All diabetic patients need to undergo dietary and exercise therapy, so do they all need to take medicine or have injections? Please refer to 100 Questions on Diabetes Health Knowledge.
Q: How many types of commonly used oral hypoglycemic drugs are there?
A: So-called oral hypoglycemic drugs mainly refer to Western medicine. Currently, the commonly used oral hypoglycemic drugs in clinical practice include sulfonylureas, biguanides, and acarbose. The important role of sulfonylurea hypoglycemic drugs is to stimulate insulin secretion, with a moderately strong hypoglycemic effect, including D860 (tolbutamide), glibenclamide, glipizide, glyburide, and gliclazide. Among these, glibenclamide has the strongest effect, glipizide acts quickly but for a short duration, gliclazide has a longer duration of action, and glyburide can be used by patients with diabetic nephropathy. Biguanide hypoglycemic drugs mainly reduce appetite and carbohydrate absorption while increasing insulin sensitivity, including phenformin and metformin. Phenformin is nearly obsolete. Acarbose belongs to the third category of oral drugs, and these drugs mainly inhibit the breakdown of polysaccharides, thereby reducing postprandial blood glucose levels by slowing down the absorption of glucose. In addition, internationally, three new types of drugs are under development, some of which have already entered the clinical trial stage.
Q: Do all diabetic patients need to use antidiabetic drugs?
A: All diabetic patients need to undergo dietary and exercise therapy, so do they all need to take medicine or have injections? Type 1 diabetic patients obviously need injections, but it's not necessarily the case for type 2 diabetic patients. Statistics show that about 20% of type 2 diabetic patients do not need antidiabetic drugs; diet and exercise therapy alone can yield satisfactory results. At Peking Union Medical College Hospital, if a newly diagnosed type 1 diabetic patient has fasting blood glucose below 11.1 mmol/L and postprandial two-hour blood glucose below 16.7 mmol/L, it indicates that the patient’s pancreas still has some function. In such cases, patients are advised to control their diet and exercise more intensely for a month to observe the outcome. If blood glucose control remains unsatisfactory, oral hypoglycemic drugs may be appropriately selected based on the situation. Of course, if the patient’s blood glucose is very high at the outset, for example, fasting blood glucose higher than 200 mg/dl and postprandial two-hour blood glucose higher than 300 mg/dl, timely medication is necessary. If fasting blood glucose exceeds 300 mg/dl and there are significant ketones in the urine, the necessity of using insulin therapy should be considered.
Q: Under what circumstances should diabetic patients avoid physical exercise?
A: In the following situations, patients should avoid exercise or reduce the amount of exercise: (1) Poor glycemic control. Excessive exercise may lead to further elevation of blood glucose, even causing diabetic ketoacidosis; (2) Severe diabetic macrovascular complications. Exercise mode and intensity must be carefully chosen to prevent an increase in blood pressure as well as cerebrovascular accidents, myocardial infarction, and lower limb necrosis; (3) Severe diabetic retinopathy. Patients with abnormal retinal microvasculature and increased permeability may experience worsening of retinopathy or even rupture and bleeding of larger retinal vessels, affecting vision, so they should avoid strenuous exercise; (4) Severe diabetic nephropathy. Excessive exercise increases renal blood flow and proteinuria, accelerating the progression of diabetic nephropathy, so such patients should avoid intense exercise; (5) Other emergency situations, including various infections, cardiovascular disease instability, recovery period after diabetic ketoacidosis or hyperosmolar nonketotic diabetic coma. Of course, unless there is an acute condition, diabetic patients do not need complete bed rest but should maintain a certain level of exercise, even if it is only partial exercise. The key issue lies in choosing appropriate exercise methods and intensity.
Q: What are the precautions for diabetic patients during exercise therapy?
A: Diabetic patients should pay attention to the following during exercise: (1) Blood pressure fluctuations: manifested by elevated blood pressure during exercise and positional hypotension after exercise; (2) Blood glucose fluctuations: hypoglycemia often occurs when the exercise volume is too large without timely meal supplementation, and sometimes stress-induced hyperglycemia may occur; (3) Worsening myocardial ischemia, possibly leading to arrhythmias, myocardial infarction, or heart failure; (4) Worsening of microvascular complications, such as increased urinary protein or retinal hemorrhage; (5) Worsening of musculoskeletal conditions, such as degenerative joint disease or exacerbation of lower limb ulcers. Of course, as long as the indications are properly managed and supervised, all these issues related to exercise can be completely avoided.
Q: What benefits does exercise offer to diabetic patients?
A: Physical exercise is one of the most important, even indispensable, means for treating diabetes. This is because exercise offers great benefits to diabetic patients, including: (1) Enhancing the body's sensitivity to insulin. It has been found that through physical exercise, diabetic patients' blood glucose and glucose tolerance improve, and simultaneously, the level of insulin in the blood decreases. This indicates an enhanced sensitivity to insulin, which can occur even without weight loss; (2) Lowering blood glucose, lipids, and blood viscosity. Physical exercise increases the utilization of blood glucose and lipids in diabetic patients and enhances insulin sensitivity; (3) Facilitating the control of chronic diabetic complications. Besides lowering lipids, exercise also reduces blood viscosity and enhances red cell deformability, improving blood supply to various organs, which helps in controlling chronic diabetic complications; (4) Reducing weight and enhancing physical fitness; Physical exercise helps eliminate excess fat tissue in diabetic patients and increases muscle mass and physical strength; (5) Bringing confidence and joy to life.
Q: How to calculate the total daily caloric intake for diabetic patients?
A: Diabetics must control their total caloric intake. But how exactly should they determine how much they should consume daily? Generally speaking, the total caloric intake for diabetics depends on age, gender, weight, and physical activity intensity. Younger individuals, males, lighter-weight individuals, and those with greater physical activity may require slightly more calories daily. If the patient is in childhood, adolescence, pregnancy, or lactation, the total daily caloric intake, especially protein intake, can be even higher. Typically, the total caloric intake per kilogram of body weight per day ranges from 15-50 kcal (63-210 kJ). Specific calculation methods are shown in the table below:
Body Weight Characteristics Bedridden Light Physical Activity Moderate Physical Activity Heavy Physical Activity
Underweight 20~25(84~105) 35(146) 40(167) 45~50(188~209)
Average 15~20(63~84) 30(125) 35(146) 40(167)
Overweight 15(63) 20~25(84~105) 30(125) 35(146)
Note: Calories [kcal(kJ)/kg body weight/day]
Patients can calculate their daily caloric intake based on their body weight characteristics and daily activity intensity and then further calculate the appropriate amount of various foods to consume.
Q: Why is dietary treatment important for diabetic patients?
A: If we compare diabetes treatment to a carriage pulled by five horses, then dietary treatment would be the main horse pulling the carriage. That is, dietary treatment is the most important aspect of diabetes management. Any type of diabetes, any diabetic patient, at any time, requires dietary treatment. A patient might not need medication, and some patients might not be able to engage in physical exercise, but for any diabetic patient, without dietary treatment, diabetes cannot be satisfactorily controlled. Diabetic patients have varying degrees of reduced insulin synthesis and secretion, which can cause postprandial blood glucose to rise significantly, even to levels severely harmful to health. Additionally, improper diet and excessive caloric intake can raise the patient's blood pressure and weight, which are extremely harmful to diabetic patients. Therefore, every diabetic patient must make reasonable dietary control a necessary means to fight the disease and maintain lifelong dietary control. Incidentally, dietary control is not only beneficial for diabetic patients but also a good health-preserving method for anyone over middle age.
Q: Why is diabetes health education necessary?
A: In 1995, the World Health Organization proposed the slogan "Reduce the cost of ignorance about diabetes" for diabetes prevention and treatment. This slogan highlights the extreme importance of diabetes education in preventing and treating diabetes. Currently, the cost of ignorance about diabetes is truly too heavy. Some studies have found that when most diabetic patients receive a clear diagnosis, they have actually had diabetes unknowingly for 7 to 10 years. Many patients already have quite severe chronic diabetic complications, and some have even reached the brink of blindness, kidney failure, or amputation. Many people are unaware of the dangers of diabetes, thinking, "Can eat and sleep, no pain or itch," "Nothing serious," resulting in delayed treatment. Many people do not know how to check for or manage diabetes, or they seek inappropriate treatments, allowing the condition to progress untreated. Therefore, vigorously promoting diabetes prevention and treatment knowledge to make it universally known is extremely important. Educating people about diabetes can significantly reduce its incidence, disability rate, and mortality rate, sparing individuals, families, workplaces, and nations significant losses. Currently, diabetes prevention and treatment work is not being done excessively but rather insufficiently. Neglecting diabetes education is a grave mistake.
Q: How should family members of diabetic patients cooperate with treatment?
A: Diabetics need to participate in social activities and interact with society. Among those who influence them most are the family members of diabetic patients. Therefore, family members bear undeniable responsibility for controlling the patient's condition. First, family members need to understand and care for diabetic patients rather than shun them due to fear of dirt or inconvenience. They should provide a close and supportive family environment. Secondly, they should realize that controlling the patient's condition and preventing various diabetic complications benefit both the patient and their family. Family members should consciously encourage and assist patients in maintaining proper dietary control and exercise, ensure they take medications on time, and conduct diabetes monitoring to achieve the best possible control of their condition. Thirdly, family members of diabetic patients should continuously learn about diabetes prevention and treatment methods, enriching their knowledge, particularly regarding observing acute complications like diabetic ketoacidosis and hypoglycemia, so they can promptly detect dangerous conditions and provide necessary interventions.
Q: Can diabetic patients enjoy the same lifespan as normal people?
A: The greatest threat to the lifespan of diabetic patients is not diabetes itself but its complications. We often see examples of many diabetic patients who, through consistent correct treatment and monitoring, live until they are 70 or even older. Therefore, the question is not whether longevity is possible but how to achieve it. To achieve healthy longevity, one must first correctly view diabetes and maintain an optimistic, broad-minded, and cheerful mindset. Second, one must consistently adhere to proper diet, exercise, and medication treatments, keeping weight, blood glucose, blood pressure, and lipid levels basically normal and effectively preventing and managing various diabetic complications. Third, systematic monitoring of diabetes is necessary, and any poor control or occurrence of complications should be detected early and treated effectively. By doing these things, diabetic patients can achieve healthy longevity.
Q: Can diabetic patients participate in normal work?
A: The answer is definite. When diabetic patients are well-controlled, they can fully participate in normal work. First, this gives patients the opportunity to continue contributing to society, realizing that they are not useless, sickly individuals but are needed by society, maintaining confidence in work and life. Second, it provides patients with opportunities to widely interact with others, increasing life's pleasures and maintaining happiness. Third, it helps patients maintain a certain level of exercise, which aids in lowering blood glucose and reducing weight. Lastly, it allows patients to maintain a higher income, alleviating economic pressures on themselves and their families. However, diabetic patients are not healthy individuals and must remember this point. In the workplace, they should do work suitable for them, balance work and rest, try to avoid dangerous environments, working at heights, and other irregular jobs.
Obesity 15(63) 20~25(84~105) 30(125) 35(146)
Note: Calories [kcal(kJ)/kg body weight/day]
Patients can calculate their daily caloric intake based on their body weight characteristics and daily activity intensity and then further calculate the appropriate amount of various foods to consume.
Q: What should diabetic patients be mindful of when attending banquets?
A: Of course, diabetic patients can attend banquets, which is also one way to enhance the quality of life. However, they must always remember that they are diabetic patients and adhere to the correct dietary treatment principles. Otherwise, at banquet occasions, they may forget themselves, overeat, and indulge, forgetting everything behind, resulting in fluctuations in their condition or even diabetic ketoacidosis, which is detrimental to their health and should be avoided as soon as possible. We suggest that diabetic patients honestly inform others that they have diabetes. Let them know what they can eat and what they cannot eat. Even in situations where dishes are served, alcohol is offered, or cigarettes are pushed, they should remain resolute.
Q: Can diabetic patients travel or go on business trips?
A: Diabetic patients can absolutely travel or go on business trips. What needs attention is that outdoor activities are always accompanied by some changes in living routines. The key issue is that patients must learn to properly arrange their diet, daily routine, and medication adherence amidst these changes, minimizing the impact of lifestyle changes on disease control. First, patients should try not to significantly alter their sleeping schedule, knowing that only by getting up and resting on time, eating on time, and taking medication on time can they maintain stable health. Secondly, they should maintain dietary control, avoiding foods they shouldn't eat and drinks they shouldn't consume, especially avoiding excessive alcohol consumption and smoking. Thirdly, they should avoid excessive fatigue. Fourthly, they should take medication on time and not recommend changing the medication plan for convenience while traveling. Lastly, they should monitor their condition and detect changes early to handle them promptly. It is advisable to carry urine glucose and urine ketone test strips when traveling, and using a glucometer for blood glucose testing is even more convenient.
Q: Why must diabetic patients live regular lives?
A: Diabetic patients must live regular lives; otherwise, it is difficult to achieve good blood sugar control. Human life activities follow certain patterns and cycles. Thus, diabetic patients should have fixed times for meals, injections, medication, exercise intensity, and rest. Disrupting these rules arbitrarily will inevitably cause blood sugar fluctuations and affect disease control. Therefore, diabetic patients must have regular lifestyles and adhere to timed and measured meals, exercise, and medication.
Q: What are the characteristics of elderly diabetic treatment?
A: Elderly diabetic patients should note: (1) Repeated, patient dissemination of diabetes knowledge is necessary. Elderly people have declining memory and response abilities, and some elderly patients have relatively low educational levels, making it difficult for some elderly diabetic friends to master diabetes prevention and treatment knowledge and skills. They need more care, and family members and doctors should have more love, patience, and detailed explanations of diabetes knowledge without finding their questions repetitive or tedious. (2) Balanced diets and small frequent meals are advocated to avoid excessive calorie intake while preventing malnutrition. (3) Appropriate exercise: Choose exercise methods and total amounts suitable for elderly physical characteristics to maintain exercise, lower blood sugar, maintain weight, and enhance physical fitness. (4) Medication treatment should be moderate: Avoid the effects of hyperglycemia, hyperlipidemia, and hypertension on the body, but be especially cautious of hypoglycemia, especially asymptomatic hypoglycemia, which is harmful to the elderly. (5) Regular blood sugar checks, paying attention to the possibility of cardiovascular complications: Sometimes elderly people have increased renal glucose thresholds, low urine sugar, and cannot reflect blood sugar levels, so regular blood sugar checks are necessary. Moreover, elderly people have more chances of developing cardiovascular diseases than younger people and should be given sufficient attention.
Q: What are the characteristics of gestational diabetes?
A: The first step in treating gestational diabetes is early diagnosis and early treatment. It is recommended that each pregnant woman checks her blood sugar to detect hidden diabetes. After confirmation, the first consideration should be the handling of the pregnancy. Patients with young onset, long course, and severe complications should be advised to terminate the pregnancy via induction, as continuing would be very detrimental to both mother and child. Pregnant women who can continue with the pregnancy should at least pay attention to the following aspects: (1) Learn more about diabetes and pregnancy, delivery, and breastfeeding to prepare mentally for different situations; (2) Diet control can be appropriately relaxed; (3) Maintain appropriate exercise: Diabetic pregnant women must exercise regularly, which is beneficial for avoiding excessive weight gain and facilitating smooth delivery, though the exercise method and total amount should conform to the characteristics of pregnancy; (4) If diet control alone cannot stabilize blood sugar, insulin treatment must be used to avoid potential adverse effects of oral drugs on the fetus, such as congenital malformations, neonatal hypoglycemia, and neonatal lactic acidosis; (5) Use blood sugar as an indicator to monitor disease control: One-third of pregnant women have positive urine sugar but normal blood sugar, and more patients have overly sensitive urine sugar, which can lead to misguidance; (6) Regular hospital visits: Diabetic pregnant women are more complex than simple diabetes or simple pregnancy, so as the pregnancy progresses, medical visits should gradually increase, prenatal examination frequency should increase, and attention should be paid to the diabetic pregnant woman and her fetus.
Parasites grow inside the host body and directly stimulate and press surrounding tissues and organs, leading to a series of secondary symptoms. (3) Toxicity and immune damage: Parasites also undergo metabolic processes inside the host body. During metabolism, the excreted metabolites, secretions, and substances released after parasite decomposition are harmful to the host, potentially causing local and systemic poisoning or immune system and pathological reactions, leading to damage to the host's tissues and functions. (4) Secondary infection: Some parasites carry other pathogens like bacteria and viruses into the host upon invasion, infecting the host and damaging its barrier mechanisms, thus lowering resistance and making the host prone to contracting other diseases. Some parasites themselves are vectors for microbial pathogens. This is why deworming should be done before vaccination. (5) Some parasites are zoonotic parasites that not only infect pets but also pose significant health threats to humans. For example, toxoplasma is a zoonotic parasite. When pregnant women are infected with toxoplasma, they develop toxoplasmosis, which can lead to fetal malformation. This is one of the reasons why pregnant women are advised not to keep pets. Clearly, parasites can cause considerable harm to your pet. However, once you understand these facts, you can take preventive measures. Early prevention and control of parasites can ensure safe pet ownership and bring joy to your life.
Is flea infestation just uncomfortable or does it cause significant harm?
Answer: Dogs react differently to flea bites. However, when bitten by fleas, fleas release certain chemicals into the dog's bloodstream, causing itching, swelling, hair loss, and dermatitis at the bite site. Initially, some less sensitive dogs may show no external symptoms, but further development can lead to anemia and even death, especially in puppies.
Pet (dog, cat) deworming knowledge Why deworm dogs and cats for tapeworms?
Answer: This needs to be explained from two aspects. First, the impact on the pet itself. Dog tapeworms are common parasites in dogs. Adult worms can reach 10-15 cm in length. Fleas in dogs and cats are intermediate hosts. Mild tapeworm infections may not show obvious symptoms, but severe infections in puppies can cause loss of appetite, indigestion, abdominal pain, diarrhea or constipation, anal itching, and even death. Second, the impact on humans. When humans come into direct contact with infected tapeworms or fleas, it can cause human tapeworm infections. Tapeworms in humans...
Hypertension and other pregnancy complications can occur, and corresponding treatments should be provided. If the pregnant woman is not suitable to continue the pregnancy, early induced abortion can be performed. Measure uterine height and abdominal circumference to understand the size of the fetus and determine whether it corresponds to the gestational week. Pelvis, birth canal, and fetal position should also be checked to ensure normality. Listen to the fetal heartbeat, and if necessary, perform an ultrasound to understand the condition of the fetus in the uterus. This can determine whether the fetus develops well. If abnormalities are found, they should be corrected as early as possible. If unable to correct, an early delivery plan can be established to ensure maternal