Diabetes Care Journal

The core misunderstanding in current clinical and home-based diabetes care is the excessive pursuit of unified sugar control standards. A truly effective care plan must be dynamically adjusted based on the individual patient's age, disease course, comorbidities, and lifestyle habits. There is no "optimal care formula" suitable for everyone.

Last week, during a follow-up visit with the chronic disease care team of the community health service center, I met 72-year-old Uncle Wang, who has had type 2 diabetes for 18 years and also has stable coronary heart disease. Previously, my child searched for "standard sugar control values" on the Internet and insisted that his fasting blood sugar must be stuck in the range of 4.4-6.1mmol/L, and if it exceeds 0.1, he must add half a tablet of metformin. As a result, I went out for a walk last Friday morning and fainted at the gate of the community. I was sent to the emergency department to check that my blood sugar was only 2.8mmol/L. Fortunately, I was sent to the hospital in time, otherwise the consequences of myocardial infarction would be unimaginable.

In fact, the controversy about sugar control targets has been going on in clinical nursing circles for almost ten years. Traditional endocrinology care standards tend to be more strict. The core logic is that long-term control of blood sugar in a range close to that of healthy people can minimize the risk of long-term complications such as diabetic foot, retinopathy, and nephropathy. This set of standards does have the highest benefits for patients with short disease duration, young age, and no other underlying diseases.

But the nursing ideas in the geriatric department are completely different. We deal with many elderly people with diabetes over 70 years old, whose disease duration generally exceeds 10 years. Most of them also have basic diseases such as hypertension and coronary heart disease, and their tolerance to hypoglycemia is particularly poor. Brain damage and myocardial infarction induced by severe hypoglycemia are more harmful than ten years of high blood sugar. Therefore, we generally relax the fasting blood sugar of such patients to 7-9mmol/L, or even adjust the medication if it exceeds 10. Stability is more important than low.

The “life-oriented care” that has become popular in the past two years is more flexible, and its core is to include the patient’s happiness in life into the evaluation criteria. I used to supervise a 40-year-old university teacher who loved to drink bubble milk tea. He quit drinking milk tea for half a year in order to control his sugar. He was depressed every day and his blood sugar went up and down. Later, we adjusted the plan for him: he was allowed to drink 3-sugar pearl milk tea once a week, and he drank it during lunch. He also reduced the rice at noon by 2/3, and walked for 20 minutes more after the meal. Later, his glycosylated hemoglobin has been stable at around 6.5%, and his overall condition has improved more than a little.

Oh, by the way, many people with diabetes always fall into a pitfall when it comes to home care: they think sugar-free foods are made casually. A while ago, a patient told me that he ate 3 sugar-free biscuits a day, but why was his blood sugar still high? If you look carefully at the ingredient list of sugar-free biscuits, the first one is wheat flour. The carbohydrate content is more than 60 grams per 100 grams. When it enters the stomach, it is decomposed into glucose, which still raises blood sugar. The so-called "sugar-free" just means that no additional sucrose is added. You really can't eat it freely.

There are still many people who insist on buying imported blood glucose meters that cost several thousand dollars. It is really not necessary. As long as it is a regular product that has passed the national medical device certification, the error is within the allowable range. The key is that you have to measure at the right time: in addition to regular fasting, occasionally eat hot pot, moon cakes, braised pork and other high-fat and high-sugar foods. Remember to also test the blood sugar 2 hours after the meal. It is much more useful than measuring fasting at a fixed time every day. It can help you understand your glycemic response to different foods. This is your exclusive guide to sugar control.

I have been doing diabetes care for almost 12 years. The most common thing I tell patients is: sugar control is for living a good life, not for you to live like an ascetic. I met a little girl who had just been diagnosed before, and she cried and asked if she could never eat birthday cake again. I told her that of course she could. If you eat a small piece on your birthday, halve the staple food of the day, and take an extra half-hour walk after meals, it won't have much impact at all. You can't even deprive yourself of the joy of your birthday just because you have diabetes, right?

After all, diabetes is a chronic disease that lasts a lifetime, and there are never any black-and-white standard answers to care plans. If you can persist for a long time, your body is comfortable, and your indicators are within a safe range, then it is the best plan for you. If you are not sure how to adjust the dosage, don't randomly change the dosage or follow the folk remedies on the Internet. Ask your bedside nurse or endocrinologist. You will never go wrong.