One of the most frequently asked questions by patients with diabetes in clinical practice is: Why does blood sugar never come down? Or does it go up and down over and over again?
People with diabetes may wish to check and see if they have the following 13 problems.
1. Have you controlled your diet?
Diet therapy is the basis of diabetes treatment. Whether it is type 1 diabetes or type 2 diabetes, regardless of the severity of the disease, whether you use anti-diabetic drugs or not, you need dietary control. If you do not pay attention to diet control, no matter how good the drugs are, it will be difficult to maintain normal blood sugar. .
But controlling your diet does not mean starving. Dietary treatment requires a scientific and reasonable arrangement of the quantity (referring to "total calories" rather than just "staple food") and quality (referring to the proportion of various nutrients) of the diet, which is required to satisfy the body. Nutritional needs, and can help control blood sugar and weight.
2. Have you continued to exercise?
Exercise is a free diabetes pill for three reasons:
•Exercise itself is an energy-consuming process. Regular aerobic exercise can promote the decomposition of muscle glycogen and the utilization of glucose by peripheral tissues;
•Exercise can also help reduce weight, improve insulin resistance, and enhance the efficacy of hypoglycemic drugs;
•Exercise helps relieve tension, maintain mental balance, and reduce blood sugar fluctuations.
Scientific and reasonable exercise can help lower blood sugar. The most important thing about exercise is persistence. You cannot fish for three days and dry the net for two days.
3. Do you have any bad emotions?
Bad emotions have a great impact on blood sugar. Emotional changes such as tension, anxiety, worry, joy, sadness, and over-excitement can cause sympathetic nerve excitement, increase the secretion of glucagon hormones (such as catecholamines, etc.), and decrease insulin secretion, causing blood sugar to rise.
Therefore, it is important to learn to control and adjust your emotions. In addition, irregular life and excessive fatigue can also cause blood sugar fluctuations.
4. Are you in a state of stress?
Colds, fever, severe infection, trauma, surgery, acute myocardial infarction or stroke and other stress states, or women during pregnancy, menstruation, etc., can increase the secretion of glucagon hormone, weaken the hypoglycemic effect of insulin, and lead to high blood sugar. It may even induce ketoacidosis.
5.Do you sleep well?
People with diabetes need to ensure 6 to 8 hours of sleep every day. Long-term insomnia or staying up late can lead to over-excitation of the sympathetic nerve, inhibit insulin secretion, increase the secretion of glucagon hormones such as epinephrine, and thereby increase blood sugar.
6. Have you chosen the right medicine?
Diabetes patients should not imitate others when taking medication. The medication should vary from person to person and be personalized. The doctor will take into account your diabetes type, pancreatic islet function, age, fatness, whether there are complications, and the characteristics of the blood sugar spectrum throughout the day. Select drugs specifically for people with diabetes to ensure safety and effectiveness.
7. Is the drug dosage appropriate?
It is easy to understand why blood sugar does not drop due to insufficient dosage of medicine, so I won’t go into details here. What needs to be alerted to is the latter situation. If the dosage of hypoglycemic drugs is too large and blood sugar drops too quickly or too low, it can cause sympathetic nerve excitement, increase the secretion of glycemic hormones such as catecholamines and glucagon, promote the decomposition of liver glycogen, and cause a rebound increase in blood sugar. At this time, if you continue to increase the dosage of medicine, the blood sugar will be higher. As the saying goes, "excessive correction" and "the extreme of things must be reversed."
For patients with elevated fasting blood sugar, it is necessary to first find out whether it is "insufficient dosage of anti-diabetic drugs" or "rebound hyperglycemia after hypoglycemia". If it is the latter situation, the amount of anti-diabetic drugs at night should be appropriate. Decrease rather than increase.
8. Is the medication used correctly?
There are many types of hypoglycemic drugs with different usage methods. Improper use will result in half the result with half the effort.
For example, sulfonylurea hypoglycemic drugs are best taken half an hour before a meal, so that the peak effect of the drug is exactly synchronized with the peak of blood sugar after a meal, thereby achieving the best hypoglycemic effect.
The main function of Baitang Ping is to delay the absorption of carbohydrates. It should be taken with the first bite of rice. Taking the medicine on an empty stomach has no effect.
Hypoglycemic drugs such as Tangsuping and Mepyrid are short-acting preparations and should be taken three times a day before meals. If taken orally once or twice a day, it will be difficult to achieve satisfactory blood sugar control throughout the day.
Drugs such as Ruiyining and glimepiride are long-acting preparations and can be taken once a day.
Look at the way you use your medications, right?
9. Is there any secondary failure of the drug?
The effect of some antihyperglycemic drugs (such as sulfonylurea drugs such as Euhyperglycemic and Mepyridine) gradually diminishes after being taken for a period of time. This is clinically called "secondary failure of oral hypoglycemic drugs". This is due to the pancreatic islet function of diabetic patients. It is caused by gradual failure as the course of the disease prolongs.
When the pancreatic islet secretion function of diabetic patients is severely damaged, the effect of insulin secretion-stimulating drugs (such as Youjiangtang, Xiaoke Wan, Damikang, etc.) will be greatly reduced or even ineffective, because the effect of such drugs depends on the function of the pancreatic islet. The presence.
Therefore, when secondary drug failure is encountered in clinical practice, the treatment plan should be adjusted in a timely manner under the guidance of a doctor.
10.Is there insulin resistance?
Insulin resistance can simply be understood as the body's insensitivity to insulin. For people with type 2 diabetes who are overweight or obese, especially in the early stages of the disease, the increase in blood sugar is mostly due to the patient's insensitivity to insulin rather than insufficient insulin secretion.
The first choice drug for the treatment of such patients is not insulin secretion agents or insulin supplementation. Instead, drugs with insulin-sensitizing effects such as biguanides and thiazolidinediones should be chosen to improve blood sugar control by eliminating insulin resistance.
11.Are you taking other drugs that may interfere with hypoglycemic control?
Some people with diabetes suffer from multiple diseases and take multiple medications at the same time, some of which can antagonize the effects of insulin and weaken the hypoglycemic effect. Such as glucocorticoids, b-receptor blockers (such as propranolol), thiazide diuretics (such as hydrochlorothiazide), estrogen, thyroid hormone, etc.
Therefore, patients with diabetes who have comorbidities should consider comprehensively when choosing drugs and try to use less or less drugs that have an impact on lowering blood sugar.
12. The impact of climate factors on blood sugar
Clinically, it has been found that the blood sugar of people with diabetes changes due to seasonal influences. Cold stimulation can increase the secretion of insulin-antagonizing hormones (such as epinephrine, etc.), increase liver glycogen output, and decrease muscle uptake of sugar, thereby increasing blood sugar and aggravating the condition.
Summer is hot and sweaty, so you should pay attention to replenishing water, otherwise blood concentration will also increase blood sugar.
13. Is there misdiagnosis and mistreatment?
Type 1 diabetes is mainly seen in children, but it seems that type 1 diabetes in adults (LADA type diabetes) is not uncommon because some of its symptoms are quite similar to type 2 diabetes, plus the current impact on pancreatic islet B cells Testing for autoantibodies is not yet widespread.
Therefore, it is often misdiagnosed as type 2 diabetes, when in fact it is a subtype of type 1 diabetes.
As the patient's pancreatic islet function rapidly fails, oral hypoglycemic drugs will quickly turn from effective in the early stages of the disease to ineffective, and blood sugar will gradually lose control from being well controlled at the beginning.
Such patients with diabetes should adjust their treatment plan as soon as possible.
Blood sugar control is a systematic project. If there is a problem in any link, it will affect the blood sugar standard. Only when doctors and patients cooperate, analyze together, find out the reasons, adapt measures to individual conditions, and take corresponding measures can we achieve satisfactory sugar control results.
