The concentration of glucose in the blood changes with the meal time during the day. Generally speaking, for three meals a day, blood sugar is lower before meals and higher after meals. If, when doing OGTT (glucose tolerance test), the blood sugar value exceeds 7.8mmol/L 2 hours after the meal, it means that you have entered the army of diabetes. Doctors suggest that Chinese diabetics should pay more attention to their blood sugar values after meals and use this as a standard to adjust their lifestyle and diet in a timely manner.
Many people have a misunderstanding that fasting blood sugar is within the normal range, which means that there is no diabetes-related problem. In fact, experts point out that compared with Westerners, the increase in blood sugar in Chinese people is mainly increased after meals. Only checking fasting blood sugar results in a 50% missed diagnosis rate of diabetes or prediabetes.
The reason why Chinese people's blood sugar increase is different from that of Westerners, mainly increased blood sugar after meals, is related to the dietary structure of eating porridge, rice noodles and noodles. From the blood sugar spectrum of people with abnormal glucose metabolism in China, the blood sugar increase of Chinese patients is mainly postprandial blood sugar increase. However, the current routine health examination only checks fasting blood sugar, and cannot timely diagnose people with simple postprandial blood sugar increase. Many people with simple postprandial blood sugar increase are able to "get away with it", resulting in a misdiagnosis rate of up to 50%.
Fasting blood sugar, postprandial blood sugar, and glycosylated hemoglobin are commonly said to be diagnostic indicators of diabetes. The three are consistent, but they just reflect the conditions under different states. Fasting blood sugar reflects the basic islet function, postprandial blood sugar reflects the islet function after load, and glycosylated hemoglobin checks the situation of glucose metabolism for 8-12 weeks, which depends on fasting blood sugar and postprandial blood sugar.
Because of the relationship with diet, coupled with the obstruction of β-cell function, our postprandial blood sugar increase is very obvious. There have been many studies on postprandial blood sugar and cardiovascular complications and disease progression in diabetic patients. If fasting blood sugar is normal, a slight increase in postprandial blood sugar will have a very clear correlation with cardiovascular morbidity and mortality, so special attention should be paid to postprandial blood sugar.
In terms of hypoglycemic treatment, dual insulin preparations break through the limitations of existing treatment options to varying degrees, and only a single injection is needed to simulate near-physiological insulin secretion. When injected subcutaneously, degludec insulin will form a multi-hexamer long chain, which will cover 24 hours continuously and steadily control fasting blood sugar; aspart insulin will quickly dissociate into monomers, rapidly lowering postprandial blood sugar. The two bioactive substances are combined into a clear solution in a fixed ratio, maintaining their respective pharmacokinetic characteristics in the body, and more effectively helping patients reduce the risk of hypoglycemia, the number of injections, and the psychological burden. Degludec aspart dual insulin is not only an innovative breakthrough in the history of insulin, but its launch also provides a new solution for Chinese diabetic patients.
Ms. Feng has been suffering from diabetes for 15 years. Recently, the treatment effect of oral hypoglycemic drugs has not been ideal. Under the guidance of a doctor, she adjusted her treatment plan to: take 1 tablet of glimepiride before breakfast every day, 1 tablet of metformin for each of the three meals, and 18 units of basal insulin before bed. Since taking insulin, Ms. Feng's fasting blood sugar and postprandial blood sugar have been quite stable, and her glycosylated hemoglobin has been controlled to meet the standard. Recently, I found that my fasting blood sugar was high, so I came to my clinic.
"My fasting blood sugar has always been as high as 11.0-12.0mmol/L recently, which is similar to the blood sugar before I took insulin. There are no major problems with my diet and exercise. Although I have less outdoor exercise after the cold weather, I usually go out for a walk when the sun is shining during the day, and do radio gymnastics, yoga, Ba Duan Jin or Tai Chi at home after dinner at night, and do housework, which is not a small amount of exercise. And I know that eating more in winter will make you gain weight, and blood sugar is difficult to control, so I pay special attention to controlling my mouth and not eating more than one bite. My children are afraid that I will have a bad memory when I am old, so they bought me a smart medicine box and set the alarm in advance to help me take injections and medicines on time, and oral hypoglycemic drugs and insulin are not missed. But why did my fasting blood sugar suddenly soar?" Ms. Feng told me as soon as she entered the clinic.
I asked her, "You have done a good job in self-management, but you only started using insulin this year. Could it be that there is something wrong with the insulin injection method?"
Ms. Feng replied, "I have had diabetes for 15 years. Although I have only been taking insulin for less than a year, I have studied the insulin injection technique seriously and asked the nurses in the hospital to personally guide me. In the past six months, I have not found any problems with insulin injections, and my blood sugar is well controlled. There are no nodules at the site where I injected insulin, so there should be no problem with insulin injection. I really don't know why my blood sugar is so high. Is it because of the cold in winter?"
I replied, "Human blood sugar will be a little higher in winter. If diet and exercise are well managed and the medicine is used correctly, blood sugar should not be so high. You should take a video of the insulin injection process for me to see if there is any problem."
So, after returning home, Ms. Feng asked her husband to help her shoot a video of her own insulin injection and sent it to me. I carefully watched the entire injection process and it was indeed normal and standardized. But I noticed a detail. After injecting insulin, she put the insulin pen into the box, and then put the box on the bedside table. There was an electric heater next to the bedside table, and the insulin pen was very close to the electric heater.
The reason was finally found. Ms. Feng's insulin was heated by the electric heater, and the insulin became ineffective due to the high temperature.
We know that insulin is a biological agent, which is afraid of both cold and heat. Ms. Feng put the insulin next to the electric heater. After one night, the insulin was damaged by the heat and lost its biological activity. Therefore, her 18 units of insulin every night were equivalent to a shot in vain, and there was no effect at all.
Therefore, diabetic patients must pay attention. Don't be bothered in winter. After injecting insulin before going to bed at night, the insulin pen should be placed in a place with normal room temperature in the house.
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