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DIABETES

Hope for a cure for diabetes?

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On February 12, 2020, a study published in Science Translational Medicine showed that under laboratory conditions, the combined use of GLP-1RA and DYRK1A inhibitors can induce rapid proliferation of human beta cells (5% -6%) And optimize the specificity of the drug β cell specificity, and has been validated in a squirrel model transplanted with human islet cells.Dr. Andrew F. Stewart, the principal of the study, said: “The synergistic effect of β-cell proliferation rate is much higher than the previous effect of using DYRK1A inhibitor alone, and it is possible to recover type 1 diabetes (T1DM) and T1DM to a certain extent.Normal β-cell function in patients with type 2 diabetes (T2DM). Previously, researchers believed that ‘β-cell proliferation’ was impossible to achieve, and it became ‘possible, but not fast enough’ by 2015, and now it has ‘yes’Probably fast enough ‘”.Method exploration: radical treatment of diabetes. Diabetes affects 422 million people worldwide, and the prevalence is still increasing year by year. All or part of the disease is caused by insufficient numbers of beta cells in the islets. For example, beta cells in T2DM patients have decreased.From 40% to 60%, beta cells in T1DM patients are reduced by 70% to 97%.Enabling islet β-cell proliferation is a key strategy in the treatment of diabetes. Researchers have tried a variety of alternative therapies to radically improve diabetes (such as islets, islet cell transplantation, stem cell therapy, etc.), but currently only pancreas transplantation is available clinically,Considering the risks of surgery and the large number of patients, the percentage of patients who can really benefit from them is very small, and patients undergoing transplantation also have to use immunosuppressants for life.Drug promotion of β-cell proliferation is a new research direction.If the drug can increase the number of beta cells, it may improve insulin secretion levels.But under natural conditions, mature beta cells can hardly increase their number through self-replication and proliferation.In 2015, an article published in the journal Nature Medicine stated that oral DYRK1A inhibitors can increase human β-cell proliferation by 2%.Later, as more research results came out, the DYRK1A inhibitor family received more and more attention.Why choose GLP-1RA in combination with DYRK1A inhibitor?In recent years, DYRK1A inhibitors (harmine, INDY, leucettine, GNF4877, 5-iodotubericidin, CC-401) have been shown to induce human β-cell proliferation, but at a slower rate.In addition, because related receptors and signal molecules are ubiquitous in humans, the specificity of drugs to human β cells is not strong. Therefore, it is urgent to find a method that can accelerate the proliferation of β cells and increase the specificity of drug β cells.GLP-1RA is widely used worldwide as a new type of hypoglycemic drug. Although GLP-1RA cannot induce human β-cell proliferation, its receptor, GLP-1R, has a limited distribution in humans, but is highly expressed in β-cells.Therefore, such drugs have significant β-cell specificity.Considering the superior β-cell specificity of GLP-1RA, and its safety has been affirmed in long-term clinical applications, researchers have selected GLP-1RA and DYRK1A inhibitors as a combination to explore.The synergistic effect of the drug combination is encouraging. The researchers obtained human islet cells from 111 non-diabetic corpse donors and 11 T2DM corpse donors.Beta cell proliferation in a cell culture environment.Finally, dose-dependent β-cell proliferation effects were observed, and the drug combination also increased the β-cell specificity of the drug.”Surprisingly and happily, we found that human islet beta cells have a high replication rate of 5% to 8% per day, some even as high as 20%,” said Dr. Andrew F. Stewart.Synergistic effect was confirmed in a mouse model of diabetes. The combined application of GLP-1RA and DYRK1A inhibitors not only enhanced human islet β-cell proliferation in cell culture, but also against diabetes induced by streptozotocin and transplanted human islet cells.In the study of the mouse model, it was observed that the combination therapy can induce the proliferation of human islet β cells, as well as the improvement of insulin secretion and glycemic control.The class-effect researchers found that each of the DYRK1A inhibitors tested in combination with GLP-1RA showed similar synergistic abilities to promote β-cell proliferation, as did GLP-1RA.This indicates that both DYRK1A inhibitors and GLP-1RA have a drug effect, that is, any member of the GLP-1RA family (exenatide, liraglutide, lixisenatide, somaglutide) and DYRK1AAny combination of members of the inhibitor family can show similar synergistic effects.What’s next?In tissue culture, human islet β cells can only survive for about a week, but if transplanted into mice that have lost immune function, human islet β cells can survive for one year or longer.”The next step is to conduct a long-term study to assess how long the drug combination can have a proliferative effect on beta cells. If this proliferation is terminated after discontinuation of the drug, it will have adverse effects on other organs.Observe the function of human pancreatic islet beta cells in mice. “Later, researchers will demonstrate the preclinical safety of the drug combination in animal models to determine that this medication will not affect the liver, muscle, spleen or other organs.Cause damage and determine the optimal dosage.Summary of this article.
Enabling islet β-cell proliferation is a key strategy in the treatment of diabetes. This study shows that GLP-1RA and DYRK1A inhibitors have a synergistic effect, on the one hand, it can stimulate the rapid proliferation of human islet β cells, and on the other hand, it improves the drug’s β cellsSpecificity, this synergistic effect was confirmed in a mouse model of diabetes.Moreover, it was also found that there is a class effect of the drug, that is, any member of GLP-1RA combined with any member of the DYRK1A inhibitor can show similar effects.The researchers said: “For patients with diabetes who need to inject insulin for life, the proliferation of beta cells was once thought impossible, but now we see greater hope. Although there is still a long way to go in the future,We are full of confidence in the future. “The above content is only authorized for exclusive use by 39Health.com, and please do not reprint it without the authorization of the copyright party.

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DIABETES

Faced with the new crown pneumonia epidemic, how should gestational diabetes patients respond?

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Maternal is a susceptible group of virus infections. It is the susceptible group of 2019-nCoV, which is more prone to complications and even progresses to severe cases.In turn, neocoronavirus pneumonia has a certain impact on pregnancy. Infection and fever during early and middle pregnancy have some adverse effects on the fetus. Therefore, pregnant women need to take appropriate protection to prevent neocorona pneumonia and protect the health of the mother and fetus.Diabetes is also a key group we have always emphasized. In the special period of the new crown virus epidemic, patients with diabetes or pregnancy or gestational diabetes (the first time that impaired glucose tolerance or diabetes is found during pregnancy), what precautions should be taken apart from daily protection??The following aspects are worthy of attention.Dietary arrangements The diet of gestational diabetes patients during pregnancy must not only ensure the energy needs of pregnant women and fetuses, but also maintain blood glucose in a normal range. Combined with the relevant dietary recommendations issued by the Health and Health Committee and the Nutrition Society, give some suggestions to gestational diabetes patients.1. Thickness and thinness: It is recommended to increase the proportion of cereals and mixed beans in staple foods. These relatively low glycemic index ingredients help stabilize blood sugar.2. Fruit and vegetable benefits: increase the intake of vegetables and fruits, try to ensure that there are vegetables in the meal, dark vegetables account for half.Fruits need to control their intake. You can choose more citrus, on the one hand, it helps to supplement vitamin C, and it is also a good source of folic acid.3. Meat, eggs and milk: Supplement high-quality protein foods, high-protein diet has a strong feeling of fullness, which is conducive to controlling appetite and enhancing resistance.Ensure daily intake of meat, eggs and dairy foods, but not excessive.4. Weight control: One of the criteria for measuring the adequacy of nutrition during pregnancy is weight. However, although one person eats two people’s food, it is not advisable to overfeed. It is not good to be overweight or underweight.The weight of early pregnancy should not be significantly increased. After mid-pregnancy, the weight gain should not exceed 1 kg per week. If there is obesity during pregnancy, weight control needs to be more stringent.5. Small meals and multiple meals: In view of the physiological characteristics of pregnant women, it is recommended that small meals and meals be made while ensuring that the total energy throughout the day is appropriate. You can add two additional meals based on three regular meals and make corresponding diet arrangements.Meals in order of vegetables-meat-staples.For meals, you can choose fruits or dairy products, nuts and other foods.For gestational diabetes patients injected with insulin, do not delay eating, do not deliberately diet, and avoid the occurrence of hypoglycemia.6. Moderate amount of water: Drink 7-8 cups of water daily. It is recommended to choose boiled water. It is not advisable to choose sugary drinks and drink less fruit juice.Exercises suggest that pregnant women should take appropriate exercise. Exercises are more important for patients with gestational diabetes and help maintain a stable blood sugar. During the outbreak, there are the following exercise suggestions.1. Persist in exercise: When there is no special requirement (such as a doctor’s request for bed rest, etc.), at least 30 minutes of exercise should be guaranteed every day. It is recommended to take a walk for 20 minutes at home after meals.2. Ensuring exercise volume: Studies have shown that, in terms of the number of exercise steps per day, blood glucose control is better for patients with gestational diabetes who have an exercise volume of 6000 steps or more per day compared with less than 6000 steps.3. Form of exercise: In the epidemic of new crown pneumonia, avoid going to crowded places, so try to exercise at home.For pregnant women, a reasonable form of exercise is also very important. It is not appropriate to choose a type of exercise that requires breathing. Indoor circle walks are recommended. In addition, some soothing upper limb-based gymnastics can also be considered.4. Outdoor activities: Compared with home sports, outdoor sports fields are wider and can also be exposed to sunlight to help supplement vitamin D.Therefore, if conditions permit, outdoor sports can be properly carried out under the premise of good protection and should be carried out in an open and ventilated environment.You can choose to take a walk, etc. It is not suitable to participate in collective projects. It is recommended to take protection when you go to the sports ground. You must wash your hands and change your outerwear in time after returning home after sports.Surveillance matters On the one hand, patients with gestational diabetes should do a good job of monitoring during pregnancy, and on the other hand, do a good job of monitoring blood glucose. Because of the impact of the epidemic, strengthen relevant self-monitoring at home.Monitoring during pregnancy: Pay attention to monitoring changes in body weight and blood pressure, as well as fetal movement, abdominal pain, vaginal bleeding, etc. If abnormal conditions occur, such as dizziness, headaches, blurred vision, shortness of breath, increased blood pressure, vaginal bleeding or bleedingFluid, abnormal abdominal pain, abnormal fetal movement (fetal movement less than 6 times within 2 hours), etc. or other signs of childbirth should seek medical treatment in a timely manner.But it is also necessary to minimize the number of unnecessary visits, do a good job of self-monitoring, and achieve online consultation.Blood glucose monitoring: In special periods, the lifestyle habits of gestational diabetes patients change, and regular diet and exercise are disrupted. Therefore, blood glucose monitoring should be strengthened.Diabetic pregnant women and patients with gestational diabetes need to monitor blood glucose for half an hour before and 2 hours after a meal. If the blood sugar is too high or too low, it is not good. Wash your hands with soap and running water before monitoring blood sugar.It is recommended to monitor the blood glucose level for a week and then conduct an online consultation. If the blood glucose has been adjusted poorly (diet, exercise, etc.), you need to seek medical help in time.Epidemic surveillance: pregnant women should also monitor their body temperature daily for any suspicious symptoms of the new coronavirus pneumonia, such as fever (temperature above 37.3 ℃), cough, sore throat, chest tightness, dyspnea, fatigue, diarrhea, conjunctivitis, musclesSoreness, etc., and I have travel history, residence history or close contact history with suspected and confirmed patients within 14 days of the epidemic-prone area. I need to go to a designated medical institution for medical treatment as soon as possible, and I need to take protective measures.Mental health.
Finally, it should be mentioned that the increased risk of anxiety and depression in pregnant women, and the impact of the new crown epidemic, are more prone to psychological problems. It is recommended that gestational diabetes patients listen to soothing music and ensure adequate sleep, and their families will give them sufficient care, To help them eliminate bad emotions in a timely manner, and if necessary, timely seek help from a relevant professional doctor.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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Blood sugar fluctuates during epidemic situation, how to prevent hypoglycemia in diabetic patients

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In the past month when people were separated from their homes, many people have entered the lifestyle of eating with “fate” and zero exercise.However, this poses considerable risks for people with diabetes.In such a situation of “more food and less exercise”, many sugar friends began to consciously control their intake of each meal and try to avoid excessive blood sugar.The common complication of hypoglycemia is often overlooked by patients.At home, the epidemic prevention is more prone to hypoglycemia. Patients with diabetes must strictly control diet and exercise to ensure the stability of blood glucose.However, as the home stays longer and longer, the amount of activity decreases sharply, and for a long time at home, it is prone to irregularities in work and rest and irregular eating.Such lifestyle changes make the blood sugar of patients with diabetes prone to fluctuate, and the risk of hypoglycemia is greatly increased.In particular, older patients with diabetes have poor ability to regulate blood glucose, prone to blood glucose virus, asymptomatic hypoglycemia, night hypoglycemia, etc., and may be life threatening.How to prevent hypoglycemia during the epidemic?1 Strictly do a good job during the blood glucose monitoring epidemic, patients are not convenient to consult the hospital, you can choose an endocrinologist to conduct online consultation.In daily life, blood glucose is recorded regularly every day, especially for patients who use insulin.Once fluctuations in blood glucose are found, communicate with the doctor in a timely manner and take corresponding measures.2 The use of hypoglycemic drugs with a lower risk of hypoglycemia has been issued by the National Medical Insurance Bureau on February 6th. During the epidemic prevention and control period, a “long prescription” reimbursement strategy can be implemented. Patients with chronic diseases such as hypertension and diabetes will be evaluated by a doctorThe amount of prescription medication can be relaxed to 3 months to protect the long-term medication needs of patients with chronic diseases during the epidemic.Under the “long prescription” policy, diabetic patients should adjust their medication regimens and choose hypoglycemic drugs with lower risk of hypoglycemia and higher safety.3 Avoid anxiety emotions Emotional fluctuations may affect blood glucose control, especially during an epidemic, if anxiety, worry, depression and other emotions appear, you can try to divert attention, or seek family and friends to ease the negative emotions.

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DIABETES

For stable blood sugar control, follow these five dietary principles

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Early diabetes mainly refers to the state where the patient’s blood glucose value is slightly higher than normal. It is usually characterized by fasting blood glucose and postprandial blood glucose abnormalities. It is a good thing if you find diabetes early.There are still ways to save it. The most important point is to pay more attention to the usual diet. The following take you to understand the principles of diet for the early symptoms of diabetes?The principles of diet for the early symptoms of diabetes follow: 1. Choose staple foods with a lower glycemic index: The amount of staple foods eaten by early diabetic patients must be controlled. It is recommended that you eat more coarse grains because the sugars in the coarse grains are very small.After eating this kind of staple food, you can fill your stomach and not raise your blood sugar. If your blood sugar is controlled, your condition will be stable.2. Control the proportion of diet: The diet control mentioned here is not to let everyone not eat at all. It is not possible to starve for a long time. Not only will people become thinner and less resistant, but they will also aggravate the condition of patients with diabetes.Diabetes patients should reasonably arrange the total calories, protein, fat and carbohydrates that they consume daily on the advice of a doctor. This is called diet control.3. The eating time must be fixed and the type must be stable: everyone must have a fixed time for three meals a day to form a certain rule, and the type of food must be more and stable, and the number of snacks must be controlled as much as possible.Try not to eat.4. Avoid spicy foods: Early diabetic patients should not eat spicy and irritating foods, eat more gluttony, hunger, thirst and drink more, Yin deficiency-based foods, spicy and irritating foods will easily increase fever.The phenomenon.5. Stay away from tobacco and alcohol: Alcohol is hot, and patients with early diabetes will directly interfere with the normal metabolic function of the human body and aggravate the disease. The alcohol in alcohol can accelerate the metabolism of hypoglycemic drugs taken by diabetic patients, and the half-life of the drug is obviousShorten, this will affect the effect of reducing blood sugar.The principles that diabetes needs to follow in the diet are relatively strict. For the sake of your health, I hope that everyone can follow these principles in the diet after discovering that their blood sugar is elevated. Eventually, they will be able to control the blood sugar very well. Some serious complicationsThe disease will not appear for the time being.

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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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2020IWGDF: 17 recommendations for diabetic foot diagnosis

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The global burden of diabetes has increased rapidly over the past decade.Since 1980, the number of patients with diabetes has tripled, and the severity of diabetes-related complications has received increasing attention. For example, diabetic foot is one of the main causes of non-traumatic amputations.Since 1999, the International Working Group on Diabetic Foot (IWGDF) has been developing evidence-based guidelines for the prevention and management of diabetic foot disease.At the beginning of 2020, the IWGDF updated the relevant content of diabetic foot diagnosis. The relevant content is organized as follows for your reference.1 Regardless of the presence or absence of foot ulcers in diabetic patients, they are screened annually for peripheral arterial disease (PAD), including related medical history collection and palpation of the dorsal foot artery.(GRADE evaluation system: strong; quality of evidence: low) Compared with patients without diabetes, PAD characteristics of patients with diabetes are as follows: 1) more common, 2) also affect young individuals, 3) often bilateral or moreLesions of the branch, 4) distal involvement, 5) higher degree of intravascular calcification, 6) faster progress and higher risk of amputation.2 According to the related medical history and palpation of the dorsal foot artery, all patients with diabetes and patients with foot ulcers will be examined clinically to determine the presence of PAD.(Strong; Low) 3 For most diabetic patients with foot ulcers, PAD cannot be completely ruled out by clinical examination. Doppler arterial waveform examination is required to measure bilateral ankle systolic blood pressure and bilateral ankle brachial index (ABI).Or measure toe systolic blood pressure and toe brachial index (TBI).There is no single way that proves to be optimal, and there is no established threshold that can be used to reliably exclude PAD.However, most PADs can be excluded when the ABI index ranges from 0.9 to 1.3; TBI ≥ 0.75; and the dorsal foot artery Doppler waveform appears as a three-phase wave.(Strong; Low) 4 Perform at least one of the following bedside tests on the patient. Any one of them can help the doctor increase the probability of predicting the cure of ulcers by 25%. These tests include skin perfusion pressure ≥40mmHg and toe pressure ≥30.mmHg or transdermal oxygen pressure (TcPO2) ≥25mmHg.(Strong; Medium) 5 For patients with diabetic foot ulcers and PAD, the classification of wounds, ischemia, and foot infections (WIfI) is used to classify the management of amputation risk management and revascularization.(Strong; Medium) 6 Always consider emergency angiography and revascularization for diabetic foot ulcer patients with ankle pressures <50mmHg, ABI <0.5, toe pressure <30mmHg or TcPO2 <25mmHg.(Strong; Low) 7 Regardless of the results of bedside examinations, if patients with ulcers are given good care but cannot be cured within 4-6 weeks, consideration should be given to timely angiography.(Strong; Low) 8 Regardless of the results of the bedside examination, if the ulcer does not heal within 4-6 weeks despite being given the best treatment, it is necessary to consider the timely revascularization of patients with diabetic foot.(Strong; Low) 9 Diabetic microangiopathy should not be considered as the cause of poor healing in patients with diabetic foot ulcers. Other possibilities that may cause poor healing should be considered.(Strong; Low) 10 When lower limb vascular reconstruction is required, the patient's anatomical information can be obtained using any of the following methods: color Doppler ultrasound, computed tomography angiography, magnetic resonance angiography or intra-arterial digital subtractionAngiography.The entire lower extremity arterial circulation needs to be assessed, especially the anterior and posterior lateral and knee and ankle arteries.(Strong; Low) 11 When revascularizing patients with diabetic foot ulcers, the goal is to restore at least one foot vessel, and preferentially select the foot artery that directly supplies blood flow in the area of ​​the arterial ulcer.After surgery, evaluate its effectiveness and objectively measure the amount of perfusion.(Strong; Low) 12 Open or hybrid revascularization technology is superior. There is insufficient evidence to confirm which method of revascularization is more advantageous, based on the patient's PAD level, availability of autologous veins, patient comorbidities and local doctors.Level of expertise, etc.(Strong; Low) 13 Any center that treats diabetic foot ulcers should have appropriate professionals who need the expertise required for diagnosis and can diagnose and treat PAD in a timely manner. They can perform intravascular techniques and surgical bypass surgery.(Strong; Low) 14 Ensure that patients with diabetic foot ulcers undergoing revascularization surgery receive a multidisciplinary treatment team as part of a comprehensive care plan.(Strong; Low) 15 Emergency assessment and treatment of patients with the following symptoms or signs: PAD and patients with signs of foot infections because of their high risk of amputation.(Strong; Medium). 16 For patients with poor risk / benefit ratios and low probability of success, revascularization should be avoided.(Strong; Low) 17 All patients with diabetes and ischemic foot ulcers should be actively managed for cardiovascular risk factors, including smoking cessation, antihypertensive and prescription statins, and low-dose aspirin or clopidogrel.(Strong; Low) 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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Which dairy products are healthier?

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1 Milk Cheats: Familiar and unfamiliar, do you drink milk? Have n’t you seen cow running, have n’t you ever drank milk?U.S. guidelines recommend that adults and children 9 years or older need to consume 3 servings of milk, cheese, yogurt, or other dairy products per day, 8 ounces (237mL) per serving.This standard can meet the human body’s nutritional requirements for calcium and reduce the risk of fractures, but the health effects of large intakes of dairy products are still unresolved. Some people even worry that too many dairy products may cause adverse health consequences.Therefore, it is necessary to fully evaluate the role of dairy product intake in human nutrition and disease prevention.A recent review published in NEJM comprehensively elaborated the relationship between milk and human health from multiple perspectives, such as the composition of dairy products, the role of dairy products in growth and development, the relationship between dairy products and bone health, and the risk of fractures [1,2]].Milk is originally a food for young mammals, which can provide it with suitable ingredients and a variety of anabolic hormones.In order to increase milk production, milk produced by cows may contain higher levels of insulin-like growth factor-I (IGF-I); at the same time, because cows are basically pregnant, progesterone, estrogen andOther hormone levels will also be higher.In addition to milk, various dairy products have been invented.For example, cheese, yogurt, and other dairy products made by fermentation may cause peptide hormone denaturation, protein antigenicity changes, reduced lactose content, and changes in flora composition during the production of these dairy products. Buttering can also be used to separate butterFor low-fat dairy products and whey protein, vitamin A or vitamin D can be added during processing, which also changes the nutritional content of dairy products.Dairy products from cows and other mammals have always been part of the traditional diet of Westerners, and milk has gradually become a part of many people’s daily lives in China.But do you really drink milk?Next, let’s take a look at what has been said in the recent “Cheat Drinking Chess” published by NEJM!2 Comprehensive inventory: From growth and development to the risk of deathIn addition, dairy products are not essential. If you can fully supplement vitamin B12 with very little intake of food of animal origin, or supplement vitamin D when the sun is not enough, you can also ensure that children do not consume dairy products.Normal development.In addition, in the case of sufficient nutrition, milk intake can also promote growth (It seems that the advertisement of drinking milk to grow tall does not deceive me …).Although it is not clear whether this result is due to specific amino acids, anabolic hormones, or other factors, as far as we know, a large number of branched chain amino acids such as leucine, isoleucine, andValine, which is the key to determining protein quality.The intake of branched chain amino acids can increase the effect of IGF-I-mediated growth hormone; at the same time, leucine can activate the mTOR pathway, promote cell replication, and inhibit apoptosis.However, it is important to note that faster growth and higher heights are not all good for health.Tall people have a lower risk of cardiovascular disease, but they have an increased risk of cancer, hip fractures, and pulmonary embolism.2 Do n’t drink too much, the more calcium you get, the more likely you are to fracture. The main reason people insist on drinking milk is to add calcium and meet bone health needs.However, the study found that countries with the highest milk and calcium intakes tend to have a higher risk of hip fractures.The relationship between the two may not be causal, and vitamin D may have an unclear and unclear effect on this result.Results from cross-sectional studies suggest that calcium intake may not be related to bone mineral density of the hip bone; prospective studies also do not seem to support the benefit of increased milk intake for hip fracture prevention.In fact, the current recommended milk intake in the United States is based on a calcium intake / excretion balance assessment study that included only 155 adults [7].The relationship between calcium supplementation and fracture risk is even more confusing, as many supplements contain both calcium and vitamin D, making it harder to assess the effects of calcium supplementation alone.The results of the meta-analysis found that calcium supplementation did not reduce all vertebral bone fractures, and even found that calcium supplementation participants had a higher risk of hip fractures [8].Do children need calcium supplements?It is also difficult to answer this question because children are growing.The US recommendation suggests that children between 4 and 8 years of age need 1000 mg of calcium per day, but the UK recommendation confirms that 450 to 550 mg is sufficient [4, 5].Cross-sectional studies in the United States have shown that taller people are more likely to fracture [9]. Calcium supplemented with milk may not be enough to offset the risk of fractures that grow taller; results from cohort studies also suggest that males drink an extra cup of milk a day during puberty and fracture their hips laterRisk increases by 9% [10].Therefore, the current evidence does not support a large intake of milk during puberty to prevent future fractures.In fact, fractures occur more frequently in countries or regions with the highest milk intake.3 Skimmed milk is as fat as full-fat milk. Although the US Department of Agriculture recommends low-fat milk for weight control, the results of the current study have not found that adults who choose low-fat milk have an advantage over full-fat milk in controlling weight..In children and adolescents, even low-fat milk intake has been found to be associated with greater long-term weight gain; the only option that may help control weight is to drink yogurt.The results of three large cohort studies showed that the intake of whole milk, low-fat milk, and cheese was not significantly related to changes in body weight, but the intake of yogurt was associated with a decrease in weight gain [11].This result may be the result of the improved intestinal flora composition of yogurt, but it may also be caused by the healthier lifestyle of participants who drink yogurt, and the specific mechanism behind it is still a mystery.4 Relationship between milk intake and blood pressure, lipids, and heart disease Milk contains more potassium, which may have the effect of lowering blood pressure. Low-fat milk is also included in the DASH diet, which is used to lower blood pressure.However, because Deshu diet recommends a low-sodium, high-fruit and vegetable diet, the role of low-fat milk in lowering blood pressure is uncertain.Compared with sugary drinks or other refined carbohydrates, milk may have a hypotensive effect; however, if milk is used instead of nuts, beans or whole grains, the effect may not be the same [12, 13].In terms of blood lipids, most suggestions are more inclined to low-fat dairy products, in order to reduce low-density lipoprotein cholesterol (LDL-c) levels by reducing saturated fat intake.Using carbohydrates instead of saturated fats can reduce LDL-c, but it may lead to reduced particles of high-density lipoprotein cholesterol (HDL-c) and LDL-c and increase inflammation indicators. Using unsaturated fats instead of saturated fats canAvoid these problems while LDL-c decreases [14-16].Dairy products themselves have no clear relationship with the risk of coronary heart disease or stroke, but the results are different when compared with different foods.Compared with red meat, whole milk and low-fat milk have a lower risk of coronary heart disease; but dairy products have a higher risk of coronary heart disease compared to fish and nuts.Compared with polyunsaturated fats or plant-derived fats, dairy products have a higher risk of cardiovascular disease; but if the diet contains high levels of carbohydrates, a moderate intake of dairy products can actually reduce the risk of cardiovascular disease.5 The relationship between milk intake and lower risk of type 1 diabetes remains unclear, and milk intake may be associated with lower risk of type 2 diabetes.Drinking milk has a lower risk of diabetes than drinking sugary beverages or fruit juices, but higher than drinking coffee [17].6 What is the relationship between drinking milk and cancer risk?Ingestion of dairy products is associated with the risk of prostate cancer, especially invasive or lethal prostate cancer [18, 19], but the impact on breast cancer risk is still controversial [18, 20], both of which may be related to IGF-I intake is related.The total intake of dairy products is associated with a higher risk of endometrial cancer, which may be related to the content of sex hormones in dairy products [21]; meanwhile, dairy product intake does not seem to be related to the risk of ovarian cancer [22];The calcium in the product may reduce the risk of colorectal cancer [20].Since almost all research on dairy products and cancer risk is currently conducted in middle-aged and elderly people, there is still a lot of room for exploration of the relationship between childhood or early adult milk product intake and future cancer risk.7 Allergies and intolerances Up to 4% of babies may be allergic to proteins in milk, which may cause nutritional problems [23].At the same time, milk intake may increase the risk of asthma, eczema, and food allergies [23, 24], and may also trigger asthma attacks and other related diseases after childhood [25, 26].The use of hydrolyzed protein formula may help alleviate the risk of allergic diseases and eczema [27], lactose intolerance greatly limits milk intake, and the replacement of milk with soy milk may help alleviate lactose intolerance[28].8 Overall risk of death The relationship between dairy products and overall risk of death varies greatly with the specific types of milk and dairy products consumed and the foods compared to them.A meta-analysis of cohort studies restricting milk or dairy product intake has nothing to do with overall risk of death [29], but whole milk is associated with a higher overall risk of death [30].Depending on the source of the protein, using milk instead of processed red meat and eggs can reduce the overall risk of death, but dairy products replacing plant-derived protein can increase the risk of death. Dairy products and unprocessed red meat, poultry, and fishIn contrast, intake-related death risks are similar [31].3 Recommended guidelines: The guidelines are very different. The two authors of the review, Walter C. Willett, MD, DrPH, and David S. Ludwig, MD, PhD are from the Harvard-Chen Zengxi School of Public Health, and also work at Harvard Medical School., Brigham and Women’s Hospital, Boston Children’s Hospital, and more.After reviewing the nutritional content of milk and dairy products and their health effects, they also pointed out: Organic milk contains lower levels of IGF-I than traditionally produced milk, but has not studied and compared the effects of two types of milk onPeople’s health impacts; as the cows are fed with forage during organic milk production, the levels of n-3 polyunsaturated fatty acids and beta carotene may be slightly higher.At the same time, the issue of organic milk is not worth tangling. People should worry about the greenhouse gases and related climate change, water pollution, and antibiotic resistance in milk production.Regarding the problem of drinking milk in daily life, they think that the current goal of consuming 3 or more dairy products per day seems unreasonable..
The optimal milk intake per person is related to the overall quality of the diet.Children in low-income areas have lower dietary quality, so dairy products can obviously improve their nutritional status; for people with higher dietary quality, increasing the intake of dairy products may not bring obvious benefits, but they should worryHarm from excessive intake.In addition to milk intake, calcium and vitamin D can also be obtained from other foods.For example, calcium can be obtained from kale, broccoli, tofu, nuts, beans, and calcium-fortified orange juice; the cost of choosing a vitamin D supplement is much lower than drinking milk.After disagreeing with the current guidelines, the two authors also raised their own expectations for future guidelines.They believe that the recommended intake of milk and dairy products should be around 0 to 2 servings per day for adults to be more acceptable; low-fat milk should not be emphasized better than full-fat milk; high risk of being overweight or obese should be suggestedPeople don’t choose sweetened dairy products.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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How do endocrinologists fight the “epidemic” war in special times!

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Recently, the epidemic of the new crown pneumonia affects everyone’s heart, and doing a good job of prevention and control is the top priority of this “battle”.On February 7, the results of the New Coronary Pneumonia Case Study paper published in “JAMA” showed that 41.3% of patients were infected in hospitals [1], and patients with diabetes belonged to high-risk groups. How should endocrinologists take precautions?Professor Shi Yongzheng, director of the Department of Endocrinology, Shanghai Long March Hospital, and Professor Hu Bijie, director of the Department of Infectious Diseases, Zhongshan Hospital affiliated to Fudan University, gave a wonderful sharing.Question 1: According to recent data analysis, nosocomial infection is the main transmission channel of new coronary pneumonia. How should medical staff and patients in the endocrinology department protect themselves from risks?Professor Hu Bijie: To raise awareness, we must have practical prevention and control measures.The proportion of nosocomial infections in new crown pneumonia varies with different stages of epidemic development and disease awareness. The proportion of nosocomial infections in 41.3% of new crown pneumonia case studies published in “JAMA” is not constant.For respiratory, infectious, and fever clinics, the risk of serious nosocomial infections is relatively small because of the higher awareness of risk prevention.However, departments including the endocrinology department usually have lower risks, and the early symptoms of patients with neocoronavirus infection are hidden, and the autoimmune function of diabetic patients is weak, so clinicians must raise awareness of disease prevention and control.Raising awareness is not only a cognitive emphasis, but also needs to be accompanied by practical prevention and control measures, including the following four aspects.● Early identification of high-risk patients. For patients with cough and fever, even if they do not have an epidemiological history in Hubei and key regions, they should be recommended for CT and nucleic acid testing if necessary.● In principle, endocrinologists do not need to wear protective clothing when receiving consultations, but they need to wear masks, and minimize face-to-face communication with patients, patient visitors, and even other department doctors. If they do not wear masks, they should maintain 1A safe social distance above meters to effectively prevent droplet transmission.● Strengthen hand hygiene, wash your hands properly and use quick-drying liquid soap containing alcohol to reduce the mucosal contact and transmission of the virus.When washing your hands, pay attention to rubbing your palms, fingers, etc., which are more important than the back of your hands.● Avoid extra beds during the epidemic and reduce staff gathering.Professor Shi Yongzheng: For medical personnel, first of all, they must strengthen their awareness of self-protection, and secondly, identify patients with the possibility of new coronary pneumonia as soon as possible.From the perspective of the whole medical behavior, the following aspects are mainly included: ● The checkpoint is moved forward. When medical staff encounters a diabetic patient, they should pay more attention to the identification of new crown infection or suspected patients.● Set up triage and fever treatment area.Fever patients, even if new coronary pneumonia is ruled out, need to design a special area for treatment.● Strengthen measures and procedures for infection control according to national needs.● The operation in special areas should be more standardized and strictly disinfected.For example, patients with diabetes need blood drawing, clinical examination, blood glucose monitoring, etc. This is related to the problems of exposure and cross infection.● Increasing training on new coronary pneumonia related prevention and control, diagnosis and treatment knowledge (real-time update, combining online and practice).Professor Shi also mentioned that a case of diabetic ketosis accompanied by fever was encountered in an outpatient clinic recently. According to the above measures, triage was performed according to the fever, and he was immediately sent to the emergency room to contact an expert on new coronary pneumonia for further examination and analysis.After three tests were negative, eventually the possibility of new coronary pneumonia was ruled out.Question 2: In the analysis of death cases of new coronary pneumonia, many patients have diabetes mellitus. How to treat and manage blood glucose in patients with diabetes who have new coronary pneumonia?Professor Hu Bijie: Maintain normal immune function and be alert to hormone and antibiotic abuse.As we all know, the population is generally susceptible to the new coronavirus, but the elderly and people with underlying diseases (such as diabetes and COPD) are more susceptible and are more likely to progress to severe illness.On January 29, The Lancet reported that of the 41 patients infected with neocrown virus early in Wuhan, 8 had diabetes, accounting for 20% [2].Early identification and treatment of those who are prone to severe illness has become the focus of Shanghai New Crown Pneumonia experts when fighting the epidemic.One of the cores of treatment lies in maintaining the normal immune function of patients.First, it is necessary to maintain a good mentality and adequate sleep, and secondly to strengthen nutritional support. For some special populations, thymosin and gamma globulin may be given to improve their immune function.Last but not least, do not abuse glucocorticoids and antibiotics.High-dose glucocorticoids currently do not show clear benefits during the treatment of new coronary pneumonia. They can reduce fever in the short term, reduce C-reactive protein levels and inflammatory symptoms, but they will delay the elimination of the virus, which is unfavorable in the long run and may even beIncrease mortality.In addition, the abuse of antibiotics can cause intestinal microecological disorders, which also requires extra vigilance.Prof. Yongyong Shi: Assess the condition and stratify the target of blood glucose management.For the management of blood glucose in patients with diabetes combined with new coronavirus pneumonia, the Diabetes Division of the Chinese Medical Association refers to the “Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2017 Edition)” [3] and the “Consultation of Experts on Blood Glucose Management in Inpatients in China” [4], and “New Coronavirus Pneumonia Diagnosis and Treatment Plan (trial version 5 for trial) [5] drafted “Management Recommendations for Diabetes Patients Complicated with New Coronavirus Pneumonia” [6].Assess the condition at admission and then stratify goals for glycemic management (Table 1).(1) Young, newly diagnosed or short-term diabetic patients without chronic complications, low-risk groups with hypoglycemia, and strict control targets.(2) In elderly patients, who cannot tolerate hypoglycemia, who have organ dysfunction, or who have severe cardiovascular or cerebrovascular disease, the control targets are loose or average.(3) For patients with severe or critically ill coronary pneumonia, control targets are loose.(4) If the patient has a higher risk of hypoglycemia, it is recommended that individualized control goals be based on clinical conditions and comorbidities.Patients with a diabetes course of ≥15 years, a history of unperceived hypoglycemia, large fluctuations in blood glucose throughout the day, repeated hypoglycemia, severe complications or associated disease (such as liver and kidney insufficiency) are at high risk of hypoglycemia.Question 3: During the epidemic, everyone is encouraged not to go out or go to the hospital as much as possible. How to eliminate cold symptoms in diabetic patients? Do they need to go to hospital for treatment?Prof. Hu Bijie: Weigh the risks. Generally, you can temporarily observe the isolation at home.During the epidemic, it is really a “tangled” question whether a diabetic patient needs to seek medical treatment immediately. It is necessary to balance the risk of infection with the benefits of medical treatment. Especially the diabetic patients themselves are high-risk groups of infection. The treatment after infection is relatively complicated.At present, hotline telephones or Internet diagnosis and treatment channels have been opened in various places. If diabetic patients have symptoms such as cough and fever, they can consider online consultation first.For cases with no epidemiological contact history and no clustered cases in the family, the patient can be isolated at home (see the Home Isolation Prevention and Control Guide issued by the Chinese Center for Disease Control), and observe the condition 1 to 2 days after the cold treatmentProgress, if not aggravated, you can temporarily maintain home treatment, if aggravated, go to the hospital as soon as possible.This approach is an expedient measure in the case of limited medical resources and a more severe epidemic situation.Professor Shi Yongzheng: It is recommended that patients be comprehensively analyzed according to the epidemiological history and clinical manifestations in the 5th edition of “New Coronavirus Pneumonia Diagnosis and Treatment Program” [5].(1) Epidemiological history ● Travel history or residence history of Wuhan City and surrounding areas or other communities with case reports within 14 days before the onset of illness; ● Patients with new-type coronavirus infection (positive nucleic acid test) within 14 days before the onset of illnessContact history; ● Patients with fever or respiratory symptoms from Wuhan and surrounding areas or from communities with case reports in the 14 days before the onset of the disease; ● Aggressive onset.(2) Clinical manifestations ● Fever and / or respiratory symptoms; ● It has the imaging features of neo-coronary pneumonia; ● The total number of white blood cells is normal or decreased in the early stage of onset, or the lymphocyte count is decreased.Have any one of the epidemiological history and meet any two of the clinical manifestations.If there is no clear epidemiological history, it meets 3 of the clinical manifestations.It is a suspected case.If the symptoms are atypical, there is no history of exposure.That is, common cold, mild fever, and catarrhal symptoms. Patients are advised not to go to the hospital for treatment, drink more water at home, and take common cold medicine to solve it.If the fever is higher than 38.5 ℃, or the symptoms are more serious, you need to go to the hospital for treatment, but the risk of cross infection in large hospitals is greater. It is recommended that patients choose community hospitals, but also need to take out protection measures.Question 4: Diabetes patients need to take medication regularly, and they should not adjust the medication without authorization. If the patient’s postprandial and fasting blood glucose are not well controlled during the epidemic, in this case, what factors should patients consider when adjusting the treatment plan?Professor Shi Yongzheng: Analyze the cause and adjust the dosing schedule if necessary.The cause of poor blood glucose control must be found from the perspective of treatment. Is it because the current epidemic is tense, the doctor’s order is poorly implemented, and medication, diet, and exercise are not well done?If yes, remind the patient to do these 4 aspects: ● It is recommended that the patient take the medicine on time and according to the dose. If there is not enough medicine, you can order the medicine online to renew the medicine, especially some well-controlled and stable patients.A few days ago, the National Medical Insurance Bureau clearly implemented the “long prescription” reimbursement policy, and the prescription dose for patients with diabetes was relaxed to 3 months.● Do a good job of diet management. If the diet management is not good, or the patient is not self-disciplined, it is recommended to adjust the treatment and choose some drugs to reduce weight, such as metformin and GLP-1 receptor agonist.● Patients are advised to maintain a moderate amount of exercise. If outdoor sports are selected, software can be used to check whether there are patients with infections around them, and then select nearby or sparsely populated areas and take protective measures.● Launch online education, push WeChat and video, and provide psychological counseling to patients with high psychological pressure.If it is indeed due to the progression of diabetes, poor glycemic control, the patient should be adjusted in time to choose a drug treatment plan, choose a formulation that has a strong effect on reducing blood sugar, is safe, durable, and can control weight, such as the once-weekly GLP-1 receptor agonist dulaGlycopeptide [7]..
Summary During the epidemic, prevention of coronavirus infection is of paramount importance, especially for medical personnel exposed to high-risk risks, they must protect themselves; blood glucose management for diabetic patients should not be dropped, maintain good living habits, adhere to reasonable medication, and make timely adjustmentSafe, potent, and durable formulation.Work together to win an early battle without smoke.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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Diabetes prescriptions can be extended to 3 months during an outbreak!

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New types of coronavirus are coming, and people across the country are calling on residents to reduce travel and take precautions.In order to facilitate the treatment and treatment of patients with chronic diseases such as diabetes, 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 support medical institutions to rationally increase the single prescription medication according to the actual situation of patients.For patients with chronic diseases such as hypertension and diabetes, after evaluation by the doctors at the treating hospital, we support the relaxation of prescription medications to 3 months to protect the patients’ long-term medication needs.01 Long prescription policy, during the special period to ensure patients’ drug demand epidemic, the most important thing is not to go out, wear a mask, and wash hands frequently.Wearing masks and washing hands frequently is not difficult for diabetic patients. The introduction of a long prescription policy has greatly reduced the pressure for diabetic patients to go out and buy medicine.Diabetes patients are susceptible to this new type of coronavirus [1]. It is no exaggeration to say that every time a diabetic patient goes out comes with the risk of infection.Extending the prescription period can prolong the time interval for patients to go out to take drugs and reduce the risk of exposure.Most of the diabetic patients are middle-aged and elderly people. In the case of insufficient medicine, patients may reduce or even stop their medicines for the sake of “saving medicine”, which will greatly increase the risk of blood sugar runaway, especially for newly diagnosed patients.For patients with type 2 diabetes (T2DM), inexperienced drug reduction and withdrawal without the guidance of a doctor may have extremely serious consequences, and the long prescription policy also solves this problem.Under the long-prescription policy, does the management plan for patients with diabetes need to make adaptive changes?The answer is yes.An important principle for the management of diabetic patients is “individualization”. Short-term prescriptions can allow doctors to understand the patient’s situation in time when the patient is revisited, and adjust the prescription. After changing to a long prescription, the interval between the patients’ re-examination is extended, and the patientSelf-management has taken longer and longer, and prescriptions naturally need to be adjusted and changed accordingly.02 How should the insulin plan be formulated under the long prescription policy?The insulin prescription under the long prescription policy is particularly important because the insulin injection of T2DM patients is usually completed autonomously, so the type and dosage of insulin in the long prescription need to be fully considered.1 Long prescription insulin plan needs more simplicity!If the insulin injection plan is too complicated, it may be difficult for patients to remember the daily injection dose and time, resulting in missed injection and wrong injection. Therefore, a simple insulin plan and personalized prescription design become more important.Here and everyone introduce the first double insulin preparation-Deguer Aspartame, which consists of basal insulin (70% Deguer insulin) and meal insulin (30% insulin aspart) [2] (Figure 1), of whichExist independently of each other, and play different roles-insulin degu can smoothly control total sky abdominal blood glucose (FPG), and insulin aspart can quickly control postprandial blood glucose (PPG) [3, 4], which is physiological to the human body.Insulin secretion is more fit.In clinical use, Deguer aspartame can be administered once or twice daily with the main meal, can be administered alone, or can be used in combination with oral anti-diabetic drugs and meal insulin [5], which is easier to useflexible.According to the results of the Step by Step study [6], Degu Aspart’s double insulin 1-2 needles / day injection scheme is similar to the traditional basic-intensified regimen of 2-4 needles / day, suggesting that compared with the 2-4 needle basis+ Meal-strengthening plan. Under the premise of achieving the same therapeutic effect, Degu aspartame double insulin has fewer total insulin injections, fewer injections, and a more simplified scheme.2 Long prescription insulin needs to be closer to the patient’s lifestyle!With the outbreak of the new coronavirus, China is the main battlefield to fight the epidemic, and Chinese patients with diabetes are also the people most affected by the epidemic.Insulin prescription and diabetes management plan design are integrated, and it is necessary to comprehensively consider the patient’s living habits (mainly dietary habits) for reasonable planning and design.Figure 3 The increase in PPG in Chinese patients is greater, suggesting that postprandial glycemic control is worse. The hyperglycemia in the Chinese T2DM population is dominated by elevated PPG.Even after eating the same amount of carbohydrates, the post-prandial blood glucose increase in the Chinese population is more obvious than in the Western population [7, 8], and the PPG increase in Chinese T2DM patients is even greater, and more rapid PPG control and smooth FPG control are needed [9-11].During the epidemic, diabetic patients may face irregular meal times, while Degu Aspartame is only injected with the main meal (the meal with the most carbohydrate intake), and the scheme is more flexible.3 Long prescription insulin, effective sugar control, but also need to be safer!During the epidemic, diabetic patients control sugar at home. They also need to actively monitor and record their own blood sugar. If they find that their blood sugar fluctuates too much or the blood sugar is low, they should consult the online platform of a regular hospital or go to the hospital for treatment.The Onishi trial showed that compared with insulin glargine once a day (QD) regimen, Deguer aspartame double insulin QD has a higher blood glucose compliance rate for initial insulin treatment [12].The proportion of patients with HbA1c <7% and no confirmed hypoglycemia in Degu aspartame group was significantly higher than that in insulin glargine group.Deguer aspartame also has advantages in reducing the risk of hypoglycemia [12], providing patients with better choices.Based on the above points, Degu Aspart is close to physiological insulin secretion, the scheme is flexible and simple, suitable for the Chinese population, and has better safety. It is the preferred insulin preparation under the long prescription policy.03 Convenient pharmacy maps helped the introduction of the diabetes management long-term prescription policy during the epidemic, which solved the problem of prescribing medicine for diabetic patients during the epidemic, and reduced the risk of patients going out.But diabetic patients still face the problem of buying medicines during the epidemic ... Insulin preparations need to be transported by cold chain, and they also have strict requirements for storage conditions. Generally, pharmaceutical companies rarely stock up in large quantities.For diabetics, if you can quickly and accurately understand the inventory of surrounding pharmacies and do consultation in advance, you can buy medicines more safelyDrug inventory and business hours to avoid running short.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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High blood sugar, watch out for these four common diabetes complications

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Diseases such as diabetes are not very serious in themselves, mainly due to complications. Some diabetic patients know that they are sick and still do not pay attention to hypoglycemic treatment and peacetime diet. Finally, they find themselves suffering from many complications.But everyone is so anxious that they want to know what to do with complications of diabetes?Then look down.What should I do if I have diabetes complications?1. The feeling of palpitations and chest tightness is most likely that patients with cardiovascular disease and diabetes have no feelings at all. If you suddenly find yourself feeling panicky, chest tightness, shortness of breath, and accompanied by dizziness, sweating, pale and other discomfort symptoms, veryThere may be complications such as cardiovascular disease. At this time, you must go to the hospital for examination to avoid accidents.2. When the eyes look blurred, it is likely that everyone with retinopathy does not have good blood sugar control. The first damage is microvessels, and the blood vessels around the eyes are the most dense and rich, so that the retina will have lesions, and gradually the strength will be blurred untilFinally, I can’t see it at all. I hope that people with diabetes should check their fundus regularly and control their blood sugar.3. Cold pain in the lower extremity is likely to be caused by neuropathy. Once the diabetic patient finds that his lower extremity is cold, it is likely to be caused by neuropathy. At this time, go to the hospital for a doctor to check the nerve. If it becomes more severe, it will becomeDiabetic foot, even severe amputation is very troublesome, I hope everyone can control blood sugar.4. Diabetic bloating and constipation. Beware of autonomic nerve damage. Diabetic patients with poor blood sugar control will cause excessive sugar in the blood. If the gastrointestinal autonomic nerve is damaged, it will cause gastrointestinal disorders and bloating and constipation.At this time, you need to take medicine for constipation and bloating under the guidance of a doctor.What should I do if I have diabetes complications?Different patients may have different periods of complications and symptoms. I hope that patients with diabetes can keep these basic knowledge in mind and take corresponding measures when they find that they have complications. Some complications can be reversed.

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