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Diabetes
What should I do about gestational diabetes?
In general, to diagnose gestational diabetes, the first step is to control the diet and engage in appropriate exercise to observe the reduction in blood glucose levels. If through dietary and exercise control, fasting and pre-meal blood glucose levels are below 5.3 mmol/L, and post-meal blood glucose levels after two hours are less than 6.7 mmol/L, and nighttime blood glucose should be higher than 4.4 mmol/L. If one can reach these standards through diet control and exercise, then continue as currently managed. However, if blood glucose levels cannot reach this range through diet and exercise, it is recommended to use insulin treatment as soon as possible. This is because uncontrolled blood glucose levels during pregnancy can significantly impact both the expectant mother and the fetus. Thus, if diet and exercise cannot normalize blood glucose levels, early treatment with insulin is advised. (Please take medications under the guidance of a qualified physician and do not self-medicate.)
The differences between gestational diabetes and diabetes
Gestational diabetes is a condition in which diabetes does not exist before pregnancy, but occurs after becoming pregnant. This is referred to as gestational diabetes. Diabetes refers to cases where the condition existed before pregnancy. Of course, sometimes it's not easy to distinguish between gestational diabetes and pre-existing diabetes, such as when diabetes exists before pregnancy but goes undiagnosed and is only discovered after becoming pregnant. In such cases, it is difficult to determine whether it is gestational diabetes or diabetes. In this situation, it is necessary to conduct further tests after childbirth; a 75g glucose screening test should be taken 6 weeks postpartum. If the results are still abnormal, it is considered diabetes.
early signs of diabetic foot
Diabetic foot, also referred to in our specialty as diabetic foot syndrome, mainly occurs in long-standing cases of diabetes, where the lower limbs develop arterial atherosclerosis and neuropathy, leading to ulcers in the feet. Severe diabetic foot can result from significant neuropathy, such as extreme numbness and pain in the lower limbs, pain akin to being pricked with needles, and severe vascular disease, such as ischemia in the lower limbs. Patients may feel unusually cold even in winter and sometimes need to wear socks even on hot days due to extreme sensitivity to cold, indicating severe vascular disease. Such serious vascular and neuropathic conditions represent a high-risk foot, which has a high likelihood of developing ulcers. The early signs of potential ulceration include these typical symptoms along with local injuries, such as nail trimming or other external injuries, which can easily trigger these conditions. Therefore, it is crucial to be vigilant and avoid these precipitating factors.
Screening time for gestational diabetes
For women without high-risk factors, the general practice is to conduct a 75g glucose tolerance test between 24 to 28 weeks of pregnancy, measuring fasting blood glucose, blood glucose one hour after glucose ingestion, and blood glucose two hours after glucose ingestion. The fasting blood glucose should not exceed 5.1 mmol/L, blood glucose one hour after glucose ingestion should not exceed 10.0 mmol/L, and blood glucose two hours after glucose ingestion should not exceed 8.5 mmol/L. For women with high-risk factors, it is advisable to screen for blood glucose levels during the first prenatal visit to detect gestational diabetes early, control blood sugar levels, and reduce the occurrence of complications. Who are the women considered to be at high risk? Those who have a history of gestational diabetes, history of delivering a macrosomic infant, are obese or have polycystic ovary syndrome, have a family history of diabetes among first-degree relatives, are found to have positive fasting and ketone bodies early in pregnancy, have a history of unexplained recurrent miscarriages, have a history of fetal anomalies and stillbirths, and those who have a history of delivering newborns with respiratory distress syndrome. These women need to undergo diabetes screening after becoming aware of the pregnancy to detect any abnormality in blood sugar levels early and treat accordingly.
Is the elderly person's diabetes severe?
Elderly diabetes often begins in a concealed manner, lacking the typical symptoms of excessive drinking, eating, urination, and weight loss. At the same time, it has many complications, such as diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy, and diabetic cardiopathy, making its manifestations more diverse and extensive. In addition, it can be complicated by infections, ketoacidosis, and hyperosmolar hyperglycemic syndrome, both of which have very high mortality rates. Fourthly, diabetes often coexists with multiple chronic diseases in the elderly, including angina, hyperlipidemia, hypertension, and heart failure, thus increasing the risk associated with polypharmacy. Fifthly, hypoglycemia can easily occur and is difficult to diagnose and treat promptly, often leading to severe adverse events such as falls and cardiovascular incidents. Therefore, we should pay more attention to diabetes in elderly individuals, managing it more thoroughly to enable a happier life in their later years.
Where does diabetes cause weight loss first?
Diabetes is a disease caused by elevated blood sugar levels, leading to metabolic disorders of proteins and fats within the body. Early-stage diabetes patients sometimes show no symptoms, while others may experience symptoms such as thirst, frequent drinking, frequent urination, increased appetite, and weight loss. This weight loss manifests as a general decrease in body weight; depending on individual constitution, some may lose 5 kilograms in a month, others may lose 10 kilograms, and in severe cases, some may lose up to 20 kilograms. This is a uniform weight decrease across the whole body, not just slimming of the arms or exclusively losing weight in other specific parts of the body, or just the face. Therefore, in addition to weight loss, patients may also suffer from fatigue, hunger, and dizziness. It is crucial to promptly test their blood sugar levels, diagnose diabetes as early as possible, and prevent the occurrence of chronic complications.
Why is it called Type 2 Diabetes?
Diabetes is afflicting people all around the world, particularly type 2 diabetes, which accounts for over 90% of all cases. The pathogenesis of type 2 diabetes is quite complex, involving genetic predispositions and environmental factors, as well as factors like insulin resistance and defects in the function of beta cells in the islets of Langerhans. Therefore, type 2 diabetes arises under the combined effects of genetic susceptibility and environmental factors, where the patient experiences a decrease in insulin sensitivity that worsens over time, leading to compensatory hyperinsulinemia and impaired insulin secretion. As the condition worsens and progresses, the function of the pancreatic beta cells deteriorates further and becomes inadequate, leading to the onset of type 2 diabetes. Thus, defects in the function of the beta cells are crucial to the development of type 2 diabetes.
Is frequent urination diabetes?
If the urine output exceeds 2500 mL in 24 hours, this condition is called polyuria. There are many causes of polyuria; diabetes is just one of them. Additionally, physiological causes are also seen, such as eating a large amount of fruits that have a diuretic effect, like watermelon, or drinking a lot of water previously. This is referred to as physiological polyuria and does not require special treatment. Pathological causes, apart from diabetes, also include diabetes insipidus or electrolyte disturbances. For instance, long-term hypokalemia, hypercalcemia, or increased aldosterone can all lead to polyuria. It is advisable to promptly visit the urology department of a hospital for tests such as blood glucose levels, routine urine tests, and endocrine examinations to understand the causes of polyuria, and to determine whether it is caused by diabetes.
What does a diabetic diet include?
The diet for diabetes primarily includes the following aspects: First, it is recommended to eat at regular times and in fixed amounts daily. Second, avoid consuming foods with a high glycemic index, such as porridge, glutinous rice, and rice noodle rolls, as these are not recommended. Third, the diet should be bland, as many diabetic patients also suffer from high blood pressure, high blood lipids, and high uric acid. Therefore, a bland diet is emphasized. Fourth, overly sweet fruits such as lychee, longan, banana, and grapes are not suitable for consumption.
What should pregnant women with diabetes eat?
If a pregnant woman has been diagnosed with gestational diabetes during pregnancy, it is still necessary to decide what food to eat based on the specific blood sugar levels. If the current blood sugar level is relatively stable, she can follow a diabetic diet, eat smaller meals more frequently, and consume more fresh fruits and vegetables. It's important to avoid foods that cause high blood sugar, and it is essential to walk or engage in appropriate exercise 30 minutes after eating to help metabolize the blood sugar. However, if the blood sugar remains high and does not decrease significantly, insulin might be needed to lower the blood sugar levels.