Generally speaking, the course of diabetes is divided into four stages. That is, genetic susceptibility period, impaired glucose tolerance period (pre-diabetes), diabetes period and late diabetes. In the first two stages, since diabetes has not yet occurred, we should adopt the methods of level 1 prevention, including diet and exercise therapy and lifestyle changes. In diabetes, we should adopt comprehensive therapy of diet, exercise, drugs, blood sugar monitoring and diabetes education, among which the drug therapy should adopt ladder therapy, which is safer, more effective, more convenient and more economical, and can be called the optimal treatment scheme for diabetes. The pathogenesis of diabetes mellitus is the theoretical basis of step therapy, because with the progress of diabetes mellitus, insulin resistance persists and gradually worsens, which makes the islet function decline progressively. Therefore, our countermeasures are to use insulin sensitizer as early as possible to reduce insulin resistance, on the other hand, to avoid using drugs to stimulate insulin secretion too early, to protect islet function as much as possible, and to ensure the daily physiological insulin requirement. Its purpose is to control metabolic disorder and prevent complications. The specific scheme is as follows: the first step is to use specific or non-specific insulin sensitizer to cooperate with diet and exercise treatment of diabetes, and if it fails, it can enter the second step; In the second step, insulin sensitizer and postprandial blood glucose regulator, such as rosiglitazone and Glucagon or Beixin or Novolone, are used, and then the third treatment scheme is selected if it fails; In the third step, insulin sensitizer is added with postprandial blood glucose regulator, and then sulfonylurea hypoglycemic agents are added. If it is ineffective, it can enter the fourth step treatment plan; The fourth step, oral medicine combined with insulin therapy, according to the degree of insulin deficiency, take insulin supplement therapy (1 ~ 2 injections a day) or insulin replacement therapy (3 ~ 4 injections a day).
The Fifth International Diabetes Federation Western Pacific Conference held in Beijing recently issued the Recommendations for Diabetes Treatment in the Western Pacific Region of the International Diabetes Federation (IDF), which put forward normative guidance from the aspects of diagnosis, treatment, control objectives, complications of metabolic syndrome and prevention.
The main diagnostic basis of diabetes is the increase of blood sugar. Due to the change of people's diet structure, under the influence of obesity and other factors, human tissues can't make their own insulin produce corresponding hypoglycemic effect, and blood sugar increases accordingly, which is called insulin resistance in medicine. The occurrence of diabetes accelerates insulin resistance, makes human metabolism disorder, thus causing hypertension and hyperlipidemia. Therefore, diabetes, hypertension, hyperlipidemia and obesity are called "death quartets", and their common source is insulin resistance. Therefore, the key to treatment is to enhance the sensitivity of human body to insulin. In addition to emphasizing scientific lifestyle, exercise to lose weight and controlling insulin resistance in the early stage of onset, the Treatment Suggestion also puts forward the control targets of blood sugar, blood pressure, body mass index, total cholesterol and high density lipoprotein, and especially recommends that thiazolidinediones represented by Avandia should be used as the first-line basic drugs for the treatment of diabetic patients with overweight or obesity. For non-obese diabetic patients, avandia should also be the first choice if they are complicated with hypertension and hyperlipidemia. It is reported that Avandia, a medical expert of GlaxoSmithKline Pharmaceutical Company, has developed a drug directly targeting insulin resistance after 2 years of research, and won the Global Medical Research Society Award in 21. In recent years, it has been used in hundreds of hospitals around China, which can effectively reduce the dosage of insulin, and some patients even stop using insulin.
What are the advantages of Chinese medicine in treating diabetes
Q: In recent years, people are more and more interested in treating DM with Chinese medicine. Professor Zhao, can you tell us something about Chinese medicine's understanding of DM?
a: TCM's understanding of DM has a long history. It was recorded in Huangdi Neijing, which was written as early as 5 AD. Later, doctors in past dynasties have continuously summarized and improved it in practice, forming a unique dialectical system. People's understanding of DM is no longer limited to the theories of "lung dryness, stomach heat and kidney deficiency" and "yin deficiency as the basis and dryness and heat as the standard". It is believed that yin deficiency is the key to the occurrence of DM, qi deficiency is the crux of prolonged healing, blood deficiency is the main cause of complications, deficiency of both yin and yang is the development trend, and damp-heat stagnation is the syndrome change in the course of disease. Therefore, many methods such as tonifying kidney and spleen, regulating liver and stomach, nourishing yin and clearing heat, invigorating qi and nourishing yin, promoting blood circulation and removing blood stasis are adopted to treat DM and its complications, which have certain effects in improving symptoms, reducing blood sugar and preventing or delaying the occurrence and development of complications. It initially shows the great advantages of traditional Chinese medicine and has attracted attention at home and abroad.
q: professor Zhao, can you tell us about the advantages of TCM in treating DM?
a: first, pay attention to the overall conditioning, dialectical treatment. Traditional Chinese medicine believes that DM occurs on the basis of yin deficiency, combined with external factors such as improper diet, appetite for fat and sweet taste, emotional imbalance, overwork and so on. The viscera involve the liver, gallbladder, spleen, pancreas, kidney and stomach. Therefore, the treatment emphasizes the balance of yin and yang and overall regulation, so as to restore the function of pancreas and play a two-way regulation role, which can not only reduce blood sugar, but also prevent hypoglycemia. Traditional Chinese medicine (TCM) treats DM by attaching importance to syndrome differentiation, adhering to the principle of individualized treatment, and adopting different treatments and methods according to patients' different constitutions, symptoms, even different seasons and living environments. Different treatments can obviously improve patients' different symptoms, improve the immunity of the body, adjust blood sugar and reduce blood viscosity, thus effectively preventing and treating the occurrence and development of DM complications.
Second, improving symptoms is obviously a major advantage of treatment, such as excessive drinking, polyphagia, polyuria, fatigue, numbness of limbs, edema, constipation, diarrhea, etc. After taking traditional Chinese medicine, it can be quickly relieved or disappeared. Combined with western medicine hypoglycemic drugs or insulin, it can obviously enhance its hypoglycemic effect and reduce its dosage and side effects.
Third, there are a variety of treatment methods. In recent years, acupuncture, massage, massage and external therapy have emerged in the treatment of DM, which plays a certain therapeutic role in the treatment of DM and its complications.
Fourth, it has obvious curative effect on chronic complications, such as diabetic nephropathy, diabetic peripheral neuropathy, diabetic fundus lesions, etc. Traditional Chinese medicine can effectively treat and curb the occurrence and development of chronic complications of DM.
Q: Acupuncture is a feature of Chinese medicine. Professor Zhao, can acupuncture treat diabetes? Is every DM patient suitable for acupuncture therapy?
A: Acupuncture treatment of DM has been recorded in ancient times, and it has been paid more attention to in modern times, especially since the 196s and 197s. Acupuncture treatment has certain effects on the complications of DM, but the indications must be selected. Not all DM patients are suitable for acupuncture treatment. Please pay attention to the following points: 1. For mild and moderate type 2 DM (especially obese DM), acupuncture treatment is better, while type 1 and severe or emaciated type 2. 2. Acupuncture treatment should be used with caution or disabled in patients with various acute and severe complications, and acupuncture treatment should be disabled in patients with skin infection. 3. During acupuncture treatment, it is still necessary to control diet, insist on exercise and continue medication. In addition, the external application of traditional Chinese medicine has been paid more and more attention. Recently, the umbilical and lumbar therapeutic belt and diabetes iontophoresis machine developed by Kaifeng First Hospital of Traditional Chinese Medicine and Kaifeng Diabetes Hospital in Henan Province have obtained national patents and achieved good results in clinical application.
Q: Some advertisements have convinced that XXX drugs can cure diabetes, and you don't need to control your diet. You can eat whatever you want. Is this correct?
A: As a patient with DM, it is understandable to be eager to control his illness effectively, but so far, DM can not be cured, but it can be prevented and controlled. Some people say that DM can be cured now, which is probably an exaggeration, and may even be a fake witch doctor. DM patients must not believe in rumors and terminate regular treatment at will, which will delay their illness and even cause great disaster. As for what you want to eat, it is even more unreasonable. As we all know, the source of blood sugar is mainly provided by the food you eat, so a reasonable diet is the most basic method to treat DM. Without diet control, it is difficult to control the disease even the best treatment plan. Therefore, I would like to remind the majority of DM patients not to believe in unrealistic advertisements. If you are sick, please go to a regular hospital for treatment. I believe that through regular and effective treatment, you will be as healthy and live a long life as normal people.