Head Nurse Zhang Mingxia: Take care of type 1 sugar friends and pay attention to the "five cornerstones" of blood sugar management

Edited by Yimaitong, please do not reprint without authorization
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On August 29, 2021, the "2021 Peking University People's Hospital Endocrinology and Metabolism Research Class" jointly organized by the Department of Endocrinology, Peking University People's Hospital and China Diabetes Magazine opened
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In this study class, the head nurse Zhang Mingxia gave you a wonderful academic sharing with the topic "From hospitalization to home-How to care for type 1 sugar friends"
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Expert introduction Zhang Mingxia, head nurse of the Department of Endocrinology, Peking University People’s Hospital, deputy chief nurse, deputy director of the Diabetes Professional Committee of the Chinese Nursing Society, deputy director of the Endocrinology Professional Committee of the Beijing Nursing Society, and Diabetes Education and Management Branch of the Chinese Health Promotion and Education Association Member of the Standing Committee, engaged in diabetes education and management for more than 20 years, completed and participated in the compilation of many endocrine, diabetes care-related books, and participated in the compilation of many diabetes clinical guidelines.
The incidence of type 1 diabetes in China continues to increase, and the trend of younger age is obvious.
At the beginning of the lecture, Zhang Mingxia Chang has analyzed the current status of type 1 diabetes in China: Among the various types of childhood diabetes in China, type 1 diabetes (T1DM) accounts for about 90%, and it has become a major pediatric endocrine disease that endangers children's health
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In recent years, the overall incidence of type 1 diabetes has been 2 to 5 cases per 100,000.
It should be noted that the average annual growth rate of type 1 diabetes in children less than 5 years old is 5%-34%, and the incidence of disease is becoming younger.

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Take care of type 1 sugar users and pay attention to the "five cornerstones" of blood sugar management.
The formulation of blood glucose management goals for type 1 diabetes patients follows the principle of individualization.
In order to better achieve the stability of blood sugar standards, we need to pay more attention to the five cornerstones of blood sugar management for type 1 diabetes.
(Diet therapy, exercise therapy, insulin therapy, blood glucose monitoring, health education) comprehensive management
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1.
Diet managementNutrition therapy is the top priority of diet management.
The overall principle is to reasonably control total calories based on the patient’s age, height, weight, and physical activity intensity based on the patient’s age, height, weight, and intensity of physical activity on the basis of meeting the needs of the body, reasonably matching nutrition, and arranging diet.
Promote small meals and more meals, regular and quantitative meals
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Step 1: Estimate the ideal weight according to the formula "standard weight (kg) = height (cm)-105"
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➤Standard: body weight ± 10%; ➤ Obesity: body weight ± 20% of standard body weight; ➤ Lean: Body weight ± 18% to 20% of standard body weight
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Step 2: Evaluate the intensity of physical labor
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Step 3: Determine the total calories the patient needs per day
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Step 4: After determining the total calories, allocate the proportions of the three major nutrients
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For example, a 27-year-old male patient with a height of 170 cm and a weight of 65 kg, an occupational accountant, has been diagnosed with type 1 diabetes for 2 years without any obvious complications
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➤Calculate the standard weight: 170-105=65 (kg); ➤Determine the patient's body shape: match the actual weight and belong to the normal weight; ➤Physical labor: the accounting belongs to the office staff, and light physical activity; ➤Calculate the daily calories: daily The caloric energy intake standard per kilogram is 25-30 kcal, and the whole day is 65X (25~30)=1625~1950 (kcal); ➤Total calorie allocation: protein 243.
75~292kcal, fat 406.
25~487.
5k Card, the rest is carbohydrate; ➤Choose and exchange food according to eating habits
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2.
Exercise therapy Before giving exercise therapy, it is necessary to explain to the patient the benefits of regular exercise, including promoting blood circulation, growth and development, reducing weight, improving insulin sensitivity, reducing insulin resistance, improving blood sugar, enhancing adaptability, and improving life Sense of well-being and social identity, etc.
, and evaluate whether the patient can adhere to regular exercise based on the patient’s own situation, and it is necessary to further understand the patient’s life and work habits.
It will be more important to embed exercise therapy in the inherent living habits.
Conducive to the improvement of compliance
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Determination of the amount of exercise ➤Intensity: The appropriate exercise intensity should make the heart rate reach 60% of the maximum oxygen consumption; ➤Time: The cumulative time of exercise is generally 20-30 minutes; ➤Frequency: Exercise 3-4 times a week
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Note: If the amount of exercise is small each time and the physical condition is good, the exercise frequency can be changed to once a day for patients who do not feel tired after each exercise; "If the exercise interval exceeds 3-4 days, the effect and accumulation are obviously weakened
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Exercise precautions ➤ Pre-exercise assessment: blood sugar is higher than 14mmol/L, exercise is prohibited; exercise is not suitable when insulin has the strongest effect (such as short-acting insulin injection, etc.
); there are obvious wounds and pulling is not suitable for exercise; blood sugar> 6.
6mmol/L.
Yes Exercise; <5.
6mmol/L need to eat 30g carbohydrates before exercising
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➤Prevention of accidents: You need to carry foods that are easy to raise blood sugar, such as glucose tablets, etc.
; avoid high-intensity exercise, prevent accidental injuries, and pay attention to foot care; carry an emergency card (including name, age, home address, emergency contact, etc.
) Information about the condition, etc.
)
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3.
Insulin injection In the early stage of insulin use, medical staff should evaluate the injection site suitable for the patient and the injection method that is easy for the patient to accept.
At the same time, it is necessary to observe and prevent adverse insulin reactions
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In addition, patients should be taught the methods of self-injection and preservation of insulin to ensure that they master the precautions
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Principles for adjusting the dose of insulin at the recommended injection site ➤Elevated morning fasting blood sugar caused by non-night hypoglycemia: increase the intermediate or long-acting insulin before dinner or before going to bed the day before; ➤ increase postprandial blood sugar: increase pre-meal quick-acting Or short-acting insulin dosage; ➤High blood sugar before lunch and dinner: Use basal insulin, increase the pre-breakfast dose/pre-lunch regular or quick-acting dose, use rapid-acting insulin, you can also adjust the ratio of carbohydrates in the diet; ➤Dawn Phenomenon: If the HbA1c standard is affected, the pre-mixed 2 insulin regimen can be changed to basic meal-time insulin analogue or insulin pump therapy; the insulin before bedtime can also be changed to insulin with a longer acting time and monitor whether there is low at night Blood sugar occurs
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The choice of needle Whether for adults or children, a 4mm needle is the safest choice.
When penetrating the skin vertically, it can enter the subcutaneous tissue, and the risk of intramuscular (or intradermal) injection is minimal
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Other precautions include: ➤For all children and adolescents, regardless of age, gender or BMI, 4mm pen needles should be used; ➤All adults, regardless of age, gender and BMI, are recommended when using 4mm insulin pen needles Insert the needle vertically at 90 degrees; ➤When using a needle or syringe with a length> 4mm, you must use the correct pinching technique or tilt the needle to avoid intramuscular injection
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4.
Blood glucose monitoring and hypoglycemia management The most basic methods for evaluating patients' blood glucose control levels include bedside blood glucose monitoring (POCT) and patient self blood glucose monitoring (SMBG) using rapid blood glucose meters
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During hospitalization, intensive blood glucose monitoring is usually before three meals a day + after three meals + before going to bed.
SMBG recommends monitoring 3-4 times a day
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In addition, continuous blood glucose monitoring (CGM) can provide continuous, all-day blood glucose information.
The advantage is that it can find high blood sugar and low blood sugar that are not easily monitored, especially asymptomatic hypoglycemia
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CGM monitoring should be performed if the patient has large blood glucose fluctuations, repeated hypoglycemia, asymptomatic hypoglycemia, or unexplained hyperglycemia
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Glycated hemoglobin (HbA1c) is the gold standard that reflects the long-term control of blood glucose (average blood glucose in the past 2-3 months)
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HbA1c control goals: children and adolescence <7.
5%, adults <7.
0%; measurement frequency: young children should be monitored 9 times a year, older children should be monitored 3-4 times a year, when conditions are limited, each child patient It should be monitored at least every 6 months
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In addition to blood glucose monitoring, attention should also be paid to the management of patients with hypoglycemia.
The specific process is shown in the figure below
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Among them, carbohydrates that can take effect quickly include: 5.
Health education needs to explain to patients the necessity of screening for diabetes complications and the frequency of screening, and inform the correct care methods for skin, mouth, eyes and other parts in daily life
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➤Skin care: keep your skin clean, wipe sweat in time, wash away oil and other secretions; use neutral soap or shower gel to bathe; pay attention to sun protection, apply sunscreen when going out, and use a parasol; avoid mosquito bites, and do not scratch after being bitten; every day; Check the skin of the feet and do not wear sandals barefoot; if there is a small wound on the skin, please seek medical attention in time
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➤Oral care: Brush your teeth every morning and evening, master the correct method of brushing your teeth; develop the habit of gargle after meals; do not use toothpicks to pick your teeth after meals, you can use elastic dental floss; patients who wear dentures, clean their dentures every day; no teeth Elderly people should also regularly clean their gums and alveolar with a soft toothbrush; check their oral cavity every six months and wash their teeth
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➤Eye care: look at your eyes for a while (reading and watching TV should not be too long, you can close your eyes to rest or look far when you feel tired); often do the action of closing your eyes and turning your eyes, which helps blood circulation and nerve regulation; Appropriate eye massage will help blood flow.
Eye massage is not suitable for people with bleeding in the fundus; it is not suitable for exercises that increase intraocular pressure such as holding breath and squatting; check vision and fundus once a year
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➤Foot care: wash your feet regularly and dry them with a dry cloth (especially dry between the toes); the water temperature should be appropriate, below 37℃; avoid walking barefoot; cut the toenails horizontally, avoid trimming the calluses or use chemicals To treat the corpus callosum or toenails; the feet sweat a lot in summer, you should pay attention to washing and keep your feet dry; it is advisable to wear thin cotton, soft, breathable socks and change them every day; do not wear tight shoes, choose breathable shoes; Before putting on shoes, check whether there are any foreign objects or abnormalities in the shoes; once any problems are found, find a specialist doctor or nurse for diagnosis and treatment in time
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