Treatment of diabetes
Goals of diabetes treatment
To effectively treat diabetes, we must first clarify the treatment goals of diabetes and choose the correct treatment method. achieve the desired therapeutic effect. The main goals of diabetes treatment include the following aspects:
(1) Correct metabolic disorders such as hyperglycemia and hyperlipidemia, and promote normal metabolism of sugar, protein and fat.
(2) Relieve symptoms caused by metabolic disorders such as hyperglycemia.
(3) Prevent and treat acute complications such as ketoacidosis poisoning and prevent and treat chronic diseases such as cardiovascular, kidney, eye and nervous system, prolong the life of patients and reduce the mortality rate.
(4) Obese people should actively lose weight and maintain a normal weight to ensure the normal growth and development of children and adolescents, ensure the smooth delivery of pregnant women with diabetes and gestational diabetes, maintain a normal workforce for adults, and improve the risk of diabetes in the elderly patient quality of life.
One of the treatments for diabetes: Psychotherapy
Many people think that the treatment of diabetes mainly consists of diet, exercise and medication. In fact, psychological treatment is very important for the control of diabetes. An optimistic and stable mood is conducive to maintaining the stability of the patient's internal environment, while anxious mood can cause the secretion of some stress hormones such as epinephrine, norepinephrine, adrenocortical hormone and glucagon, thereby antagonizing insulin and causing blood sugar to rise. High, aggravating the condition. The correct mental state and attitude towards the disease should be under the correct guidance of the doctor, giving full play to subjective initiative, learning knowledge about preventing and treating diabetes, and through monitoring urine sugar and blood sugar, exploring the favorable and unfavorable factors that affect the condition, and mastering the characteristics of one's own condition. Have strong confidence and perseverance, treat seriously without being nervous, persist in a reasonable diet, physical activity, and balance work with rest. Correct use of medications can keep body weight, blood sugar, urine sugar, blood sugar, and blood lipids at reasonable levels. In case of infection, surgery or major mental burden, they must be dealt with promptly and correctly. In short, through the cooperation of psychological therapy, diabetes can be effectively controlled and prevented.
Diabetes Treatment 2: Diet Treatment
Food is the most important thing for people. People may not exercise every day, but they must eat every day. Diet has a direct impact on diabetes, so controlling diet is very important in the treatment of diabetes. Traditional Chinese medicine believes that thirst is often caused by an addiction to alcohol and strong taste, which damages the spleen and stomach, fails in transportation and transformation, consumes grains and body fluids, and indulges in sexual desire and damages yin, which is caused by yin deficiency, dryness and heat. For example, the "Huangdi Neijing" says: "The origin of this fatness is that the person must eat a vegetarian diet that is sweet and fat. The fat ones make people feel hot inside, and the sweet ones make people feel full, so the overflow of Qi turns into quenching thirst." "Jingyue Quanshu" says: "Dialysis, which is the cause of the disease, is caused by fat and sweetness, alcohol, sex and fatigue. It is a disease of rich and noble people, but it is rare for poor and lowly people." It points out that obese people, People with affluent lifestyles are more likely to suffer from this disease, which is consistent with modern medicine’s understanding of the causes of diabetes. The level of blood sugar is closely related to the amount and type of food consumed due to the secretion of insulin. Therefore, dietary therapy is the basis for the treatment of various types of diabetes. Regardless of the type of diabetes, the severity of the disease or the presence of complications, and the type of drug treatment, dietary therapy should be used. Carry out strict and long-term dietary control.
As early as the 1950s, Chinese and foreign treatment plans were based on low-carbohydrate, high-fat, and high-protein diets. According to clinical practice, this kind of diet is not beneficial to the pancreatic islet function of diabetic patients, while a high-fat diet will aggravate vascular disease in diabetic patients, and a high-protein diet will increase the incidence of diabetic nephropathy. Current medical experts advocate a diet with high carbohydrate content, lower fat ratio, and controlled protein intake, which has a good effect on improving blood sugar tolerance. The specific content of dietary therapy is as follows:
1. Regular and quantitative diet
Estimate the total daily calories required based on age, gender, occupation, and standard weight [(length-100)×0.9]. Men need about 5 more calories per day than women. The caloric requirements for different ages also vary. Generally, the caloric calorie requirements per kilogram of body weight are adolescents > middle-aged people > elderly people >, with an average of 5 to 10 kilocalories per kilogram of body weight per day.
Different manual workers consume different amounts of energy every day. Light physical workers consume 30~35kcal per kilogram of body weight per day; medium physical workers consume 35~40kcal per kilogram of body weight per day; heavy manual workers consume more than 40kcal per kilogram of body weight per day. Generally speaking, pregnant women, wet nurses, malnourished people and those with wasting diseases should increase the dosage as appropriate, and reduce it as appropriate for obese people, so that the patient's weight can be maintained at about 5% of the normal weight, and the condition can often be satisfactorily controlled.
2. Reasonably adjust the proportions of the three major nutrients
The proportions of sugar, fat, and protein in the diet must be reasonably arranged and adjusted. It not only achieves the purpose of treating diseases, but also meets the physiological needs of the human body. Currently, the American Diabetes Association (ADA) advocates that carbohydrates should account for 55-60% of total calories in the diet of diabetic patients; protein intake should not exceed 15% of total daily calories. The appropriate amount is 0.8~1.2g per kilogram of body weight per day. Adolescents in the development period, pregnant women, wet nurses or people with special occupations and patients with other comorbidities can increase the amount to about 1.5g; the total daily fat intake should not exceed 30% of the total calories, with 0.6~1g per kilogram of body weight per day. Well, for obese patients, especially those with hyperlipidemia or arteriosclerosis, the fat intake should be adjusted based on the specific situation.
3. Diet calculation and calorie calculation
There are three types of nutrients that supply heat energy to the body: protein, fat, and carbohydrates. Among them, carbohydrates and proteins can provide 4kcal of heat energy per gram (1kcal=4.184kj), and fat can provide 9kcal (37.74kj) of heat energy per gram. Diabetic patients can allocate the total calories (kcal) required by each person per day according to their labor intensity according to the ratio of carbohydrates accounting for 69, protein accounting for 15, and fat accounting for 25. Calculate the heat energy supplied by various components, and then calculate the amount of energy produced per gram of fat. The heat is 9kcal, and each gram of carbohydrates and protein produces 4kcal. Calculate the weight needed to provide the patient with different nutrients, which can be three or four meals a day. The calorie distribution of the three meals is 1/5 for breakfast, 2/5 for lunch and dinner. The calorie distribution of the four meals is 1/7 for breakfast and 2/7 for each of the other three meals. For example: a medium-strength worker weighing 60kg and an adult diabetic patient of normal size, calculated based on 40kcal per kilogram of body weight per day, the total calories per day is 2400kcal. According to the above proportion, 1440kcal calories come from carbohydrates and 360kcal calories come from protein. , 600kcal comes from fat. To provide these calories, 360g of carbohydrates, 90g of protein, and 66g of fat are required.
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, they should make large changes in weight at intervals or Calculate the time and formulate a diet plan for the next stage, and eat less sweets and greasy foods. The dietary choices should be principled but strive to be diverse.
The third treatment for diabetes: exercise therapy
Exercise therapy uses physical exercise to prevent and treat diseases, enhance the body’s resistance, and help patients overcome the disease and recover based on the patient’s functional status and disease characteristics. An effective way to stay healthy. The benefits of exercise to the body will be explained in detail in the exercise methods listed below. In the treatment of diabetes, exercise therapy is an important component, especially for elderly patients and obese patients. Motherland medicine has long recognized the importance of exercise in the recovery of diabetes. The Sui Dynasty's "Treatise on the Causes and Symptoms of Diseases" and the Tang Dynasty's "Waitai Mi Yao" both recorded physical exercise therapy for diabetes. Since then, doctors of all ages have discussed it.
By the mid-18th century, some famous foreign medical scientists also began to advocate that patients with diabetes should do appropriate physical activities, and listed physical activity, diet control, and insulin injection as the three magic weapons for treating diabetes. Some patients with mild diabetes can recover by simply insisting on physical exercise combined with diet control.
Swimming exercise method
1. The benefits of swimming to human health
Swimming, like many sports, not only has a certain therapeutic effect on a variety of chronic diseases, but also has its own unique therapeutic value. The main reasons are as follows:
(l) Swimming is a sports event performed in a good natural environment where sunlight, air and cold water baths are combined, thus concentrating all the curative effects of sun bathing, air bathing and cold water bathing on people.
(2) Swimming exercise is a whole-body exercise, so its treatment of diseases is also a comprehensive and systemic treatment. Swimming exercise can enhance the function of the human nervous system, improve blood circulation, and improve the digestion and absorption of nutrients, thereby strengthening physical fitness, enhancing resistance to disease, and obtaining good therapeutic effects.
(3) Swimming exercise can enhance the functions of various organs and systems of the human body. Chronic patients can enhance the functions of underdeveloped organs and systems through swimming exercises, so that the functions of weakened organs and systems can be restored. Restore and strengthen so that disease can be cured.
(4) Swimming exercise can not only cultivate sentiment, temper will, and cultivate people's fighting spirit to fight with nature, but also help patients build confidence in defeating the disease and overcome the negative psychology of fear and worry about the disease. Therefore, it is very beneficial to the recovery of health and the treatment of diseases.
2. Mastering the amount of swimming exercise
Swimming exercise is the same as other physical exercise projects that people engage in. Only by scientifically controlling the amount of exercise can we achieve the purpose of each exercise without causing excessive fatigue and damaging the body. produce adverse reactions.
How to scientifically control the amount of exercise when swimming?
There are many ways to master the amount of exercise in swimming exercises, but for ordinary swimming enthusiasts, the easiest way is to measure the amount of exercise based on changes in the swimmer's pulse.
The normal pulse rate of normal people in my country is 60-80 times per minute. People who regularly participate in swimming exercises will have a relatively slow pulse rate of 50-60 times per minute; people who are well-trained will have a lower pulse rate. For ordinary swimmers, if the pulse rate reaches 120-140 beats per minute after each swim, the amount of exercise is high; if the pulse frequency is 90-110 times per minute, the amount of exercise is moderate; swimming After exercise, if the pulse does not change much and the number of times it increases is within 10 times, it is a small amount of exercise.
When choosing the amount of swimming exercise, it should vary from person to person and act according to your ability. Ordinary swimmers, even young and strong ones, should not engage in heavy exercise more than twice a week; while middle-aged people should do moderate exercise and avoid or rarely engage in excessive exercise; Swimming exercises with small and moderate amounts of exercise are most suitable for the elderly.
Jogging exercise method
Jogging is a convenient and flexible exercise method suitable for all ages. It has increasingly become one of the means for people to keep fit and prevent diseases.
1. Running and fitness
(1) Exercise the heart and protect the heart. Keeping running can increase the body's oxygen uptake, enhance myocardial contraction, increase coronary blood flow, and prevent coronary arteriosclerosis.
(2) Promote blood circulation and remove blood stasis, improve circulation. When running, the large muscles of the lower limbs alternately contract and relax, effectively driving venous blood backflow, which can reduce venous and pelvic blood congestion in the lower limbs and prevent intravenous thrombosis. High-intensity running exercise can also increase the activity of blood fibrinolytic enzymes and prevent thrombosis.
(3) Promote metabolism and control weight. Controlling your weight is an important principle for staying healthy. Because running can promote metabolism, consume a large amount of blood sugar, and reduce fat storage, running is an effective "prescription" for treating diabetes and obesity.
(4) Improve lipid metabolism and prevent arteriosclerosis. For those with high serum cholesterol and lipids, their blood lipids can be reduced after running exercise, which helps prevent and treat arteriosclerosis and coronary heart disease.
(5) Enhance physical fitness and prolong life.
Life lies in movement. The more a person exercises, the stronger the body's ability to adapt to the outside world.
2. Running fitness method
Fitness running should strictly control the amount of exercise. Factors that determine the amount of exercise include distance speed, interval time, number of exercises per day, number of practice days per week, etc. Weak people who start to practice running can do short-distance jogging, starting from 50 meters and gradually increasing to 100 meters, 150 meters, and 200 meters. The speed is generally 100 meters/30 seconds-100 meters/40 seconds.
(1) Slow long-distance running: It is a typical fitness run, with the distance starting from 1,000 meters. After adaptation, increase the distance by 1,000 meters every week or every two weeks, generally to 3,000-6,000 meters, and the speed can be controlled at 6-8 minutes to run 1,000 meters.
(2) Running exercise: run for 30 seconds and walk for 60 seconds to reduce the burden on the heart. Repeat this running 20-30 times for a total time of 30-45 minutes. This running exercise is suitable for those with poor cardiopulmonary function.
Number of runs: Short-distance jogging and running exercises can be done once a day or every other day; older people can run once every 2-3 days, for 20-30 minutes each time.
It is best to match your running pace with your breathing. You can take two or three steps forward and inhale, and then run two or three steps and exhale. When running, it is more comfortable to swing your arms back and forth and slightly outward, lean your upper body slightly forward, and try to relax your muscles all over the body. It is generally better to touch the ground on your toes.
3． Notes
(1) Understand the indications and contraindications of running. Healthy middle-aged and elderly people can do running exercises to prevent coronary heart disease, hypertension, hyperlipidemia and control weight; patients with mild diabetes and those with moderate or weak physical strength can do running exercises to strengthen their physical fitness and improve their cardiopulmonary function.
Liver cirrhosis, unstable tuberculosis, arthritis that affects function, severe diabetes, hyperthyroidism, severe anemia, patients with bleeding tendencies, cardiovascular diseases such as valvular disease, myocardial infarction, and frequent angina pectoris It is not suitable for running.
(2) Running should be avoided immediately after a meal or in very cold, hot, humid or windy weather.
(3) Running exercise should be done step by step. Start from a short distance and at a slow pace, run within your ability, and run with enough energy to spare. Don't make yourself overtired or overburden your heart.
(4) Running is best done in the morning. You can do exercises first and then run. It is generally not suitable to run before going to bed.
Walking exercise method
(1) Ordinary walking method: Take a walk at a slow speed (60-70 steps/minute) or a medium speed (80-90 steps/minute), each time 30-60 minutes, can be used for general health care.
(2) Fast walking method: walk 5000-7000 meters per hour, 30-60 minutes each time, used for ordinary middle-aged and elderly people to strengthen their heart strength and lose weight. The maximum heart rate should be controlled at 120 beats/ minutes or less.
When you feel depressed and can’t get excited about anything, you might as well walk briskly for ten minutes to restore your mental balance.
(3) Quantitative walking method (also known as medical walking): walk 100 meters on a 30-degree slope, and then gradually increase to 2,000 meters on a 50-degree slope, or walk along a 30-50 degree slope Walk on a slope for 15 minutes, then on flat ground for 15 minutes. This method is suitable for patients with diabetes, chronic diseases of the cardiovascular system and obesity.
(4) Arm-swinging walking method: Swing your arms forward and back while walking, which can increase the activity of the shoulders and chest, and is suitable for patients with chronic respiratory diseases.
(5) Abdomen walking method: Massage the abdomen while walking. It is suitable for preventing and treating indigestion and chronic gastrointestinal diseases.
(6) Walking in light rain: Walking in the rain is more beneficial than walking on a sunny day. Rainwater not only purifies the polluted air, but the large amount of negative ions produced in the sunshine before the rain and when the drizzle first falls also has the function of calming the nerves and lowering blood pressure. Walking in the drizzle can also help eliminate the depression caused by rainy weather and make people feel relaxed and happy.
The drizzle is like a natural cold water bath, massaging the face, scalp and skin, making people feel refreshed and relieved of worries.
The fourth treatment for diabetes: drug treatment
For those patients with more severe disease, exercise and diet alone may not be able to control the disease. At this time, it is necessary to cooperate with drug treatment. The following is an introduction to some commonly used medications. It is recommended that patients use it under the guidance of a doctor.
Western medicines
Sulfonylureas
One of the earliest applied oral hypoglycemic drugs, it has now developed into the third generation and is still the leading drug in clinical type 2 diabetes. first-line medication. Mainly works by stimulating insulin secretion. Medication is most effective when taken half an hour before meals.
Biguanides
The veteran of oral hypoglycemic drugs. It has a definite hypoglycemic effect, does not induce hypoglycemia, and has cardiovascular protective effects other than hypoglycemic effects, such as lipid regulation, anti-platelet aggregation, etc. However, it is not recommended for patients with severe heart, liver, lung, and kidney dysfunction. use. To reduce the gastrointestinal side effects of biguanides, it is generally recommended to take them after meals.
Glycosidase inhibitors
By inhibiting glycosidase on the surface of small intestinal mucosal epithelial cells, they delay the absorption of carbohydrates (just like artificially causing "eating less and more meals"), thereby reducing Postprandial blood sugar, so it is suitable for patients whose main problem is mainly elevated postprandial blood sugar. Take it before a meal or with the first bite of rice, and the meal must contain a certain amount of carbohydrates (such as rice, flour, etc.) to be effective.
Thiazolidinediones
The newest oral hypoglycemic drugs to date. It is an insulin sensitizer that lowers blood sugar by increasing the sensitivity of peripheral tissues to insulin and improving insulin resistance. It can also improve various cardiovascular risk factors related to low insulin resistance. Liver function must be paid close attention to during the use of this type of drugs.
Methylmethylbenzoic acid derivatives
The non-sulfonylurea insulin secretagogue developed in recent years has a fast onset, short action time, and is effective in postprandial blood sugar. Therefore, it is also called a mealtime blood sugar regulator. Take before meals.
Insulin
There are many types of insulin. Common classification methods include:
Classification based on action time
Short-acting insulin: It is the most commonly used ordinary insulin, which is a colorless and transparent liquid. The onset of action after subcutaneous injection is 20 to 30 minutes, the peak of action is 2 to 4 hours, and the duration is 5 to 8 hours.
Intermediate-acting insulin: Also called low-protamine zinc insulin, it is a milky white turbid liquid. The onset of action is 1.5 to 4 hours, the peak of action is 6 to 10 hours, and the duration is about 12 to 14 hours.
Long-acting insulin: Also called protamine zinc insulin, it is also a milky white turbid liquid. It takes 3 to 4 hours to take effect, peaks at 14 to 20 hours, and lasts about 24 to 36 hours.
Premixed insulin: In order to meet further needs, imported insulin mixes short-acting preparations and medium-acting preparations (R and N) in different proportions, resulting in an action time between the two. of premixed insulin.
Classification based on source
Bovine insulin: Extracted from bovine pancreas. The molecular structure has three amino acids that are different from human insulin. It is slightly less effective and prone to allergies or insulin resistance. The only advantage of animal insulin is that it is cheap. Patients can afford it easily.
Pig insulin: Extracted from pig pancreas, only one amino acid in the molecule is different from human insulin, so it has better efficacy than bovine insulin and fewer side effects than bovine insulin. At present, most domestically produced insulin is porcine insulin.
Human insulin: Human insulin is not extracted from the human pancreas, but is produced through genetic engineering. It has higher purity and fewer side effects, but is more expensive. All imported insulin is human insulin. China has gradually begun to have the ability to produce human insulin.
Classified according to insulin concentration
U-40: 40 units/ml
U-100: 100 units/ml, often used exclusively for insulin pens.
Domestic insulin is 40 units/ml,
Foreign insulin is available in both types. Patients must know which concentration of insulin they are using before using a syringe to draw insulin, otherwise the consequences will be serious.
Different concentrations of insulin have different uses:
U-40 is used for routine injections
U-100 is mainly used for insulin pens
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