The goals of diabetes mellitus treatment
To effectively treat diabetes mellitus, the goals of diabetes mellitus treatment must first be clearly defined, so as to choose the correct treatment method and achieve the ideal therapeutic effect. The goals of diabetes treatment are as follows:
(1) Correct metabolic disorders such as hyperglycemia and hyperlipidemia, and promote the normal metabolism of sugar, protein and fat.
(2) To relieve symptoms caused by metabolic disorders such as hyperglycemia.
(3) Preventing and controlling acute complications such as ketoacidosis and chronic lesions of cardiovascular, renal, ocular and neurological systems, prolonging the patients' life span and lowering the death rate.
(4) Obese people should actively lose weight, maintain normal weight, ensure the normal growth and development of children and adolescents, ensure the smooth delivery of diabetic pregnant women and gestational diabetic mothers, maintain the normal labor force of adults, and improve the quality of survival of elderly diabetic patients.
One of the treatments for diabetes: psychotherapy
Many people think that the treatment of diabetes is mainly diet, exercise and medication. In fact, psychotherapy is very important to the control of diabetes. An optimistic and stable mood is conducive to maintaining the stability of the patient's internal environment, while anxiety can cause the secretion of some stress hormones such as adrenaline, norepinephrine, adrenocorticotropic hormone and glucagon, which can antagonize insulin and cause blood glucose to rise, aggravating the condition. The correct state of mind and attitude towards the disease should be under the correct guidance of the doctor, take the initiative, learn the knowledge of prevention and treatment of diabetes mellitus, feel out the favorable and unfavorable factors affecting the condition through the monitoring of urine glucose and blood glucose, grasp the characteristics of one's own condition, have strong confidence and perseverance, treat the disease earnestly without being nervous, and persevere with reasonable diet, physical activities, and combination of work and rest. Correct use of drugs to maintain body weight, blood sugar, urine sugar, blood glucose, blood lipids at a reasonable level. When there are infections, surgeries, and major mental burdens, they should be handled correctly and in a timely manner. In short, through the cooperation of psychotherapy to achieve effective control and prevention of diabetes.
The second part of the treatment of diabetes: dietary treatment
People eat, people do not necessarily exercise every day, but certainly have to eat every day. And diet has a direct impact on diabetes, so diet control is very important for diabetes treatment. Traditional Chinese medicine believes that: thirst is mostly due to addiction to alcohol and thick flavors, damage to the spleen and stomach, dysfunction of transport, elimination of grain consumption, indulgence and injury to the yin and change the yin deficiency and dryness and heat for the development of this disease. Such as "Huang Di Nei Jing" said: "this fat and beauty of the hair also, this person must vegetarian diet sweet and fat also, fat people internal heat, sweet people in full, so its gas overflow into thirst". Jingyue quanquan" said: "thirst disease, the origin of the disease, all the cream of the fat and sweet change, wine and color labor injury over, are rich and noble people sick, and the poor and lowly people less also." Pointed out that obese people, rich people suffer from this disease, which is consistent with the modern medical understanding of the causes of diabetes. Blood glucose levels due to insulin secretion and into the amount and type of food is closely related to the diet therapy is the basis of treatment of various types of diabetes, regardless of the type of diabetes, the severity of the disease or complications, the use of what kind of drug therapy, should be strictly and long-term adherence to dietary control.
Before the 1950s, both Chinese and foreign treatment programs were based on a low-carbohydrate, high-fat, high-protein diet. According to clinical practice, this dietary structure is not beneficial to the pancreatic function of diabetic patients, and high-fat diets will also aggravate the vascular lesions of diabetic patients, and high-protein diets will lead to diabetic nephropathy, the incidence of increased. Currently, medical experts advocate a high carbohydrate, reduce the proportion of fat, control protein intake of the diet structure, to improve blood glucose tolerance has a better effect, the specific content of the dietary therapy is as follows:
One of the dietary timetable
According to the age, gender, occupation, the standard body weight [(length-100) × 0.9] estimate the total number of calories required daily. Men need about 5% more calories per day than women. And the age of different calorie requirements also have differences, generally per kilogram of body weight calories needed for adolescents > middle-aged > elderly >, an average of 5% to 10% higher per kilogram of body weight / day. Different manual laborers also consume different amounts of energy every day. Light manual laborers consume 30~35kcal per kilogram of body weight per day; medium manual laborers consume 35~40kcal per kilogram of body weight per day; heavy manual laborers need more than 40kcal per kilogram of body weight per day. Generally speaking, pregnant women, lactating mothers, malnourished people and consumptive diseases should be increased as appropriate, obese people discretionary reduction, so that the patient's body weight to maintain the normal body weight of about 5%, often can make the disease get satisfactory control.
Second, rationalize the proportion of the three major nutrients
The proportion of the three major nutrients in the diet, sugar, fat and protein, should be rationally arranged and adjusted. Both to achieve the purpose of treatment of disease, but also to meet the physiological needs of the body. Currently, the American Diabetes Association (ADA) advocates that carbohydrates in the diet of diabetic patients should account for 55% to 60% of the total calories; protein intake should not exceed 15% of the total daily calories. 0.8~1.2g per kilogram of body weight per day is appropriate. Developmental adolescents and pregnant women, lactating mothers or special occupations and other comorbidities of the patient can be added to about 1.5g; daily fat intake should not exceed 30% of the total calories to 0.6 ~ 1g per kilogram of body weight per day is good, such as obese patients, especially with high blood fat or arteriosclerosis, fat intake should be adjusted according to the specific circumstances.
Three, dietary calculations and calorie calculations
There are three kinds of nutrients that supply the body with calories: protein, fat and carbohydrates. Among them, carbohydrates and proteins can supply 4kcal (1kcal=4.184kj) per gram of caloric energy, and 9kcal (37.74kj) per gram of fat. Diabetic patients can be based on their labor intensity will be required per person per day total calories (kcal) in accordance with carbohydrates accounted for 69%, protein accounted for 15%, fat accounted for 25% of the proportion of the distribution of the various components of the supply of caloric energy, and then according to the fat per gram of caloric 9kcal, carbohydrates and protein per gram of caloric 4kcal converted to supply the patient with the different nutrients need to be the weight of the patient, can be three meals a day or Four meals a day. The calorie distribution of three meals is 1/5 for breakfast, 2/5 for lunch and 2/5 for dinner, and the calorie distribution of four meals is 1/7 for breakfast and 2/7 for each of the remaining three meals. e.g.: for a 60kg medium manual laborer, a normal-sized adult diabetic patient with normal body mass, according to the calculation of 40kcal per kilogram of body mass per day, the total calorie of a day is 2400kcal, and the distribution of calorie according to the above ratio is 1440kcal. Calories come from carbohydrates, 360kcal from protein and 600kcal from fat. To provide these calories you need to supply 360g of carbohydrates, 90g of protein and 66g of fat.
We emphasize the method of dietary control of calories, not to require diabetic patients must be mechanically calculated every day, but should be mastered in this calculation method, every once in a while or when there is a substantial change in body weight calculations, to formulate the next stage of the diet program, and less sweet, greasy food, dietary choices are both the principle of but to strive for a variety of.
Diabetes treatment three: exercise therapy
Exercise therapy is based on the patient's functional condition and disease characteristics, the use of physical exercise to prevent and treat diseases, enhance the body's resistance, help patients overcome the disease, restore health effective method. The benefits of exercise to the body will be specifically described in the following list of exercise methods. In the treatment of diabetes, exercise therapy is an important part, especially for elderly and obese patients. The motherland medicine has long recognized the importance of exercise for the recovery of diabetes mellitus, the Sui Dynasty's "the source of all diseases," the Tang Dynasty's "Wai Tai secret" have recorded the thirst disease of sports therapy. Since then, the medical practitioners of all generations have discussed it.
To the mid-eighteenth century, some famous foreign medical doctors also began to advocate that diabetic patients should do appropriate physical activity, and physical activity, dietary control, insulin injection as the treatment of diabetes mellitus as the three major treasures. Some light diabetes patients only adhere to physical exercise and combined with dietary control that can achieve recovery.
Swimming exercise method
1. Swimming on human health benefits
Swimming is not only the same as many sports, a variety of chronic diseases have a certain therapeutic effect, but also its unique therapeutic value, the main reason for the following points:
(l) swimming is in the sun, air, cold water three baths and a good natural environment for the sports program, thus concentrating all the therapeutic effects of sunshine bath, air bath and cold water bath on people.
(2) Swimming exercise is a kind of whole-body exercise, so it is also a comprehensive and whole-body treatment for the treatment of diseases. Through swimming exercise, it can enhance the function of human body's nervous system, improve blood circulation, improve the digestion and absorption of nutrients, thus it can strengthen the body, enhance the resistance to diseases, and get good therapeutic effect.
(3) Swimming exercise can enhance the function of various organs and systems of the human body, chronic patients through swimming exercise, can enhance the function of the organs and systems of the development of incomplete, so that has been weakened organs and systems of the function of the restoration and enhancement of the treatment of diseases.
(4) Swimming exercise can not only cultivate sentiment, refine the will, and cultivate the spirit of fighting with nature, but also enable the patient to build up the confidence of overcoming the disease, to overcome the negative psychology of the disease of fear and worry, and thus very conducive to the recovery of health and treatment of diseases.
2. Swimming exercise mastery
Swimming exercise, and people engaged in other physical exercise programs, as well as only scientifically master the amount of exercise, in order to make each exercise both to achieve the purpose of exercise, but not to excessive fatigue and make the body produce adverse reactions.
Swimming exercise, how to scientifically grasp the amount of exercise?
There are many ways to grasp the amount of swimming exercise, but for ordinary swimmers, the easiest way to measure the amount of exercise is based on the change in the swimmer's pulse.
China's normal quiet pulse rate of 60-80 times per minute. Regularly participate in swimming exercise people, quiet pulse rate is more slow, for 50-60 times per minute; Exercise vegetative people, the pulse rate is also a little lower. For ordinary swimmers, after each swim, the pulse rate reaches 120-140 times per minute, the exercise of the exercise for the amount of large exercise; pulse rate of 90 - 110 times per minute, the amount of medium exercise; swimming exercise, the pulse rate does not change much, the number of times it increases within 10 times, the amount of small exercise. .
When choosing the amount of swimming exercise, it is important to vary from person to person, according to their ability. Ordinary swimmers, even young and strong, weekly exercise, should not be more than 2 times; and middle-aged people to moderate exercise is appropriate, do not or less exercise too much swimming exercise; the elderly is most suitable for small exercise and moderate to small exercise swimming exercise.
Jogging
Running is a convenient and flexible way to exercise, young and old, has increasingly become one of the means of fitness and disease prevention.
1. Running and fitness
(1) Exercise the heart, protect the heart. Adherence to running can increase the body's oxygen uptake, enhance myocardial contractility, increase coronary blood flow, prevent coronary atherosclerosis.
(2) Activate blood circulation and improve circulation. When running, the large muscle groups of the lower limbs alternately contract and relax, and vigorously drive the venous blood back, which can reduce the venous blood stasis in the lower limbs and pelvis, and prevent intraventricular thrombosis. The large amount of running exercise, can also improve the blood fibrinolytic enzyme activity, to prevent thrombosis.
(3) Promote metabolism and control weight. Weight control is an important principle to maintain health. Because running can promote metabolism, consume a lot of blood sugar, reduce fat accumulation, so adhere to the running is the treatment of diabetes and obesity an effective "prescription".
(4) Improve lipid metabolism and prevent atherosclerosis. Serum cholesterol lipids are too high, after running exercise, blood lipids can be reduced, thus helping to prevent and control vascular sclerosis and coronary heart disease.
(5) Enhance physical fitness and prolong life. Life is movement, the more people exercise, the stronger the body's ability to adapt to the outside world.
2. Running fitness
Fitness running should strictly grasp the amount of exercise. The factors that determine the amount of exercise are distance speed, interval time, the number of times a day to practice, the number of days a week to practice and so on. Start practicing running for the frail can be a short distance jogging, starting from 50 meters, gradually increased to 100 meters, 150 meters, 200 meters. The speed is generally 100 meters / 30 seconds - l00 meters / 40 seconds.
(1) slow long-distance running: a typical fitness running, distance from 1000 meters. After adaptation, weekly or every 2 weeks to increase 1000 meters, generally can be increased to 3000-6000 meters, the speed can be mastered in 6-8 minutes to run 1000 meters.
(2) running exercise: run for 30 seconds, walk for 60 seconds to reduce the burden on the heart, so that repeated running 20-30 times, the total time 30-45 minutes. This kind of running exercise is suitable for people with poor cardiorespiratory function.
The number of times of running: short-distance jogging and running exercises can be 1 time a day or every other day; older can run every 2-3 days, each 20-30 minutes.
The footwork of running is best matched with your breathing, which can be inhaled after two or three steps forward and exhaled after two or three steps back. When running, the two arms before and after and slightly outward swing is more comfortable, the upper body slightly forward, try to relax the muscles of the whole body, generally to the toes on the ground for good.
3. Precautions
(1) Master the indications and contraindications for running. Healthy middle-aged and old people for the prevention of coronary heart disease, hypertension, hyperlipidemia, weight control; mild diabetic patients, moderate or weak physical strength, in order to enhance physical fitness, improve cardiorespiratory function, can be running exercise.
Cirrhosis, unstable tuberculosis, arthritis affecting function, severe diabetes, hyperthyroidism, severe anemia, patients with bleeding tendency, cardiovascular diseases such as valvular disease, myocardial infarction, frequent angina and so on are not suitable for running.
(2) Running should be avoided immediately after meals, or in very cold, hot, humid and windy weather.
(3) Running exercise should be gradual. Start from a short distance at a slow speed, to do the amount of running, running, do not get overly fatigued or make the heart overburdened.
(4) Running is best done in the morning, you can do exercises and then run before going to bed.
Walking method
(1) ordinary walking method: walk at a slow speed (60-70 steps/minute) or medium speed (80-90 steps/minute) for 30-60 minutes each time, can be used for general health care.
(2) Fast walking method: walking 5000-7000 meters per hour, each exercise 30-60 minutes, for general middle-aged and elderly people to enhance the heart and reduce weight, the highest heart rate should be controlled below 120 beats/minute.
When you feel depressed and can't get energized about anything, you may want to walk briskly for ten minutes or so to restore your mental balance.
(3) Quantitative Walking Method (also known as Medical Walking): Walk 100 meters on a 30-degree slope, then gradually increase to 2000 meters on a 50-degree slope, or walk along a 30-degree-50-degree slope for 15 minutes, followed by a 15-minute walk on a flat surface. This method is suitable for patients with diabetes, chronic diseases of the cardiovascular system and obesity.
(4) Swinging arm walking method: Walking with both arms swinging forward and backward, can enhance shoulder and thorax activities, applicable to patients with chronic respiratory diseases.
(5) Mo abdomen walking method: walking while massaging the abdomen, suitable for the prevention and treatment of indigestion and gastrointestinal chronic diseases.
(6) Walking in the rain: Walking in the rain is more beneficial than walking on a sunny day. Rain not only purifies the polluted air, before the rain in the sunshine and the first drop of rain produced by a large number of negative ions also has the function of tranquility and relaxation, lower blood pressure. Walking in the rain, but also help to eliminate the rainy weather caused by the human body depressed mood, make people feel relaxed and happy. The rain is like a natural cold water bath, face, scalp, skin massage, people are refreshed, worry all removed.
Diabetes treatment four: medication
For those patients with severe conditions, exercise alone, diet may not be able to control the condition. This time it is necessary to cooperate with drug treatment. The following is an introduction to some commonly used drugs. Patients are advised to use them under the guidance of their doctors.
Western medicine
Sulfonylurea
One of the earliest oral hypoglycemic agents, now in its third generation, is still the first-line drug for type 2 diabetes. They work mainly by stimulating insulin secretion. The best results are achieved half an hour before meals.
Biguanide
Oral hypoglycemic drugs in the oldest. Glucose-lowering effect is certain, does not induce hypoglycemia, with glucose-lowering effect other than cardiovascular protection, such as regulating lipids, anti-small platelet coagulation, etc., but for patients with serious cardiac, hepatic, pulmonary and renal dysfunction, is not recommended to use. In order to reduce the gastrointestinal side effects of biguanides, it is generally recommended to take them after meals.
Glycosidase inhibitors
By inhibiting the enzyme glycosidase on the surface of the epithelial cells of the small intestinal mucosa, the absorption of carbohydrates is slowed down (as if artificially causing "less food, more food"), thus lowering the postprandial blood glucose, so it is suitable for those who have postprandial glucose elevation as their main concern. It should be taken immediately before a meal or with the first meal, and the meal must contain a certain amount of carbohydrates (e.g., rice, flour, etc.) in order to be effective.
Thiazolidinedione
The newest oral hypoglycemic agent to date. It is an insulin sensitizer, which lowers blood glucose by increasing the sensitivity of peripheral tissues to insulin, improving insulin resistance, and ameliorating a number of cardiovascular risk factors associated with low insulin resistance. Liver function must be closely monitored during the application of this class of drugs.
Methylmethylaminobenzoic acid derivatives
Non-sulfonylurea insulin secretagogues developed in recent years, fast onset of action, short duration of action, postprandial blood glucose effective good effect, so also known as meal-time blood glucose regulator. It is also known as a mealtime glucose regulator.
Insulin
There are many kinds of insulin, and the common classification methods are:
Classification according to the time of action
Short-acting insulin: the most commonly used kind of ordinary insulin, colorless and transparent liquid, with the onset of action time of 20-30 minutes after subcutaneous injection, the peak of action of 2-4 hours, and the duration of 5-8 hours.
Intermediate-acting insulin: also called low-arginine zinc insulin, is a milky white turbid liquid, with an onset of action of 1.5 to 4 hours, a peak of action of 6 to 10 hours, and a duration of about 12 to 14 hours.
Long-acting insulin: also called zinc arginate insulin, also a milky-white turbid liquid, with an onset of action of 3 to 4 hours, a peak of action of 14 to 20 hours, and a duration of about 24 to 36 hours.
Premixed insulin: in order to adapt to further needs, imported insulin and the short-acting preparation and intermediate-acting preparation (R and N) for different ratios of mixing, resulting in the duration of action between the two premixed insulin.
Classification according to the source
Bovine insulin: extracted from the bovine pancreas, the molecular structure of three amino acids and human insulin is different, the efficacy is slightly worse, prone to allergies or insulin resistance. The only advantage of animal insulin is that it is cheap. Patients can easily afford it.
Pig insulin: extracted from pig's pancreas, only one amino acid in the molecule is different from human insulin, so the efficacy is better than bovine insulin, and the side effects are less than bovine insulin. At present, most of the domestic insulin is porcine insulin.
Human insulin: human insulin is not extracted from human pancreas, but produced through genetic engineering, higher purity, fewer side effects, but more expensive. Imported insulin are human insulin. The country has also gradually begun to have the ability to produce human insulin a few days ago.
Classification according to insulin concentration
U-40: 40 units/mL
U-100: 100 units/mL, often used exclusively in insulin pens.
Domestic insulins are all 40 units/mL,
Foreign insulins are both. Patients need to know which concentration of insulin they are using before drawing insulin with a syringe, otherwise the consequences will be serious.
Different concentrations of insulin are used for different purposes:
U-40 is used for routine injections
U-100 is mainly used for insulin pens
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