How to control blood sugar in elderly patients with diabetes

　　Elderly diabetes usually refers to diabetes whose patients are over 60 years old. It is characterized by high incidence rate, mostly type 2 diabetes, slow onset, and asymptomatic diagnosis. It is often found through routine physical examination or examination of blood sugar or urine sugar when treating other diseases. In some elderly patients with diabetes, complications are the first manifestation, often accompanied by metabolic abnormalities. At the same time, the elderly patients have poor treatment compliance and tolerance, so their blood glucose control methods are different from those of young and middle-aged patients. It is very important to give individualized treatment on the basis of understanding the characteristics of patients.

　　Oral drug therapy

　　Sulfonylureas This class of drugs is mainly second-generation sulphonylureas, such as glibenclamide, gliclazide, glipizide, gliquidone and glimepiride. If the elderly patients use these drugs improperly, it may lead to hypoglycemia. Especially for the elderly patients with liver and kidney insufficiency, the use of glibenclamide and other drugs that are mainly metabolized by the kidney can easily cause hypoglycemic reactions and aggravate the damage to liver and kidney functions. Therefore, the elderly patients should closely observe the drug use under the guidance of doctors.

　　Glinides This class of drugs mainly includes repaglinide, nateglinide, etc., and is applicable to elderly patients with type 2 diabetes at the early postprandial hyperglycemia stage or mainly postprandial hyperglycemia. These drugs should be taken immediately before meals and can be used alone or in combination with other hypoglycemic drugs (excluding sulfonylureas). Common adverse reactions after treatment include hypoglycemia and weight gain, but the frequency and intensity of hypoglycemia are lower than those of sulfonylureas.

　　Biguanidine drugs This kind of drugs mainly include phenformin, metformin, and butyformin. The use of metformin alone will not lead to hypoglycemia, but the combination of insulin or insulin secretagogue can increase the risk of hypoglycemia. The most serious adverse reaction of biguanidine drugs is lactic acidosis, especially when the dosage of phenformin is large or the patient is accompanied by liver, kidney, heart and lung dysfunction and hypoxia.

　　α- Glucosidase inhibitors These drugs mainly include acarbose, voglibose, etc. These drugs are suitable for those with normal or slightly elevated fasting blood glucose but significantly elevated postprandial blood glucose, and can be used alone or in combination with other hypoglycemic drugs. Type 1 diabetes patients can reduce postprandial hyperglycemia by adding such drugs to insulin therapy. When taking this kind of drug, it should be noted that it should be chewed at the same time with the first bite of food and swallowed. The main adverse reactions are gastrointestinal reactions and hypoglycemia.

　　Insulin therapy

　　Indications of insulin use More than 95% of elderly diabetes patients are non insulin dependent type 2 diabetes, and generally do not need insulin treatment; However, about 20% of the elderly patients with diabetes can not control their blood sugar well only by diet therapy and oral hypoglycemic drugs, so they need insulin treatment. The indications for insulin use in elderly patients with diabetes mainly include the following:

　　● Insulin dependent type 1 diabetes patients;

　　● diabetes patients with ketoacidosis or hyperosmolar coma;

　　● Type 2 diabetes patients with oral hypoglycemic drug failure;

　　● When combined with infection, trauma, major surgery, cerebrovascular accident, myocardial infarction, heart failure and other emergency situations, insulin should be used temporarily even if the original oral hypoglycemic drugs have good effects;

　　● Type 2 diabetes patients who cannot be controlled by dietotherapy and should not use oral hypoglycemic drugs.

　　Disease monitoring and control criteria The disease monitoring items when insulin is used mainly include urinary ketone body, fasting blood glucose, 2 hours postprandial blood glucose, diabetes "three more" symptoms and hypoglycemia.

　　Precautions for medication

　　Relax the goal of blood glucose control to avoid hypoglycemia Research shows that the goal of blood glucose control for elderly diabetes patients should be appropriately relaxed, with fasting blood glucose below 7.8 mmol/L and blood glucose below 11.1 mmol/L 2 hours after meal. If the patient has frequent hypoglycemia, unstable condition or long-term bed rest, the standard should also be revised to broaden the scale.

　　Rational selection of hypoglycemic drugs The elderly diabetes mostly belongs to type 2 diabetes. When diet and exercise treatment cannot make the blood sugar of patients reach the standard, oral hypoglycemic drugs can be used. It should be specially reminded that the same drug should not be taken for too long, and other drugs can be used under the guidance of doctors in time to better control blood sugar.

　　Pay attention to the safety of drugs and avoid the first choice of hypoglycemic drugs with strong effects and long duration (such as glibenclamide), so as to avoid hypoglycemic symptoms in patients. Elderly diabetes patients with heart disease or high risk of heart disease should avoid using insulin sensitizers (such as rosiglitazone). It is recommended to use quick-acting insulin lysine, insulin aspart or long-acting insulin glargine analogues. The incidence of hypoglycemia and other adverse reactions of the above drugs is low, which is more suitable for elderly patients.

　　Pay attention to the liver and kidney function. If the liver and kidney function of the patient is seriously damaged, oral hypoglycemic drugs that are not metabolized by the liver or kidney should be the first choice, or insulin should be used for treatment. If the liver and kidney function of the patient is not significantly damaged, and insulin resistance is the main factor, metformin can be taken orally, and the blood lactic acid level should be regularly detected during use.

　　Treatment of complications and complications The elderly patients with diabetes should not only control their blood sugar, but also treat the combined cardiovascular, cerebrovascular, neurological, renal and retinal diseases, so as to improve the quality of life and prolong their life.

　　The single dose should not be too large. Too large a dose of hypoglycemic agents does not significantly enhance the efficacy, but is prone to cause adverse drug reactions. For example, when the daily dose of gliclazide is more than 320 mg, the daily dose of glipizide is more than 30 mg, the daily dose of metformin is more than 2 g, the daily dose of rosiglitazone is more than 8 mg, and the daily dose of glimepiride is more than 4 mg, the hypoglycemic effect will not be better, It is easy to cause adverse reactions such as hypoglycemia.

　　Note that the oral medicine should be taken at a specific time according to the different time of taking medicine, so as to achieve a better drug effect. For example, the first and second generation sulfonylureas should be taken orally half an hour or more before meals; Glimepiride once a day should be taken at a certain time every day; Dietary blood glucose regulator Glinide and α- Glucosidase inhibitors (such as acarbose) should be taken before meals; Biguanidine drugs should be taken during or after meals.

　　It is suggested that the combination of drugs with different mechanisms of action should be used in the early stage to promote the advantages and avoid the disadvantages, which is more conducive to the control of blood sugar and the protection of pancreatic islets β Cell function, improve insulin resistance.

　　Clinically, the combination of sulfonylureas and biguanides is the most common; Sulfonylureas and α- The combined use of glucosidase inhibitors is more conducive to the control of postprandial blood glucose; Biguanidine and α- The combination of glucosidase inhibitors or thiazolidinediones can improve the secondary failure of sulfonylureas; The combination of dietary glucose regulators and biguanidine drugs can significantly reduce the fluctuating blood glucose.

　　After stopping the use of hypoglycemic drugs, it is necessary to carefully stabilize the blood glucose index through drug treatment, and then gradually adjust the dosage under the guidance of the doctor, but do not stop all drugs by yourself, so as not to cause the blood glucose rebound and affect the treatment effect.

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