Manager Yin's confusion

This is the 3618th article of Da Yi Xiao Nursing

One

Manager Yin has had several symptoms of sudden panic, shaking hands, and cold sweats in the past six months, which makes him very puzzled: he does not have diabetes, has not used hypoglycemic drugs, has always had a good appetite, eats a lot, how can there be hypoglycemia?

Manager Yin is the manager of a pharmacy door market department, very much knowledge of medicine, he knows that people gradually become blessed in middle age, it is not a good thing, and to solve the problem of obesity, one is to eat less, the other is to move more. But it has not been seriously implemented, low blood sugar has come to the door, how can you consider eating less? As for exercise, how many years have no habits, now it has belonged to the scope of obesity, walking more is still difficult, how can you lose weight through exercise?

Manager Yin Shulin, whose ancestral home is Linyi, Shandong, is 56 years old, with a height of 1 meter 62 and a weight of 90 kilograms. Manager Yin has white skin and a ruddy face, wears a pair of myopic glasses that are not deep, has a high school education and likes to read, giving people a gentle and elegant impression. Once joined the army, after the recovery of the county pharmaceutical company, serious work, excellent business, a few years ago transferred to a store department as a manager, after arriving at the post Ofe Yin felt: Now the people suffer from the lack of medical treatment, as a manager of the medical store department, should strive to think of the masses, anxious about the needs of the masses. It is the proper meaning to strive to equip the store with a variety of commonly used drugs, and for some common diseases, over-the-counter drugs are commonly used, and the public should also give guidance as much as possible when they come to ask for medicines. Therefore, Manager Yin has not only worked hard to learn medical knowledge over the years, but also led other employees to study hard, and the business level of the employees of the store department has been greatly improved, the service has improved, and the surrounding people are all praised.

Yin Shulin is fat, the amount of activity is small, outside the work is to read books, the reading range is quite wide, literature and history philosophy, astronomical geography, Chinese and foreign novels are involved, but the most read is the medical books, in the early years also read two years of pharmacy majors in the TV university, but in the medical aspects of completely rely on self-study. However, modern medicine is based on anatomy, physiology, biochemistry, pathology, microbiology, and biostatistics, and it is not easy to learn on its own.

Two

At about 11:00 a.m. one day, the manager of the main store accompanied the leaders of the Price Bureau and the Medical Insurance Bureau to inspect the work of the store department, and Manager Yin was prepared, and the introduction of the work situation was the first to be the road, and several leaders praised it. While talking, Manager Yin suddenly felt palpitations, and then his hands began to tremble and sweat slightly, knowing that it was the onset of hypoglycemia symptoms. There was candy in his pocket, but Manager Yin felt that in front of many leaders, taking out candy to eat, it seemed that it was not elegant, so he had to try to endure. The medical insurance director talks a lot, asking this, asking that, asking non-stop. Manager Yin couldn't stand it, so he had to lie that he wanted to go to the toilet and wanted to eat some candy in the toilet. At this time, the manager of the main store noticed that Manager Yin's face was congested, and he held the wall with his hand and said:

"What happened to Lao Yin?" Go and rest for a while. ”

"It's okay, it's okay."

"Manager Yin probably had a low blood sugar." An old worker said

"Then drink glucose water!" The head office manager has experience, and what is available in the pharmacy is glucose water.

"Don't, don't." Manager Yin also said:

"Xiao Wang, I have a bag of white sugar on my table, help me make a cup of sugar water, thank you."

The inspection work was over, and several leaders expressed satisfaction with Manager Yin's work, and the manager of the main store took care of it:

"Old Yin, your health is very important, you must go to the hospital to check and examine."

Lao Yin ate candy and drank sugar water after a while and then returned to normal. Some confusion in the heart, this hypoglycemia comes up quickly, gets better and faster, what is the cause of it, in the medical books he saw did not seem to talk about this disease, before studying pharmacology in the TV University to mention that some hypoglycemic drugs may cause hypoglycemia, but they did not take these drugs. However, today there was a bit of a foreign appearance at a critical juncture, and this matter had to be seen in the hospital.

Yin Shulin has worked in a pharmaceutical company for many years, a pharmaceutical family, the deputy director of the internal medicine department of the county hospital is an acquaintance, acquaintances are good at doing things, the next afternoon Manager Yin has appeared in the office of deputy director Meng, talking about his low blood sugar problem, ask why this. Deputy Director Meng did indeed move high and said:

"If this symptom of hypoglycemia is not caused by an overdose of hypoglycemic drugs, the following conditions need to be considered: severe cirrhosis, chronic alcoholism, and surgery for most of the stomach, which are not related to you. But there is also a disease called islet beta cell tumor, also known as insulinoma. Islet beita cells are insulin-producing cells, if these cells proliferate, forming tumors with insulin secretory function, a large amount of insulin from time to time into the bloodstream, will produce paroxysmal hypoglycemia. If this is the case, the tumor can be cured by removing it. ”

Manager Yin felt that what Deputy Director Meng said was indeed reasonable, and if it was a disease, it was of course good to have an operation to cure it. So he followed Director Meng's suggestion and went to the endocrinology department of the affiliated hospital of the medical school for further examination. The results of the test ruled out the possibility of islet beta cell tumors, which were considered to be a diabetes-related reactive hypoglycemia caused by "hyperinsulinemia".

Why is insulin in the blood elevated? Diabetes is caused by absolute or relative insufficiency of insulin, so it is characterized by elevated blood sugar, how can your own insulin rise, causing a hypoglycemic response but provoking diabetes? Manager Yin fell into a deep confusion. Manager Yin's habit is to find answers when encountering difficulties, and over the years Yin Shulin has learned to go online to find answers, and his experience is that the answers on the Internet come quickly, but the "quality" is not as good as in the book. But this time, whether online or in books, there seems to be no clear answer.

Three

Manager Yin still believes in Deputy Director Meng, so he asked him about the doubts in his heart, Deputy Director Meng because the last consideration of islet beta cell tumor was not confirmed, the heart seems to be a little ashamed of friends, and the confusion in Manager Yin's heart seems to have no clear understanding at once, so he carefully consulted the information, Deputy Director Meng has received strict medical education, and a check of medical literature on this issue has been clearly understood. One day I called Manager Yin and said that if he had a poop, he could come over and talk about low blood sugar.

One day at about four o'clock in the afternoon, the two were still a little free, so they met in the office of Deputy Director Meng.

Deputy Director Meng's office is on the east end of the third floor of the county hospital administrative building, about ten square meters, which is shared by him and Deputy Director Kong, and each person has a set of office equipment and bookcases. This afternoon, Deputy Director Kong was looking at the outpatient clinic, and Yin and Meng sat down on two single sofas, and Deputy Director Meng said:

"I have checked some medical literature about your low blood sugar, and it seems that your low blood sugar has something to do with diabetes."

"Really? Diabetes should be high blood sugar. "This is very clear to Manager Yin.

"Yes, the most notable feature of diabetes is increased blood sugar, which is caused by an absolute or relative lack of insulin. The so-called relative lack, but also includes a lot of quantity, but the efficacy is reduced, that is, the human body has resistance to insulin, and most of the more common type 2 diabetes in the elderly is now caused by this. ”

"Yes, yes." Manager Yin's medical knowledge is quite good.

"In general, people's blood sugar, whether on an empty stomach or after a meal, is roughly maintained between 3.3 and 8.9 mmol/L, and maintains relative stability. The digestion, absorption and metabolism of sugar are controlled and regulated by a variety of hormones, enzymes and nerves in the human body, so that the production and consumption of blood glucose form a dynamic balance. Among the various related hormones, the most important is insulin, which can promote the use of sugar and lower blood sugar, but the pancreas also produces "glucagon" by breaking down liver glycogen or promoting the heterogenesis of glycogen in the liver, that is, the conversion of fats and proteins into sugar, and raising blood sugar. In addition, epinephrine, growth hormone, and glucocorticoids can also raise blood sugar through similar effects. When the carbohydrate intake is too much, it will promote the secretion of insulin, and the secretion of hormones that have a glycemic effect when hungry increases, so the general hunger, blood sugar has not dropped too much. ”

Manager Yin did not know much about these physiological knowledge. Deputy Director Meng also said:

"When the blood glucose drops to 4.5 mmol/L, insulin secretion stops, when the blood glucose is lower than 3.9 mmol/L, it is possible to stimulate the secretion of glucagon, and as low as 3.0 mmol/L, it can stimulate sympathetic excitation, secrete epinephrine, norepinephrine and some peptide substances, causing palpitations, hand shaking, cold sweat and other hypoglycemia symptoms." Therefore, the appearance of hypoglycemia symptoms indicates that the body secretes too much insulin, exceeding the body's ability to stabilize blood sugar. Deputy Director Meng explained the origin of the symptoms of hypoglycemia.

"Usually half an hour to an hour after eating, blood sugar rises, which stimulates insulin secretion, promotes the use of sugar, and stabilizes blood sugar." However, if the secretion of insulin is very slow, blood sugar has dropped, insulin continues to be secreted, and there may be insufficient secretion of glucagon, which may lead to hypoglycemic symptoms. Therefore, this hypoglycemia symptom that occurs four or five hours after a meal indicates that there is an abnormality in insulin secretion function, and also indicates a disorder of blood sugar regulation function, so this hypoglycemia is essentially related to diabetes, which is called in some internal medicine works: early diabetes-related reactive hypoglycemia. ”

"Oh, looking at the essence through the phenomenon, the essence of high insulin and low blood sugar is blood sugar regulation dysfunction, which is indeed related to diabetes." Manager Yin summed it up very well.

"So what to do?"

"The key is to prevent the development of diabetes, and the way to prevent it is: eat less and move more."

"Isn't it more likely to have hypoglycemia when you eat less?"

"You can eat a small amount and multiple meals, such as adding a snack between meals, avoiding eating too much at one time, making blood sugar rise significantly, and stimulating continuous insulin secretion." More exercise can reduce the body's resistance to insulin, restore sensitivity to insulin, and thus help reduce the amount of insulin secreted, which can reduce the onset of hypoglycemic reactions and also help prevent the occurrence of diabetes. ”

"Recently I saw some people put forward the so-called "new three highs", including a hyperinsulinemia, referring to a situation like mine? Manager Yin asked

"Yes, the definition of hyperinsulinemia, diagnostic criteria, pathophysiology, and the chance of turning into diabetes need further research, but it is positive to make this statement and let people like you with hypoglycemic reactions pay attention to the prevention of diabetes."

……

Just as the so-called listening to Jun's words is better than reading ten years of books, Manager Yin has since worked hard to "eat less and move more", the hypoglycemic reaction has gradually decreased, the weight has also decreased, worked until retirement, and has been basically healthy for many years after retirement, and has not been converted into diabetes.

Manager Yin often says to people: knowledge is power, and medical knowledge is health.

Author: Health educator Yang Binghui