Old Chen Jingren introduces candy friend of 63 years old, come be in hospital.
Had been the Laochen of 15 years of candy age, still meet with me for the first time. It is to give probably sufficient introducer feelings, also be the first time interrogation to me is interested probably, stable lived to come down here. This has been the thing 10 days ago.
Laochen is a chunk head, the height of 170cm, the weight when be in hospital has 98kg unexpectedly, waistline has 114cm, attentive Dr Yang was calculated his BMI, it is 33.9kg/m2. Laochen says tastily, "It is to give or take an injection those who hit, abdomen smooth circle " " .
The circle that insulin injects, hint diabetic education holds the post of heavy and the path is far
The course of diseases that is in 15 years so, insulin is holding dominant from beginning to end, what use nearly 3 years is door winter insulin 30 inject fluid, everyday morning and evening 20 units. Blood sugar is bad, weight went up again many jins 10, blood pressure also becomes special control hard. The blood pressure when be in hospital is 170/113mmHg actually, it is 3 class hypertension.
I place the point of view that understands me above all: If diabetic cure makes fat fatter, thin thinner, although blood sugar is good, also be failing mark.
He seems to be very interested in this word.
Original fat bodily form, increased one annulus again, this is of obvious. So whether is blood sugar good? The saccharify after be in hospital checks a result 8.4% , only to 63 years old, still do not consider the candy that going up is old age friendly, it is unfavorable control result apparently very.
Next I asked about a very serious problem: Whether to have hypoglycemia?
Because of insulin and sulphur Niao kind be more incidental hypoglycemia, and of hypoglycemia preventive dine or treat a gender to dine, often the mainest factor of gain weight. And the risk that use insulin produces hypoglycemia, it is with mixing insulin beforehand again most. (see figure below)
Laochen gain weight, whether true related to this?
Through the inquiry, my guess got test and verify: Laochen often felt at 11 o'clock in the morning want to have a thing very much, before sleeping, also be such, still have nightly 1-3 dot a few times to awake suddenly flustered, give cold sweat. Actually, these moment are the time of hypoglycemia easy hair that mixes insulin beforehand.
Regrettablly he did not measure blood sugar.
Can that do how?
"I want to stop your insulin " , my mood follows sturdy. I see shine suddenly in his eye, say then, "But you must be done according to what I say " .
Diabetic diagnosis and treatment is a center with the patient, this is the spirit of the guideline, can I let a patient must listen to me how?
This is a kind of bully gas, but in a few moment, be confidence of can sturdy patient. "Doctor so know how things stand and feel confident of handling them is angry, affirmative travel " .
Face bemused young doctor, my what I reiterate idea:
Friendly to fat candy, should choose not to increase weight to reduce the medicaments of weight even as far as possible on cure. This patient is fat, BMI33.9, if do not have contraindication, want to regard remedial foundation as 2 armour double guanidine, and should be used arrive everyday 1500-2000mg.
If blood sugar does not amount to mark, can add used remedy to still have: DPP-4 depressor, candy glucoside enzymatic depressor, GLP-1 accepts put oneself in another's position excited agent and SGLT2 depressor, these medicaments are OK weight to.
If still blood sugar is not ideal, consider sulphur Niao again kind or insulin preparation, but, after the position should lean. The patient is treated toward insulin already, or because,be hypoglycemia problem, or it is tall insulin hematic disease problem, appetite is very good, eat very more, must change this kind of outcome.
After insulin of out of service increases 2 armour double guanidine, patient appetite should be met have improvement, we had been done even suffer from religion, reasonable food and motion, raise the consciousness that patient weight manages.
Be in hospital the examination result after two days, fatty liver, carotid inside in it is normal that film adds function of kidney of thick, liver, ACR40mg/g, hollow insulin 33.59uU/mL. Insulin resistance index (Haffner) computation: 33.59X9.69/22.5=14.47 (insulin is counteractive and apparent)
10 days went, today hollow blood sugar of the patient is 6.5mmol/L, blood pressure 119/84mmHg. Current medicaments is: Delay of 2 armour double guanidine commentate piece, everyday 2000mg (doctor's advice can write 1500mg only, was to exceed a manual to use drug otherwise) , dimension Glenn lowing 50mg, daily. Still have the depressor, medicine that move fat and aspirin of course.
Give 40 units insulin really stopped, the key is blood sugar good.
After two days, laochen was about to leave hospital. I tell him: Must notice to reduce weight, if 15 kilograms can reduce weight inside a year, do not need probably to take medicine to also can control blood sugar, blood pressure good.
Laochen, originate successfully your accredit and effort, cheer!
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Look be like bland diabetic, not be medicine taking a place absolutely, get ready needle, measure measure blood sugar so simple. The any detail in diagnosis and treatment appears unusual, what may bring about final final result is different.
Resemble above Laochen's abdomen, insulin injects " the circle is encircled " , although say palpability suffers from the shoulder heavy responsibilities that teachs the job, although to him, had injected no longer insulin. But, in friend of a candy on individual body, probable namely so little looks seem the question that not matter, brought about the out of control of blood sugar. .
So, if be of candy friend you, very dissatisfactory to oneself blood sugar, I hope you can do good illness to record really, to li of face examine is not vivid Baidu seeks advice on the net. Occasionally, the observation of 1-2 day can find the source of the problem.
