"Abnormally elevated blood creatinine, urine protein 2+, ketone body 2+, yes it is diabetic nephropathy ..."
In the corridor of the outpatient clinic, 67-year-old Uncle Wang kept holding the examination sheet in his hand. I was shaking, thinking over and over again in my mind the diagnosis just made by the doctor. He never spoke or showed any expression. He just sat quietly, his thin figure looking particularly stubborn. Until his wife came to pick him up and asked, "Old man, are you okay? Let's go home!" As soon as he finished speaking, Uncle Wang cried "Wow" like a child.
"I'm hopeless! The doctor said it's diabetic nephropathy! It's all my fault that I don't listen to you and can't keep my mouth shut!" Uncle Wang calmed down a little and began to tell his wife about his condition.
"What a big deal! We have been through ups and downs in our lives, and we have never seen any big storms. Don't worry, let's go find a doctor. Now that medical skills are so advanced, we will definitely be able to cure your disease!" Uncle Wang's wife was first He was startled, and then began to comfort Uncle Wang.
Half an hour later, Uncle Wang and his wife supported each other and walked out of the hospital, holding several boxes of medicine in the bags in their hands. At this time, Uncle Wang had a proud look on his face and kept saying, "Medical skills are really advanced now. I didn't expect that there would be medicine that can treat my kidney disease. I will have to take medicine and keep my mouth shut in the future!"
I happened to accompany my mother-in-law to the endocrinology department for a review that day and witnessed the entire process. My mother-in-law was very curious: What magic medicine did the doctor prescribe to Uncle Wang that could make Uncle Wang's mood so different? In fact, it is not a "miracle drug", but a new type of antidiabetic drug - dapagliflozin .
1. The new star of antidiabetic medicine—dapagliflozin
There are many kinds of antidiabetic drugs on the market. Where is the new antidiabetic drug dapagliflozin?
. New ways to lower blood sugar
Existing classic hypoglycemic drugs have been used to lower blood sugar from various aspects, such as metformin and other biguanide hypoglycemic drugs inhibit liver glycogen output, miglitol and other alpha glycosides Enzyme inhibitors delay the intestinal absorption of sugar in food, drugs such as pioglitazone and glimepiride are used to sensitize and promote insulin , and there are also ways to directly supplement exogenous insulin - many diabetes patients are more resistant to "belly piercing" injections of insulin or insulin analogues. However, dapagliflozin takes a different approach, allowing patients to pee out the sugar in their bodies to lower blood sugar .
Dapagliflozin belongs to , a sodium-glucose coordinated transporter-2 inhibitor . It can act on the proximal tubule of the glomerulus, inhibiting its reabsorption of glucose , allowing glucose to enter the urine and be excreted from the body, thereby exert blood sugar lowering effect. Moreover, this effect is dependent on blood sugar. If the patient has a high blood sugar level, more glucose will be excreted in the urine, and if the blood sugar level is low, less glucose will be excreted from the body. It is very friendly to patients with diabetes at all stages.
. New cross-border efficacy
Dapagliflozin is also the "king of cross-borders". It can not only lower blood sugar, but also reduce urinary protein and inflammatory response by reducing RAAS activity, reduce glomerular hyperperfusion, High filtration, high pressure, etc. protect the kidneys; protect the heart and improve the prognosis of heart failure by promoting natriuresis and diuresis, improving vascular endothelial function, and inhibiting myocardial fibrosis; it can also induce osmotic diuresis in the process of promoting sodium excretion, Play a role in reducing blood pressure, etc.
In other words, dapagliflozin is a new drug that has multiple functions such as lowering blood sugar, protecting kidneys, protecting the heart, and lowering blood sugar.
2. Why do diabetic nephropathy patients see hope with dapagliflozin?
The incidence rate of diabetic nephropathy is about 40%. The root cause of its occurrence is that the patient's blood sugar cannot be stably controlled for a long time. The sudden high and low blood sugar will damage the renal microvessels, cause renal microvascular disease, and also enhance the oxidative response of the blood vessels. Stimulating causes the glomerular blood vessels to harden and become brittle, and the original reabsorption and filtration functions of the kidneys are severely damaged.If there is no timely intervention, the patient will progress from initial polyuria and lower limb edema to oliguria or anuria, a large increase in urinary protein, and eventually lead to renal failure, uremia.
To prevent diabetic nephropathy from developing into renal failure and uremia, the key is to protect the patient's renal function, and dapagliflozin is such a drug. Research has found that dapagliflozin reduces the risk of renal events by up to 47% and protects kidney function better than ARB drugs. Whether it is primary prevention of diabetic nephropathy or secondary prevention, taking dapagliflozin reduces the risk of kidney disease at a higher rate. It is the highest and has renal protection benefits even when taken by non-diabetic patients.
3. When taking dapagliflozin for a long time, be sure to pay attention to these two matters
Patients with diabetic nephropathy generally need to take dapagliflozin for a long time. During the specific use, be sure to pay attention to these points.
Note 1: Urinary tract infection
Dapagliflozin lowers blood sugar by excreting more glucose into the urine. If there is too much glucose in the urine, the urinary system will naturally be prone to bacterial and mold growth problems. Therefore, it has been clinically found that patients will develop urinary tract infection during the course of taking dapagliflozin, with a probability of about 5%, and the infection is generally mild to moderate.
countermeasures: There is generally no need to stop the medication during medication. It is recommended to pay attention to hygiene during the medication. You can reduce the risk of infection by drinking more water to flush the urethra and cleaning it every day.
Note 2: Malnutrition
Dapagliflozin can promote the body's excretion of glucose. If a diabetic patient has an unbalanced diet, or eats braised vegetables or excessive dieting because of diabetes, it is easy to suffer from malnutrition and excessive weight loss. Problems such as fast blood sugar further affect the body's ability to regulate blood sugar, which is not conducive to blood sugar control.
Countermeasures : It is recommended to eat a reasonable diet. On the basis of strictly controlling the total calories in the diet not to exceed the standard, pay attention to the intake of high-quality protein such as fish, shrimp, poultry, eggs, and milk to ensure a balanced diet.
