Hello, Sina netizens!

Host: Famous doctors gather to talk about people's health. Good afternoon, Sina netizens! Welcome to the famous doctor hall broadcast live by Sina Health and Medical Forum. I'm Cui Yinmo. While broadcasting the program, you can also communicate with our experts through our interactive platform. Now people's lives are generally improving. With the improvement of the quality of life, a disease called "silent killer" has crept into our lives, that is, diabetes. Many people with diabetes will feel very tired, and their immunity will decline. Diseases such as colds, pneumonia, and tuberculosis infection will also be difficult to cure. In this issue, we specially invited Professor Li Qiang, the director of the Department of Endocrine and Metabolic Diseases of the Second Affiliated Hospital of Harbin Medical University, to talk about the topic of diabetes prevention and treatment. Hello, Professor Li!

Li Qiang: Hello, netizens.

Host: Professor Li, let's see an example. In March 2011, a teacher Zhu found that he had diabetes in his physical examination. He felt that he was not unwell, but he didn't take it seriously. He ate and drank as usual. Until September this year, before the examination, he found that his urine was turbid, the foam was very much, and the smell was very fishy. He found that diabetes had complicated kidney disease, So I received intensive treatment for one month in the hospital. The condition was not under control at all. Now facing various treatment methods, Mr. Zhu suddenly felt that he was very troubled and didn't know how to choose. He especially regretted that he had discovered early a year ago that he could not control it. Maybe in our life, many friends around us will have diabetes problems, and we may also encounter problems like Mr. Zhu. In fact, most people have a superficial understanding of diabetes. What is diabetes? First, please ask Professor Li to popularize it to us in ordinary simple language.

Li Qiang: In fact, diabetes is not unique in modern times. With the improvement of living standards, I heard that many of Muran's friends have diabetes. In fact, this disease has existed in ancient times. As early as the fifth to sixth century BC, two Indian monks found that some people would attract ants to urinate on the ground. After tasting the urine, they found that the urine was sweet, so they found diabetes. Not only in India, but also in ancient China, there was a book called The Yellow Emperor's Canon of Internal Medicine, which also recorded a disease of "obesity", which belongs to diabetes now. In addition, there are also records of polyuria, now known as diabetes, in the cultural relics unearthed from the Egyptian pharaoh's tomb. This disease has existed since ancient times. What is diabetes? In short, it is a group of endocrine and metabolic diseases characterized by chronic hyperglycemia. It is characterized by chronic hyperglycemia, and any increase in blood sugar during this period can be diagnosed as diabetes. It is a group of metabolic syndrome, including type I and type II, special type of gestational diabetes. There are many common syndromes that we call diabetes.

Host: Did you just say that type I and type II were divided into different stages according to the early stage of the disease?

Li Qiang: It is not related to the early stage, but to the pathogenesis. Typing is related to the pathogenesis, for example, type I is mainly related to the autoimmune reaction. It includes both acute and slow onset. The acute onset, commonly referred to as insulin dependent diabetes, is particularly acute. At the beginning, similar acid viruses may appear and insulin treatment is needed.

There are also slow onset diabetes, autoimmune latent diabetes. At the beginning of onset, it is like type II diabetes. At the beginning, taking medicine is effective, but it gradually becomes invalid. We check our own sugar body, which is positive, and we classify it into the category of slow onset. Type I diabetes is usually caused by autoimmune reaction.

Another type of diabetes is called type II diabetes. Type II diabetes is that its insulin secretion can be reduced, but at the same time it is accompanied by insulin resistance. That is to say, it does not work when it secretes more insulin, and it does not work when insulin and receptor bind. This type of diabetes accounts for the vast majority. At present, 90% of the diabetes that most people get is this type of diabetes.

There is a third type. The third type is usually referred to as a special type of diabetes, which is mainly caused by a certain disease and has a clear reason. For example, long-term use of glucocorticoid may lead to diabetes or endocrine diseases. For example, people who are very fat and have fingerprints on their stomachs are also prone to diabetes.

For example, exocrine diabetes is very easy to develop diabetes after suffering from pancreatitis, which requires endocrinologists to have a look. The specific cause is special diabetes.

The fourth is gestational diabetes. As long as her blood sugar is higher than that of normal people, we can diagnose diabetes during pregnancy. Whether diabetes or diabetes mellitus is lower, as long as the blood sugar gained during pregnancy increases, we can call it gestational diabetes.

As you can see, there are four types: type I, type II, special type and gestational diabetes. The most common type is type II diabetes.

Host: Can it be understood that Type I is congenital and Type II is acquired?

Li Qiang: Generally speaking, the occurrence of diabetes is related to genetic factors and environmental factors, including type II diabetes, which is also related to genetic factors. However, on the basis of genetic background, environmental factors have caused the onset of diabetes. Environmental factors, especially changes in our lifestyle, including the increase in our calorie intake and sedentary lifestyle, are important factors to promote the occurrence of diabetes.

Host: I often hear that once I get diabetes, my life will be reduced by ten years. I wonder if there is any real scientific basis for this sentence. What kind of harm will diabetes do to our body?

Li Qiang: We said that having diabetes will not really affect our life span. That is to say, it is not true that our life span will be reduced by ten years when we have diabetes. But we must be careful. The main reason is that if you don't take diabetes seriously, like the example you mentioned just now, if it is not well treated, it will have many complications, which will kill you and reduce your life. Diabetes itself will not reduce our life span, but if not well treated, it will endanger our life span if we get complications.

Host: In the example just now, Mr. Zhu, if he had controlled diabetes well when he found it just one year ago, it might not have such a big impact on his life?

Li Qiang: You are absolutely right. There was a teacher in our school who discovered diabetes when he was in college and began to use insulin. Now the old man is in his 80s and very healthy. It's not terrible to get diabetes. The key is to treat it correctly in time, and you can prolong your life.

Host: It is often said that drugs are highly toxic. Many people with diabetes often want to try to stay conservative for a while. Once diabetes is diagnosed, we should take drugs in time and control it. We often hear ourselves say that my blood sugar is low when I am hungry today, and I feel dizzy when I eat a piece of candy. Low blood sugar will have obvious physical feelings. How does the body feel when blood sugar is high? Usually we say that the blood sugar rises, is it diabetes?

Li Qiang: Just now I mentioned that our diabetes is characterized by chronic hyperglycemia, so the blood sugar will definitely rise after we get diabetes. After the increase, there will be some clinical manifestations. Usually, if we are very typical of diabetes, there will be "more than three and less" symptoms. The typical patient will suffer from polyuria, polydipsia, polydipsia and emaciation. When the blood sugar is very high, first of all, the sugar will be discharged through the urine, and the urine volume will increase. After more urine, you will be thirsty and drink more. After a lot of sugar is drained, he will feel hungry and eat more. With more sugar drained, he will suffer. Typical patients will have more than three or less symptoms.

If the blood sugar does not reach a certain value in the early stage of the disease, there may be no symptoms, just a feeling of fatigue, feeling powerless recently, and there may be no symptoms of more than three or less. The final diagnosis of diabetes depends on tests, not just symptoms.

Compere: We have these symptoms. We should pay attention to whether there is such a possibility of recessive disease in our living habits.

Li Qiang: Yes. If a person has symptoms such as polyuria, polydipsia and polydipsia, I suggest that he or she should go to the hospital immediately to check his or her blood sugar to see if it is higher than normal.

Host: As you said, maybe he has already metabolized the sugar in his body through urination, so he will have this symptom.

Li Qiang: Yes.

Host: Everyone is concerned about whether diabetes can be cured?

Li Qiang: I asked a very critical question. According to our existing understanding of the disease, we have not yet fully and truly understood the pathogenesis of diabetes. Although we have a lot of understanding of the pathogenesis, we have now realized that it is on the basis of heredity, due to the role of environmental factors, there are many hormones involved, This causes diabetes. But we have not yet found a way to eradicate it. So I also remind all patients not to listen to some misleading propaganda. It will affect your correct treatment.

Compere: So we should think twice when we see the so-called propaganda that can cure and cure. Does it mean that if I get diabetes, I will need to take medicine for life?

Li Qiang: After getting diabetes, we said that in most cases, it may be necessary to take medicine for life. However, in some cases, it may be possible to get rid of drugs. For example, when you get sick, it is very timely and very early. Maybe you have a lot of pancreatic cells and islet cells. In this case, if you go through a short-term intensive insulin treatment, usually we mean two weeks, it may restore your pancreatic islet function, so you may not need to use drugs in the future.

Compere: Many people don't like it. They say that taking medicine and injection every day is not a big problem. They all think it is very troublesome. They hope to find a simple way to solve this problem. Many people think of surgery. Can this weight loss surgery control diabetes? But what is the principle? Could you introduce it to us?

Li Qiang: Actually, there are four kinds of operations for weight loss. The first is the operation of adjustable gastric pouch, the second is the excision of bromine, the third is the removal of shunt, and the fourth is the gastrointestinal shunt operation, also known as bypass surgery. Why can these four ways attract people's attention and treat diabetes? There are many experiments that have been confirmed, especially the famous article in New Medical Journal this year, which compares the drug treatment, then bromogastectomy, and gastrointestinal bypass surgery. After the surgery, he can see whether it is glycosylated hemoglobin, fasting blood glucose, or weight, After the operation, it was significantly reduced, especially in the group of gastrointestinal bypass surgery. Is it possible that this operation can be completely popularized to all our diabetic patients as a way to treat diabetes? Maybe not yet.

Because you can see the articles in their experiments, they still have some requirements for selecting patients. For example, the BMI value they choose is above 35. This is a very fat person. For example, the course of disease is 5 years, and then the glycosylated hemoglobin is 7%. When you look at the value of glycosylated hemoglobin, it is a patient who is not too heavy, and the course of disease is relatively short, especially fat people. Such people may have a better effect of surgery.

If your course of disease is very long and your blood sugar index is also very high, for example, we often see patients with 9%, 10% and 11% of glycosylated hemoglobin in outpatient clinics, which may not be suitable. Or people of normal weight like us, if they go for weight-loss surgery, may be less likely to cure diabetes. So I suggest that the operation should be larger according to BMI. According to the requirements of the Asia Pacific Society, it should be at least 30. It may be more appropriate for us to have this weight loss surgery.

Host: So if the main cause of diabetes is obesity, it is more suitable for this operation.

Li Qiang: Yes.

Host: Do you think the four operations are basically the same in principle, but actually they help the person control his weight?

Li Qiang: Yes. It is mainly to reduce the amount of food intake. After reducing the amount of food intake, some hormones secreted by the gastrointestinal tract will be less. For example, the secretion of hormones such as receptors will decrease, which will affect the metabolism of blood sugar. But I think these operations also need some evidence of evidence-based medicine. What is the long-term effect, whether it can get rid of drug treatment for a long time, and whether the other one will cause obstacles to the absorption of other substances? We also need to observe.

Moderator: Just now, it was mentioned that some people are particularly prone to diabetes. For example, people who perform these operations are obese people. In addition to this fat person, who else is particularly prone to diabetes?

Li Qiang: There are some cases. The first one is that his blood sugar has increased after checking in the past. When we have a physical examination, for example, blood sugar exceeds 6 or just after 6 o'clock, maybe the doctor didn't remind him and he didn't pay attention to it. Such people should pay attention to the first kind of people.

The second group is over 40 years old, and middle-aged and elderly people need attention.

The third kind of people we mentioned just now are overweight and obese people. In particular, those whose waistlines exceed 90cm for men and 85cm for women should be particularly worried.

For the fourth group, we said that some of our family members had diabetes. For example, if your parents are diabetic, or your siblings have diabetes, you may have the same genetic background and have this susceptibility gene. Such people need to pay attention.

The sixth kind is the person who gives birth to a fat child. When you are born, your weight is also very large. Usually we say that the child is more than 8 kg. Chinese tradition says that fat kids are especially good, but they are not.

The seventh person with high blood pressure. People with hypertension have insulin resistance, especially those whose blood pressure exceeds 140/90mm Hg should pay attention.

Next are people with abnormal blood lipids, cholesterol, triglycerides, cardiovascular diseases, such as angina pectoris, myocardial infarction, stent free, sedentary people who do not exercise every day. Such people should be careful.

In addition, some people have used certain drugs, such as glucocorticoid. Some people have a cold and fever. It is not advisable to take prednisone. Such people are very likely to develop diabetes in the future. So the people I just mentioned should be checked regularly. If the fasting blood sugar is more than 6, or the blood sugar after a meal is more than 7.8, you should go to the hospital for a diabetes test to determine whether there is diabetes.

Host: After listening to your explanation, I may be over 40 years old, and I am fat. Someone in my family has diabetes gene. I meet several requirements. Should I go to the hospital to check if I have diabetes?

Li Qiang: Normally, if you take the physical examination every year, the physical examination items include blood sugar, fasting blood sugar, and blood sugar two hours after meals. I think it is OK. If you don't take physical examination every year and haven't checked your blood sugar for many years, you are still a risk factor. I suggest you go to the hospital to have your blood sugar checked. In addition, I suggest that we not only check the blood sugar two hours after meals, but also check the blood sugar two hours after meals. In the case of diabetes, the increase in blood sugar first shows the increase in blood sugar two hours after meals, and then the increase in fasting blood sugar. Don't let me see a report from the doctor. My fasting blood sugar is normal. Be sure to have blood sugar two hours after cooking.

Host: How about Xie two hours after dinner. I have done these two examinations. Is it possible to know if I am ill?

Li Qiang: Yes.

Compere: We often see many words during physical examination, but we don't understand them. For example, "fasting blood sugar", which may be easier to understand. What are the meanings of "sugar tolerance", "urine sugar", and "glycosylated hemoglobin"?

Li Qiang: There is no doubt about the fasting blood glucose. The blood glucose measured when we did not eat in the morning is usually less than 6. If it exceeds 6, we should be careful, and we should do a sugar tolerance test. Another thing that doctors often check for you is that the blood sugar two hours after a meal is less than 7.8 mm mol, calculated from the first mouthful of food and calculated for you two hours later. We can diagnose diabetes by doing glucose tolerance test, taking blood glucose on an empty stomach, drinking glucose, and taking blood one or two hours after drinking. The fasting blood glucose exceeds 11 mmol, and the fasting blood glucose exceeds 11.1 mmol. During the physical examination, the blood sugar is higher than that of normal people. Such people, or the ten dangerous situations just mentioned, are suitable for this examination to determine whether there is diabetes.

The fourth examination is what we usually call glycosylated hemoglobin, which reflects the average level of blood glucose in two to three months. As a monitoring method, I have been treated for a period of time, and the fasting blood glucose control is also very good after meals. Whether I have reached the standard during this period of time, the average level of blood glucose in three months can be seen by measuring this indicator, Usually we require less than 7 to qualify for treatment. If it is very high, as mentioned just now, 9, 10 and 11 indicate that the control is very poor, and you need to find a doctor to adjust your treatment plan.

There are also doctors in the hospital who advise you to check the function of islets, which usually refers to insulin release test and C-peptide excitation test. Drink glucose on an empty stomach and draw blood. The difference is that it measures insulin and C-peptide, which can reflect the function of islets. After drinking sugar, insulin is secreted in multiples, reaching 5 or 6 times, which means that the function is very good. If it is doubled, it will be doubled. In this way, people need to take insulin. The people in front are treated with oral medicine.

Also, check whether there is ketone body or protein in the urine. In the example just now, whether Mr. Zhu has diabetic nephropathy or not, and whether protein is present at the beginning, these indicators are all routine tests for diabetes.

Compere: If there is protein, is the urine turbid at ordinary times?

Li Qiang: Yes.

Host: The fasting blood sugar you just said should be below 7, is it normal?

Li Qiang: Fasting blood sugar is below 6. If it exceeds 7, diabetes will be diagnosed.

Compere: So it's between 6 and 7.

Li Qiang: The diabetes experiment should be done.

Netizen: 45 years old, male, physical examination last November, blood sugar 6.38, physical examination again this November, blood sugar 6.51, blood sugar is on the high side, does it count as diabetes? How to prevent and treat? Do you need to take medicine?

Li Qiang: This netizen should go to the hospital for examination. His blood sugar has exceeded the normal value twice, both exceeding the upper limit of "6 normal" as we said. We need him to go to the hospital for a glucose tolerance test to see if his fasting blood glucose can exceed 7, and if it exceeds 11.1 after two hours of sugar consumption, he will be diagnosed as diabetes. If it does not exceed, his fasting blood sugar is between 6 and 7, and the blood sugar is between 7-11.1 two hours after drinking sugar, he can be diagnosed as impaired glucose tolerance, which also needs intervention, especially lifestyle adjustment.

Netizen: 46 years old, male, blood sugar after meals is between 10-12, before meals is 7-9, body is a little fat, especially like to eat fat, how to treat and prevent?

Li Qiang: In terms of his blood sugar, it has reached the diagnostic standard of diabetes, because his fasting blood sugar is above 7. If the fasting is more than 7, we can diagnose the patient as diabetic. His postprandial blood sugar occasionally reached 12, and his diagnosis was OK.

If we make a preliminary judgment, a slightly fatter person should have type II diabetes. Obese people generally have insulin resistance. For him, first of all, he should control his diet. He said that if he eats fat meat regularly, he must change this eating habit. Second, we should strengthen exercise to reduce weight. Third, medication. Because he is a little fatter, I suggest that he can use biguanides if his liver and kidney functions are normal. For specific treatment, he can do insulin test and C-peptide test to confirm whether the idea is correct and decide which drug is more appropriate.

Compere: There are many kinds of drugs, which should be used according to the type of diabetes.

Li Qiang: Yes.

Netizen: My mother is 54 years old this year. She has suffered from diabetes for a long time and has not paid attention to it. In the past two years, she went to check. Because she did not know enough, she never had special control over her diet. Now her mother's diabetes level is 1.8 and she takes insulin. Want to know if there is any saving method to control diabetes, and can mother's body recover?

Li Qiang: This netizen also suggested that you take your mother to the hospital for insulin test and glycosylated hemoglobin test to determine the level of your mother's islet function.

If there is a lot of insulin secretion after drinking sugar, it can be treated with oral medicine. If you drink sugar, you should do a diabetes test to determine whether he is diabetic or not.

Host: So the control at this time may be more important than any other forms of diabetes patients.

Li Qiang: Yes.

Compere: Can we say that if a child is a giant, he may have a much higher risk of diabetes than an ordinary child?

Li Qiang: Yes. Just now we talked about the risk group of diabetes. If the weight is more than 8 kg at birth, both the child and his mother are dangerous people. Therefore, such people should focus on monitoring in the future.

Host: So we often talk about giving more care to pregnant women, and often let them eat this and that. I suddenly found that diet really needs a balanced state. Maybe too much nutrition is not a good thing, and there may be hidden dangers such as diabetes. And we just saw that many netizens are asking this question. They are asking themselves whether they can diagnose diabetes and how to treat it. At present, we have several treatments for diabetes?

Li Qiang: At present, there are three types of diabetes. The first is the adjustment of lifestyle. For example, diet control and exercise are the most basic. If your total calories are not greatly controlled, weight gain will lead to obesity, which is not conducive to disease control. The second is to strengthen exercise, which will increase insulin sensitivity and reduce weight. It is very beneficial to control the disease. This is the first thing we say, which is the change of lifestyle.

Compere: We often say to keep your mouth shut and open your legs.

Li Qiang: Yes. The second is oral medicine, which can increase insulin secretion. Sulfonylurea drugs, non sulphonylurea secretagogues, metformin, including non insulin injection GRPY, and intestinal islet stimulating hormone, are the second class drugs. The third type is insulin, which includes fast acting insulin, medium acting insulin, long-acting insulin analogues, and premixed insulin. These three kinds of drugs constitute our main weapons for treating diabetes.

Host: Sometimes we think that diabetes, as you said, is not particularly serious as long as the problem is well controlled, but we are particularly worried about complications caused by diabetes. Generally speaking, how can we prevent complications?

Li Qiang: Actually, the occurrence of complications is related to the level of diabetes control. Many studies have confirmed that if your glycosylated hemoglobin exceeds 6.5, the risk of all complications will increase. So in this sense, for our diabetic patients, the first goal must be to control blood sugar. Usually we say the fasting blood sugar is 3.9-7.2, the blood sugar after meals is less than 10, and the glycosylated hemoglobin is less than 7. This is the first blood sugar goal.

The second goal is blood pressure, which should be controlled at 130/80mm Hg. This is the second goal.

The third goal we usually talk about is blood fat. The primary goal of blood lipids is the level of low-density lipoprotein cholesterol. The level of low-density lipoprotein cholesterol is less than 1.8 if there is coronary heart disease, and less than 2.6 if there is no coronary heart disease. In addition to LDL cholesterol, we require that triglycerides be less than 1.7. This is the third category of target lipids.

The fourth target is weight. The body mass index should be less than 24. This body mass index is calculated by dividing your weight by the square of your height. It is usually a simple method. We can also calculate it by subtracting 105 from your height, or we can get an approximate standard weight. This is the fourth.

The fifth indicator is the excretion rate of urinary protein. The excretion rate of urinary protein is the ratio of urinary protein, albumin and creatinine, which is less than 1.5 for men and 2.5 for women. These indicators are well controlled and diabetes is far away from complications. However, if I take medicine to control diabetes, you may be very close to complications. Therefore, for diabetes, the key to preventing complications is to reach the treatment standard, so not only the blood sugar standard, but also the blood pressure, blood lipids, body mass index, and urine microalbumin should be up to the standard, so that we can stay away from complications.

Host: Just now, I heard that there are so many indicators, including blood glucose and blood lipid. Many indicators say that I should be less than what. Many patients have a misconception that the smaller the better. They control their weight, overcorrect, control their mouth and eat less, and increase a lot of exercise every day. In order to reduce blood sugar, sometimes it becomes hypoglycemia. If hypoglycemia occurs, will it do harm to our body?

Li Qiang: Yes. After hypoglycemia, in fact, it will have a very important impact on the activity of brain cells. Very serious hypoglycemia will cause people to lose consciousness and cause life worries. Therefore, for diabetic patients, blood sugar should not be overcorrected or cause hypoglycemia. It must be within an appropriate range. The range mentioned just now is between 3.9 and 7.2, and should not be lower than 3.9.

Under what circumstances will he suffer from hypoglycemia? For example, as you just said, this person doesn't eat anything, especially if he doesn't eat the staple food, he is prone to hypoglycemia. In the second case, I took too much medicine. The doctor ordered me to take one tablet at a time. He said that my blood sugar was high. I took two tablets and three tablets at a time, which led to the increase of the drug effect. Some people even took insulin. If they did not take more than the doctor said, they might cause hypoglycemia.

The third situation is high activity. The doctor usually tells him that if he exercises for half an hour, he may go out for two hours or even three hours, which is particularly easy to cause hypoglycemia. Therefore, we should avoid these situations.

Once hypoglycemia occurs, it should be treated in time. First, if you feel uncomfortable, check your blood sugar immediately to see if it is hypoglycemia. Second, if it is relatively mild hypoglycemia, eating can be improved, for example, eating some biscuits and chocolate candy can be improved. Very serious hypoglycemia must be treated by the doctor in the hospital.

Host: We often find that diabetics should not only keep their mouths shut, but also have some snacks in their bags, which may prevent hypoglycemia. Is it necessary to prepare snacks? What kind of snacks should we suggest they bring?

Li Qiang: Generally speaking, there may be some biscuits in the bag. A little candy is enough. For mild hypoglycemia, for example, if the blood sugar is between 3-4, we can let the patient eat something first, which can well alleviate his symptoms. Especially severe hypoglycemia, for example, a few hypoglycemia we often encounter, must be sent to the hospital, so that eating will not increase much.

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