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"There must be fragrant grass within ten steps, and there may not be no orchid fragrance within a hundred miles." This old saying not only speaks to the wonders of the natural world, but also aptly describes the complexity of our human body. The human body is like a sophisticated city, blood sugar is just one of the main roads, and the road to health is much more than that.
Diabetes, a chronic disease that has made countless people smell and change, is like an uninvited guest, quietly coming and staying for a long time. It's not diabetes itself that's really scary, it's its long-dormant complications.
Over the years, too many patients have focused their entire attention on their blood sugar metrics and ignored other, equally important health signals. Today, I would like to share with you a little-known secret: in addition to blood sugar, there are also 6 key indicators, which are like six silent sentinels, silently guarding our health city.
1. Blood Pressure: The Silent Killer
The ancients said: "The upper healing cures the disease". In the prevention and control of diabetes, blood pressure management is a typical case of "preventive treatment". Many people may not know that high blood pressure and diabetes often go hand in hand, forming the so-called "metabolic syndrome".
High blood pressure is known as the "silent killer" because it often silently damages our vascular system. For diabetics, this harm is even worse.
Continuously elevated blood pressure accelerates arteriosclerosis and increases the risk of cardiovascular and cerebrovascular diseases. Worse, it can also worsen the progression of diabetic nephropathy, leading to accelerated deterioration of kidney function.
What is the ideal goal for blood pressure control? For most people with diabetes, blood pressure should be kept below 130/80mmHg. But this is not set in stone and needs to be adjusted according to individual circumstances.
For example, in older patients or those with pre-existing cardiovascular disease, more stringent control criteria may be required.
How to effectively control blood pressure? In addition to the necessary medications, lifestyle modifications are equally important. Reducing sodium intake, increasing physical activity, maintaining an ideal weight, quitting smoking and limiting alcohol are seemingly simple measures, but they can have unexpected effects.
Remember, blood pressure management is a constant battle that requires constant vigilance.
2. Blood lipids: the guardian of the arteries
"The Peach Blossom Pond is a thousand feet deep, not as deep as Wang Lun to send me love." Although Li Bai's poem describes friendship, it is not an exaggeration to use it as a metaphor for the importance of blood lipids to arteries.
Patients often ask, "Doctor, my blood sugar is well controlled, why do I need to check my blood lipids?" "In fact, dyslipidemia and diabetes are like twin brothers, often appearing at the same time. Hyperlipidemia not only accelerates the progression of atherosclerosis, but also increases the risk of serious complications such as myocardial infarction and stroke.
For diabetic patients, the focus of lipid management is mainly focused on the following aspects:
Low-density lipoprotein cholesterol (LDL-C): This is the so-called "bad" cholesterol and should be kept below 1.8 mmol/L.
- 高密度脂蛋白胆固醇（HDL-C）：这是"好"胆固醇，男性应高于1.0mmol/L，女性应高于1.3mmol/L。
- Triglycerides: should be controlled below 1.7mmol/L.
The key to lipid management is persistence. In addition to medication, dietary modification is crucial. Increasing dietary fiber intake, choosing foods rich in unsaturated fatty acids (e.g., olive oil, nuts, etc.), and reducing trans fatty acid intake are all proven ways.
In addition, regular exercise can also significantly improve the lipid profile. At least 150 minutes of moderate-intensity aerobic exercise per week not only helps control blood sugar, but also increases HDL-C levels and lowers LDL-C and triglyceride levels.
3. Body mass index (BMI): A barometer of the body
"Slimming for a thousand days, fat is easy for a while." This proverb speaks to the difficulty of losing weight, but the importance of maintaining a healthy weight cannot be overemphasized for people with diabetes.
Body mass index (BMI) is a simple and effective indicator to assess whether a person is obese or not. It is calculated by dividing the weight in kilograms by the square of the height (meters). For Chinese adults:
- BMI < 18.5：体重过轻
- 18.5 ≤ BMI < 24：正常体重
- 24 ≤ BMI < 28：超重
- BMI ≥ 28：肥胖
Obesity not only worsens insulin resistance, but also increases the risk of diabetes complications. Studies have shown that for every 1 kg of body weight lost, fasting blood sugar decreases by about 0.2mmol/L.
Therefore, for diabetic patients who are overweight or obese, weight loss should be an integral part of the treatment regimen.
Losing weight is not an easy task. I often tell my patients, "Weight loss is not a sprint, it's a marathon." "It takes perseverance and a scientific approach. Controlling total calorie intake, increasing the proportion of fruits and vegetables, and choosing whole grains are all effective dietary strategies.
At the same time, regular exercise is also the key to weight loss. 30 minutes of moderate-intensity exercise a day not only helps with weight control, but also improves insulin sensitivity.
4. Glycosylated hemoglobin (HbA1c): the "historical record" of blood glucose
"If you want to know a big tree, you must wear the roots; If you want to know this, you have to ask the root cause. This old saying is perfect to describe the role of glycosylated hemoglobin.
Unlike a blood glucose test, glycosylated hemoglobin reflects the average blood sugar level over the past 2-3 months. It's like a "history recorder" that faithfully records our blood sugar control. For patients with diabetes, HbA1c is the gold standard for assessing the effectiveness of long-term glycemic control.
In general, the target HbA1c value of diabetic patients should be controlled below 7%. However, this is not set in stone and needs to be individualized according to the patient's age, course of disease, complications, etc.
For example, for younger, uncomplicated patients, goals can be set more strictly; For elderly patients or patients with serious complications, the criteria can be relaxed appropriately.
It's important to note that lower is not always better. Excessive lowering of HbA1c may increase the risk of hypoglycemia, especially in older patients. Therefore, when setting blood sugar control goals, we need to weigh the pros and cons and find the "sweet spot" that works best for the patient.
5. Urine microalbumin: the kidney's "early warning system"
"The embankment of a thousand miles collapsed in the anthill." This old saying vividly describes the development of diabetic nephropathy. Urine microalbumin testing acts as a sensitive "early warning system" to detect minor damage to the kidneys at an early stage, before kidney function is significantly impaired.
Normally, there is little protein in the urine. When urine microalbumin is elevated (30 to 300 mg/24 hours), it means that the filtration function of the kidneys has begun to be impaired.
This is an early manifestation of diabetic nephropathy and a reversible stage. If timely intervention can be made at this stage, it is possible to stop or delay the progression of kidney disease.
For people with diabetes, it is essential to have a urine microalbumin test at least once a year. If test results are abnormal, more frequent monitoring and more aggressive interventions may be required.
In addition to tight control of blood sugar and blood pressure, there are a few things you can do to help protect your kidneys:
- Control protein intake: Excessive protein intake can increase the burden on the kidneys. The general recommended daily protein intake is 0.8-1.0 g/kg body weight.
- Limit sodium intake: Excessive sodium intake can lead to sodium and water retention, which can increase the burden on the kidneys.
- Quit smoking and limit alcohol: Smoking and excessive alcohol consumption can accelerate the deterioration of kidney function.
- Moderate exercise: Regular aerobic exercise can improve blood flow to the kidneys and help protect kidney function.
6. Fundus Examination: A "Health Barometer" for the Retina
"The mirror reflects the form, and the ancient things know the present." Fundus examination is like a mirror that reflects not only the health of the eye, but also the condition of the blood vessels throughout the body.
Diabetic retinopathy is one of the most common microvascular complications of diabetes and a leading cause of blindness in adults. In the early stages, patients often have no obvious symptoms. Therefore, it is important to have regular fundus examinations.
Fundus examination can detect minor changes in the retina, such as microaneurysms, hemorrhage spots, and effusions, at an early stage. These changes are often an early manifestation of diabetic retinopathy. Timely detection and intervention can effectively prevent vision impairment.
For diabetic patients, it is recommended to have a comprehensive fundus exam at least once a year. If retinopathy has been identified, more frequent tests and follow-up visits may be needed.
In addition to regular checkups, there are a few things you can do to help protect your eyes:
- Tight blood sugar control: Good blood sugar control is key to preventing and delaying retinopathy.
- Control blood pressure: High blood pressure can accelerate the progression of retinopathy.
- Quit smoking: Smoking can damage retinal blood vessels and accelerate the progression of retinopathy.
- Eat a balanced diet: Eat foods rich in antioxidants, such as dark vegetables and fruits, which may help protect the retina.
Epilogue:
"The upper medicine treats the disease, the Chinese medicine treats the disease, and the lower medicine treats the serious disease." This classic saying of Chinese medicine speaks to the importance of disease prevention. For diabetic patients, preventing complications is the best embodiment of "curing the disease".
Blood pressure, blood lipids, body mass index, glycosylated hemoglobin, urine microalbumin and fundus examination, these six indicators are like six loyal guards, silently guarding our health. They are interrelated and influence each other, and together they form a panorama of diabetes management.
Remember, managing diabetes is not an overnight thing, it's a long-term battle.
It requires our patience, perseverance, and wisdom. As the ancients said: "If you don't accumulate steps, you can't reach thousands of miles; If you don't accumulate small streams, you can't become rivers and seas. "Every little effort is contributing to our health.
Let's join hands to protect this city called "health". I believe that as long as we are vigilant and scientifically managed, we will be able to defeat diabetes and live a wonderful life!
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