I often encounter patients who are a little nervous when their blood sugar reaches 7, start to feel anxious when their blood sugar reaches 8, and start to add insulin when their blood sugar reaches 10 ...
Is this right? Is the lower the blood sugar control, the better for people with type 1 diabetes? …Of course not!
What should we do?
Figure 1 Anxiety
1. How important is it for people with diabetes to reduce high blood sugar ?
“If you eat just a little bit, your blood sugar will go up!” “Blood sugar is always difficult to lower!”… High blood sugar is the most distressing problem for people with type 1 diabetes. Long-term hyperglycemia is very likely to gradually cause various chronic complications. In severe cases, it can lead to blindness, amputation, etc. Therefore, it is urgent to actively reduce high blood sugar and control blood sugar within the normal range.
Figure 2 Avoiding high blood sugar
2. Diabetes How important is it to prevent hypoglycemia?
Is high blood sugar scary? horrible! However, hypoglycemia is even scarier! !
High blood sugar at least gives us a buffer period, but low blood sugar is very harmful, and it can be fatal if you are not careful!
If your blood sugar is " swinging ", sometimes high and sometimes low, such fluctuations in blood sugar are very harmful. Severe hypoglycemia may cause stroke, angina pectoris, heart failure and myocardial infarction. Wait , and aggravate the original retinopathy of diabetics.
Therefore, sugar lovers should have a bottom line when it comes to sugar control. Lower is not always better. Reducing hyperglycemia and preventing hypoglycemia are the two major goals of blood sugar control in type diabetes. The currently recognized blood sugar control standard is: keeping the blood sugar of patients with diabetes as close to normal levels as possible with the least occurrence of hypoglycemia.
Diabetes What is the appropriate level of blood sugar control?
For most adults, simplified blood sugar control targets generally recommend a fasting blood sugar control target of 4.4~7.0 mmol/L, a non-fasting blood sugar target of <10.0mmol/l,>
Continued Let's take a look at the blood sugar control goals for special groups:
(1) All types of hyperglycemia during pregnancy. Blood sugar goals during pregnancy: Fasting blood sugar .3 mmol/L, 1 h after a meal, blood sugar 7.8 mmol/L, 2 h after a meal Blood sugar 6.7 mmol/L. (2) Hypoglycemia should be avoided in blood sugar control during pregnancy. When blood sugar during pregnancy is 3.3 mmol/L, the treatment plan needs to be adjusted and immediate treatment is required. Since glycated hemoglobin (HbA1c) will physiologically decline during pregnancy, it is recommended to evaluate the glycated hemoglobin (HbA1c) level every 1 to 2 months. The target is the same as before pregnancy (6.0% to 6.5%), and is controlled in the middle and late stages of pregnancy. Glycated hemoglobin (HbA1c) 6.0% What's more, it can be seen that the blood sugar control goals during pregnancy are more stringent than those of the general population.
Children with diabetes also need to perform self-monitoring of blood sugar. The frequency should be individualized according to blood sugar control status, mainly measuring fasting and postprandial blood sugar. Once the blood glucose reaches the target, the frequency of monitoring can be adjusted according to the treatment plan, degree of intensification and level of metabolic control. HbA1c should be measured at least twice a year, or every 3 months if insulin therapy is used or blood sugar control is not up to standard. The control goal is set on the premise that the child maintains normal growth and development, loses weight, and avoids hypoglycemia. The HbA1c of those taking oral medication should be controlled below 7.0% as much as possible. The control goal of those taking insulin can be appropriately relaxed.
Note: ISPAD is the International Juvenile Diabetes Alliance; ADA is the American Diabetes Association; CDA is the Chinese Diabetes Association; HbA1c is glycosylated hemoglobin; - is no recommended reference value
As the aging of our country intensifies, the incidence of diabetes in the elderly The incidence rate has increased significantly, and patients with diabetes aged ≥65 years are defined as elderly patients with diabetes, including those diagnosed with diabetes before the age of 65 and those diagnosed with diabetes after the age of 65. Elderly patients with diabetes are highly heterogeneous and have different blood sugar control goals. They need to adopt a hierarchical and highly individualized management strategy. First, assess their own health status (A), and then classify themselves according to the type of anti-diabetic drugs they use (B). Classify and find control targets that suit you.
A. Health status assessment:
Health level | Characteristics of diabetes in elderly patients |
Good | The patient has no comorbidities or is combined with ≤2 chronic diseases other than diabetes (including stroke , hypertension , stage 1 to 3 kidney disease, Osteoarthritis, etc.) and the patient has no ADL injury, and the number of IADL injuries is ≤1 |
moderate | The patient has ≥3 chronic diseases other than diabetes (including stroke, hypertension, stage 1 to 3 renal disease, osteoarthritis, etc.) and ( or) The patient meets any of the following: (1) Moderate cognitive impairment or early dementia; (2) The number of IADL injuries ≥ 2 |
poor | The patient meets any of the following: (1) Combined ≥1 treatment limitations Chronic diseases (including metastatic malignant tumors, lung diseases requiring oxygen therapy , end-stage renal disease requiring dialysis, and advanced heart failure) with shorter life expectancy; (2) Moderate and severe dementia; ( 3) Number of ADL injuries ≥ 2; (4) Long-term care required |
Note: ADL refers to the ability to carry out activities of daily living, including going to the toilet, eating, dressing, grooming, and walking; IADL refers to the ability to perform instrumental activities of daily living, including making phone calls, Shopping, cooking, taking medications, and financial management
B. Determine your blood sugar control goals based on your health status and the medications you use:
B1: Diabetes Use medications with a higher risk of hypoglycemia: such as insulin, sulfonylureas, and glinide Drugs, etc.
B2: Diabetes No hypoglycemic drugs with a higher risk of hypoglycemia are used:
People with diabetes Blood sugar cannot only be looked at for a while, but must be well controlled in the long term. The glycated hemoglobin must reach the standard
Another important indicator for controlling diabetes is glycated hemoglobin. , Glycated hemoglobin can reflect the average blood sugar level in the past 3 months. Generally, the glycated hemoglobin of adults should be less than 6.5%. However, glycated hemoglobin is also different in different situations.
, glycated hemoglobin less than 7.0%
is suitable for patients with an expected survival period greater than 10 years, complications and associated diseases are mild, there is a certain risk of hypoglycemia, and the use of insulin secretagogue hypoglycemic drugs (sulfonylureas) or other Patients with type 2 and type 1 diabetes who are primarily treated with insulin.
, glycosylated hemoglobin less than 7.5%
It is suitable for patients with an expected survival period greater than 5 years, moderate complications and accompanying diseases, risk of hypoglycemia, use of insulin secretagogues hypoglycemic drugs or multiple insulin injections. Main elderly diabetics.
, glycated hemoglobin is less than 8.0%
, the life expectancy is less than 5 years, the ability to self-management is completely lost, etc., the control standard of glycated hemoglobin can be relaxed to less than 8.0%.
At the same time, it is necessary to avoid acute complications of diabetes and refractory infections caused by severe hyperglycemia. Why is survival period an important reference indicator? Because the damage caused by chronic hyperglycemia has a certain time effect.
