Diabetes Care Discussion Questions

There is no standardized care plan suitable for all patients. All sugar control goals, diet, exercise, and medication strategies must be dynamically adjusted based on individual conditions. Any one-size-fits-all requirement may bring more serious health risks than elevated blood sugar.

I have been working in the endocrinology department of a tertiary hospital for 6 years, and I have seen too many patients who had problems because of rigid "standard answers". What impressed me most was the 72-year-old Uncle Zhang who worked the night shift last winter. When he was helped in by his family, he was sweating all over and shaking when he spoke. His fingertip blood sugar was only 2.1mmol/L, which is typical of severe hypoglycemia. After asking about it, I found out that his glycation level was 6.8% a while ago. I heard from a patient that it must be below 6.5% to be considered "successful in sugar control." So he cut his dinner staple food in half and didn't dare to add any snacks before going to bed. That's why this happened.

Interestingly, the controversy about sugar control targets has never stopped in the academic community: the 2023 U.S. ADA guidelines still recommend that most adults with type 2 diabetes without serious complications should control their glycated hemoglobin within 7.0%, or even close to the normal level of 6.5% if conditions permit. ; However, the consensus on elderly diabetes care issued by the Chinese Geriatrics Society clearly mentions that for elderly people over 80 years old, with a history of cardiovascular and cerebrovascular diseases, and frequent episodes of hypoglycemia, it is completely fine to relax glycation to 8.0% to 9.0%. Avoiding the risk of brain damage and myocardial infarction caused by hypoglycemia is the first priority. Later, Uncle Zhang adjusted his sugar control target and relaxed it to 7.5%. He can now eat more than half a bowl of rice at each meal, and occasionally eats two bites of peach cakes made by his wife. His overall energy level is more than a little better. The last time he checked, his glycemic index was 7.3%, and he has not had a single episode of hypoglycemia.

In addition to the controversy over indicators, the most frequently asked question in outpatient clinics is the issue of taboos. Do you have to completely avoid milk tea, cakes, and hot pot if you have diabetes? Last month, I met Xiao Zhou, a 28-year-old programmer who had just been diagnosed with type 2 diabetes. He sat in the clinic with his head hanging down and said that he had been eating boiled vegetables every day for the past two weeks, and even only dared to eat half a bowl of rice. Last week, he couldn't help but secretly drink a cup of full-sugar milk tea. His blood sugar soared to 18mmol/L. He was so scared that he would never have fun in the rest of his life, and he didn't even want to go to class.

There are two completely different care ideas on this issue: traditional diabetes care requires strict limits on the intake of added sugar, high oil and high salt foods, and it is best not to touch them at all; but now more and more clinical practitioners are advocating the concept of "flexible diet" - as long as the total calories of the day are controlled, eating two small bites of high glycemic index foods, eating them with low GI foods, and combining them with a small amount of exercise, there is no need to completely deprive the pleasure of eating. I calculated for Xiao Zhou at that time that he could drink milk tea with 30% sugar and no additives once a week. As long as he reduced the staple food of the day by half and walked slowly for 20 minutes after drinking, his blood sugar would be completely stable within 10mmol/L. He went back and tried for two months. Last week he came back to check the glycation level of 6.2%. He said that now he finally no longer feels that controlling sugar is a burden, and even his work efficiency has improved a lot.

The problem of eating has been solved, but many people are stuck on exercise. Aunt Li, who has degenerative knee disease, came to me with an online "Exercise Guide for Sugar Control" and said it required 30 minutes of moderate-intensity exercise every day. Her knees were in unbearable pain after walking for 10 minutes, so she couldn't control her sugar? This is actually a question that has been discussed for a long time: the old version of the diabetes care guidelines did require a total of 150 minutes of moderate-intensity aerobic exercise per week, but the China Consensus on the Prevention and Treatment of Type 2 Diabetes just updated in 2024 has clearly mentioned that fragmented light exercise is equally useful - even if it is divided into three times a day, 10 minutes each time of tiptoeing, lifting a mineral water bottle filled with water, and standing and washing the bowl for 10 minutes after a meal, the accumulated sugar control effect is no worse than walking for half an hour at a time. Aunt Li later started doing 10-minute sitting leg raises three times a day at home, and occasionally went downstairs to walk slowly for two laps. Over the past six months, her blood sugar has been more stable than before when she was forced to walk.

To be honest, when I teach, I never give patients a list of "must dos" and "not dos". After all, the purpose of controlling sugar is to live a good life, not to become an ascetic. If you see others eating oatmeal to lower blood sugar, maybe it will rise if you eat it, then oatmeal is not a good sugar control food for you. It is convenient for others to wear a dynamic blood glucose meter, but you think it is expensive and expensive. Then it is perfectly fine to use an ordinary fingertip blood glucose meter to measure it every day. Don’t be so anxious that you can’t sleep just because of a 0.3mmol/L value difference. After all, the home blood glucose meter itself allows an error of ±15%. It is much more useful to look at the long-term trend than to worry about a single value.

To put it bluntly, diabetes care is essentially a long-term process of getting in touch with your body. There is no absolute right or wrong, and the best plan is the one that suits you.