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DIABETES

When diabetes suffers from new coronary pneumonia, the most terrible thing is actually this complication …

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In the past two months, the new coronavirus has swept across the country. As of 24:00 on February 16, 2020, more than 70,000 cases have been confirmed nationwide, including as many as 10,644 critically ill patients.Patients with chronic diseases such as diabetes, obesity, and hypertension have become susceptible to the new crown virus due to poor autoimmunity [1], but it is not only the virus that plagues patients with diabetes, but also various emergencies during the epidemic… [Case Express] Patient, male, 62 years old.He was admitted to hospital with “cough and fever for 1 week” with “suspected pneumonia of new coronavirus infection”.He had a history of hypertension and type 2 diabetes (T2DM) for 8 years.He usually took riglitazone and acarbose for hypoglycemic effect. In the past 3 days, due to poor blood glucose control after lung infection, he himself added glibenclamide / metformin tablets to control blood sugar.Examination BP: 148 / 90mmHg, obesity, smell of wet lungs and wet rales, heart rate of 61 beats / min, occasional premature beats.Depressive edema below the knee joint of both lower limbs.Extremities muscle strength and muscle tension were normal, and pathological signs were not elicited.Seeing admission symptoms: cough, fever, fatigue, shortness of breath, normal diet, thin stools.Four hours after admission, the patient suddenly developed unresponsiveness and drowsiness.Random blood glucose was checked at 2.68 mmol / L, laboratory tests: serum creatinine 147.9 μmol / L ↑, ALT 48 U / L ↑, AST 66 U / L ↑.The fingertip blood glucose fluctuated between 1.3-3mmol / L, and glucose could not be corrected by eating and intravenous bolus injection. The insulin release index was 0.17.After continuous administration of intravenous glucose for 48 h, the blood glucose level rose back to about 10 mmol / L and the symptoms disappeared.Excluding other disease factors, consider the severe hypoglycemia caused by the accumulation of glibenclamide caused by renal insufficiency.Fortunately, the patient was hospitalized at the time of the onset of the disease, and timely treatment was used to correct the hypoglycemia.If the patient is at home when the symptoms appear, the consequences are unknown … // 1 // Pay attention to the epidemic and don’t ignore hypoglycemia!1 Hypoglycemia is a potentially serious complication of diabetes. For diabetic patients, intensive glycemic control and prolonged disease duration will gradually increase the risk of hypoglycemia (Figure 1).At the same time, hypoglycemia is also the main obstacle for T2DM patients to reach blood glucose control standards [2]. Hypoglycemia is often accompanied by blood glucose variability and persistent hyperglycemia [3].Severe hypoglycemia may induce cardiovascular death, and a single hypoglycemia may also offset the benefits of maintaining a normal blood glucose in the patient’s life (Figure 2) [4].2 Inconvenient medical treatment during the epidemic, it is difficult to treat severe hypoglycemia. From the above case, we can see that only 4 hours after the patient was admitted to the hospital, the symptoms of “hypoglycemia, lethargy” hypoglycemia occurred and could not be corrected by eating.Imagine if the patient had a hypoglycemia at home, and due to lack of travel control and emergency resources during the epidemic, there was no way to rush to the hospital for emergency treatment in time, and the consequences could be unimaginable.Persistent severe hypoglycemia can lead to loss of consciousness in the patient, causing permanent nerve damage.If hypoglycemia is not corrected in time, it can even lead to persistent vegetative states [8] and death [2].If the harm of hyperglycemia is calculated on an annual basis, the harm of hypoglycemia needs to be calculated in minutes.3 During the epidemic, patients at home are more likely to develop hypoglycemia!During the epidemic, in order to meet the needs of epidemic prevention, the home time of diabetics gradually prolonged, the outing activities decreased sharply, and even irregular diet may occur.These lifestyle changes may increase blood sugar fluctuations in people with diabetes.For T2DM patients, especially older patients (over 70 years of age), hypoglycemia is often accompanied by large blood glucose fluctuations, and the increase in blood glucose fluctuations also makes patients prone to asymptomatic hypoglycemia, severe hypoglycemia andNocturnal hypoglycemia [3].In this special period, in addition to calling on patients to reduce their travels, protect them, and not give the virus a chance, how can they help patients prevent and control hypoglycemia in the management of patients with diabetes?// 2 // Prevent and control hypoglycemia during the epidemic, and communicate with patients!During the epidemic, if the patient is not convenient to go to the hospital for consultation, the endocrinologist can communicate with the patient in time through communication tools such as online consultation, text message, WeChat, etc., and the blood glucose alert value (Table 1) and related symptoms (Table 2) related to hypoglycemia.), Remind patients to perform self-blood glucose monitoring (SMBG) in a timely manner, especially for patients using insulin, SMBG needs to be performed at least 3 times a day and timely recording [2].On the one hand, strict self-glycemic monitoring records can help patients to find out whether they have hypoglycemia. On the other hand, the patient’s blood glucose fluctuation can estimate the risk of hypoglycemia [3], and provide targeted reminders.// 3 // Reasonable prescription for drugs with low risk of hypoglycemia and reduction of blood glucose fluctuations. On February 6, the National Medical Insurance Bureau proposed that during the epidemic prevention and control period, a “long prescription” reimbursement policy be implemented to propose chronic diseases such as hypertension and diabetes.Patients, after evaluation by the doctors at the diagnosis and treatment hospital, support the relaxation of prescription medication to 3 months to ensure the long-term medication needs of the insured patients.Under the long-prescription policy, it is very important for the management of diabetic patients to rationally choose a sugar control program with lower risk of hypoglycemia and higher safety.1 Glucose-like peptide-1 receptor agonist (GLP-1RA), a new type of hypoglycemic drug with a longer-lasting glucose control effect, can improve blood glucose of patients through multiple mechanisms and achieve long-term glucose control [10].Laluotide is taken as an example. The LEAD series [11-17] studies have confirmed that liraglutide can effectively improve the glycated hemoglobin (HbA1c) of patients by 1.1% -1.6%, and long-term treatment can control blood glucose levels. After 2 years of treatment,It can obviously control the HbA1c of patients, and the hypoglycemic effect is obviously better than the traditional hypoglycemic oral drug glimepiride, which is more suitable for long-term prescription.2 The use of the LEAD series of hypoglycemic drugs with low risk of hypoglycemia has also confirmed that the incidence of mild hypoglycemia of liraglutide is significantly lower than that of glimepiride (P <0.0001) [13];No risk of severe hypoglycemia was reported with thiazolidinediones [14]; the incidence of hypoglycemia was lower in the liraglutide-treated group than in the exenatide-treated group, which is also GLP-1RA (P = 0.0131) [16].In addition, the results of the LEADER study published in 2017 [18] showed that liraglutide significantly reduced the risk of severe hypoglycemia in T2DM, and the number of patients with severe hypoglycemia in the liraglutide treatment group decreased during the study period compared to the placebo group.31%, and this decrease is statistically different.to sum up:. At the critical period, "strive for peace"!In the management of diabetes during the epidemic, in addition to reminding patients to reduce going out and strengthen protection, attention should also be paid to the management of acute complications of diabetes such as hypoglycemia.The new hypoglycemic drug GLP-1RA liraglutide effectively reduces the incidence of severe hypoglycemia events on the basis of effectively reducing patients' HbA1c and achieving long-term stable glucose control without increasing the risk of mild hypoglycemia events, and the dose adjustment method is simple,Suitable for long-term prescriptions during an outbreak.Liraglutide successfully renewed the nationally negotiated drug list in 2019, and was reimbursed in accordance with Class B drugs, which was implemented on January 1, 2020.Serve the majority of patients at a lower price.For patients with long-term home-controlled glucose, liraglutide is the preferred hypoglycemic agent in the prescription.The above content is only authorized for exclusive use by 39Health.com, please do not reprint without the authorization of the copyright party.

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