Abstract:Diabetes mellitus has become almost the mainstream of patients in China with the continuous improvement of living standards in recent years. And the harm of diabetes mellitus is becoming more and more serious, it may lead to acute complications represented by ketoacidosis and chronic complications, including the whole retina and neuropathy, there are vascular lesions caused by paraplegia of the lower limbs and other serious sequelae. In this paper, we start from the etiology of diabetes mellitus to understand the causes of the outbreak of diabetes mellitus as well as the clinical symptoms, the social development of the classification of diabetes mellitus in the specificity of the different types of different manifestations and causes. Popularize the clinical treatment of diabetes and precautions, but also emphasize the importance of self-care of diabetic patients, for which we have to make more efforts to study the prevention and treatment of diabetes in the future.
Keywords: diabetes self-management, diabetes classification, prevention and treatment methods, future prospects
Abstract: With the continuous improvement of living standards in recent years, diabetes patients have almost become the mainstream of Chinese patients. The harm of diabetes is becoming more and more serious. It may lead to acute complications and chronic complications such as ketoacidosis. It may lead to acute complications and chronic complications such as ketoacidosis, including retinopathy and neuropathy, paraplegia caused by vascular diseases and other serious sequelae. This article starts from the etiology of diabetes and its effects on the health of patients. article starts from the etiology of diabetes, to understand the causes of the outbreak of diabetes and clinical symptoms, the classification of social development diabetes, different types of different diabetes, the causes of the outbreak of diabetes and the clinical symptoms. This article starts from the etiology of diabetes, to understand the causes of the outbreak of diabetes and clinical symptoms, the classification of social development diabetes, different types of different manifestations and causes. To popularize the clinical treatment methods and precautions of diabetes, we should emphasize the importance of self-care of diabetes patients. For this, we should make more efforts to study the prevention and treatment of diabetes in the future. For this, we should make more efforts to study the prevention and treatment of diabetes in the future.
Key words: diabetes self-management; diabetes classification; prevention and treatment; future prospect
Table of Contents
1 Causes of diabetes and prevalence rates .................... .3
2.11 Type 11 diabetes ................................... .4
2.22 Type 2 diabetes .................................. .5
2.2.1 Genetic susceptibility ................................... .5
2.2.2 Insulin resistance (IR) and defective B-cell function ............ .5
2.2.3 Decreased glucose tolerance (TGP) and fasting glucose .................... .5
2.2.4 Clinical diabetes ................................... .6
2.3 Gestational diabetes and more .............................. .6
3 Enumeration and correction of non-scientific diabetes self-management ......... .7
3.1 Misrecognition .................................... .7
3.2 Dietary problems .................................... .7
3.3 Exercise problems .................................... .8
3.4 Mental health .................................... .8
4 Importance and perspectives of diabetes self-management ................ .9
5 Impact of poor diabetes self-management on the lives of older people ......... .10
Elderly people are those who have reached the age of 65. Unlike the youthful and robust age group, elderly people have irreversible damage to various parts of their bodies and their physiological functions gradually deteriorate, such as the decline of the digestive system and metabolic functions. Due to the physical weakness of the elderly, increasing the chances of the elderly disease, especially in the elderly group in the high incidence of diabetes prevalence of the first to bear the brunt of the annual number of elderly people suffering from diabetes accounted for 26% of the total number of elderly people, and this data has been rising in recent years, more striking data is that each year about nearly 1.3 million elderly people due to diabetes died.
With the improvement of the quality of life of the elderly and the weakening of exercise, the prevalence of diabetes [1] is not to be underestimated, and diabetes has caused a lot of physical and mental pain to many of the elderly, but also has a considerable economic burden on these families. However, diabetes is a chronic disease, overnight treatment does not exist, it requires a greater degree of self-discipline and self-health control of the elderly, the need for long-term struggle with diabetes.
I. Causes and prevalence of diabetes
Diabetes is a group of metabolic diseases mainly characterized by high blood sugar, due to the absolute or relative insufficiency of insulin secretion, caused by a series of metabolic disorders of the body's blood glucose rise. After suffering from diabetes, there are some typical characteristics: polyuria, polydipsia, polyphagia and weight loss, and these methods are a reference method to determine whether the elderly suffer from diabetes. There are three ways to accurately test and determine whether an older person has diabetes. The first is to test the older person's fasting venous blood glucose twice in a row to see if it is greater than or equal to 7.0 mmol, the second is to observe the older person's postprandial blood glucose is greater than or equal to 11.1 mmol/l, and the last is to observe the older person's blood glucose is greater than or equal to 11.1 mmol/l at any time. Once the above three test results occur, the elderly should immediately consult a doctor and follow the doctor's instructions, so as to achieve early detection and early treatment. At the same time, insulin is broken down from insulinogen, and every time a molecule of insulin is produced, a molecule of C-peptide is also produced. C-peptide is able to detect its own insulin secretion, which is extremely helpful in identifying different types of diabetes.
According to the relevant report of the World Health Organization, about 382 million people in the world suffered from diabetes in 2019, of which the number of Chinese diabetics is 114.4 million, ranking the highest number of diabetics in the world.In 2008, diabetics accounted for 9.7% of the adult population in China, and in 2010, the number of people with diabetes rose to 11.6%, what a shocking evidence and The number of people with diabetes is still growing day by day, based on this data, there are many scholars predicted that in 2030, the number of people with diabetes in the world will be as high as 578.4 million, and continue to rise in 2045, most likely to reach 700.2 million, what kind of concept is this? In 2019, about 1 in 11 people will have diabetes, and in 2030, about 1 in 9 people will have diabetes. 2045? What about 2045? It's easy to see how diabetes could become a scary disease in the long run. And we should know more clearly that diabetes as a chronic disease, the treatment of difficult to deal with the patient's family will cause much economic distress, there will be more and more people and families due to diabetes this evil gradually into the predicament, and even fall apart. Diabetes in addition to its own cause of the infestation, can not be ignored is that it is a variety of complications, involving a wide range of small to diabetic neuropathy, cardiovascular disease and so on, can not be completely cured. According to the existing data analysis, it can be concluded that diabetic patients will eventually due to various reasons, about 15% of diabetic patients will suffer from diabetic foot disease, in which about 80% of diabetic foot disease patients may be due to this disease lead to amputation, and diabetic patients with lower limb amputation risk is more than 15 times that of non-diabetic patients [2] the main method of eradicating such a condition is the focus of the paper and the meaning of the comprehensive understanding of diabetes and self-awareness of diabetes, which is a comprehensive understanding of diabetes, and the significance of diabetes. significance of this thesis is the comprehensive understanding of diabetes mellitus and self-management approaches and methods.
II. Classification of diabetes mellitus
Diabetes mellitus is a collective term for a category of adrenaline insufficiency. In fact, the classification of diabetes can be roughly divided into three categories.
(A) Type 1 diabetes
The cause of this type of disease is insufficient insulin secretion due to the destruction or imperfect function of the pancreatic islet B cells, which produces diabetic ketoacidosis. 1 diabetes mellitus is due to the body's absolute insufficiency of insulin secretion, so the treatment of 1 type of insulin oral drugs are completely ineffective, can only be through the lifelong injection of insulin for the human body to carry out insulin supplementation. supplementation. There are autoimmune and idiopathic secondary classifications of type 1 insulin, and autoimmune diabetes mellitus is divided into acute and bradyphylactic because of its early or late onset. Acute diabetes is usually recognized in adolescence and is prone to diabetic ketoacidosis. Delayed-onset diabetes, also known as late-onset autoimmune diabetes in adults, usually develops between the ages of 20 and 48.
(II) Type 2 diabetes
Type 2 diabetes is the most prevalent type of diabetes in the classification of diabetes mellitus, with up to 95% prevalence. Its pathogenesis has a clear genetic basis, insulin resistance and B-cell secretion abnormalities. However, its etiology can be analyzed mainly from genetics, increased body load caused by improper diet, too little exercise, excessive life stress, excessive alcohol consumption, and the onset of this type of diabetes mellitus is divided into four stages[3]:
1) Genetic susceptibility: on the basis of genetic characteristics, it is more morbidity triggers are environmental factors. It can start from the aging population, human obesity, reduced exercise, sudden increase in stress and other factors, forcing the activation of genetic genes of diabetes mellitus.
②Insulin resistance (IR) and B-cell defects
Insulin resistance and insufficient insulin secretion are long-lasting triggers, and as two of the major factors in the onset of type 2 diabetes, they lurk in the background for many years before diabetes develops, looking for an opportunity to act.
3 Reduced glucose tolerance ( TGP ) and impaired fasting glucose mediation ( IFG )
Generally TGP is more of a prediabetic manifestation, specifically one of the types of glucose intolerance; IFG is a class of non-diabetic fasting hyperglycemia that is judged by its higher-than-normal but lower-than-diabetic blood glucose concentrations. Both represent a metabolic state between normal glucose homeostasis and the hyperglycemia of diabetes, indicating impaired mediation.
④Clinical diabetes
In this stage, the erosion of diabetes on the body is accelerated, but due to the different conditions of each organism, some organisms have no obvious symptoms, some or accompanied by the emergence of metabolic disorders marquee, and there are even the emergence of complications of diabetes mellitus. In this period, the pancreatic islet secretion function is gradually defeated, the secretion function is reduced, the insulin resistance ability is strengthened, the peripheral tissues and organs such as adipose tissue, muscle tissue sensitivity to insulin has a significant reduction in glucose intake and utilization of glucose is insufficient, the inhibition of glucose output of the liver by insulin is weakened, and the glucose external transport situation is serious, which leads to the increase of postprandial blood glucose, and the fasting and postprandial persistent hyperglycemia. In severe cases or islet B cell failure, basal insulin secretion is insufficient to suffer from ketosis [4].
(C), gestational diabetes mellitus and so on
The onset of this type of diabetes mellitus is concentrated in the gestation period, and can be avoided by controlling the diet during pregnancy and proper exercise [5], even though this type of diabetes mellitus recovers after the period of labor and delivery, but there are 22%-50% of pregnant women who develop type 2 diabetes mellitus, and when pregnant women are pregnant again, there is a 50% likelihood of recurrence [5]. The other aspect of gestational diabetes has to be emphasized by stating that a pregnant woman with poor glycemic control during pregnancy is very likely to have a child with metabolic syndrome such as diabetes and obesity [6].
Third, non-scientific diabetes self-management enumeration and correction
Diabetes self-management must be dependent on a scientific and reasonable prevention and treatment program, a reasonable plan will be in the prevention and treatment of diabetes in action with half the effort, but an irrational self-management will make the patient fall into the abyss, aggravate the condition, leading to complications of diabetes [7]. Therefore, organizing the misconceptions of diabetes self-management and providing guidance and corrections can greatly avoid non-scientific diabetes self-management and will be of great help to patients as well as their families [7].
(I) cognitive errors
According to a set of data published in 2017, in China, on average, every 30 seconds there will be a person who suffers from cancer, on average, every 30 seconds there will be a person who suffers from diabetes, and on average, every 30 seconds, there is at least one person who dies due to cardiovascular and cerebral vascular diseases, so this also creates another situation, a part of the patients and the patients' family members intermediation, the existence of diabetes cognitive Error , that once suffering from diabetes is sentenced to death, so as to give up the treatment, resulting in diabetes can not be effectively inhibited, miss the golden time of treatment [8]. Another part of the patients due to their own diabetes has no obvious symptoms, think "it's okay", "I'm not sick, eat everything," so in the early stages of diabetes do not care, delayed treatment. Some patients, after using medication to control diabetes in a short period of time, give up the treatment, thinking that they have been cured, but do not know that this will face more serious consequences [9].
(2) Dietary problems
Diabetic patients in the daily diet must pay attention to a balanced diet, with a reasonable combination of the patient's daily calorie intake by carbohydrates, proteins, fats, the three major energy-supplying substances [10], in addition to the other part of the body: water, trace elements, vitamins, mineral salts, etc. as a complementary material used to equalize the body's nutrition. However, some pessimistic patients think that the rest of the time is not much left, and thus eat a lot of food, that should not "treat" themselves; there are also patients using starvation therapy, resulting in nutritional deficiencies, in fact, the above two psychological understanding are incomplete, incorrect, diabetic patients need to control intake but does not mean that diabetic patients have to bear the yoke of dieting [10]. the yoke of dieting [11].
Since the diabetic patients daily intake of calories to basically maintain the same, some patients in order not to make a mistake of perhaps will choose a set dietary substances, ignoring the diversity of the diet [12], and focus on the same, resulting in the patient's boredom, in the dietary management of diabetes in the guarantee of intake of calories unchanged under the conditions of the patient's diet can be changed [13]. At the same time there should not be no planning for the time of eating, irregularity in eating time and amount of food is greatly detrimental to the self-management of diabetic patients. Diabetic patients should catch to eat less and more frequent meals, meals are timed and quantitative, quit smoking and alcohol [14].
Exercise problems
As the body of the elderly is difficult to withstand the amount of high-intensity exercise, all more and more elderly people choose to rest at home, but the scientific mediation shows that appropriate exercise will help the physical health of the elderly for diabetic patients?On May 9, 2018, Xinhua News Agency, Kunming, China reported: scientists from the Chinese Academy of Sciences through the four-year period of time for rhesus macaque monkey experiments, this experimental The final data results revealed that obesity is the culprit of diabetes, corroborating the independent and dangerous elements of diabetes development is diabetes. The results have been published in the international journal American Physiology - Endocrinology and Metabolism. Kunming Institute of Zoology, Chinese Academy of Sciences, researcher Liang Bin said, the link between obesity and diabetes in short is from obesity to diabetes in the process, the human liver energy metabolism appeared in the transformation of fat accumulation to branched-chain amino acid degradation". Thus, it is recommended that diabetic patients exercise to exercise, such as some of the intensity of aerobic exercise, walking, Tai Chi, aerial bamboo, square dance and other sports, compared to the snail home, go out to exercise on the physical and mental health of diabetic patients have a great help [15]. However, some patients have great confidence in their own physical and mental qualities, and may choose pull-ups, push-ups and other kinds of strength exercise, but this is very irrational. According to the analysis of medical data, strength exercise will usually have a significant enhancement of the patient's cardiac load in a short period of time, which is very likely to cause heart disease [16].
Mental health
According to scientific analysis of some diabetic patients due to diabetes, psychological depression tendency, and psychiatric patients suffering from depression is much greater than the average person, this is particularly obvious in the elderly diabetic patients. Especially because the disease appears to be repeated, the patient may appear tired of interpersonal communication, fatigue, drowsiness, loss of appetite and even the psychological breakthrough, but more due to our inability to empathize with the patient, all of us are difficult to understand the psychological changes in diabetic patients, and then ignored. Once the patient's tendency to disobey medical advice and resist treatment, his family members are often difficult to understand, resulting in conflicts between the patient and his family, adding to the patient's emotions [17].
In the daily treatment of diabetic patients, psychotherapy can be added appropriately to reduce the psychological burden of diabetic patients. In daily life, communication between patients and their families is also essential, and the two go hand in hand to provide a deep understanding of the patient's inner world, and then solve the patient's psychological problems [18].
Importance and prospect of diabetes self-management
To date, the incidence of diabetes mellitus and disability rate is still high, difficult to cure, but a reasonable, feasible diabetes self-management system will effectively inhibit the incidence of diabetes mellitus, diabetic self-management is a set of social ecological model based on the level of the patient, which is aimed at controlling diabetic blood sugar to achieve stabilization of the disease, the purpose of which is to control diabetic blood glucose. , in order to achieve the purpose of stabilizing the condition and preventing diabetic complications. The self-management approach to diabetes can improve patients' health and well-being [19].
The current diabetes self-management is mainly divided into four categories, diet control, exercise control, psychological examination and drug management. Based on drug management, i.e., under the condition of strict compliance with medical advice, self-management is carried out for patients. Scientific research has proven that the improvement of self-management system is directly related to the length of life of patients. Therefore, the treatment of diabetes depends more on self-management in life [20].
In the treatment of diabetes, we must actively mobilize all social resources around us to create an efficient and convenient way for diabetic patients, so that they have enough space and medical level to improve self-management [21]. At the medical level, more resources should be allocated to diabetic patients, to strengthen the research and clinical trials of new drugs for treating diabetes, to mix the research of Chinese herbal medicine and western medicine, to explore the road, and also to take into account the artificial intelligence, which may also help us to overcome diabetes, to avoid diabetes from becoming a difficult disease plaguing the Chinese society in the future; at the social level, to give diabetic patients more help, and to the diabetic At the social level, more help should be given to diabetic patients to help them with their family financial burden and psychological treatment; at the same time, the publicity of diabetes should be increased so that the general public can have a certain degree of understanding of diabetes and achieve early detection and prevention [22]. And it provides some self-management references for some families with patients to avoid bias in the management of patients due to knowledge blindness. With the global and even our country's medical level of development is rising, the cure for diabetes will also have a great improvement, through the active supervision of the patient's family and the patient's self-management, the community's *** with the efforts to create good medical conditions for diabetic patients, the level of treatment of diabetic patients and self-management level of our country's *** with the same level of enhancement, I believe that the gospel of diabetic patients in the future can be expected [ 23].
V Impact of poor self-management of diabetes mellitus on the lives of the elderly
For patients with long-term diabetes mellitus, the level of self-management determines the quality of life. Elderly people are predominantly found in diabetes-prone groups [24], so that self-management and care of diabetes in the elderly play a key role. On the social level, this task is not simple. Because nowadays the society is basically more empty-nested elderly people, and the sons and daughters all go out to work, the perfection of self-management is not fully guaranteed. [25] ①Elderly people do not know much about diabetes, so they cannot fully grasp the key points of self-management, and they cannot evaluate the health of their own body correctly. This includes the confusion of the family members about diabetes knowledge [26], which may lead to a decrease in the comfort of the elderly life, a momentary restriction in traveling, and blind treatment may lead to further deterioration of diabetes. ② On the basis of basic knowledge understanding, self-management begins to control diet and exercise, the body of the elderly originally metabolic decline, poor exercise endurance, in the case of poor self-management, may lead to more serious complications such as ketoacidosis [27], diabetic renal failure, and vascular pathology caused by respiratory failure or paraplegia of the lower limbs, exacerbating the tragedy of elderly life. Facing the far-reaching effects of poor self-management of diabetes is a mountain of snow in the short time left for the elderly, so the elderly are enjoying a beautiful old age while doing a good job of self-management [28].
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