.
According to standard weight calculated daily required calories quantity, but also adjust to other patients. Children, adolescent, lactation, Innutrition Thin, and chronic wasting disease should be increased total calories. The obese to strictly limit the total calories and fat content, given the low calorie diet, no more than 1 million 500 thousand calories per day total, general per month decreased by 0.5 ~ 1.0kg is appropriate, to be close to the standard weight, according to the calculation method of total daily calories. In addition, the older than the younger adult women need fewer calories, less calories than men.
2 carbohydrate
Carbohydrate per gram of heat 4 thousand cards, is the main source of calories, carbohydrates should think now accounted for 55% of the total energy diet to 65%, by the following formula:
According to the life of the Chinese people's habits, can enter the staple food (rice or flour) 250 ~ 400g, could make the following preliminary estimates, the rest of their staple food every day 200 ~ 250g, 250 ~ 300g mild physical labor, moderate physical labor 300 ~ 400g, heavy manual workers more than 400g.
3 protein
4 thousand calories per gram of protein. 12% to 15% of total calories. The protein requirement in adults per kg of body weight of about 1G. In children, pregnant and lactating women, Innutrition There is, emaciation, consumptive disease should increase to 1.5 ~ 2.0g per kg of body weight. Diabetes nephropathy Should reduce the intake of protein per kilogram of body weight, 0.8g, if there is renal insufficiency, intake of high quality protein intake should be further reduced to 0.6g per kg of body weight.
4 fat
The higher energy per gram of fat, 9 thousand calories. About 25% of total calories, generally not more than 30%, the daily per kilogram of body weight 0.8 ~ 1G. Animal fat containing saturated fatty acid. Vegetable oil contains unsaturated fatty acid, Yi Huan in patients with diabetes mellitus atherosclerosis That should use vegetable oil based.

Expert interpretation