Starting from a Case of Diabetes Mellitus

Case Introduction

Aunt Chen is over 60 years old, Slightly overweight, Retired at home, There has been no chronic disease in what before, I don’t go to the hospital very much. A month ago, my physical examination found that my blood sugar was too high. To visit our center, The doctor inquired about the medical history, and after a simple physical examination, she perfected the blood sugar, blood lipid, abdominal B-ultrasound and other items. After 3 days, she got the report, and the blood report suggested [fasting blood sugar 10.0 mmol/L, glycosylated hemoglobin 8.2%, triglyceride 6.7 mmol/L], and B-ultrasound suggested [fatty liver]. Aunt Chen did not believe it at that time, saying [I used to be in good health and had no family history. How could it be diabetes and hyperlipidemia? ]. The doctor explained, Her blood sugar has been high and her blood lipid has been high for some time. Just because there are no symptoms, No physical examination, So I don’t know. After confirming the diagnosis of [diabetes], The doctor gave the initial treatment plan, diet control, proper exercise, medication, As well as monitoring blood sugar at home. Stop drugs indiscriminately, Changing drugs indiscriminately, Be careful of the deterioration of the disease. Since then, Aunt Chen has been dispensing medicine in the community health service center. And bought a finger blood sugar meter to measure finger blood sugar at home. After 3 months of reexamination, The report showed a slight improvement in blood sugar, But the glycosylated hemoglobin was still high (7.8 mmol/L), The control is not ideal. Upon the doctor’s inquiry, Aunt Chen said she went back to take medicine for a period of time, The blood sugar was not high, There is nothing wrong with myself, Look at the instructions. Each drug has a lot of side effects. He reduced the amount of medicine himself. After the doctor’s education, Aunt Chen learned that diabetes drugs cannot be taken and stopped. Because of the action of drugs, blood sugar can be controlled. Not to mention the so-called drug [side effects] can stop the drug. Diet control and moderate exercise are part of the treatment. After a period of time, Aunt Chen came again. Why do you always feel dizzy these two days? He also broke out in a cold sweat. Upon the doctor’s inquiry, Aunt Chen said that now all the medicines are taken on time and according to the amount, Eating is not taboo, Sometimes I feel that if I eat too much, I will eat less at the next meal. The doctor told me that this was a manifestation of hypoglycemia. Educated by doctors, Aunt Chen knows that diet control, exercise therapy and taking medicine are as important. In addition, the stabilization of blood sugar is also part of controlling blood sugar. Sometimes it is more important than lowering blood sugar. Understanding diabetes, In order to overcome diabetes, Aunt Chen said, I don’t know much about medicine, Sometimes I don’t know what to do at all, So the doctor suggested Aunt Chen to attend the health education lectures held regularly by the center. Now, After more than two years of adjustment, Although Aunt Chen’s blood sugar fluctuates occasionally, But most of the time it is relatively stable, At present, there are no traces of complications. Aunt Chen has learned a lot about diabetes in the past 2 years. It can also achieve basic diabetes self-management, He also served as the team leader of the diabetes self-management team in the community. I often share with you the experience and lessons of the past 2 years. Case analysis 1. Early detection, early diagnosis and early treatment concepts such as [health preservation] and [preventive treatment] are very popular on the market now. Many people think that they often eat certain foods or health products, Or go to health care institutions [detoxification]. Remove the ingredients of commercial speculation, These concepts are actually [disease prevention] and [health promotion] in modern medicine. Secondary prevention of diseases requires diseases [early detection, early diagnosis and early treatment]. Aunt Chen was not without diabetes before she came to see a doctor. But because he ignored the physical examination, he knew nothing about his physical condition. If she continues to delay, she is bound to miss the best treatment opportunity. At the same time, the development of epidemiology has revealed many [high risk factors] of diabetes. Such as family history, obesity, lack of exercise, excessive total calorie intake, Controlling these high risk factors, Can reduce the risk of diabetes, 2. There may be no symptoms in the early stage of diabetes. Typical symptoms of diabetes include [thirst, excessive drinking, eating, emaciation], However, in practice, most patients have no obvious symptoms at an early stage. Many patients find high blood sugar during physical examination, preoperative examination or other reasons. And complications have already occurred when symptoms really appear, Such as vision loss caused by retinopathy, Numbness of hands and feet caused by peripheral neuropathy, Thirst, irritability, coma, etc. when ketoacidosis occurs. Therefore, one cannot think that one cannot have diabetes just because one has no symptoms. 3. Diet and exercise are very important. The common misconception of the public is: [Traditional Chinese medicine should avoid eating, Western medicine does not need to avoid food], So after taking the medicine, you don’t control your diet, Or exercise, Blood sugar is higher than before. However, in some patients, Often out of fear of diabetic complications, Without monitoring blood sugar and glycosylated hemoglobin, Increasing unnecessary stress, Also often leads to malnutrition. 4. Another common misconception of people who take drugs according to doctor’s advice is: Chinese medicine has no side effect, Western medicine hurts liver and kidney]. Many patients blindly believe that their blood sugar control is very good. Worried about the side effects of drugs, Self-reduction, withdrawal, Others are reluctant to control their diet, If you eat too much, increase the dosage at will. Causing blood sugar to be very unstable. Fluctuations in blood sugar increase the risk of hypoglycemia. Its harm is more serious than high blood sugar. Doctors’ medication plan is based on theory, practice and evidence. Follow the doctor’s advice, It is not only a manifestation of trust in clinicians and modern medicine, It also provides the basis for adjusting the treatment plan. 5. Self-management and health education. Chronic diseases such as diabetes, hypertension and coronary heart disease are not enough to rely solely on doctors’ guidance and drug treatment. Doctors are not very familiar with the specific situation of everyone. More often than not, it depends on the patient’s self-management. But as Aunt Chen said, I have no knowledge of what medicine, Most of the time I don’t know what to do. This kind of situation requires health education for patients. For example, regular health talks are held, publicity materials are distributed, community diabetes patients are organized to form diabetes self-management groups, etc. Patients need to spend more time and energy on understanding some knowledge of diabetes. Only by controlling diet, exercising properly, standardizing self-blood sugar monitoring and cooperating with doctors’ drug treatment can long-term management of diabetes be truly achieved.