Mr. Wang is just over fifty and was diagnosed with diabetes two years ago. Over the years, he has learned a lot about diabetes and is well aware of the harm of high blood sugar to the body. He is also very careful in his daily life. He insists on taking medication and never neglects it. His blood sugar has always been well controlled. His fasting blood sugar has been checked at 7.0mmol many times. /L or less.
Mr. Wang's vision has been blurry recently. After going to the hospital for examination, he found that he had severe fundus lesions and was in danger of losing his sight at any time.
In this regard, he was deeply puzzled: His blood sugar has been well controlled, so how could complications occur?
In fact, clinical situations similar to Mr. Wang's are not uncommon, and the reasons are relatively complex. From analysis, supervision is still insufficient and the following four factors are ignored:
1. Neglecting to control other cardiovascular risk factors
Macrovascular complications of diabetes (mainly heart, brain and lower limb blood vessels) are the result of the combined effects of multiple risk factors.
Therefore, to prevent macrovascular complications, it is not enough to just control blood sugar. It is also necessary to control blood pressure, blood lipids, blood viscosity and weight at the same time, and to meet the standards. This problem cannot be ruled out in Mr. Wang's case.
2. Neglecting the management of prediabetes
As early as the prediabetes stage (i.e., the stage of impaired glucose tolerance and abnormal fasting blood glucose), macrovascular complications may have begun with the emergence of insulin resistance, and not all appear after diabetes.
Therefore, it is currently emphasized that active intervention should be carried out for high-risk groups with prediabetes, not only to reduce the occurrence of diabetes, but also to prevent macrovascular complications.
3. Neglecting to control postprandial blood sugar
Although Mr. Wang's fasting blood sugar is well controlled, it does not mean that his postprandial blood sugar is also well controlled. It is currently believed that compared with fasting hyperglycemia, postprandial hyperglycemia has a greater impact on the overall blood sugar level (commonly expressed as glycated hemoglobin in clinical practice) throughout the day and even over a period of time, and is more closely related to the macrovascular complications of diabetes. Therefore, it has a greater impact on diabetes. The harm to patients is even greater.
Therefore, when monitoring the condition of diabetic patients, they should not only check fasting blood sugar, but also check postprandial blood sugar and glycated hemoglobin. If the patient's fasting blood sugar is normal but the glycated hemoglobin is elevated, it indicates that the patient's overall blood sugar level control is not ideal and postprandial hyperglycemia is likely to occur.
At this time, it is necessary to readjust the treatment plan and strengthen the control of postprandial hyperglycemia to reduce the occurrence of diabetic cardiovascular complications.
4. Ignoring blood sugar fluctuations
Research in recent years has shown that the occurrence and development of chronic complications of diabetes are not only closely related to the increase in overall blood sugar levels, but also closely related to blood sugar fluctuations (i.e., high and low). The greater the blood sugar fluctuations, the higher the risk of chronic complications. The higher the incidence, the worse the prognosis.
Therefore, while strictly controlling high blood sugar, hypoglycemia should be avoided as much as possible to reduce the harm caused by blood sugar fluctuations.
Although some diabetic patients have strict blood sugar control and low glycated hemoglobin, they still develop complications. This is not unrelated to frequent hypoglycemia and excessive blood sugar fluctuations.
Mr. Wang's situation may be related to the above-mentioned factors.
Multiple studies have confirmed that strict control of blood sugar can reduce diabetic microvascular complications (i.e. kidney, retinal and neurological diseases) by about 2/3. In addition, macrovascular complications can also be reduced to a certain extent. However, "significantly reduced" does not mean "not at all".
However, we must not relax our strict control of blood sugar just because we cannot 100% prevent the occurrence of complications. After all, the effectiveness of strict blood sugar control is still quite significant.
Diabetic friends: Diabetic patients need to intervene in hyperglycemia early and comprehensively control various cardiovascular risk factors, such as blood sugar, blood pressure, blood lipids, blood viscosity, obesity, etc., so that fasting blood sugar and postprandial blood sugar can reach the standard, and blood sugar fluctuations can be reduced. Incidence of chronic complications of diabetes.
