Hyperglycemia is a common feature of all diabetic patients, but specific to each patient, the characteristics of the blood glucose spectrum are different: some patients are mainly increased in fasting blood glucose, some patients are mainly elevated in postprandial blood glucose, and more patients are significantly elevated in fasting and postprandial blood glucose.
Drug options vary due to the different characteristics of the blood glucose spectrum. Even if it is the same type of hyperglycemia, it may be treated in the opposite way because of its different causes. For example, if the same fasting blood glucose is high, if it belongs to the "Sumuji reaction", it is necessary to reduce the amount of antidiabetic drugs at night, and if it belongs to the "dawn phenomenon", it is necessary to increase the amount of antidiabetic drugs at night.
Below, we will talk about the causes of various types of high blood sugar and countermeasures.
Causes of fasting hyperglycemia and coping strategies
1. Sumuji reaction
Cause: The so-called "Sumuji reaction" refers to the rebound increase in the fasting blood glucose in the early morning after the patient has hypoglycemia at night (often in the early morning), and the reason is related to the excessive dosage of hypoglycemic drugs (including insulin) at night.
Countermeasures: Avoid the occurrence of nocturnal hypoglycemia by appropriately reducing the dose of oral hypoglycemic drugs (or medium- and long-acting insulin before bedtime) before dinner, and fasting blood glucose can return to normal.
2. Dawn phenomenon
Cause: The so-called "dawn phenomenon" refers to the phenomenon of normal blood glucose at night and hyperglycemia on an empty stomach in the early morning, which is related to the increased secretion of various glycemic hormones (such as glucocorticoids, growth hormones, etc.) in the body in the early morning.
Countermeasures: Choose long-acting hypoglycemic drugs (including insulin), because their efficacy is maintained for a long enough time to effectively control early morning fasting hyperglycemia.
The main oral hypoglycemic drugs to choose from are: long-acting sulfonylureas (such as glimepiride, gliclazide extended-release tablets, glipizide controlled-release tablets), metformin extended-release tablets, sodium-glucose synergistic transporter-2 (SGLT-2) inhibitors, etc., once a day orally.
In addition, moderate and long-acting insulin, long-acting insulin analogues can also be selected, injected subcutaneously at night before going to bed, and then adjust the dose of medication as appropriate according to the results of blood glucose monitoring until blood glucose is satisfactorily controlled.
3. Eat too much at night
Cause: Some patients eat too little for dinner, get up at night to add more meals, and eat too much, resulting in an increase in fasting blood glucose.
Countermeasures: In order to avoid low blood sugar at night, it is best to add a small amount of food before going to bed at night (around 10 pm), do not wait for hypoglycemia to occur at night to add food, which will often eat a lot, which is not conducive to blood sugar control.
4. Poor night sleep
Causes: Anxiety and insomnia can lead to sympathetic excitement and increased blood sugar on the fasting stomach.
Countermeasures: Maintain emotional stability, avoid excessive anxiety, and use sedative sleeping pills if necessary.
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Causes of postprandial hyperglycemia and coping strategies
1. Eat too much at each meal
Cause: Excessive meal intake or a high glycemic index of the food eaten can lead to postprandial hyperglycemia. Diet control diabetes treatment basis, in any case to adhere to, without good diet control, even the best drugs are in vain.
countermeasure:
1) Control the amount of food, eat seven or eight points of fullness per meal (generally no more than 2 two);
2) Eat fewer and more meals. In order to alleviate the hunger between meals, try to choose coarse grains or whole grain foods with high dietary fiber content;
3) The "glycemic index" of porridge and sticky porridge is high, which can significantly increase the blood sugar after meals, so diabetics try not to drink or drink less;
4) Eat less greasy foods, fatty foods have higher calorie content.
2. Improper drug selection
Cause: Different hypoglycemic drugs (including types and dosage forms) have different characteristics of action. Improper drug selection, incorrect use, and insufficient dosage are also important reasons for poor postprandial blood glucose control.
Countermeasures: for postprandial hyperglycemia, short-acting hypoglycemic agents (including insulin) should be selected. Alternative oral hypoglycemic drugs are: short-acting sulfonylureas, glinides, α-glycosidase inhibitors, dipeptylpeptidase-4 (DPP-4) inhibitors and so on.
Insulin, on the other hand, should be selected as an ultra-short-acting insulin analogue or a short-acting insulin. In addition, short-acting glucagon-like peptide-1 receptor agonists may be selected.
Drug usage is also important, such as α-glycosidase inhibitors require chewing together with the first bite of meal, glinide requires pre-meal administration, glyquinone and glipizide require oral administration half an hour before a meal, and benarutide requires subcutaneous injection 5 minutes before a meal.
Note: These oral hypoglycemic or insulin preparations for postprandial hyperglycemia usually require preprandial administration three times a day (note: WITH THE EXCEPTION OF DPP-4 inhibitors). If used incorrectly, the efficacy will be greatly reduced. If drug selection and usage are fine and the blood glucose is still high after a meal, the dose can be increased or a combination may be taken as appropriate.
3. Do not exercise after meals
Cause: Aerobic exercise can play an auxiliary hypoglycemic role, and inactivity after meals is also one of the causes of postprandial hyperglycemia.
Countermeasures: Exercise appropriately after meals. It is generally recommended to start exercising half an hour after meals, and should choose the form of aerobic exercise (such as jogging, brisk walking, swimming, fitness dance, etc.), the exercise intensity should not be too large, and the time should be mastered in 30 to 45 minutes.
Note: Do not do intense anaerobic exercise, which stimulates sympathetic excitement and will raise blood sugar.
Causes and coping strategies for high blood glucose before and after meals
The reasons for the increase in fasting blood glucose and postprandial blood glucose were discussed separately, mainly to facilitate the analysis of the causes. In fact, there are not too many cases of simple fasting or postprandial blood glucose rise, more often than not, fasting and postprandial blood glucose are high, or a certain party is mainly elevated.
Fasting blood glucose and postprandial blood glucose interact with each other. Fasting blood glucose reflects the level of basal blood glucose, and postprandial blood glucose is further elevated above the basal level; in turn, poor postprandial blood glucose control will also affect the next meal of preprandial blood glucose (or fasting blood glucose) to increase it.
For the treatment of high blood glucose before and after meals, it is necessary to take both into account and distinguish between priorities and priorities. In addition to adjusting the diet and moderate exercise, it is advocated to adopt "combination of long and short" and "combined drug" in terms of medication. Long-acting drugs are mainly used to control fasting blood glucose, and short-acting drugs are mainly used to control postprandial blood glucose.
In addition, it should be noted that stress conditions such as severe infection, high fever, surgical trauma and other stress conditions will also cause a significant increase in blood sugar, so patients who are not satisfied with blood glucose control must pay attention to the exclusion of stress factors such as infection and deal with them in time.