2011年1月4日星期二

Diabetes basics _ three AI Tong Medicine Museum

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Type I diabetes occurs in young people, because of a lack of insulin secretion, insulin dependence on exogenous added to sustain life. Diabetes prevalent in, the elderly, the amount of insulin secretion is not low, even higher than that of the clinical manifestations is not enough for the body to insulin. Diabetes symptoms can be summarized as "three more a little", the so-called "three more" means "more food and drink, polyuria," and "a little" means "weight reduction". (1) more food: as a result of the massive loss of urine, such as the daily loss of more than 500 grams of sugar, the body is in a half-starved, caused by the lack of need for additional energy appetite, increased appetite. At the same time because of high blood glucose stimulation of insulin secretion and, therefore, the patient is easy to produce hunger, appetite, a sense of feeling of food, or even eat five or six times with rice, the staple food for up to 1 ~ 1.5 kg supplement also increased significantly compared to normal people, also cannot satisfy the appetite. (2) more drink: polyuria, excessive moisture loss, dehydration, occurs in cells stimulate the central nervous system, appear tired and thirsty thirsty to drink more, the number of drinking water and drinking water are increasing, as additional moisture. Urination, the more the more drinking water, forming a proportional relationship. (3) number of urine: polyuria, every day and night urine output of up to 3000-5000 ml up to 10000 ml or more. Increased urination number, a two-hour 1 may piss, some patients even every day and night of up to 30 times. (4) weight (weight reduction): due to lack of insulin, the body cannot make full use of glucose, fat and protein decomposition accelerates to replenish the energy and heat. The results make the carbohydrate, fats and protein are massive consumption, coupled with moisture loss, weight loss, body weight, even tens of pounds of body weight can be reduced, resulting in fatigue, mental sluggishness. Similarly, the longer the course, the higher the blood sugar, the heavier the weight loss condition, the more obvious. Diagnosis of diabetes mellitus (1) diagnosed as diabetes: 1, with typical symptoms, fasting plasma glucose �� 7.0 mmol/l or postprandial blood glucose �� 11.1 mmol/l. 2, there is no typical symptoms, only the fasting plasma glucose �� 7.0 mmol/l or postprandial blood glucose �� 11.1mmol/l should again, still up to the above values, can be diagnosed as diabetes. 3, there is no typical symptoms, only the fasting plasma glucose �� 7.0 mmol/l or postprandial blood glucose �� 11.1mmol/l glucose tolerance test 2-hour blood glucose �� 11.1mmol/l may be diagnosed as diabetes. (B) to exclude diabetes: 1, such as glucose tolerance 2-hour blood glucose 7.8-11.1 mmol/l, as impaired glucose tolerance; if fasting plasma glucose 6.1-7.0mmol/l, as impaired fasting glucose, will not be diagnosed as diabetes. 2. If the postprandial blood glucose < 7.8mmol/l and fasting blood glucose < 5.6mmol/l can exclude diabetes. Diabetes treatment long-term adherence to standard treatment is most important, including: diet, regular exercise workout, rational use of medicines. Current medical experts are advocating high carbohydrate content, lower fat ratio control protein intake of the diet, to improve glucose tolerance have better results, the specific treatment method summarized as follows: first, the human immune therapy through stimulating the body's immune-based treatment of diabetes is now very leading method! in academic journals, marketing literature can be seen. Second, medical nutrition therapy diet control is particularly important for diabetes patients, you can lose weight, improve blood glucose and lipid metabolism disorders, reducing the dose of hypoglycemic agents. 1. calculate the total calories according to gender, age, height, a simple table lookup or formula ideal weight (ideal weight kg = height cm-105), and then under ideal weight and nature of the work, the reference to the original living habits, calculate the total calories. 2, nutrient content of sugars accounted for total calories of 50-60%, advocate for Roughage, surfaces, and a certain amount of cereal crops, glucose, sugar, honey and its products. The protein content of less than 15%, with renal insufficiency, protein intake reduction (a physician), about 30% fat, control cholesterol intake, not exceeding 300mg/day 3, reasonable allocation per gram of carbohydrate, protein (4kcal) per gram of fat (9kcal), heat conversion into food recipes, developed after the extinction of life habits, medical conditions and medications. Early-late food can be in a 1: 2: 2 or 1: 1: 1 assignment. 4. follow-up of the above are only estimates of obesity in principle, measures appropriate to the weight does not decline should further reduce diet; emaciation of patients if there has been an increase in body weight, its diet programmes should also be adjusted to avoid weight continues to increase. Third, physical exercise and diet control, drug treatment is equally important. Moderate physical activity can reduce weight and increase insulin sensitivity (that is, units of insulin to lower blood glucose more). The heart and brain diseases patients or serious microangiopathy, arranged according to the circumstances. 4. regular monitoring of blood glucose monitoring, regular medical check-up, easy to adjust medication programmes. Regular monitoring of blood, heart, kidneys, nerves and eyes, the early detection of complications. 5. insulin treatment applies to of type I diabetes and diabetes patients of late. Diabetes complications and the corresponding processing Br > cardiovascular disease subject to strict control diabetes and must adhere to the long term, early to deal with a variety of cardiovascular problems. Have the acute myocardial infarction, heart failure, or cerebral vascular accident who is ketotic, should be short (fast)-activity of insulin injection 1 fractionated dose should be relatively small, so as to avoid hypoglycemia when induced myocardial infarction, in recent years, also found in diabetic patients with severe heart failure and arrhythmia occurs only T wave inversion, a little early to strictly control the diabetes and hypertension. Kidney lesions early control diabetes, neuropathy can be reversed. For renal lesions in the early stages, microalbuminuria stage, with or without hypertension, using angiotensin-converting enzyme inhibitor (ACEI) first or second generation drugs can make urinary albumin excretion rate reduction, you must also strictly controlling hypertension is also beneficial to the control of kidney disease. Should intake low protein diet in patients with advanced renal failure should be used in dialysis treatment for peritoneal dialysis more secure, end-stage renal transplantation can be done. Neuropathy early control motor nerve conduction velocity of diabetes can be reversed back to normal, but less effect on sensory nerves. Ever try vitamin B family, B12, B6, B1, B2, NAA and other effects of suspicious. Retinopathy basic treatment for early control of diabetes. Periodic testing retinal, control blood sugar are the most important and difficult as a result of wounds in patients with diabetes mellitus, healing difficult surgery. Hemorrhage and seepage can try clofibrate, about 43.5% improvement in Visual acuity, with the exception of medical treatment, laser cauterization, diabetic-Hemangioma of the retina, vitreous bleeding, bleeding in the destruction, elimination of neovascularization retinal edema and capillaries, micro-embolization to reduce bleeding and glial fibrillary hyperplasia. Foot ulcers mainly by lower extremity neuropathy and vascular disease are local compression even injury. As with other chronic complications of prevention is worth a pound of cure. Patients should pay attention to the protection of the feet, try to reduce the daily life of various activities on the feet skin damage. If necessary, the use of antibiotics, vasodilator and promoting blood circulation and other therapy, Ulcer of locally you can trim dead tissue, packing to go to dispersing new drugs, try to avoid amputation. Diabetes is easy to confuse with the diseases, non-glucose urinary 1 as the lactose found in the urine of pregnant and lactating or infant, fructose and rarely seen in pentose urine eating lots of fruits, a very rare congenital disorders. Find diabetes positive, should contact the medical situation analysis and judgement, not immediately sure to diabetes. 2, non-diabetic glucose urinary �� hunger of diabetes: when the hunger is run, and enter large amounts of carbohydrate food, insulin secretion couldn't adapt to produce the diabetes and impaired glucose tolerance. �� After diabetes: diabetes occurs after feeding large quantities of sugar in the food or to absorb too fast, elevated blood glucose concentration exceeds the threshold of renal glucose temporarily and diabetes, but fasting blood sugar and glucose tolerance test normal. �� Renal diabetes: because of the renal tubule and absorption ability to reduce sugar, renal blood sugar low glucose threshold, while normal and diabetes, found in a small number of pregnant women have a transient renal glucose threshold decreases, the need for postpartum follow-up as a memento of the differential. �� neurotic diabetes: seen in brain haemorrhage, brain, cranial fractures, asphyxia, narcotic, sometimes transient blood sugar is too high with diabetes may be patient follow-up. 3. secondary diabetes by pancreatitis, pancreatic cancer, caused by partial should consider combining history analysis.

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