Preventing complications of diabetes

Don’t just focus on fasting blood sugar values, but also conduct individualized and comprehensive control of blood sugar, blood pressure, and blood lipids. At the same time, insist on early screening for complications every year. More than 90% of diabetes-related disability and fatal complications can be effectively postponed or even avoided.

The 52-year-old Uncle Zhang who was followed up a while ago has been diagnosed with type 2 diabetes for 3 years. He usually tests his fasting blood sugar at home at around 6mmol/L. He tells everyone he controls his sugar well. However, the physical examination showed that the amount of microalbumin in his urine exceeds the standard, indicating that he has early-stage diabetic nephropathy. When he came to the clinic with the report sheet, he was confused: My blood sugar is normal, how come there are complications?

You must know that many people with diabetes still have the understanding of sugar control that "if fasting blood sugar is normal, everything will be fine". They have never paid attention to whether blood sugar has risen above 11mmol/L 2 hours after a meal, and have never checked glycated hemoglobin, which reflects the average blood sugar level in the past three months. What's more, high blood sugar is never the only driver of complications: Uncle Zhang's low-density lipoprotein cholesterol was found to be 3.4mmol/L, far exceeding the 2.6mmol/L threshold required by diabetics. He usually smokes two packs of cigarettes a day. When all these factors come together, even if his fasting blood sugar is acceptable, his blood vessels and kidneys have already been slowly damaged.

When it comes to sugar control goals, there are actually two groups of clear research supports in the academic community. There is no absolute right or wrong. Those who support strict sugar control use the data from the DCCT study and believe that lowering the glycated hemoglobin to less than 6.5% for young and middle-aged diabetics who have just been diagnosed with no underlying diseases can reduce the risk of microvascular complications by 70%; while those who support looser sugar control rely on the results of the ACCORD study and point out that for elderly patients with a history of cardiovascular disease and who are prone to hypoglycemia, a hard red line of 6.5% will increase the risk of all-cause death, and relaxing it to 7% to 7.5% is safer. To put it bluntly, there is no unified standard answer. Don’t copy other people’s sugar control homework on the Internet. Talk to your attending doctor about your physical condition and set a goal that is suitable for you.

I have followed the director in outpatient service for so long, and I have seen too many patients with diabetes who think that "the medicine is only three parts poisonous". They stop taking the medicine without permission when their blood sugar is stable, or they think that controlling sugar means completely giving up carbohydrates and eating boiled vegetables every day until they are malnourished, which in turn destroys the body. There’s really no need to be so extreme. Change your meals to more whole grains, mix white rice with half of brown rice and oats, add an extra chopstick to stir-fry green leafy vegetables with rice at lunch, make skewers with friends at night and choose grilled lean meat instead of fried chicken skin. Sugar-free sparkling water is better than tons of iced Coke, so it’s not that difficult to adjust. Oh, by the way, it’s best to quit smoking as soon as possible. Eight out of ten patients with diabetic foot encountered in the clinic are regular smokers. The nicotine in cigarettes will block the peripheral blood vessels so much that even a small cut in the foot will not be able to grow. In severe cases, amputation will be necessary. It is really not possible.

Many people with diabetes think that it will cost a lot of money when they hear that they need to check for complications. In fact, this is not the case. An additional urine microalbumin/creatinine ratio is prescribed during the annual routine physical examination. For thirty to forty yuan, kidney damage can be detected at the earliest, three to five years earlier than waiting for lower limb edema to be checked. A fundus examination every six months, for less than one hundred yuan, can detect retinopathy before you feel the decline in vision. If you intervene early, it will basically not progress to the point of blindness. As for peripheral neuropathy, you can usually test it at home by touching your feet with a cold metal spoon. If they feel numb to the touch, like a thick layer of socks, go to the hospital for a checkup immediately. Don’t delay.

I met a 78-year-old man a while ago. He was diagnosed with diabetes 22 years ago. Now his eyes, kidney function, and cardiovascular system are all in good condition, with no signs of complications at all. His secrets are not magical at all: he goes downstairs and walks slowly for 20 minutes after eating every day. He never misses taking medicine. He undergoes regular screenings every year. Even his favorite braised pork is only eaten after two pieces. He is very self-disciplined.

To put it bluntly, there is really no panacea for preventing complications of diabetes, and there is no need to be overly anxious. It does not mean that you will definitely end up blind or amputated if you have diabetes. As long as you pay more attention, don't believe in those folk remedies that "cure diabetes", don't turn a deaf ear to the doctor's words, and find the right rhythm that suits you, it is not difficult to live peacefully with diabetes for a lifetime.

Oh, by the way, one last thing, if you have a diabetic friend at home, remind him more often. Don’t always let him eat leftovers, and don’t always say, “You can’t eat this, you can’t eat that.” Taking more walks with you is better than anything else.