Diabetes monitoring is a guarantee, but the vast majority of diabetic patients only focus on drug treatment and underestimate monitoring, which is incorrect. Next, I will talk to you about diabetes monitoring. What checks should patients with diabetes do regularly?
blood sugar
Blood glucose monitoring can be divided into venous blood glucose and finger blood glucose. Self-monitoring at home by patients using a portable blood glucose meter is more common, that is, blood glucose. The time for blood glucose monitoring is: before each meal (of which fasting blood sugar is the most important before breakfast); 2 hours after a meal; before going to bed; when symptoms of hypoglycemia occur; if fasting hyperglycemia occurs, nighttime blood sugar should also be monitored.
specific method:
・For patients taking oral hypoglycemic drugs, two weeks before starting to adjust the dose, blood glucose should be measured continuously on an empty stomach, 2 hours after three meals, and before bed once a week.
・After blood sugar is stable, blood sugar can be measured on an empty stomach and 2 hours after three meals every 2 to 4 weeks.
・ Diabetic patients who use insulin multiple times a day should measure blood sugar before three meals and 2 hours after three meals a week, as well as before bedtime. If necessary, measure blood sugar in the early morning.
・When blood sugar fluctuates greatly or is combined with other diseases such as fever, the number of blood sugar measurements should be increased; when blood sugar is relatively stable, the number of blood sugar measurements can be reduced as appropriate.
・When accompanied by other diseases or when blood sugar is >16.7mmol/L, you should go to the hospital in time to measure blood and urine ketones.
Glycated hemoglobin
Glycated hemoglobin is the “gold standard” for evaluating long-term blood sugar control and an important basis for guiding clinical adjustment of treatment plans. It can reflect the average level of blood sugar control in the past 2 to 3 months.
Diabetic patients who are in the early stages of treatment, whose blood sugar control has not reached the target, or whose treatment plan has been adjusted, should be checked every 3 months. When blood sugar control reaches the target, they can be checked every 6 months. In patients with anemia and hemoglobin abnormalities, glycated hemoglobin test results are unreliable and glycated serum protein can be used to evaluate glycemic control.
Through routine urine examination, you can learn about urine sugar, urine ketone bodies, urine protein, qualitative urine microalbumin, urine red and white blood cells, urine specific gravity, urine pH, etc. If the condition is stable, urine routine and urine microalbumin should be checked once a month. If blood sugar is too high or there is a stressful situation such as infection, a routine urine test can be done at any time.
Monitoring of urinary ketones is an important part of daily diabetes management in patients with type 1 diabetes, long-term type 2 diabetes, diabetes combined with pregnancy, and gestational diabetes. Any diabetic patient who has the following needs to have their urine tested for ketones:
・When vomiting or abdominal pain occurs;
・When the patient's face turns red and his breathing becomes rapid;
・During illness;
・ Random blood sugar >16.7mmol/L.
Urinary protein and urinary microalbumin
Urinary albumin excretion rate is a sensitive indicator for detecting early diabetic nephropathy, that is, urinary microalbumin greater than 20 micrograms/minute indicates early diabetic nephropathy.
To do this examination, you need to collect 24-hour urine output, record the total urine output, and take a part of it (about 20 ml) for inspection. It is difficult to operate and is affected by a variety of influencing factors. Therefore, it is currently recommended internationally to measure the albumin/creatinine ratio of immediate urine specimens to screen and diagnose microalbuminuria.
Kidney function Type 2 diabetes patients should be screened for kidney disease every year after diagnosis. The most basic one is urine routine. Kidney function should be checked once a year. Serum creatinine is used to estimate the glomerular filtration rate. The glomerular filtration rate is the most accurate dynamic evaluation index of renal function. When the creatinine clearance rate is abnormal, you should go to the nephrology department for treatment.
Blood lipids It is recommended that patients with diabetes check their blood lipids once a year. If there is a blood lipid disorder and those who are receiving non-lipid-lowering drug treatment should be reviewed every 3 months, and once every 6 to 12 months after reaching the standard; if they are receiving lipid-lowering drug treatment, they should be reviewed every 6 to 8 weeks, and after reaching the standard Review every 4 to 6 months or 12 months.
Liver function: Diabetic patients take many types of medications, so liver function should be monitored regularly and checked every six months.
Monitoring of eye diseases Routine eye examinations for diabetic patients include:
・ Vision;
・Pupillary light reflex;
・Perform fundus examination after dilating mydriasis (mydriasis is contraindicated in patients with glaucoma);
・Slit lamp examination: iris area, anterior chamber, angle;
・Measurement of intraocular pressure;
・Fundus fluorescence imaging.
For general diabetic patients, if there is no retinopathy, they should be checked every 1 to 2 years; if they have mild retinopathy, they should be checked once a year; for patients with severe retinopathy, they should be checked every 3 to 6 months. For patients with gestational diabetes, if there is no retinopathy, they should be followed up every 3 months; if there is retinopathy, they should be followed up once a month. Another particularly important point is that patients with type 2 diabetes should go to an ophthalmologist for a fundus examination as soon as they are diagnosed.
Diabetic patients with neuropathy should be screened for diabetic peripheral neuropathy at least once a year after being diagnosed with diabetes; patients with longer duration of diabetes or those with microvascular complications such as fundus lesions and nephropathy should be reviewed every 3 to 6 months.
macrovascular disease
・Electrocardiogram should be checked regularly, at least once every six months. If there is clear precordial discomfort or palpitations caused by hypoglycemia, you should go to the hospital immediately for an electrocardiogram.
・For diabetic patients over 50 years old, a routine examination of atherosclerotic lesions in the lower extremities, i.e., ankle-brachial artery pressure ratio examination, should be performed.
・For patients with cardiovascular and cerebrovascular diseases, dyslipidemia, hypertension, smoking, or diabetes for more than 5 years, the ankle-brachial ratio should be checked at least once a year.
Finally, I would like to remind everyone to measure their blood pressure every time they see a doctor. Monitor your own weight. Every patient should be his own doctor. Timely and correct monitoring is a powerful weapon to defeat diabetes. Let each of us take action!
