How to prevent diabetic

  Diabetic it is to be compared at present " popular " a kind of disease, sharp violent wind raises patient number, cause very big menace to the health of people. So, how should we prevent diabetic happening? 1. One class precaution is pressing with a finger the blame that individual to diabetic easy feeling or whole crowd undertakes chooses to prevent, basically point to wait through changing environmental element and way of life, all activities that prevent or reduce diabetic happening. If proper limitation energy is absorbed, avoid fat, stimulative weight to be mixed normally encourage undertake more manual activity wait. The carries out general need country, government and door of Ministry of Public Health height of this precautionary measures takes seriously, regard a national policy as its, start health care of broad medical matters personnel and use public agency to have social conduct propaganda and education extensively thoroughly, raise people to concern diabetic ABC, understanding is diabetic the harm sex that reachs its complication and seriousness, achieve expectant result thereby. Additional, 2 model diabetic it is disease of tendentiousness of heredity of a kind of polygene, already discovered at present 20 many because if insulin gene, insulin suffers body gene, insulin,Hou Xuanji gets body heart thing – gene of 1 gene, albumen of dextrose have a change of luck, dextrose kinase gene, glycogen synthesizes enzymatic gene, β 3 gene accepting put oneself in another’s position and gene of line bead body with, afore-mentioned Hou Xuanji because with 2 model the research of diabetic correlation is us to undertake in the group the risk is forecasted coming on provided molecular biology basis, at present a lot of world nations are in the research that devotes oneself to this respect, believe before long can prevent and cure for us in the future or defer 2 model diabetic happening and the condition with develop innovation better. Concern 1 model diabetic one class precaution has an author to suggest to be opposite positive of antibody of cell of companion pancreas islet and (or) glutamic acid takes off positive of carboxyl enzymatic antibody 1 model diabetic one class relative adopts immunity (purine of Qiu radical of element of mildew of the Bao that be like annulus and 6- ) with freedom base, already was in earlier exploration and research phase at present, but this mark is worn precaution 1 model diabetic epochal coming. 2. 2 class prevent with 2 model diabetic Gao Wei crowd (basically include to have diabetic familial history, 40 years old of hypertensive, tall lipemia, above fat or overweight reach gravid diabetic wait) for census object, to inchoate discovery recessive 2 model the diabetic metabolization that reach candy is disorder [candy is able to bear or endure the quantity is damaged (IGT) or damage of hollow blood sugar (IFG) or (IGT IFG)] crowd has inchoate interpose cure and government in time, prevent or reduce the happening of diabetic complication, it is precaution or defer mainly especially the crowd of phase of diabetic early days (include IGT or IFG or IGT IFG) to 2 model diabetic progress. Think IGT is development is extensively at present 2 model transfer diabeticly level, also call sometimes " diabetic early days " (Prediabetic Phase) . International is diabetic allied research report thinks, almost all 2 model diabetic, want to pass IGT level before come on. From the point of the whole world, the sicken rate of IGT is in different and phyletic a presence is very large difference, limits is 3% ~ 20% . With 2 model diabetic same, the happening of IGT increases along with the age and grow in quantity, with gain weight or fat reach manual activity lack to concern, 2 model diabetic positive is familial history the strong critical factor that is IGT, additional, inside fetal palace hidebound, low be born weight with on the low side of the weight after be born 1 year person also adumbrative the possibility heighten that its will produce IGT 60 years old in 40 ~ henceforth, in addition, have think triglyceride heighten and IGT concern blood, but both causal have not decide. Rate of sicken of our country IGT is 2.5% ~ 4.2% , in patient of each country IGT, have 2% ~ every year 14% change is the likelihood 2 model diabetic. General document reports 5 ~ 10 years, IGT patient 19% ~ 60% it is change 2 model diabetic. The data reports our country IGT turns for 2 model year of diabetic change ratio for 7.7% ~ 8.95% . On the other hand, research returns discovery, IGT patient metabolizes except candy unusual, return constant companion to have tall insulin metabolization of hematic disease, fat is disorder (cholesterol of tall triglyceride, HDL- is reduced, LDL- cholesterol lifts) , obstacle of function of disease of blood of disease of acerbity blood of high make water, tall fibrinogen and fine dissolve system (stayer of content of activation of zymogen of the dissolve that be like fine – , active of zymogen of organization fine dissolve is reduced) etc, send blood vessel of head of hypertensive, heart thereby the dangerous sex that arteriosclerosis sex disease produces is remarkable and elevatory. Because of this, already was mentioned to the interpose cure of IGT crowd at present significant position, main purpose is to reduce 2 model diabetic the dangerous sex with cardiovascular disease. Make much more diabetic research center domestic and internationally already will was opposite now the interpose cure of IGT crowd labels main task to undertake much center efforts studies. Interpose cure basically includes behavior interpose and medicaments intervention two respects. (1) behavior intervenes: Include to restrict total quantity of heat to absorb, in reducing food and drink adipose (30%) , especially the content of saturated fatty acid (smoke of 10%); give up, abstinence or reduce drinking; to increase manual activity, strengthen; of motion having oxygen to reduce weight (5%) or it is normal to carry weight. Interpose success is more, to change diabeticly rate is lower. Increase manual activity apparently beneficial to IGT patient, if advocate,ride a bicycle or stand ahead of schedule commute increase a pace to row spacing leaves and wait less by elevator. Eriksson ever contrasted to sex of the look up before 181 IGT male observe 6 years, the result shows: Encourage have groovy movement group, diabetic occurence rate is 10.6% , group of interpose of and rather than is 28.6% , relatively dangerous sex is 0.37. Usually, food and motion intervene the method often undertakes at the same time. The random to 522 IGT patient cent such as Finnish Tuomilehto is group of dietary exercise interpose (tutorial, decrease always adipose absorb adiposely with saturation, increase cellulose absorb and carry momentum, the purpose is to reduce weight) and contrast group, follow on average visit 3.2 years, the incidence of a disease of diabetic accumulative total of group of the interpose after 4 years is 11% , contrast group for 23% , patient of interpose group IGT’s diabetic during the experiment dangerous sex drops 58% . Home comes from the investigation data of Daqing show, food adds motion to be able to make IGT to 2 model change diabeticly rate decrease 50% . Behavior intervenes means is a foundation, safe and effective, but its carry out existence for a long time certain blemish, affected its long-dated interpose result thereby. Can be like next expression: Said, but did not hear. Listened, but did not understand. Understood, but did not accept. Accepted, but did not put into practice. Acted, but fail to hold to for a long time. (2) medicaments intervenes: Because undertake food and motion intervene, the patient in practice often perserves hard, comply with sex owes beautiful, the effect that its intervene for a long time is finite, in recent years medicaments interpose IGT gets friend gradually take seriously, basically include double guanidine kind medicaments (2 armour double guanidine) , α – dextrose glucoside enzymatic depressor and thiazole alkyl 2 ketone ramification — insulin adds quick agent to wait. The premise that medicaments intervenes is medicaments itself does not have noxiousness, can improve insulin resistance and function of protective B cell, can reduce the critical factor of cardiovascular disease, do not add weight, do not cause hypoglycemia, take security for a long time. 2 armour double guanidine can improve insulin resistance, reduce alvine path dextrose to absorb, restrain liver glycogen different to be born, improve candy to be able to bear or endure quantity, reduce weight and blood pressure, certain level improves fat metabolization to wait, undesirable reaction is little. Of the United States ” diabetic precaution plans (DPP) ” collect 3234 IGT patient in all (accompany 5.6mmoL/L) of ≥ of hollow blood sugar, random cent contrasts to comfort an agent group (food of N=1082) , aggrandizement and athletic interpose group (N=1079, decrease adipose absorb with caloric, assure weekly motion 150min) and group of interpose of 2 armour double guanidine (N=1082, 1700mg/d) of 2 armour double guanidine, consider only then 1996, the result shows, with comfort an agent to contrast group of photograph comparing, aggrandizement food and athletic interpose group and weight of group of 2 armour double guanidine all drop apparently, diabetic accumulative total occurence rate drops respectively 58% with 31% . α – dextrose glucoside enzymatic depressor (do obeisance to candy times gentler glad) the absorption that defers alvine path dextrose, the blood sugar after reducing meat effectively is elevatory extent, improve insulin resistance, reduce hematic insulin level and blood pressure, improve fat metabolization. Applied α – dextrose glucoside enzymatic depressor (do obeisance to candy to make the same score) of the large and clinical trial that intervenes as IGT have international polycentric ” the research that prevents NIDDM (STOP-NIDDM) ” , this research collects 1429 IGT patient in all, random cent to comfort agent group is mixed do obeisance to sugar smooth group (do obeisance to candy to make the same score, 100mg, 3 / D) , follow on average visit 3.3 years, the result shows do obeisance to candy to average group of diabetic accumulative total occurence rate for 32.7% , comfort agent group for 41.9% , do obeisance to candy to make the same score make diabetic absolutely and dangerous sex is reduced 9% , research thinks to do obeisance to candy to make the same score to deferring IGT to diabetic changeover effective. Other application does obeisance to candy to make the same score the research that prevents IGT to still have England ” inchoate diabetic interpose studies (EDIT: Do obeisance to candy double guanidine of smooth, 2 armour, do obeisance to candy to make the same score 2 armour double guanidine) ” with Dutch ” IGT of interpose of A Kabo candy studies (DAISI) ” etc. A series of this important IGT work to trial test is about to finish and be announced, the biggest sample book plans to apply Nagelienai and Xie Sha Tan to prevent 2 model diabetic research also afoot (plan to collect 7500 patients, already finished case of illness to collect now, plan to announced result) 2008. Thiazole alkyl 2 ketone ramification (ketone of music Glenn ketone, Luo Ge row and Bi Glenn ketone) the action that can enhance insulin directly, reduce hematic insulin level, improve IGT. Metabolize with diabetic candy fat and spend gently reduce blood pressure. Music Glenn ketone ever was regarded as one of interpose medicaments of IGT by American DPP 1996, but the deadly sex liver that in using a process, happened to be concerned with medicaments is damaged and was stopped to use 1999. Harmful response the congener product with fewer, stronger action lists ketone like Luo Ge (DREAM, plan to collect 4000 IGT, look up sex observes 3 years in group before, predict to was finished 2006, in order to observe interpose is treated diabetic to precaution reach its big hemal disease is affected) or Bi Glenn ketone having clinical trial, answer to monitor liver function closely in use process. But the value that concerns medicaments interpose IGT at present – the relation of benefit still very not clear, remain afore-mentioned research give as a result clarify. Think commonly, IGT and the critical factor that its companion sends and development are diabetic can prevent or defer. Other but the medicaments of try out still has medicaments reducing weight to be like Xibuquming and Sainike (restrain lipase of gastric bowel path optionally) etc, can prevent or defer fat patient IGT or 2 model diabetic happening. Recently, the report such as Tenenbaum, they are in to 303 hollow blood sugar sex of the look up before the patient of coronary heart disease of 6.1 ~ 7.0mmol/L undertakes in group (benzene pitchs shellfish spy series, 156, benzene plunges into shellfish spy 400mg/d; comforts an agent to contrast group, 147) observe 6.2 years, result benzene pitchs shellfish spy series diabetic occurence rate is apparent under comfort agent group (42.3% ∶ 54.4%) , is metabolization of clew improvement fat OK is coronary heart disease reduced to accompany hollow blood sugar to suffer on certain level? Is Gua buccal? 2 model the risk that diabetic happening, this result is worth while and clinical begin more research. About 1 model diabetic 2 class precaution basically is at present differentiate in the diabetic that depends on from blame insulin as early as possible go out clinical come on initial stage is exactly like 2 model diabetic [but antibody of pancreas islet cell (ICA) , glutamic acid takes off carboxyl enzymatic antibody (albumen of enzymatic appearance of GAAs) and cheese ammonia acerbity phosphoric acid, LADA) . The remedial method that tries to its has: ① is inchoate use insulin, insulin inject adds profess to convinced 2 nitrogen Qin (Diazoxide: Open Potassium leaves subchannel, restrain insulin to secrete) , avoid to use sulphur acyl Niao kind medicaments, afore-mentioned measure conduce to the negative charge that reduces cell of pancreas islet B, reduce element of immunity of pancreas islet cell [oneself antigen and main organization consistence are compound content (the expression of MHC)] and immunity of ② of immune injury; restrain: Purine of Zun of A of element of mildew of Bao of small dose annulus, sulfur or Chinese traditional medicine glucoside of Thunder God cane, in order to intervene T lymphocyte hyperplasia and the ③ of scathing action; to cell of pancreas islet B promote repair: The patient development that amine of acyl of smoke of long-term profess to convinced can prevent or clinical research report defers positive of antibody of pancreas islet cell is dominance 1 model diabetic, lengthen new hair 1 model diabetic爱上海 is opposite with the city touch

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clinical alleviate period; ④ immunity adjusts: Hypodermic and vaccinal BCG vaccine can raise new hair 1 model diabetic clinical alleviate rate. A few kinds of afore-mentioned main purposes that treat a method are the B cell that reduces oneself immunity to damage remaining further, avoid or defer its to completeness 1 model diabetic progress, this is controlled to the patient’s blood sugar and the prevention and cure of complication is beneficial, but the clinical data that afore-mentioned methods treat to LADA Shangbuduo, effect of wh some of which is unsure, have certain noxiousness effect, the price is high wait to all be accepted not easily, only curative effect of insulin of inject of inchoate small dose is more positive, and more practical, but still need clinical accumulate experience further. 3. 3 class precaution is opposite namely already the diabetic of diagnose, treat integratedly through all sorts of methods with prevent or deferring its complication, the happening that what basically be aimed at is chronic complication develops. (1) is diabetic the harm sex of chronic complication: Diabetic chronic complication involves the whole body all organizations and organ, among them hemal (include old blood vessel and capillary) pathological changes and expression of nerve pathological changes are mixed apparently most outstanding. Epidemiology investigation and clinical research show: The 2 ~ that the occurence rate of disease of diabetic heart and vessels is average crowd 4 times, and have disease early, prognosis is poor, be 2 model the main cause of death of the diabetic. Document report is in developed country, 2 model diabetic 50% because be short of heart disease of courage and uprightness,deadly; diabetic produces cerebral blood-vessel disease, be short of disease of blood-vessel of head of courage and uprightness especially, dangerous sex dispute is diabetic the 2 ~ of the crowd 3 times, seize the 15%; limb old blood vessel of patient cause of death about, especially lower limbs arteriosclerosis or out-of-the-way disease, it is the main reason that brings about adult amputation (occupy 50%); diabetic nephrosis about (DN) is the chronic capillary complication with main diabetic, 1 model the diabetic has 30% ~ finally 40% produce kidney function not complete, 2 model clinical albuminuria sicken leads the diabetic to also be as high as 10% ~ 25% , course of diseases after 20 years, the accumulation of clinical albuminuria occurence rate amounts to 25% ~ 31% , clinical on 5% ~ of 10% 2 model the diabetic because nephrosis is deadly. In Euramerican wait for national DN to already became evening kidney to the function fails and need now dialytic or the single the mainest reason of kidney transplant, increase of the number significantly as the diabetic, already also became in our country DN bring about one of main reasons with kidney not whole function. Diabetic retinal pathological changes is a diabetic another main capillary complication, be bring about adult eyesight to drop or one of main reasons of blindness, the direct fee that is used every year at diabetic eye to disease is diagnosed and be treated in the United States is as high as 60 much. Diabetic nerve pathological changes (include all round nerve and own nerve) it is diabetic the commonnest chronic complication, often bring very great anguish and serious harm to the patient. In addition, diabetic often bring about cataract, skin and bone joint pathological changes and infection opportunity to increase significantly etc other a variety of complication. (2) is diabetic the measure of comprehensive prophylaxis and treatment of chronic complication: The happening of diabetic chronic complication suffers the effect of a variety of elements, happen to decrease as far as possible or defer diabetic chronic complication and develop, need to take comprehensive and logical integrated step. ① controls actively or remove the critical factor that concerns with complication: A. Dominate tall blood sugar ideally, eliminate or reduce effect of noxiousness of chronic tall blood sugar: Can use diabetic education, dietotherapy, kinesiatrics, medication reach blood sugar to monitor it is normal to wait for a variety of methods to make blood sugar adjacent as far as possible (6.0mmoL/L of hollow blood sugar, 8.0mmol/L of blood sugar of the 2h after eat, hbA1c 6.5%) , this is prevention and cure the foundation of diabetic chronic complication. The diabetic control that comes from North America and complication experiment (DCCT) and England (U.k. ) before look up sex is diabetic research (the research of UKPDS) confirms control of good blood sugar clearly already to be able to decrease apparently 1 model diabetic and 2 model the diabetic is chronic the happening of complication and development. Latter not little learned man pays close attention to, in diabetic long-term remedy, want good control blood sugar not only, still answer to avoid the apparent wave motion of blood sugar as far as possible at the same time, because the apparent wave motion of blood sugar has the harm that hypoglycemia brings not only, and sclerotic to arterial congee appearance formation also has apparent undesirable effect. B. Reasonable use fall blood pressure medicaments, ideal controls blood pressure: Hypertensive constant with diabetic amalgamative existence, quicken diabetic the happening of a variety of chronic complication and development, good control blood pressure can decrease apparently or delay the happening of diabetic old blood vessel and capillary complication and development. Current and clinical commonly usedly 6 kinds of big a gleam of fall blood pressure medicaments, if diuretic, β suffers body retarder, α ,suffer body retarder, calcic ionic Jie to fight medicine and changeover of hemal and nervous element enzymatic depressor and Ⅱ of hemal and nervous element suffer body retarder to wait. Hind to candy fat fine of metabolization all without exception is affected two kinds, can regard first selection as medicaments. Especially hemal and nervous element changes enzymatic depressor to be taken seriously extensively, its are in fall effectively blood pressure while, right diabetic a variety of chronic complication can be offerred relative to action of more significant prevention and cure. Should strive for to the diabetic of amalgamative hypertension make blood pressure control is controlled in 130/80mmHg, lower even, blood pressure of the person that have albuminuria should be controlled it is under 125/75mmHg. C. Correct fat metabolization is disorder: Diabetic often incorporate fat qualitative metabolization is unusual (hematic disease and HDL- cholesterol reduce cholesterol of if Gao Gan is oily disease of 3 ester blood, tall LDL- and oxidize – LDL and saccharification LDL level increase wait for) , can promote the happening of size blood-vessel complication. Clinical should adopt different remedy according to different tall lipemia type [at present domestic and international clinical go up to fall commonly usedly hematic fat medicaments has 5 kinds big: Biliary acerbity interleaving agent, nicotinic acid kind, fiber acerbity ramification and hydroxide are methylic the fifth of the ten Heavenly Stem 2 acerbity odd acyl complementary enzymatic A(HMG-CoA) is reductive enzymatic depressor] treat with food, control of stimulative blood fat is normal. The much center efforts that comes from abroad considers to report: Reductive enzymatic depressor can reduce HMG-CoA significantly diabetic blood cholesterol and triglyceride, elevatory HDL, reduce coronary heart disease apparently (include cardiac muscle to straighten dead) the occurence rate with death, reduce albumen of make water of diabetic nephrosis patient to excrete the fall with kidney function apparently at the same time speed, those who reduce diabetic retinal pathological changes is oozy, defer its to make progress, those who reduce its to reduce and be lost of eyesight is dangerous. D. Improve insulin resistance, reduce tall insulin hematic disease: The diabetic often reachs the cure of impropriety because of existence insulin resistance and send tall insulin hematic disease, hematic disease can stimulate abiding tall insulin arterial wall is flowing flesh and endodermis cell hyperplasia, increase hepatic VLDL generation, fat of stimulative artery wall is qualitative ad cool-headed, if exciting endodermis cell produces stayer of content of activation of fine dissolve zymogen,damage system of dissolve of fine of sex of the source inside airframe – 1(PAI-1) , stimulative thrombosis; is long-term hematic disease returns tall insulin to lift through a variety of mechanisms blood pressure is reached bring about gain weight to wait, afore-mentioned action all can accelerate the happening with diabetic size sclerotic blood-vessel and process. Accordingly, while cure is diabetic, adopt proper measure to improve insulin sensitivity, reduce or avoid tall insulin hematic disease, conduce to the prevention and cure of diabetic hemal complication. Current and commonly used by clinical confirm the remedy that different level improves insulin to resist has: Double guanidine kind 2 ketone ramification mixes alkyl of medicaments, thiazole α – dextrose glucoside enzymatic depressor, other still hemal and nervous element changes enzymatic depressor (if ACEI) , microelement is tervalent chromic He Fan, a few fall fat medicaments if fiber acerbity ramification and 3- hydroxyl – 3- is methylic 2 acyl of the fifth of the ten Heavenly Stem complementary enzymatic A(HMG-CoA) is reductive enzymatic depressor and β 3 suffer substance excited drug to wait. Reasonable food and proper movement are right the sensitivity that heightens insulin also beneficial. E. Improve hematic current to change learn: The diabetic often increases as a result of sex of adhere of hyperfunction of function of endodermis cell damage, plaque, red blood cell reach be out of shape ability is reduced, cruor function enhances function of system of the dissolve that reach fine to reduce bring about blood to appear to get together stickily, high high reach Gao Ning position, promote the happening of complication of diabetic size blood-vessel, because this can answer appropriately1000 beautiful community of Shanghai

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With Xi Luo his Zun (earth up amount to) , pancreas stimulates peptide to release enzymatic (happy) , Sai is chloric be equal to calm, 2, 2 hydroxyl of 5- benzene sulfur is acerbity (guide litre bright) , small dose aspirin, double Mi amounts to Mo Jizhong medicine is like the root of red-rooted salvia and the rhizome of chuanxiong to wait. F. Compensatory antioxidant: Diabetic on one hand as a result of the freedom inside body base generation adds, airframe is free on the other hand base cleared system function is abate, send freedom radical to pile up inside body, diabetic chronic complication also is promoted to happen on certain level, because this can complement appropriately,antioxidant is like E of vitamin C, vitamin, β carotene and exceed oxide branch to change enzymatic etc, the freedom that increases in order to reduce inside body base the injury to the organization. G. Other: Diabetic when, content of the inositol inside the cell decreases, especially content of the inositol inside nerve cell decreases more apparent, participated in the happening of diabetic chronic complication consequently, according to inositol exhaust doctrine, proper to the diabetic compensatory inositol is chronic to preventing and cure complication, especially nerve pathological changes may be beneficial; aldose reductive enzymatic depressor (the 3 pear mellow access of the activation when restraining diabetic tall blood sugar) close matter with amino guanidine apperception (restrain protein to be not enzymatic saccharify eventually of end result form) , the clinical research of animal experiment and little scope already confirmed its are right diabetic a variety of chronic complication have effect of better prevention and cure, remain farther large-scale is clinical research gives experiment of evaluation; animal shows depressor of β of C- of particularity albumen kinase (the happening that LY333531) can reduce diabetic nephrosis and retina and development, restrain the proliferous fleshy of the film inside blood-vessel, clinical research shows the abecedarian to have effect of certain prevention and cure to diabetic blood-vessel and nerve pathological changes. ② is inchoate diagnose, inchoate cure: The disease since diabetic chronic complication hides, progress is slow, inchoate the clinical show with constant apparent lack, do not take seriously for the patient, once make progress,come when chronic complication however clinical phase, appear clinical expression, its pathological changes constant hard changeover, monitor because of what this strengthens pair of diabetic chronic complication, inchoate it is very important to diagnose. A. Capillary complication: Basically include diabetic nephrosis and diabetic retinal pathological change. Can determine to be checked with ophthalmology through albumen of fixed make water with inchoate diagnose. A. Uric albumin determines: The proposal is all 2 model diabetic with course of diseases 3 years 1 model the diabetic should undertake uric albumin is excreted every year rate (UAER) is chosen determine, heighten person (20 μ of UAER ≥ G/min or 30mg/24h make water) should be in 3 ~ check inside 6 months, like UAER2 second determine to all be 20 ~ 200 μ G/min hints inchoate diabetic nephrosis, strengthen interpose cure to conduce to right now prevent an illness to make progress or make its changeover. Of concerned urine sample stay take, still do not have consistent and accepted good method, include time make water of make water of 24h make water, 12h of of the previous night, 2h or 1h to wait. The termless albumin that measure make water, answer to measure uric total albumen regularly. B. Ophthalmic examination: Before the patient drops apparently in eyesight or be being lost, inchoate adopt laser to cure can be prevented or delay illness progress, protect vision, because this suggests all diabetics all should undertake the ophthalmoscope after sufficient enlarge pupil is checked every year, simple ophthalmoscope examination can discover inchoate diabetic retinal pathological changes approvingly, go when necessary radiography of eye ground fluorescence, have fundamental value to directive cure. Ophthalmic examination still conduces to inchoate discovery the pathological change of department of other key point such as cataract, glaucoma. B. Big hemal complication: Still do not have at present detect the simple method of pathological changes of old blood vessel of clinical early days, a lot of evidence make clear, have albuminuria or uric patient produces minim albumin the danger of disease of heart head blood-vessel and death increases significantly, should consider all diabetics to all be faced with the dangerous sex heighten that produces big hemal disease. Strengthen critical to big hemal disease factor to be like blood sugar (the hollow blood sugar, blood sugar after eat and saccharification haemoglobin) , hematic fat (current of HDL and cholesterol, triglyceride, LDL) , blood pressure, blood changes learn, smoking circumstance, fat wait monitor. Fixed cardiogram checks what can discover a few patients to be short of blood without painful sex cardiac muscle, straighten dead without painful sex cardiac muscle even. C. Nerve pathological changes: Nerve pathological changes feels with limb symmetry the obstacle is given priority to all round, often behave all sorts of feelings to drop or feel unusual reflex with genu abate or disappear, applied tonometer determines vibration becomes aware is the simple method that monitors diabetic feeling to drop. The examination of own nerve pathological changes is like a heart own nerve function determines and gastric bowel is kinetic determine to often be compared complex, but B exceeds determine cystic and leftover make water is handier, pathological changes of own to clew bladder nerve has fair value. D. Diabetic sufficient: Hemal (old blood vessel and capillary) with nerve pathological changes it is the foundation that its come on, if outer ministry inducement happens below the circumstance such as infection and scar. The patient that accompanies lower limbs nerve and hemal disease is to happen diabetic sufficient tall danger patient. Sufficient ministry palpate conduces to judgement blood-vessel beating and temperature change, it is difficult to be like touch arterial pulse, can go further supersonic Duopule is checked. Each diabetic should undertake sufficient ministry is checked regularly, examination content should include sense of pain, temperature to become aware, touch, vibration becomes aware and to pressure experience rate, if claw of toe evaginate, eagle is sufficient,watch sufficient external form wait and have the change that does not have dot getting power. The diabetic sufficient ulcer of 80% can high high through finding out sick support of the people gives nurse appropriately teach and prevent. ③ takes crowds of pair of impressionable of diabetic chronic complication seriously: Not little recently foundation and the happening that clinical research discovers diabetic chronic complication and development often exist genetic easy sensibility, clinical observation is diabetic the consistency with the happening of chronic complication and development and complete lack of diabetic illness control, clinical on have 20% ~ 3Fall in love with the sea

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The diabetic of 0% no matter blood sugar controls stand or fall, sicken never produces serious and chronic complication for years, and the diabetic of about 5% is in short-term inside, although blood sugar control is good, produce serious chronic complication however, this kind of phenomenon is behaved more apparently in diabetic nephrosis especially, like clinical discovery 1 model diabetic final only 30% ~ 40% happen eventually evening kidney function is not complete, and its come on the height is in the 15 ~ of diabetic course of diseases 20 years during, later the dangerous sex of the happening of diabetic nephrosis is reduced significantly, 2 model diabetic also only 5% ~ the patient of 10% because nephrosis is deadly, and clinical observation discovers existence of diabetic nephrosis patient is familial collect a gender. Exact mechanism is not clear, a few research hint polysaccharide of albumen of genetic tendency, vitriolic heparin concerns likelihood and hypertension of former hair sex enzymatic (if N- takes off acetyl enzymatic) I of hemal and sex of heredity much condition, nervous element changes sex of enzymatic gene much condition, insulin to suffer body gene mutation and aldose reductive enzymatic active is individual. Element of heredity easy feeling is like in the action in diabetic chronic complication can hold water completely, but exact molecular biology mechanism still needs to clarify further, so that be clinical the happening that forecasts diabetic chronic complication the risk provides strong measure, be helpful for undertaking to afore-mentioned easy feeling crowds aggrandizement is treated. ④ launchs epidemiology investigation and the general investigation to tall danger crowd: Diabetic especially 2 model diabetic, inchoate because lack apparent clinical show,often reach the people deficient to diabetic concerned knowledge, in order to make major (is patient of 1/3 ~ 2/3) in for a long time? Does shaming crash  prick   in person suffer from basketry shut hesitating of Lang rare  is intense of Chuo of branny only buccal Gu v/LIT all over the ground inclined ǜ of S of Sha of camel of  of ⒍ of ⒅ of ⒎ showing die young? 2 model diabetic when be being diagnosed clearly, the course of disease that already had 3 ~ on average 7 years, because this launchs diabetic epidemiology investigation and the general investigation to crowd of diabetic tall danger actively, inchoate check goes out those who be in condition of tall blood sugar is recessive diabetic be able to bear or endure with candy quantity damage patient, undertake in time intervening remedial appearing very important. ⑤ strengthens pair of diabetics and its family member to concern diabetic knowledge education: Undertake concerned to diabetic and its family member diabetic reach education of its complication ABC, make its understand the harm sex that controls diabetic importance and complication, visit with cooperating actively to treat and be followed, very important also to diabetic illness control.


   Diabetic it is to be compared at present " popular " a kind of disease, sharp violent wind raises patient number, cause very big menace to the health of people. So, how should we prevent diabetic happening? 1. One class precaution is pressing with a finger the blame that individual to diabetic easy feeling or whole crowd undertakes chooses to prevent, basically point to wait through changing environmental element and way of life, all activities that prevent or reduce diabetic happening. If proper limitation energy is absorbed, avoid fat, stimulative weight to be mixed normally encourage undertake more manual activity wait. The carries out general need country, government and door of Ministry of Public Health height of this precautionary measures takes seriously, regard a national policy as its, start health care of broad medical matters personnel and use public agency to have social conduct propaganda and education extensively thoroughly, raise people to concern diabetic ABC, understanding is diabetic the harm sex that reachs its complication and seriousness, achieve expectant result thereby. Additional, 2 model diabetic it is disease of tendentiousness of heredity of a kind of polygene, already discovered at present 20 many because if insulin gene, insulin suffers body gene, insulin,Hou Xuanji gets body heart thing – gene of 1 gene, albumen of dextrose have a change of luck, dextrose kinase gene, glycogen synthesizes enzymatic gene, β 3 gene accepting put oneself in another’s position and gene of line bead body with, afore-mentioned Hou Xuanji because with 2 model the research of diabetic correlation is us to undertake in the group the risk is forecasted coming on provided molecular biology basis, at present a lot of world nations are in the research that devotes oneself to this respect, believe before long can prevent and cure for us in the future or defer 2 model diabetic happening and the condition with develop innovation better. Concern 1 model diabetic one class precaution has an author to suggest to be opposite positive of antibody of cell of companion pancreas islet and (or) glutamic acid takes off positive of carboxyl enzymatic antibody 1 model diabetic one class relative adopts immunity (purine of Qiu radical of element of mildew of the Bao that be like annulus and 6- ) with freedom base, already was in earlier exploration and research phase at present, but this mark is worn precaution 1 model diabetic epochal coming. 2. 2 class prevent with 2 model diabetic Gao Wei crowd (basically include to have diabetic familial history, 40 years old of hypertensive, tall lipemia, above fat or overweight reach gravid diabetic wait) for census object, to inchoate discovery recessive 2 model the diabetic metabolization that reach candy is disorder [candy is able to bear or endure the quantity is damaged (IGT) or damage of hollow blood sugar (IFG) or (IGT IFG)] crowd has inchoate interpose cure and government in time, prevent or reduce the happening of diabetic complication, it is precaution or defer mainly especially the crowd of phase of diabetic early days (include IGT or IFG or IGT IFG) to 2 model diabetic progress. Think IGT is development is extensively at present 2 model transfer diabeticly level, also call sometimes " diabetic early days " (Prediabetic Phase) . International is diabetic allied research report thinks, almost all 2 model diabetic, want to pass IGT level before come on. From the point of the whole world, the sicken rate of IGT is in different and phyletic a presence is very large difference, limits is 3% ~ 20% . With 2 model diabetic same, the happening of IGT increases along with the age and grow in quantity, with gain weight or fat reach manual activity lack to concern, 2 model diabetic positive is familial history the strong critical factor that is IGT, additional, inside fetal palace hidebound, low be born weight with on the low side of the weight after be born 1 year person also adumbrative the possibility heighten that its will produce IGT 60 years old in 40 ~ henceforth, in addition, have think triglyceride heighten and IGT concern blood, but both causal have not decide. Rate of sicken of our country IGT is 2.5% ~ 4.2% , in patient of each country IGT, have 2% ~ every year 14% change is the likelihood 2 model diabetic. General document reports 5 ~ 10 years, IGT patient 19% ~ 60% it is change 2 model diabetic. The data reports our country IGT turns for 2 model year of diabetic change ratio for 7.7% ~ 8.95% . On the other hand, research returns discovery, IGT patient metabolizes except candy unusual, return constant companion to have tall insulin metabolization of hematic disease, fat is disorder (cholesterol of tall triglyceride, HDL- is reduced, LDL- cholesterol lifts) , obstacle of function of disease of blood of disease of acerbity blood of high make water, tall fibrinogen and fine dissolve system (stayer of content of activation of zymogen of the dissolve that be like fine – , active of zymogen of organization fine dissolve is reduced) etc, send blood vessel of head of hypertensive, heart thereby the dangerous sex that arteriosclerosis sex disease produces is remarkable and elevatory. Because of this, already was mentioned to the interpose cure of IGT crowd at present significant position, main purpose is to reduce 2 model diabetic the dangerous sex with cardiovascular disease. Make much more diabetic research center domestic and internationally already will was opposite now the interpose cure of IGT crowd labels main task to undertake much center efforts studies. Interpose cure basically includes behavior interpose and medicaments intervention two respects. (1) behavior intervenes: Include to restrict total quantity of heat to absorb, in reducing food and drink adipose (30%) , especially the content of saturated fatty acid (smoke of 10%); give up, abstinence or reduce drinking; to increase manual activity, strengthen; of motion having oxygen to reduce weight (5%) or it is normal to carry weight. Interpose success is more, to change diabeticly rate is lower. Increase manual activity apparently beneficial to IGT patient, if advocate,ride a bicycle or stand ahead of schedule commute increase a pace to row spacing leaves and wait less by elevator. Eriksson ever contrasted to sex of the look up before 181 IGT male observe 6 years, the result shows: Encourage have groovy movement group, diabetic occurence rate is 10.6% , group of interpose of and rather than is 28.6% , relatively dangerous sex is 0.37. Usually, food and motion intervene the method often undertakes at the same time. The random to 522 IGT patient cent such as Finnish Tuomilehto is group of dietary exercise interpose (tutorial, decrease always adipose absorb adiposely with saturation, increase cellulose absorb and carry momentum, the purpose is to reduce weight) and contrast group, follow on average visit 3.2 years, the incidence of a disease of diabetic accumulative total of group of the interpose after 4 years is 11% , contrast group for 23% , patient of interpose group IGT’s diabetic during the experiment dangerous sex drops 58% . Home comes from the investigation data of Daqing show, food adds motion to be able to make IGT to 2 model change diabeticly rate decrease 50% . Behavior intervenes means is a foundation, safe and effective, but its carry out existence for a long time certain blemish, affected its long-dated interpose result thereby. Can be like next expression: Said, but did not hear. Listened, but did not understand. Understood, but did not accept. Accepted, but did not put into practice. Acted, but fail to hold to for a long time. (2) medicaments intervenes: Because undertake food and motion intervene, the patient in practice often perserves hard, comply with sex owes beautiful, the effect that its intervene for a long time is finite, in recent years medicaments interpose IGT gets friend gradually take seriously, basically include double guanidine kind medicaments (2 armour double guanidine) , α – dextrose glucoside enzymatic depressor and thiazole alkyl 2 ketone ramification — insulin adds quick agent to wait. The premise that medicaments intervenes is medicaments itself does not have noxiousness, can improve insulin resistance and function of protective B cell, can reduce the critical factor of cardiovascular disease, do not add weight, do not cause hypoglycemia, take security for a long time. 2 armour double guanidine can improve insulin resistance, reduce alvine path dextrose to absorb, restrain liver glycogen different to be born, improve candy to be able to bear or endure quantity, reduce weight and blood pressure, certain level improves fat metabolization to wait, undesirable reaction is little. Of the United States ” diabetic precaution plans (DPP) ” collect 3234 IGT patient in all (accompany 5.6mmoL/L) of ≥ of hollow blood sugar, random cent contrasts to comfort an agent group (food of N=1082) , aggrandizement and athletic interpose group (N=1079, decrease adipose absorb with caloric, assure weekly motion 150min) and group of interpose of 2 armour double guanidine (N=1082, 1700mg/d) of 2 armour double guanidine, consider only then 1996, the result shows, with comfort an agent to contrast group of photograph comparing, aggrandizement food and athletic interpose group and weight of group of 2 armour double guanidine all drop apparently, diabetic accumulative total occurence rate drops respectively 58% with 31% . α – dextrose glucoside enzymatic depressor (do obeisance to candy times gentler glad) the absorption that defers alvine path dextrose, the blood sugar after reducing meat effectively is elevatory extent, improve insulin resistance, reduce hematic insulin level and blood pressure, improve fat metabolization. Applied α – dextrose glucoside enzymatic depressor (do obeisance to candy to make the same score) of the large and clinical trial that intervenes as IGT have international polycentric ” the research that prevents NIDDM (STOP-NIDDM) ” , this research collects 1429 IGT patient in all, random cent to comfort agent group is mixed do obeisance to sugar smooth group (do obeisance to candy to make the same score, 100mg, 3 / D) , follow on average visit 3.3 years, the result shows do obeisance to candy to average group of diabetic accumulative total occurence rate for 32.7% , comfort agent group for 41.9% , do obeisance to candy to make the same score make diabetic absolutely and dangerous sex is reduced 9% , research thinks to do obeisance to candy to make the same score to deferring IGT to diabetic changeover effective. Other application does obeisance to candy to make the same score the research that prevents IGT to still have England ” inchoate diabetic interpose studies (EDIT: Do obeisance to candy double guanidine of smooth, 2 armour, do obeisance to candy to make the same score 2 armour double guanidine) ” with Dutch ” IGT of interpose of A Kabo candy studies (DAISI) ” etc. A series of this important IGT work to trial test is about to finish and be announced, the biggest sample book plans to apply Nagelienai and Xie Sha Tan to prevent 2 model diabetic research also afoot (plan to collect 7500 patients, already finished case of illness to collect now, plan to announced result) 2008. Thiazole alkyl 2 ketone ramification (ketone of music Glenn ketone, Luo Ge row and Bi Glenn ketone) the action that can enhance insulin directly, reduce hematic insulin level, improve IGT. Metabolize with diabetic candy fat and spend gently reduce blood pressure. Music Glenn ketone ever was regarded as one of interpose medicaments of IGT by American DPP 1996, but the deadly sex liver that in using a process, happened to be concerned with medicaments is damaged and was stopped to use 1999. Harmful response the congener product with fewer, stronger action lists ketone like Luo Ge (DREAM, plan to collect 4000 IGT, look up sex observes 3 years in group before, predict to was finished 2006, in order to observe interpose is treated diabetic to precaution reach its big hemal disease is affected) or Bi Glenn ketone having clinical trial, answer to monitor liver function closely in use process. But the value that concerns medicaments interpose IGT at present – the relation of benefit still very not clear, remain afore-mentioned research give as a result clarify. Think commonly, IGT and the critical factor that its companion sends and development are diabetic can prevent or defer. Other but the medicaments of try out still has medicaments reducing weight to be like Xibuquming and Sainike (restrain lipase of gastric bowel path optionally) etc, can prevent or defer fat patient IGT or 2 model diabetic happening. Recently, the report such as Tenenbaum, they are in to 303 hollow blood sugar sex of the look up before the patient of coronary heart disease of 6.1 ~ 7.0mmol/L undertakes in group (benzene pitchs shellfish spy series, 156, benzene plunges into shellfish spy 400mg/d; comforts an agent to contrast group, 147) observe 6.2 years, result benzene pitchs shellfish spy series diabetic occurence rate is apparent under comfort agent group (42.3% ∶ 54.4%) , is metabolization of clew improvement fat OK is coronary heart disease reduced to accompany hollow blood sugar to suffer on certain level? Is Gua buccal? 2 model the risk that diabetic happening, this result is worth while and clinical begin more research. About 1 model diabetic 2 class precaution basically is at present differentiate in the diabetic that depends on from blame insulin as early as possible go out clinical come on initial stage is exactly like 2 model diabetic [but antibody of pancreas islet cell (ICA) , glutamic acid takes off carboxyl enzymatic antibody (albumen of enzymatic appearance of GAAs) and cheese ammonia acerbity phosphoric acid, LADA) . The remedial method that tries to its has: ① is inchoate use insulin, insulin inject adds profess to convinced 2 nitrogen Qin (Diazoxide: Open Potassium leaves subchannel, restrain insulin to secrete) , avoid to use sulphur acyl Niao kind medicaments, afore-mentioned measure conduce to the negative charge that reduces cell of pancreas islet B, reduce element of immunity of pancreas islet cell [oneself antigen and main organization consistence are compound content (the expression of MHC)] and immunity of ② of immune injury; restrain: Purine of Zun of A of element of mildew of Bao of small dose annulus, sulfur or Chinese traditional medicine glucoside of Thunder God cane, in order to intervene T lymphocyte hyperplasia and the ③ of scathing action; to cell of pancreas islet B promote repair: The patient development that amine of acyl of smoke of long-term profess to convinced can prevent or clinical research report defers positive of antibody of pancreas islet cell is dominance 1 model diabetic, lengthen new hair 1 model diabetic clinical alleviate period; ④ immunity adjusts: Hypodermic and vaccinal BCG vaccine can raise new hair 1 model diabetic clinical alleviate rate. A few kinds of afore-mentioned main purposes that treat a method are the B cell that reduces oneself immunity to damage remaining further, avoid or defer its to completeness 1 model diabetic progress, this is controlled to the patient’s blood sugar and the prevention and cure of complication is beneficial, but the clinical data that afore-mentioned methods treat to LADA Shangbuduo, effect of wh some of which is unsure, have certain noxiousness effect, the price is high wait to all be accepted not easily, only curative effect of insulin of inject of inchoate small dose is more positive, and more practical, but still need clinical accumulate experience further. 3. 3 class precaution is opposite namely already the diabetic of diagnose, treat integratedly through all sorts of methods with prevent or deferring its complication, the happening that what basically be aimed at is chronic complication develops. (1) is diabetic the harm sex of chronic complication: Diabetic chronic complication involves the whole body all organizations and organ, among them hemal (include old blood vessel and capillary) pathological changes and expression of nerve pathological changes are mixed apparently most outstanding. Epidemiology investigation and clinical research show: The 2 ~ that the occurence rate of disease of diabetic heart and vessels is average crowd 4 times, and have disease early, prognosis is poor, be 2 model the main cause of death of the diabetic. Document report is in developed country, 2 model diabetic 50% because be short of heart disease of courage and uprightness,deadly; diabetic produces cerebral blood-vessel disease, be short of disease of blood-vessel of head of courage and uprightness especially, dangerous sex dispute is diabetic the 2 ~ of the crowd 3 times, seize the 15%; limb old blood vessel of patient cause of death about, especially lower limbs arteriosclerosis or out-of-the-way disease, it is the main reason that brings about adult amputation (occupy 50%); diabetic nephrosis about (DN) is the chronic capillary complication with main diabetic, 1 model the diabetic has 30% ~ finally 40% produce kidney function not complete, 2 model clinical albuminuria sicken leads the diabetic to also be as high as 10% ~ 25% , course of diseases after 20 years, the accumulation of clinical albuminuria occurence rate amounts to 25% ~ 31% , clinical on 5% ~ of 10% 2 model the diabetic because nephrosis is deadly. In Euramerican wait for national DN to already became evening kidney to the function fails and need now dialytic or the single the mainest reason of kidney transplant, increase of the number significantly as the diabetic, already also became in our country DN bring about one of main reasons with kidney not whole function. Diabetic retinal pathological changes is a diabetic another main capillary complication, be bring about adult eyesight to drop or one of main reasons of blindness, the direct fee that is used every year at diabetic eye to disease is diagnosed and be treated in the United States is as high as 60 much. Diabetic nerve pathological changes (include all round nerve and own nerve) it is diabetic the commonnest chronic complication, often bring very great anguish and serious harm to the patient. In addition, diabetic often bring about cataract, skin and bone joint pathological changes and infection opportunity to increase significantly etc other a variety of complication. (2) is diabetic the measure of comprehensive prophylaxis and treatment of chronic complication: The happening of diabetic chronic complication suffers the effect of a variety of elements, happen to decrease as far as possible or defer diabetic chronic complication and develop, need to take comprehensive and logical integrated step. ① controls actively or remove the critical factor that concerns with complication: A. Dominate tall blood sugar ideally, eliminate or reduce effect of noxiousness of chronic tall blood sugar: Can use diabetic education, dietotherapy, kinesiatrics, medication reach blood sugar to monitor it is normal to wait for a variety of methods to make blood sugar adjacent as far as possible (6.0mmoL/L of hollow blood sugar, 8.0mmol/L of blood sugar of the 2h after eat, hbA1c 6.5%) , this is prevention and cure the foundation of diabetic chronic complication. The diabetic control that comes from North America and complication experiment (DCCT) and England (U.k. ) before look up sex is diabetic research (the research of UKPDS) confirms control of good blood sugar clearly already to be able to decrease apparently 1 model diabetic and 2 model the diabetic is chronic the happening of complication and development. Latter not little learned man pays close attention to, in diabetic long-term remedy, want good control blood sugar not only, still answer to avoid the apparent wave motion of blood sugar as far as possible at the same time, because the apparent wave motion of blood sugar has the harm that hypoglycemia brings not only, and sclerotic to arterial congee appearance formation also has apparent undesirable effect. B. Reasonable use fall blood pressure medicaments, ideal controls blood pressure: Hypertensive constant with diabetic amalgamative existence, quicken diabetic the happening of a variety of chronic complication and development, good control blood pressure can decrease apparently or delay the happening of diabetic old blood vessel and capillary complication and development. Current and clinical commonly usedly 6 kinds of big a gleam of fall blood pressure medicaments, if diuretic, β suffers body retarder, α ,suffer body retarder, calcic ionic Jie to fight medicine and changeover of hemal and nervous element enzymatic depressor and Ⅱ of hemal and nervous element suffer body retarder to wait. Hind to candy fat fine of metabolization all without exception is affected two kinds, can regard first selection as medicaments. Especially hemal and nervous element changes enzymatic depressor to be taken seriously extensively, its are in fall effectively blood pressure while, right diabetic a variety of chronic complication can be offerred relative to action of more significant prevention and cure. Should strive for to the diabetic of amalgamative hypertension make blood pressure control is controlled in 130/80mmHg, lower even, blood pressure of the person that have albuminuria should be controlled it is under 125/75mmHg. C. Correct fat metabolization is disorder: Diabetic often incorporate fat qualitative metabolization is unusual (hematic disease and HDL- cholesterol reduce cholesterol of if Gao Gan is oily disease of 3 ester blood, tall LDL- and oxidize – LDL and saccharification LDL level increase wait for) , can promote the happening of size blood-vessel complication. Clinical should adopt different remedy according to different tall lipemia type [at present domestic and international clinical go up to fall commonly usedly hematic fat medicaments has 5 kinds big: Biliary acerbity interleaving agent, nicotinic acid kind, fiber acerbity ramification and hydroxide are methylic the fifth of the ten Heavenly Stem 2 acerbity odd acyl complementary enzymatic A(HMG-CoA) is reductive enzymatic depressor] treat with food, control of stimulative blood fat is normal. The much center efforts that comes from abroad considers to report: Reductive enzymatic depressor can reduce HMG-CoA significantly diabetic blood cholesterol and triglyceride, elevatory HDL, reduce coronary heart disease apparently (include cardiac muscle to straighten dead) the occurence rate with death, reduce albumen of make water of diabetic nephrosis patient to excrete the fall with kidney function apparently at the same time speed, those who reduce diabetic retinal pathological changes is oozy, defer its to make progress, those who reduce its to reduce and be lost of eyesight is dangerous. D. Improve insulin resistance, reduce tall insulin hematic disease: The diabetic often reachs the cure of impropriety because of existence insulin resistance and send tall insulin hematic disease, hematic disease can stimulate abiding tall insulin arterial wall is flowing flesh and endodermis cell hyperplasia, increase hepatic VLDL generation, fat of stimulative artery wall is qualitative ad cool-headed, if exciting endodermis cell produces stayer of content of activation of fine dissolve zymogen,damage system of dissolve of fine of sex of the source inside airframe – 1(PAI-1) , stimulative thrombus form爱上海 is opposite with the city touch

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Into; hematic disease returns long-term tall insulin to lift through a variety of mechanisms blood pressure is reached bring about gain weight to wait, afore-mentioned action all can accelerate the happening with diabetic size sclerotic blood-vessel and process. Accordingly, while cure is diabetic, adopt proper measure to improve insulin sensitivity, reduce or avoid tall insulin hematic disease, conduce to the prevention and cure of diabetic hemal complication. Current and commonly used by clinical confirm the remedy that different level improves insulin to resist has: Double guanidine kind 2 ketone ramification mixes alkyl of medicaments, thiazole α – dextrose glucoside enzymatic depressor, other still hemal and nervous element changes enzymatic depressor (if ACEI) , microelement is tervalent chromic He Fan, a few fall fat medicaments if fiber acerbity ramification and 3- hydroxyl – 3- is methylic 2 acyl of the fifth of the ten Heavenly Stem complementary enzymatic A(HMG-CoA) is reductive enzymatic depressor and β 3 suffer substance excited drug to wait. Reasonable food and proper movement are right the sensitivity that heightens insulin also beneficial. E. Improve hematic current to change learn: The diabetic often increases as a result of sex of adhere of hyperfunction of function of endodermis cell damage, plaque, red blood cell reach be out of shape ability is reduced, cruor function enhances function of system of the dissolve that reach fine to reduce bring about blood to appear to get together stickily, high high reach Gao Ning position, promote the happening of complication of diabetic size blood-vessel, because this can apply Xi Luo appropriately his Zun (earth up amount to) , pancreas stimulates peptide to release enzymatic (happy) , Sai is chloric be equal to calm, 2, 2 hydroxyl of 5- benzene sulfur is acerbity (guide litre bright) , small dose aspirin, double Mi amounts to Mo Jizhong medicine is like the root of red-rooted salvia and the rhizome of chuanxiong to wait. F. Compensatory antioxidant: Diabetic on one hand as a result of the freedom inside body base generation adds, airframe is free on the other hand base cleared system function is abate, send freedom radical to pile up inside body, diabetic chronic complication also is promoted to happen on certain level, because this can complement appropriately,antioxidant is like E of vitamin C, vitamin, β carotene and exceed oxide branch to change enzymatic etc, the freedom that increases in order to reduce inside body base the injury to the organization. G. Other: Diabetic when, content of the inositol inside the cell decreases, especially content of the inositol inside nerve cell decreases more apparent, participated in the happening of diabetic chronic complication consequently, according to inositol exhaust doctrine, proper to the diabetic compensatory inositol is chronic to preventing and cure complication, especially nerve pathological changes may be beneficial; aldose reductive enzymatic depressor (the 3 pear mellow access of the activation when restraining diabetic tall blood sugar) close matter with amino guanidine apperception (restrain protein to be not enzymatic saccharify eventually of end result form) , the clinical research of animal experiment and little scope already confirmed its are right diabetic a variety of chronic complication have effect of better prevention and cure, remain farther large-scale is clinical research gives experiment of evaluation; animal shows depressor of β of C- of particularity albumen kinase (the happening that LY333531) can reduce diabetic nephrosis and retina and development, restrain the proliferous fleshy of the film inside blood-vessel, clinical research shows the abecedarian to have effect of certain prevention and cure to diabetic blood-vessel and nerve pathological changes. ② is inchoate diagnose, inchoate cure: The disease since diabetic chronic complication hides, progress is slow, inchoate the clinical show with constant apparent lack, do not take seriously for the patient, once make progress,come when chronic complication however clinical phase, appear clinical expression, its pathological changes constant hard changeover, monitor because of what this strengthens pair of diabetic chronic complication, inchoate it is very important to diagnose. A. Capillary complication: Basically include diabetic nephrosis and diabetic retinal pathological change. Can determine to be checked with ophthalmology through albumen of fixed make water with inchoate diagnose. A. Uric albumin determines: The proposal is all 2 model diabetic with course of diseases 3 years 1 model the diabetic should undertake uric albumin is excreted every year rate (UAER) is chosen determine, heighten person (20 μ of UAER ≥ G/min or 30mg/24h make water) should be in 3 ~ inside 6 monthsShanghai noble baby communicates an area

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Check, like UAER2 second determine to all be 20 ~ 200 μ G/min hints inchoate diabetic nephrosis, strengthen interpose cure to conduce to right now prevent an illness to make progress or make its changeover. Of concerned urine sample stay take, still do not have consistent and accepted good method, include time make water of make water of 24h make water, 12h of of the previous night, 2h or 1h to wait. The termless albumin that measure make water, answer to measure uric total albumen regularly. B. Ophthalmic examination: Before the patient drops apparently in eyesight or be being lost, inchoate adopt laser to cure can be prevented or delay illness progress, protect vision, because this suggests all diabetics all should undertake the ophthalmoscope after sufficient enlarge pupil is checked every year, simple ophthalmoscope examination can discover inchoate diabetic retinal pathological changes approvingly, go when necessary radiography of eye ground fluorescence, have fundamental value to directive cure. Ophthalmic examination still conduces to inchoate discovery the pathological change of department of other key point such as cataract, glaucoma. B. Big hemal complication: Still do not have at present detect the simple method of pathological changes of old blood vessel of clinical early days, a lot of evidence make clear, have albuminuria or uric patient produces minim albumin the danger of disease of heart head blood-vessel and death increases significantly, should consider all diabetics to all be faced with the dangerous sex heighten that produces big hemal disease. Strengthen critical to big hemal disease factor to be like blood sugar (the hollow blood sugar, blood sugar after eat and saccharification haemoglobin) , hematic fat (current of HDL and cholesterol, triglyceride, LDL) , blood pressure, blood changes learn, smoking circumstance, fat wait monitor. Fixed cardiogram checks what can discover a few patients to be short of blood without painful sex cardiac muscle, straighten dead without painful sex cardiac muscle even. C. Nerve pathological changes: Nerve pathological changes feels with limb symmetry the obstacle is given priority to all round, often behave all sorts of feelings to drop or feel unusual reflex with genu abate or disappear, applied tonometer determines vibration becomes aware is the simple method that monitors diabetic feeling to drop. The examination of own nerve pathological changes is like a heart own nerve function determines and gastric bowel is kinetic determine to often be compared complex, but B exceeds determine cystic and leftover make water is handier, pathological changes of own to clew bladder nerve has fair value. D. Diabetic sufficient: Hemal (old blood vessel and capillary) with nerve pathological changes it is the foundation that its come on, if outer ministry inducement happens below the circumstance such as infection and scar. The patient that accompanies lower limbs nerve and hemal disease is to happen diabetic sufficient tall danger patient. Sufficient ministry palpate conduces to judgement blood-vessel beating and temperature change, it is difficult to be like touch arterial pulse, can go further supersonic Duopule is checked. Each diabetic should undertake sufficient ministry is checked regularly, examination content should include sense of pain, temperature to become aware, touch, vibration becomes aware and to pressure experience rate, if claw of toe evaginate, eagle is sufficient,watch sufficient external form wait and have the change that does not have dot getting power. The diabetic sufficient ulcer of 80% can high high through finding out sick support of the people gives nurse appropriately teach and prevent. ③ takes crowds of pair of impressionable of diabetic chronic complication seriously: Not little recently foundation and the happening that clinical research discovers diabetic chronic complication and development often exist genetic easy sensibility, clinical observationForum of 1000 the Long Feng that spend a net

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The happening of diabetic chronic complication and development and diabetic illness control lack complete consistency, clinical on have 20% ~ the diabetic of 30% no matter blood sugar controls stand or fall, sicken never produces serious and chronic complication for years, and the diabetic of about 5% is in short-term inside, although blood sugar control is good, produce serious chronic complication however, this kind of phenomenon is behaved more apparently in diabetic nephrosis especially, like clinical discovery 1 model diabetic final only 30% ~ 40% happen eventually evening kidney function is not complete, and its come on the height is in the 15 ~ of diabetic course of diseases 20 years during, later the dangerous sex of the happening of diabetic nephrosis is reduced significantly, 2 model diabetic also only 5% ~ the patient of 10% because nephrosis is deadly, and clinical observation discovers existence of diabetic nephrosis patient is familial collect a gender. Exact mechanism is not clear, a few research hint polysaccharide of albumen of genetic tendency, vitriolic heparin concerns likelihood and hypertension of former hair sex enzymatic (if N- takes off acetyl enzymatic) I of hemal and sex of heredity much condition, nervous element changes sex of enzymatic gene much condition, insulin to suffer body gene mutation and aldose reductive enzymatic active is individual. Element of heredity easy feeling is like in the action in diabetic chronic complication can hold water completely, but exact molecular biology mechanism still needs to clarify further, so that be clinical the happening that forecasts diabetic chronic complication the risk provides strong measure, be helpful for undertaking to afore-mentioned easy feeling crowds aggrandizement is treated. ④ launchs epidemiology investigation and the general investigation to tall danger crowd: Diabetic especially 2 model diabetic, inchoate because lack apparent clinical show,often reach the people deficient to diabetic concerned knowledge, in order to make major (is patient of 1/3 ~ 2/3) in for a long time? Does shaming crash  prick   in person suffer from basketry shut hesitating of Lang rare  is intense of Chuo of branny only buccal Gu v/LIT all over the ground inclined ǜ of S of Sha of camel of  of ⒍ of ⒅ of ⒎ showing die young? 2 model diabetic when be being diagnosed clearly, the course of disease that already had 3 ~ on average 7 years, because this launchs diabetic epidemiology investigation and the general investigation to crowd of diabetic tall danger actively, inchoate check goes out those who be in condition of tall blood sugar is recessive diabetic be able to bear or endure with candy quantity damage patient, undertake in time intervening remedial appearing very important. ⑤ strengthens pair of diabetics and its family member to concern diabetic knowledge education: Undertake concerned to diabetic and its family member diabetic reach education of its complication ABC, make its understand the harm sex that controls diabetic importance and complication, visit with cooperating actively to treat and be followed, very important also to diabetic illness control.

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