——Mr. Xu Rongrong’s Sugar Friends Class (27)
Professor Xu Rongrong, Chief Physician, Experts Group of the 306 Hospital of the People’s Liberation Army, Diabetes Clinic of the Whole Army
Editor Zuo Tianyu of the Brand Quality Management Office
[Case] 53 years old, male Laid-off workers, suffering from diabetes for nearly 20 years, with hypertension, dyslipidemia, lacunar infarction, coronary heart disease, lower extremity arterial occlusive disease, fatty liver, obesity. He had a history of cerebral infarction 12 years ago and recovered after treatment. Smoking 3 packs a day. Shortly after walking for 1~2 months (less than 100 meters), I feel that my lower limbs are weak, my legs are difficult to lift, my calf muscles are painful, and my right lower limbs are more serious. Speaking is not as fluent as before, and the reaction is slow. Usually, hypoglycemic drugs are treated irregularly and often do not take drugs. 2 months ago, I was advised by a doctor to start insulin therapy. 6 units of short-acting insulin per day, before three meals; medium-acting insulin 10 units, before bedtime. Do not self-test blood sugar at home. Occasionally, the hospital measures fasting blood glucose, which is above 10 mmol/L. At present, basically do not take antihypertensive drugs, lipid-lowering drugs. Examination: 150~160/100 mmHg, height 1.68 m, weight 86 kg, BMI 30.5 kg/M2, the right dorsal artery and posterior tibial artery pulsation were not touched, the left dorsal artery pulsation was not touched, Arterial pulsation is weak; fasting blood glucose 11 mmol/L, glycosylated hemoglobin 12%, blood cholesterol 6.0 mmol/L, low-density lipoprotein 3.6 mmol/L, triglyceride 4.7 mmol/L, high-density lipoprotein 0.72 mmol/L, blood Creatinine 110 umol /L, uric acid 546 umol /L, urinary albumin /creatinine= 430 mg /g, the fundus is basically normal, brain CT see multiple lacunar infarction, brain atrophy, electrocardiogram shows extensive myocardial ischemia.
The patient asks: What is going on with me? It is more and more difficult to walk, the speech is getting slower and slower, the expression is difficult, and the memory is extremely poor.
Experts: You are a typical type of diabetes with a variety of cardiovascular risk factors, the so-called diabetes with metabolic syndrome, and there are already serious heart and brain and lower extremity arterial lesions. Severe cerebral arterial disease leads to multiple lacunar infarction and brain atrophy, which is the main reason for your lack of fluency, difficulty in expression and severe memory loss. Lower extremity arterial occlusive disease is the cause of lower limb muscle pain caused by walking weakness in your lower limbs and even walking. The medical term is intermittent claudication, which is a serious manifestation of lower limb ischemia. The electrocardiogram shows that your coronary arteries also have severe lesions, and the heart muscle is severely ischemic. Therefore, you are not only long-term high blood sugar is not well controlled, but also have at least 7 cardiovascular risk factors (hypertension, dyslipidemia, fatty liver, hyperuricemia, obesity, proteinuria, smoking). In particular, you have severe heart, brain and lower extremity arterial lesions. Therefore, you are at great risk of cardiovascular and cerebrovascular events such as myocardial infarction, cerebral infarction and lower limb ischemia. The possibility of sudden cardiac death is also large. It is recommended that you immediately pay attention to the control of hyperglycemia and these cardiovascular risk factors, and pay attention to the comprehensive prevention and treatment of diabetes and cardiovascular disease. Otherwise, your life will be greatly shortened and your quality of life will be seriously degraded. You are only 53 years old today, and 12 years ago, when you were 41 years old, you have had a cerebral infarction and now you have an arterial and lower extremity arterial lesion.
Therefore, it is highly recommended that you adjust the insulin dose just to strengthen your blood glucose monitoring. Monitor blood glucose at least 7 to 8 times a day for 1 to 2 days in a week (before three meals, two hours after three meals, before going to bed, and if necessary, add blood glucose at 2 to 3 o’clock in the middle of the night). The goal of glycemic control is 5~7 mmol/L on fasting, the minimum blood glucose cut should not be lower than 4 mmol/L, and the highest should not be higher than 8 mmol/L. Postprandial blood glucose control is below 10 mmol/L. Glycated hemoglobin is below 7%. It may take a period of insulin to gradually increase to achieve this goal. Self-monitoring blood glucose is the basis for ensuring a safe and effective insulin dosage. Diet and exercise also need to be regular. You need to keep in touch with the doctor and nurse to ensure that the insulin dose is properly adjusted.
Second, try to control blood pressure below 140/80 mmHg. It is best to use two antihypertensive drugs in combination, such as perindopril and indapamide. Pay attention to monitoring blood pressure. If you can’t control your blood pressure by taking two antihypertensive drugs, you need to check back in time and adjust the medication under the guidance of a doctor.
Third, you need to take a statin lipid-lowering drug. Severe dyslipidemia can lead to atherosclerotic disease. Your high cholesterol, high triglycerides and low-density lipoprotein lipids are typical of the lipid profile that causes arterial lesions. In fact, you already have a severe range of arterial lesions. You should stick to statin lipid-lowering drugs and aspirin. Then, review the blood lipids and liver function 1 to 2 months later. Ensure that lipid-lowering treatments are effective and safe.
Third, reduce weight by limiting diet and exercise. If you can reduce the weight of 5-10 kg, your quality of life will be improved, blood pressure, blood sugar control will be easier.
Fourth, severe myocardial ischemia requires not only antiplatelet drugs and vasodilators, but also further examination to understand the location and severity of your coronary ischemia and whether immediate intervention is required. . It is recommended that you visit a cardiovascular specialist for further diagnosis and treatment.
Sixth, you must quit smoking immediately. 3 packs of cigarettes per day may trigger your acute myocardial infarction and cerebral infarction. A regular follow-up is required. Regular follow-up is also for your timely and comprehensive treatment, as well as early detection and problem solving.
Finally, the most important thing is to ask yourself to pay attention to your health and care for yourself. Change unhealthy lifestyles, limit diet, moderate exercise and stop smoking immediately, adhere to medication and regular checkups. These all require your own efforts. You don’t work hard, and even the best doctors can’t help you slow down the progress of your disease and improve your quality of life.