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*For medical professionals only
Don't just use lactulose and Kaiser dew!
Constipation is an unspeakable hidden problem for many diabetic patients, and it is more common
among elderly sugar friends.
Elderly diabetic patients have more harm from constipation, and other complications may occur
due to straining during defecation.
So do diabetics who encounter these constipation clinically only use lactulose and Kaiser dew?
Why do diabetics experience constipation?
Before prescribing a doctor's order, we must first find out the cause of the patient's constipation before we can prescribe the right treatment
.
- Poor blood sugar control in diabetics may damage the body's autonomic nerves, inhibit gastric contraction and gastric emptying, resulting in a decrease in peristalsis function of the gastrointestinal tract, difficulty in stool discharge, and abdominal distension
.
In addition, hyperglycemia will excrete too much water in the body through osmotic action, reduce the water in the large intestine, and cause the stool to not be sufficiently softened and become dry, resulting in constipation
.
- Diabetics with an unreasonable diet, insufficient water intake, or insufficient intake of high-fiber foods may affect intestinal peristalsis and cause obstacles
to smooth bowel movements.
Some patients lack exercise, like to be still and do not move, sit still for too long, will make their own muscles contract weakly, and the peristalsis ability of the digestive tract may also be impressed
.
- Many diabetics need to take drugs to lower blood sugar and prevent complications
.
Some drugs may have certain irritation and damage to the gastrointestinal tract, causing intestinal flora imbalance, affecting gastrointestinal peristalsis, resulting in difficulty
in defecation.
In addition, people who regularly take laxatives have reduced sensitivity to the intestinal mucosa, which can also induce or aggravate constipation
.
- Due to long-term illness, some diabetics are depressed, usually overly anxious and nervous, or easily angry
.
A large number of studies have shown that bad emotions can inhibit the normal movement and secretion of the stomach, and also inhibit intestinal peristalsis, resulting in constipation
.
What are the dangers of constipation for diabetics? Many elderly diabetics are accompanied by cardiovascular and cerebrovascular diseases such as hypertension, arteriosclerosis, coronary heart disease, etc.
, and constipation may cause some more serious problems:
1.
Possible fundus hemorrhage and blindness: When you defecate hard, your blood pressure will rise
.
Older people with diabetic retinopathy may cause blood vessels to rupture, cause fundus hemorrhage, and lead to blindness
.
2.
May induce cardiovascular and cerebrovascular events: excessive force during defecation will increase abdominal pressure, increase blood pressure, accelerate heart rate, increase myocardial oxygen consumption, and aggravate cardiac load, in which case it may induce angina, acute myocardial infarction, aortic aneurysm or heart ventricular aneurysm rupture, cerebral vascular rupture and other serious consequences
.
3.
Other hazards: constipation may cause "fecal stone" intestinal obstruction, induce diverticulosis and diverticulitis, induce or aggravate hemorrhoids and rectal prolapse, fissures, and increase the risk of colon cancer
.
What are the medications? For such patients with diabetic constipation, the basis of treatment is first to control blood sugar; Secondly, when choosing drugs for the treatment of constipation, it is also necessary to consider that many elderly patients may also have a variety of underlying diseases, reduced body tolerance, and limited mobility, therefore, for such groups of people should pay attention to safety, easy to take, according to the situation to choose the following drugs:
1.
Laxatives
.
For patients with constipation who do not have organic lesions, conservative treatment is the mainstay, and excessive or long-term use of laxatives
is avoided as much as possible.
Laxatives usually have these categories: bulk laxatives (such as gum, psyllium, wheat bran, methylcellulose, polyethylene glycol, agar, etc.
), osmotic laxatives (such as lactulose, salt laxatives magnesium sulfate), lubricating laxatives (such as liquid paraffin, glycerin), stimulant laxatives (such as rhubarb, Senna, phenolphthalein, castor oil).
2.
Supplement with probiotics
.
Microecological preparations can change the intestinal microecology, regulate the normal peristalsis of the intestine, and have a certain effect
on relieving constipation and bloating.
Commonly used microecological preparations include bifidotrile live bacterial tablets, caseic acid tablets, etc
.
It has been reported that the application of probiotics has a certain therapeutic effect on type 2 diabetes constipation [1].
3.
Gastrointestinal motility drugs
.
Commonly used drugs are mosapride and itopride, which have a certain effect on constipation [2].
4.
Hypoglycemic drugs and nutritional neurological drugs
.
Hypoglycemic drugs can make blood sugar well controlled for a long time, and avoid or delay the occurrence and development
of neuropathy to a certain extent.
If neuropathy occurs, oral nutritional neurologic drugs such as methylcobalamin and vitamin B1 may be considered [3].
5.
Proprietary Chinese medicine
.
Ma seed pills, four mill soup, Cistanche laxative oral liquid, etc.
can be selected for differentiation [4].
How is patient education done?
Although some diabetic constipation patients have to use drugs for treatment temporarily, medication is not a long-term solution after all, prevention is the key, and comprehensive conditioning
should be carried out in combination with diet, mood and exercise.
1.
Develop a good habit
of regular bowel movements.
Regular bowel movements every day allow the body to form reflexes
.
Generally, it is easy to defecate every morning or just after dinner, so be sure to defecate in time and develop a habit
.
2.
Reasonable diet
.
Drink plenty of water, eat more green leafy vegetables, coarse grains and other high-fiber diets
.
Eating too fine (lack of dietary fiber) and drinking insufficient water can slow the movement of gastrointestinal contents and poor bowel movements
.
Dietary fiber can not only increase the volume of feces, stimulate intestinal peristalsis, effectively prevent constipation, but also delay the absorption of sugar in food and play a role
in stabilizing blood sugar.
3.
Exercise
appropriately.
Prolonged sitting and little exercise may make the colon less stressful, which can lead to constipation
.
Proper exercise is not only conducive to reducing insulin resistance, increasing the utilization and consumption of blood sugar, helping to control blood sugar, but also helping to relieve constipation
.
It is recommended that diabetics can choose jogging, brisk walking, tai chi, baduanjin, do geriatric exercises or square dancing and other activities
.
4.
Rub your stomach often and do lifting exercises
.
When rubbing the belly, tell diabetics to follow the direction of the large intestine, starting from the right lower abdomen and rubbing the stomach in a clockwise circle, which can promote the movement of the large intestine, and then promote bowel
movements.
lifting exercise refers to regularly lifting the anus up and down, and then relaxing, lifting and loosening is lifting exercise
.
Standing, sitting, and walking can be performed, and each lifting exercise can be
done about 30-50 times, lasting 5-10 minutes.
lifting exercise can promote local blood circulation, which is beneficial
to constipation, improve physiological function, and prevent hemorrhoids.
5.
Regular work and rest, good mood
.
Stressful work, irregular schedules, excessive stress or depression may inhibit the natural bowel reflex and lead to constipation
.
Regular daily life, work, and rest, thinking openly and relaxing in case of accidents also help to improve constipation
.
References:
[1] Liu Donghong, Suo Youmei
.
Clinical observation of 45 cases of bifidobacterium quadruple live tablets in the treatment of type 2 diabetes constipation[J].
Chinese Journal of Proctology,2019,39(09):36-37
.
[2] Gastrointestinal dynamics
of the Chinese Society of Gastroenterology.
Guidelines for the diagnosis and treatment of chronic constipation in China[J].
Gastroenterology,2013,18(10):605-612
.
[3] Chen Fengying, Xue Cuiqing
.
Progress in the prevention and treatment of constipation in diabetic patients[J].
New World of Diabetes,2018,21(09):195-196
.
[4] Li Lingxia, Zhu Li.
Application of integrated nursing interventions in elderly patients with functional constipation[J].
Electronic Journal of Integrative Traditional Chinese and Western Medicine for Cardiovascular Diseases,2018,6(35):133-136
.
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