Engaged in diabetes and other endocrine and metabolic diseases clinical and research work.
Normal blood sugar is not static, 24 hours a day there will be some degree of volatility: the formation of absorption of food after meals three major peaks; the formation of hepatic glucose output as early as 4-8 points a small peak; am 1-3 points gastrointestinal empty, all kinds of glucagon are both at a low level, then the lowest blood sugar. Under the regulation of various hormones, fasting blood glucose is usually stable at 3.9-5.6 mmol / l, postprandial blood glucose within 1 hour maximum, but generally not more than 7.8 mmol / liter. The same day fluctuations in blood glucose 2.0-3.0 mmol / l, between the different blood glucose fluctuations on even smaller. However, patients with diabetes day and day of the volatility is 2-3 times the normal islet function worse, volatility, the more obvious and easy to hypoglycemia reaction.
National study found that large fluctuations of blood glucose in type 2 diabetic patients with microalbuminuria risk is greater. In patients with type 1 diabetes, long-term blood sugar fluctuations, and diabetic retinopathy will increase the risk of kidney disease.
Recent opinion that there are many diabetic patients "accelerated brain aging" factor, blood glucose fluctuations in one of them. In elderly patients with type 2 diabetes, the use of a rapid onset of oral hypoglycemic drugs to reduce the postprandial blood sugar, good for slow cognitive decline.
Shows the average blood sugar control of diabetes should not only down to normal, but also to avoid postprandial hyperglycemia and hypoglycemia. How to avoid blood sugar "jumping up and down" mean?
1. To determine the appropriate glucose goals. Glycosylated hemoglobin should be controlled in less than 7%. In addition, the postprandial blood glucose should be less than 10 mmol / liter.
2. To detect blood glucose fluctuations. Found in patients with blood glucose self-monitoring of blood glucose is the primary means of fluctuations in blood glucose monitoring can reflect the patient's blood glucose fluctuations in day and day, if necessary, to do 72 hours of continuous glucose monitoring.
3. Looking for incentives. Cause blood sugar fluctuations due to a internal and external categories: underlying causes, including liver, kidney, gastrointestinal, such as pituitary disease, food, drug absorption changes, diet, exercise, mood and sleep. The type external causes, including food, fiber content and method of cooking, eating time, change, anti-diabetic drugs, especially insulin secretagogue agents and insulin type, dose, injection time, and with insulin use and changes in diet and exercise.
4. To prevent low blood sugar. Easily lead to long-acting sulfonylureas, hypoglycemia, short-acting sulfonylureas, acid drugs, biguanide, such as thiazole Wan dione lower risk of hypoglycemia. Bolus or premixed insulin regular insulin before meals easily lead to the next low blood sugar, ultra-short acting insulin can reduce the probability of its occurrence. Long-acting insulin analogue glargine insulin action and in particular a more gentle, long duration, compared to the traditional intermediate-acting insulin, can reduce the occurrence of nocturnal hypoglycemia.
Normal blood sugar is not static, 24 hours a day there will be some degree of volatility: the formation of absorption of food after meals three major peaks; the formation of hepatic glucose output as early as 4-8 points a small peak; am 1-3 points gastrointestinal empty, all kinds of glucagon are both at a low level, then the lowest blood sugar. Under the regulation of various hormones, fasting blood glucose is usually stable at 3.9-5.6 mmol / l, postprandial blood glucose within 1 hour maximum, but generally not more than 7.8 mmol / liter. The same day fluctuations in blood glucose 2.0-3.0 mmol / l, between the different blood glucose fluctuations on even smaller. However, patients with diabetes day and day of the volatility is 2-3 times the normal islet function worse, volatility, the more obvious and easy to hypoglycemia reaction.
National study found that large fluctuations of blood glucose in type 2 diabetic patients with microalbuminuria risk is greater. In patients with type 1 diabetes, long-term blood sugar fluctuations, and diabetic retinopathy will increase the risk of kidney disease.
Recent opinion that there are many diabetic patients "accelerated brain aging" factor, blood glucose fluctuations in one of them. In elderly patients with type 2 diabetes, the use of a rapid onset of oral hypoglycemic drugs to reduce the postprandial blood sugar, good for slow cognitive decline.
Shows the average blood sugar control of diabetes should not only down to normal, but also to avoid postprandial hyperglycemia and hypoglycemia. How to avoid blood sugar "jumping up and down" mean?
1. To determine the appropriate glucose goals. Glycosylated hemoglobin should be controlled in less than 7%. In addition, the postprandial blood glucose should be less than 10 mmol / liter.
2. To detect blood glucose fluctuations. Found in patients with blood glucose self-monitoring of blood glucose is the primary means of fluctuations in blood glucose monitoring can reflect the patient's blood glucose fluctuations in day and day, if necessary, to do 72 hours of continuous glucose monitoring.
3. Looking for incentives. Cause blood sugar fluctuations due to a internal and external categories: underlying causes, including liver, kidney, gastrointestinal, such as pituitary disease, food, drug absorption changes, diet, exercise, mood and sleep. The type external causes, including food, fiber content and method of cooking, eating time, change, anti-diabetic drugs, especially insulin secretagogue agents and insulin type, dose, injection time, and with insulin use and changes in diet and exercise.
4. To prevent low blood sugar. Easily lead to long-acting sulfonylureas, hypoglycemia, short-acting sulfonylureas, acid drugs, biguanide, such as thiazole Wan dione lower risk of hypoglycemia. Bolus or premixed insulin regular insulin before meals easily lead to the next low blood sugar, ultra-short acting insulin can reduce the probability of its occurrence. Long-acting insulin analogue glargine insulin action and in particular a more gentle, long duration, compared to the traditional intermediate-acting insulin, can reduce the occurrence of nocturnal hypoglycemia.
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