{"countAll":0,"orderType":null,"readLevel":"0","lyTopicReq":{"id":"1935","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":null,"content":null,"barId":"1935","topicTypeId":null,"topicThemeId":"1028","readLevel":0,"files":null,"clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":null},"lyBarModerators":{"list":[{"id":"d488fa875df011e9972100163e0462f1","isDel":0,"createAt":1555162398021,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"applyId":"b28735085df011e9972100163e0462f1","userId":"84404015eff611e6a61c00163e04584d","webType":0,"barId":"1935","status":0,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1}}],"list4Map":null,"pageBegin":0,"pageSize":8,"pageNumber":1,"totalPage":1,"totalRow":1},"metaSearch":{"description":"为您提供:糖尿病的治疗方法_糖尿病的自我疗法有哪些等相关信息，让病友在便捷的求医路上不花一分冤枉钱。","keywords":"糖尿病的治疗方法_糖尿病的自我疗法有哪些","title":"糖尿病的治疗方法_糖尿病的自我疗法有哪些","channels":null},"data":{"list":[{"id":"25237","isDel":0,"createAt":1555162322454,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"糖尿病低密度脂蛋白降到多少","content":"

   糖尿病低密度脂蛋白降到多少合适，许多糖友们并不清楚，今天小编一一为您梳理下：

 \"糖尿病低密度脂蛋白降到多少\"

   2型糖尿病患者发生冠心病、心梗、脑梗的风险显著增高，这是糖尿病对健康的最大威胁。然而，单纯控制血糖并不能降低发生心脑血管疾病的风险。因此，在控制血糖的同时还要严格控制血压、严格控制胆固醇。

 

  糖尿病患者的血压不应超过130/80 mmHg，只要超过此数值就要干预。首选的干预方式当然是控制饮食、增加运动、减轻体重。如果通过这些措施血压仍然不能得到满意控制，就要应用降压药物。无论如何，要努力把血压控制在130/80 mmHg，这样能够显著降低发生心脑血管疾病的风险。

 

  同样，控制胆固醇水平对于降低心脑血管病风险也至关重要。一般来讲，所有糖尿病患者的低密度脂蛋白胆固醇水平都不应超过2.6 mmol/L，只要超过这个数值就要干预。首选的干预措施仍然是控制饮食、增加运动、减轻体重。如果经过这些措施处理后胆固醇仍不能满意控制，就要用药治疗。首选的药物就是他汀。他汀治疗后如果胆固醇不能满意控制可以联合使用依折麦布。仍不能达标者还可以联合依洛尤单抗等药物。如果糖尿病患者同时合并冠心病、脑卒中、颈动脉疾病或其他外周动脉疾病，则应该把低密度脂蛋白胆固醇降低到1.8 mmol/L以下，最好降到1.4 mmol/L以下。如果糖尿病患者合并冠心病，并且把低密度脂蛋白胆固醇降低到1.8 mmHg以下后仍有心绞痛发作，这样的患者发生心血管事件的风险非常大，应该更为严格的控制胆固醇，把低密度脂蛋白胆固醇降低到1.4 mmol/L以下。实际上，几乎所有40岁以上的糖尿病患者都应该吃上他汀，这样能给心脑血管提供更多保护。


\"糖尿病低密度脂蛋白降到多少\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":2093,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1555162322454,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":1,"digestEffectTime":1563024905564,"top":1,"topEffectTime":1563024912656,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1555162322454,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25562","isDel":0,"createAt":1558103798897,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"降糖最新方法","content":"

近日，降糖治疗领域有两个降糖最新方法让人惊喜：一个是DECLARE-TIMI 58研究初步结论公布，显示SGLT-2抑制剂达格列净治疗组两终点之一心血管死亡或因心衰住院发生率显著低于对照组（其详细数据预期将于下月公布）；另一个消息是，今天刚刚揭晓了Harmony Outcomes研究结果，GLP-1激动剂阿必鲁肽（albiglutide）显著降低了主要终点事件发生率。

 \"降糖最新方法\"

Harmony Outcomes研究共纳入9574例（9463例纳入最终数据分析）确诊动脉粥样硬化性心血管疾病（冠心病、脑血管病或外周动脉疾病）的2型糖尿病患者，在标准治疗基础上随机分组后分别应用GLP-1激动剂阿必鲁肽（albiglutide）或安慰剂。主要复合终点为首次发生心血管死亡、心肌梗死或卒中。随访结束时结果显示，与安慰剂组相比，阿必鲁肽治疗组患者主要复合终点发生率降低22%（非劣效性p＜0.0001；优效性p=0.0006）。然而令人惋惜的是，因为经济原因，该药竟从全球撤市了（In August 2017, GSK announced that it intended to withdraw the drug from the worldwide market by July 2018 for economic reasons）。

 

现在，我们有必要对已经结束的关于SGLT-2抑制剂与GLP-1激动剂的数项降糖药物试验进行一下简要回顾：

 

1. 结束于2015年的ELIXA研究结果显示，与安慰剂组相比，在常规治疗基础上加用GLP-1激动剂利西拉来对主要心血管终点事件无影响。

 

2. 结束于2015年的EMPA-REG OUTCOME研究堪称降糖领域的破冰之旅，该研究发现，与安慰剂组相比，在常规治疗基础上加用SGLT-2抑制剂恩格列净可以使全因死亡率降低32%,使心血管死亡率降低38%，均达到统计学显著性差异。

 

3. 于2016年6月在ADA年会期间公布的LEADER研究结果显示，与安慰剂组相比，在常规治疗基础上加用GLP-1类似物利拉鲁肽可以显著降低2型糖尿病患者主要复合终点事件、心血管死亡与全因死亡发生率。这一研究使得利拉鲁肽成为继SGLT-2抑制剂恩格列净之后第二种被随机化临床试验证实能够产生心血管获益的降糖药物。

 

4. 于2016年9月公布的SUSTAIN-6研究结果显示，与安慰剂组相比，接受索马鲁肽治疗的患者主要终点事件发生率降低26%（优效性检验p=0.02）。这项研究使得索马鲁肽成为继利拉鲁肽之后第二种被证实具有心血管获益的GLP-1激动剂类药物，也是即恩格列净与利拉鲁肽之后第三种被证实具有心血管获益的降糖药物。

 

5. 于2017年6月公布的CANVAS研究结果显示，与安慰剂组相比，坎格列净治疗组心血管复合终点发生率降低14%（95% CI，0.75-0.97），因心衰住院风险减少33%、肾脏复合结局风险降低40%。

 

6. 于2017年9月公布的EXSCEL研究结果显示，艾塞那肽治疗组与安慰剂治疗组主要复合终点发生率无显著差异。次要终点（因心血管死亡、非致死性心肌梗死、致死或非致死性卒中死亡和因心衰及急性冠脉综合征住院发生率）方面，两组也未表现出显著差异。

 

7. 刚刚公布初步结论的DECLARE-TIMI 58研究得到阳性结果。

 

8. 刚刚揭晓的Harmony Outcomes研究得到阳性结果。

 

纵观上述8项研究，我们有理由认为降糖治疗已经进入一个全新时代，由SGLT-2抑制剂和GLP-1激动剂所引领的新型降糖药物为2型糖尿病患者带来了新希望、新生机。虽然由于研究设计、同类药物不同品种之间的作用差异、以及受试者基线特征等原因，利西拉来与艾塞那肽未能得出预期的阳性结果，但这并不妨碍GLP-1激动剂将成为具有广阔应用前景的一类降糖药。而SGLT-2抑制剂乘风破浪、三战全胜，更为其推广应用奠定了坚实的基础。

 

回顾历史，虽然“文迪雅事件”一波三折、遗憾重重，但它却成为推动降糖药物研发方向转型的关键因素。如果没有这一事件，现行的降糖药物审批制度以及血糖管理策略或许仍然以降糖幅度为主要依据。由此而论，文迪雅恰如一颗蜡烛，燃烧了自己，照亮了血糖管理的征途。而SGLT-2抑制剂与GLP-1激动剂生逢其时，不负众望，将降糖治疗带入一个全新时代。

\"降糖最新方法\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1471,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1558103798898,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":1,"digestEffectTime":1566052621635,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1558103798898,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25540","isDel":0,"createAt":1558020386384,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"糖尿病血压应该降到多少算正常，吃什么降压药好","content":"

糖尿病和高血压都是心脑血管病的重要危险因素，二者同时存在时，发生心梗、脑梗的风险更大，因此应该更为积极的控制血压。那么糖尿病血压应该降到多少算正常，吃什么降压药好呢

 \"糖尿病血压应该降到多少算正常，吃什么降压药好\"

对于合并糖尿病的高血压患者，应该将血压控制在130/80 mmHg以下。很多人以为血压不超过140/90 mmHg就可以了，这是不正确的。把血压控制在130/80 mmHg以下可以更为有效地降低发生心脑血管病的风险。

 

在降压药物选择方面，此类患者也有其特殊性。

 

一般来讲，降压药应该首选普利类（如依那普利、卡托普利、苯那普利、培哚普利、赖诺普利、福辛普利等）或者沙坦类（如厄贝沙坦、缬沙坦、氯沙坦、替米沙坦、坎地沙坦等）。

 

如果一种药物不能满意控制血压，可在此基础上联合应用钙通道阻滞剂（即地平类，如氨氯地平、硝苯地平控释片、非洛地平缓释片等）。


血压仍然不能达标时，可联合应用三种药物，即地平类+沙坦类+利尿剂（如氢氯噻嗪、吲达帕胺等），或者地平类+普利类+或利尿剂。还是不能达标时可以增加地平类或者沙坦类、普利类剂量，或咨询专门从事高血压研究工作的专家。

\"糖尿病血压应该降到多少算正常，吃什么降压药好\"

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\"糖尿病血压应该降到多少算正常，吃什么降压药好\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1339,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1558020386385,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":1,"digestEffectTime":1565969196688,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1558020386385,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25364","isDel":0,"createAt":1556119186724,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"40岁以上的糖尿病患者吃什么药","content":"

糖尿病最大的危害不是高血糖本身，而是增加心梗、脑梗以及下肢动脉疾病的风险。治疗糖尿病的主要目的在于降低患者心脑血管病发生率。40岁以上的糖尿病患者吃什么药好呢？现有研究表明，单纯通过降低血糖水平难以达到此目的，除了降糖之外，应该更加重视对血压和血脂的管理。大量研究证实，积极控制血压水平、严格控制胆固醇水平可以大幅度降低糖尿病患者心脑血管病事件的发生率。

 \"40岁以上的糖尿病患者吃什么药\"

因为血压测量较简单且普遍，人们对高血压的关注相对较多，但对于胆固醇的关注程度远远不够，这是导致我国糖尿病患者心脑血管病发生发生率居高不下的重要原因之一。

 

基于现行国内外指南，40岁以上的糖尿病患者应将低密度脂蛋白胆固醇水平控制在2.6 mmol/L以下，或将低密度脂蛋白胆固醇较基础水平降低50%以上，这就意味着多数40岁以上的糖尿病患者均应该服用他汀。应用常规剂量他汀治疗后胆固醇不能达到上述标准的患者，还应该在他汀治疗基础上联合应用依折麦布，这样可以在不增加不良反应风险的前提下更大幅度的降低胆固醇水平。

本文关键信息：1. 所有糖尿病患者每年必须检验血脂，各项血脂指标中最重要的是低密度脂蛋白胆固醇；2. 不要以为血脂化验单中没有向上的箭头就是血脂正常，糖尿病人的低密度脂蛋白胆固醇超过2.6mmol/L就算增高了；3. 只要低密度脂蛋白胆固醇超过2.6mmol/L就应该考虑接受他汀治疗；4. 不要以为没有症状就忽视胆固醇，其实胆固醇是最坏的东西，胆固醇增高是糖尿病患者发生心梗脑梗的重要原因，必须重视并且积极治疗。

  

\"40岁以上的糖尿病患者吃什么药\"

下载二维码，微信识别，观看丁荣晶教授主讲三小时的《心肌梗死与心肌康复》

\"40岁以上的糖尿病患者吃什么药\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1372,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1556119186727,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":1,"digestEffectTime":1563981602660,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1556119186727,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"27404","isDel":0,"createAt":1571388878080,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"血糖监测的注意事项","content":"

在找良医网糖尿病群内，有病人问过关于血糖监测的注意事项。为什么自己在家监测血糖了，还要去医院查糖化血红蛋白？找良医网告诉你，目前临床上血糖监测方法包括利用血糖仪进行的毛细血管血糖监测（扎指血）、持续葡萄糖监测、糖化血红蛋白和糖化白蛋白的检测等。

\"血糖监测的注意事项\" 

自己在家测的血糖是毛细血管血糖，它反应的是测的当时的单时间点的血糖，而糖化血红蛋白反映的是在较长一段时间内的血糖。

 

糖化血红蛋白的控制情况可以给医生提供抽血前2～3个月的血糖控制好坏的信息，是医生决定是否需要调整降糖治疗的重要依据。

 

而单时间点的毛细血管血糖可以为医生提供如何调整降糖治疗的信息，比如空腹血糖高可以加强控制空腹血糖的治疗，中午餐后血糖高可以加强中午餐后血糖的治疗。    

 \"血糖监测的注意事项\"

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说！


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1827,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1571388878081,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1571388878081,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"26830","isDel":0,"createAt":1568274688472,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"血糖多高算糖尿病范围","content":"

在丁荣晶教授《心肌梗死与心肌康复》读者交流群里，有病人问过血糖多高算糖尿病范围，对于心梗的危险因素之一的糖尿病来说，控制不好，极容易引发心梗的发生，找良医网告诉你，要确诊糖尿病需要看症状和血糖。

\"血糖多高算糖尿病范围\" 

典型的糖尿病症状包括总是觉得渴、喝水多，尿多，吃得多，体重反而下降，即三多一少。

 

典型的糖尿病症状合并以下三项中的一项可诊断糖尿病

（1）随机血糖≥11.1 mmol/L；

（2）空腹血糖≥7.0 mmol/L；

（3）口服葡萄糖耐量试验（喝糖水后测血糖）的2小时血糖≥11.1 mmol/L。

 

没有典型的糖尿病症状者，如果符合上述血糖标准，需改日复查血糖，如果仍然符合上述血糖标准，就可诊断糖尿病。      

\"血糖多高算糖尿病范围\" 

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说！


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1496,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1568274688473,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1568274688473,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"26624","isDel":0,"createAt":1567501961138,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"糖尿病视力下降","content":"

糖尿病人有一个现象很明显，那就是会有视力下降的情况，那么，糖尿病视力下降是什么原因呢？找良医网告诉你，有糖尿病会引起各种并发症，眼睛也是糖尿病损伤的主要器官之一。

\"糖尿病视力下降\" 

糖尿病引起视力下降的原因主要有下面几个：

 

第一是因为血糖短时间内波动剧烈，当血糖短时间升高明显或糖尿病患者服用降糖药血糖迅速下降时，会引起眼睛晶状体内渗透压急剧变化，使屈光度发生变化，引起视物模糊，这种情况常发生在刚诊断的糖尿病患者中。

 

第二是因为白内障，无糖尿病的老年人也会出现白内障，但糖尿病患者白内障出现的早而且进展的要快。

 

第三是糖尿病视网膜病变，它是糖尿病的微血管并发症，也是导致失明的主要原因。

 

糖尿病患者由于长期血糖升高，体内代谢紊乱，损伤全身微血管，眼底视网膜血管容易受损，即发生糖尿病性视网膜病变。早期眼底会有微血管瘤，以及不同程度的渗血、出血。后期，由于视网膜缺血，为了弥补缺血，视网膜会逐渐新生一些毛细血管，这些毛细血管通常不正常，不但不能弥补视网膜缺血，反而容易出血，最终将严重影响视力，甚至失明。     

\"糖尿病视力下降\" 

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说！


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1745,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1567501961139,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1567501961139,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25072","isDel":0,"createAt":1553355042440,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"糖尿病人血压血脂控制多少合适","content":"

糖尿病患者最大的威胁就是心脑血管疾病(如冠心病、心肌梗死、脑梗死等)。因此，防治心脑血管疾病是糖尿病患者的首要任务。糖尿病患者应在医生指导下接受正规的降糖治疗。但是，很多糖尿病患者只知道关注自己的血糖，只关心自己血糖是否已经控制正常，这是远远不够的！对于糖尿病人而言，控制血压、控制胆固醇比控制血糖更重要！以下几点是糖尿病人必须充分重视的：

 

生活方式管理

主要内容包括合理饮食、适量运动、控制体重、限制饮酒、戒烟等。首先，合理的饮食结构与总热量摄入不仅是降糖治疗的基石，也是降低心血管系统整体风险水平的有效措施，因而适用于所有糖尿病患者。对于肥胖的患者，应以低碳水化合物、低脂肪饮食为主。其次，适量运动有助于控制体重、改善糖代谢和脂代谢状态并降低血压水平，对心血管系统具有有益影响。建议糖尿病患者坚持规律性的中等强度有氧运动（例如快步行走、太极拳、自行车运动等）。体重在正常范围者每日运动时间不少于30分钟，每周不少于5天。超重/肥胖者需要增加运动量，每日运动时间不少于1小时，每周不少于5天。若无禁忌证，应鼓励患者每周进行2-3次阻抗训练（如俯卧撑、仰卧起坐、下蹲运动、举哑铃等）。第三，吸烟可以增高不良心血管事件的危险性，因此吸烟者应努力戒烟。

 \"糖尿病人血压血脂控制多少合适\"

血压管理

当糖尿病患者血压水平高于130/80 mmHg时，其不良心血管事件发生率将显著增高，因此多数患者的血压应控制在此水平以下。但是对于高龄、一般健康状况较差或已经发生严重心脑血管疾病的患者，过于严格的血压控制可能会对患者产生不利影响，将血压控制在140/90 mmHg以下就可以了。降压药物可以首选普利类或沙坦类，血压不能达标时可以联合应用地平类或利尿剂等。将血压控制在130/80 mmHg以下可以显著降低心梗、脑梗的发生率！

 

血脂管理

对于已经发生心脑血管疾病的患者，无论其血脂水平如何，均应接受他汀治疗，将低密度脂蛋白胆固醇（LDL-C）控制在1.8mmol/L以下。没有心脑血管疾病但年龄≥40岁的患者，虽然其血脂水平不高也应该服用他汀类药物，将LDL-C控制于2.6 mmol/L以下。换言之，多数2型糖尿病患者需要接受他汀治疗。控制胆固醇并维持胆固醇在比较低的水平是预防心梗脑梗的重要且有效的措施！

 

抗血小板治疗

若无禁忌证，所有合并心脑血管疾病的患者均应服用小剂量阿司匹林（75-150 mg/d）。具有使用阿司匹林适应证但不能耐受治疗者，可应用氯吡格雷替代（75 mg/d）。无心脑血管疾病的50岁以上男性与60岁以上女性患者且伴有至少1项其他危险因素（吸烟，高血压，血脂异常，早发冠心病家族史，蛋白尿）者，若其不存在出血性并发症的高危因素（既往有胃肠道出血史或消化性溃疡病史，或正在服用非甾体类抗炎药物或华法林等增加出血风险的药物），也建议服用小剂量（75-150 mg/d）阿司匹林。

 

最后需要强调的是，糖尿病患者的药物治疗必须在正规医院医生指导下进行，切忌擅自购药或自行更改治疗方案。


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1536,"score":0,"partCount":0,"replayCount":1,"publishStatus":1,"publishTime":1553355042441,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1563196706570,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25870","isDel":0,"createAt":1561968936960,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"糖尿病人可以怀孕生孩子吗?","content":"

在医院经常可以听到很多患者问医生，我是糖尿病人，我想问一下，糖尿病人可以怀孕生孩子吗？今天，找良医网在本文中为大家简单介绍一下这方面知识。

\"糖尿病人可以怀孕生孩子吗?\" 

如果没有严重的糖尿病并发症，女性糖尿病人可以妊娠，但孕前需先将血糖控制好。

 

在不出现低血糖的前提下，空腹和餐后血糖需尽可能接近正常，建议糖化血红蛋白<6.5%时妊娠，以减少先天异常的风险。应用胰岛素治疗者可糖化血红蛋白<7.0%，餐前血糖控制在3.9~6.5 mmol/L，餐后血糖在8.5 mmol/L以下。

 

合理饮食和运动是孕期糖尿病治疗的基础，如果不能达到治疗目标，应该加用药物治疗。首选降糖药物是胰岛素。

 

在怀孕期间，血糖目标：空腹血糖<5.3 mmol/L、餐后1 h血糖<7.8 mmol/L；餐后2 h血糖<6.7 mmol/L。避免发生低血糖。      

 \"糖尿病人可以怀孕生孩子吗?\"

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说！


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1510,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1561968936961,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1561968936961,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25813","isDel":0,"createAt":1561260609069,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"糖尿病人还需复查什么东西","content":"

很多糖尿病人除需要查血糖外，还需复查很多，这也是多数糖尿病人不知道的，今天，找良医网为大家讲解糖尿病人还需复查什么东西？一起来了解一下吧！

\"糖尿病人还需复查什么东西\" 

Q：糖尿病人除血糖外，还需复查什么？

 

A：首先，除血糖外，需要查糖化血红蛋白。其可以评估长期血糖控制的状况，也是临床决定是否需要调整治疗的重要依据，所以至少每3个月检查一次糖化血红蛋白。

 

糖化血红蛋白可以稳定达标的病人，可以延长至6个月查一次。

 

另外，糖尿病人需要定期复查并发症情况。确诊糖尿病后至少每年进行一次肾脏功能检查、眼底检查、周围神经病变检查、下肢动脉检查、颈动脉超声、心电图检查等。

 

定期复查这些项目是为了及时发现并发症，做到及时治疗。对已经存在相关并发症的患者，相应的项目复查频率可能需要更频繁，需按医生要求进行。

 

此外，糖尿病人还需要复查其他危险因素或疾病的情况，比如血脂、血压。     

 \"糖尿病人还需复查什么东西\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1604,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1561260609072,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1561260609072,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25812","isDel":0,"createAt":1561260443027,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"糖尿病人要注意哪些","content":"

对于糖尿病来说，很多人不知道自己有糖尿病了，那么，为什么很多糖尿病人不知道自己得了糖尿病？糖尿病人要注意哪些？找良医网在本文简单解答一下这方面！

\"糖尿病人要注意哪些\" 

Q：为什么很多糖尿病人不知道自己得了糖尿病？

 

A：很多糖尿病病人是在发生糖尿病并发症就医时才发现糖尿病的。

 

尤其是老年人，很多病人都会说，我什么感觉都没有，怎么会是糖尿病。或者当被问起来，才回忆说好像有些口干，或者晚上小便次数增多等。

 

我们常说“三多一少”（多饮、多食、多尿、消瘦）是糖尿病的症状，但很多患者并没有这些典型症状。

 

或者有些症状，但自己不认为这是一种疾病的表现，没往心里去。比如认为“多食”是健康的表现；认为“体重减轻”是有钱难买老来瘦。

 

所以，定期体检查血糖才是早期发现糖尿病，早期治疗，避免发生严重并发症的靠谱方法。

\"糖尿病人要注意哪些\"


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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1638,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1561260443029,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1561260443029,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25801","isDel":0,"createAt":1561186899709,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"光靠饮食可以控制糖尿病吗","content":"

很多糖尿病的患者也问过这样的问题，光靠饮食可以控制糖尿病吗？对于糖尿病来说，饮食忌口是绝对的，那么，控制饮食是否可以控制，或者治疗糖尿病呢？本文章，找良医网为大家解答一下！

\"光靠饮食可以控制糖尿病吗\" 

Q：光靠饮食可以控制糖尿病吗？

 

A：糖尿病病人由于体内胰岛素分泌绝对或相对不足，若不控制饮食，而是像正常人一样的进食，血糖就会升的很高，不仅会加重胰岛β细胞的负担，而且还长期的持续高血糖促使糖尿病多种并发症发生与发展，甚至危及生命。

 

因此每个糖尿病病人，不管病情轻重，不管是否有注射胰岛素，都需要长期的坚持合理的饮食治疗。

 

但是，纯饮食控制只能使一部分病情较轻的患者达到血糖满意控制，对于大部分患者来说仅仅为药物治疗提供了一个基础。因此对那些单纯饮食控制不能达到治疗目标的糖尿病患者，必须加用适当的药物治疗。

\"光靠饮食可以控制糖尿病吗\"         

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1549,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1561186899710,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1561186899710,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25775","isDel":0,"createAt":1560930322726,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"血糖偏高但还不是糖尿病怎么控制血糖","content":"

我国有约50%的成人处于糖尿病前期。糖尿病前期就是血糖已经高于正常，但尚未达到糖尿病的诊断标准，包括空腹血糖偏高，和/或餐后血糖偏高。那么你知道血糖偏高但还不是糖尿病怎么控制血糖吗？本文找良医网为您详细解答！

\"血糖偏高但还不是糖尿病怎么控制血糖\" 

糖尿病前期人群是发生糖尿病的最危险人群，每年有6%~10%进展为糖尿病。因此，糖尿病前期人群要积极预防糖尿病。

 

积极预防糖尿病的好处不仅仅是可以不得或延迟得糖尿病，更可以延长寿命、减少糖尿病各种并发症。这是阜外医院内分泌和心血管病中心主任、中日友好医院内分泌首席专家李光伟教授研究团队的大庆研究30年的随访结果。

 

研究开始于1986年，共入选576例餐后血糖偏高（糖耐量受损）者，其中438例患者接受饮食和/或运动的生活方式改变的治疗。

 

经过6年积极生活方式治疗后，对受试者进行了长达30年的随访。

 

结果显示，与没有接受生活方式治疗的人相比，生活方式治疗使糖耐量受损人群的糖尿病发病时间延迟3.96年。

 

同时，生活方式治疗使糖尿病发生风险降低39%，心血管疾病发生风险降低26%，糖尿病微血管病变发生率降低35%，心血管疾病死亡率降低33%，总死亡率降低26%；平均预期寿命增加1.44年。

 

大庆研究告诉我们，不用吃药，单纯采取健康的生活方式就可以预防糖尿病、减少心脑血管疾病、延长寿命。

 

同时也告诉我们，血糖偏高者，虽然还不到糖尿病的诊断标准，也是时候开始行动了。早行动，早获益。

 

我国2型糖尿病防治指南也建议，糖尿病前期者者应通过饮食控制和运动以降低糖尿病的发生风险。具体目标为：

 

（1）超重或肥胖者体重指数（体重/身高2）达到或接近24 kg/m2，或体重至少下降7%；

（2）每日饮食总热量至少减少400~500 kcal（1 kcal=4.184 kJ）；

（3）饱和脂肪酸摄入占总脂肪酸摄入的30%以下；

（4）中等强度体力活动至少保持在150分钟/周。            

\"血糖偏高但还不是糖尿病怎么控制血糖\" 

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1587,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1560930322726,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1560930322726,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25669","isDel":0,"createAt":1559399977819,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"同时有糖尿病和高血压该怎么治疗","content":"

同时患有高血压和糖尿病的人应该更加重视，因为这两种疾病同时存在时更容易发生心梗和脑梗。那么同时有糖尿病和高血压该怎么治疗呢？

 \"同时有糖尿病和高血压该怎么治疗\"

首先，要强调健康生活习惯，例如要合理饮食（不要吃太多、不要吃含糖量太多的食物、不要吃太咸、不要吃太肥腻的食物、多吃蔬菜等）、增加运动、把体重控制在理想范围（肥胖的人更容易发生高血压和糖尿病以及心脑血管病）、不要大量喝酒、努力戒烟等。

 

第二，一定要在医生指导下好好控制血压，糖尿病人的血压最好控制在130/80 mmol/L以下。该用药时就要用药，并且要长期坚持服用降压药物，不要因为担心降压药的副作用而拒绝用药，更不要等着心脏、脑和肾脏都出了问题才想起去吃降压药。

 

第三，在医生指导下好好控制血糖，既要治疗高血糖，又要预防低血糖。

 

第四，血液中胆固醇水平越高，就越容易发生心脑血管病。所以高血压合并糖尿病的人要定期去医院检查血脂，如果低密度脂蛋白胆固醇超过1.8 mmol/L就要吃一类叫做“他汀”的药物，努力把胆固醇降得更低一些。

 

上面这四个方面，只要长期坚持做到，就能够把发生心脑血管疾病的风险降到最低水平。


\"同时有糖尿病和高血压该怎么治疗\" 


下载二维码，微信识别，观看丁荣晶教授主讲三小时的《心肌梗死与心肌康复》

\"同时有糖尿病和高血压该怎么治疗\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1430,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1559399977823,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1559399977823,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25641","isDel":0,"createAt":1559119702110,"createBy":"425fdc1d2e6111e8a3d800163e04584d","createName":"求一红颜笑看余生","updateAt":0,"updateBy":null,"updateName":null,"userId":"425fdc1d2e6111e8a3d800163e04584d","title":"糖尿病患者一定要长期服用他汀吗","content":"

众所周知，糖尿病是分型的，在本文中，要告诫的是，40岁以上的2型糖尿病患者别忘了用他汀。这样就有很多患者问了，40岁以上的2型糖尿病患者一定要长期服用他汀吗？别着急，我们往下看！

\"糖尿病患者一定要长期服用他汀吗\" 

2型糖尿病最大的致残致命风险是冠心病、心肌梗死和卒中。仅靠降血糖，主要获益的是小血管病（视网膜和肾脏病变），而对预防威胁更大的冠心病、心肌梗死与卒中的力度远远不够。

 

有项研究（CARDS）发现，即使用药前血胆固醇，尤其坏胆固醇水平无明显升高的患者，如能使用很安全的小剂量他汀，即各种原研他汀一片的半计量，比用安慰剂，可使心肌梗死的相对风险下降40%，使卒中下降30%。

 

40岁以上的2型糖尿病患者数量巨大，很多患者只关注血糖，忽略了他汀。

 

2型糖尿病患者常合并有血脂异常，但化验单上显示的异常是甘油三酯升高，好胆固醇（高密度胆固醇）降低，而总胆固醇和坏胆固醇的水平都在化验单标注的参考范围之内，即“不升高”。因此，众多40岁以上2型糖尿病患者忽略了用他汀类药物。

 

如果40岁以上糖尿病患者体检的化验单上显示，总胆固醇和坏胆固醇升高，标示有箭头向上，可选用中等剂量他汀，即各种他汀的1片。如化验单上显示，总胆固醇与坏胆固醇在参考范围内，可用小剂量他汀，即各种他汀的半片。

 

40岁以上的2型糖尿病患者应把坏胆固醇水平降至2.6mmol/L以下，如果同时有高血压，又吸烟，可把坏胆固醇降到1.8mmol/L以下。

 

高胆固醇低时，升高它的最好办法是坚持有氧运动。

 

甘油三酯升高时，要限酒和戒烟，坚持有氧运动，控制血糖稳定，限制精加工米面和甜品。大多数他汀都有一定程度降甘油三酯的作用。   

 \"糖尿病患者一定要长期服用他汀吗\"

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","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1431,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1559119702111,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1559119702111,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"425fdc1d2e6111e8a3d800163e04584d","isDel":0,"createAt":1521785589502,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"求一红颜笑看余生","password":"zx13401068656","level":0,"nickName":"找良医网问答助手","realName":null,"signName":"找良医网问题解答专员！","head":"http://01luntan.com/ly_img/1539831954338.png","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"1769604826@qq.com","address":null,"identityType":5,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110114","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25277","isDel":0,"createAt":1555425292041,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"SGLT-2抑制剂主要优势","content":"

肾脏并发症是糖尿病致死致残的重要原因之一。在此之前，尚无以肾脏并发症为主要终点的降糖药物临床试验证据。刚刚公布的CREDENCE研究填补了这一空白。

 \"SGLT-2抑制剂主要优势\"

CREDENCE研究旨在探讨卡格列净对合并2期或3期CKD并大量蛋白尿的2型糖尿病患者肾脏终点事件的影响。共纳入4401例经ARB治疗后白蛋白肌酐比值300-5000的CKD患者（eGFR 30-90），在常规治疗基础上随机接受卡格列净或安慰剂治疗，主要终点为由终末期肾病、血肌酐倍增、肾脏或心血管死亡所组成的复合终点。因卡格列净组获益显著，本研究在随访2.62年（中位数时间）时提前结束。结果显示，与安慰剂组相比，卡格列净治疗组患者主要终点事件发生率降低30%，肾脏复合终点（终末期肾病、血肌酐倍增和肾脏性死亡）降低34%。与此同时，卡格列净治疗组复合心血管终点事件（心血管死亡、心肌梗死或卒中）发生率降低20%，因心衰住院减少39%。两组受试者间截肢或骨折风险无显著差异。研究结论认为，卡格列净可以显著降低合并CKD的2型糖尿病患者肾脏复合终点与心血管事件发生率，但不增加截肢与骨折风险。


如前所述，CREDENCE研究是针对降糖药进行的首项肾脏终点随机化临床试验，在降糖治疗领域具有里程碑意义。本研究证实了SGLT-2抑制剂卡格列净具有肾脏与心血管双重保护作用。这一结果应在预料之中。此前结束的CANVAS研究表明，确诊心血管疾病或具有心血管事件高危因素的2型糖尿病患者，应用卡格列净治疗可使主要复合终点事件发生率降低14%，全因死亡率降低13%，心血管死亡率降低13%，因心衰住院率降低33%。其二级终点蛋白尿加重或复合肾脏终点事件发生率分别降低27%与40%。针对基线特征不同的患者所进行的CREDENCE研究再次论证了卡格列净可以显著改善2型糖尿病患者肾脏与心血管预后。但在CANVAS研究中，卡格列净治疗组患者截肢风险显著增高，因而该药的安全性受到广泛关注。CREDENCE研究结果表明卡格列净不会增加截肢或骨质疏松风险，有助于打消人们对该药安全性的顾虑。

 

虽然大血管并发症是2型糖尿病患者致死致残的主要原因，但其肾脏并发症同样不可忽视。自UKPDS研究之后，多项降糖治疗试验显示严格控制血糖可以显著减少肾脏终点事件的发生，但对于预后影响最大的严重终点事件（肌酐倍增、终末期肾病、肾脏性死亡）并无明显减少。以GLP-1受体激动剂与SGLT-2抑制剂为代表的新型降糖药物的临床应用，为糖尿病患者的肾脏保护提供了新希望。在应用利拉鲁肽进行的LEADER研究与应用索马鲁肽进行的SUSTAIN-6研究中，与安慰剂组相比，GLP-1受体激动剂治疗组患者主要复合心血管事件发生率显著降低，作为二级终点的肾脏事件也有明显减少，但同类药物阿必鲁肽并未显示出肾脏保护作用。而应用SGLT-2抑制剂恩格列净、卡格列净、达格列净所进行的EMPA-REG研究、CANVAS研究以及DECLARE研究预设的肾脏终点事件均表现出一致性减少，提示SGLT-2抑制剂的肾脏保护作用具有类效应。刚刚结束的CREDENCE研究用更为有力的数据进一步论证了这一结论。

 

基于现有研究结论可以认为，新型降糖药物SGLT-2抑制剂不仅具有理想的降糖作用，更具有可靠的心血管与肾脏保护作用，相较于传统降糖药物展示出了全面优势，为其临床广泛应用奠定了坚实基础。

 

毕竟，我们降糖治疗的目的不在于降低血糖水平本身，而在于减少糖尿病相关的心脑肾等靶器官损害的发生。

 \"SGLT-2抑制剂主要优势\"

欢迎扫描二维码加入QQ群，听听病友们怎么说，听听医生怎么说

 


","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1541,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1555425292042,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1555425292042,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"25259","isDel":0,"createAt":1555339611092,"createBy":"84404015eff611e6a61c00163e04584d","createName":"13911686944","updateAt":0,"updateBy":null,"updateName":null,"userId":"84404015eff611e6a61c00163e04584d","title":"新型口服降糖药物的优势是什么","content":"

近年来，国内外陆续上市了一些新型降糖药物，例如恩格列净、达格列净、卡格列净、利拉鲁肽等。与传统的降糖药物相比，这些新型口服降糖药物的优势是什么呢？

 

这些新型口服降糖药物不仅能够有效地降低血糖水平，还能够对血压、血脂、体重等心血管病危险因素产生有益的影响。更为重要的是，这些药物可以降低心梗、心衰、脑梗发生率，有的药物还可以降低死亡率。这些优点对于糖尿病人来说当然是非常重要的。我们治疗糖尿病的目的不仅仅是把血糖控制在正常或者接近正常的范围内，更重要的是要减少糖尿病并发症的发生、改善生活质量并延长寿命。因此，这些新型降糖药物能够更好的满足这些需求。所以说，近年来开始应用的新药将糖尿病的药物治疗带进了新时期。

 \"新型口服降糖药物的优势是什么\"

目前临床常用的降糖药物有很多种，比如人们熟悉的胰岛素、二甲双胍、磺脲类药物（格列本脲、格列美脲、格列吡嗪、格列齐特）等等，这些药物降糖机制不同，临床作用各具千秋。多年以来，这些药物对于糖尿病及其并发症的防治发挥了很重要的作用。但是这些药物也有美中不足的地方：糖尿病最大的危害是引起大血管并发症，比如冠心病、心肌梗死、脑梗死等等，而前述那些降糖药物并不能降低这些严重并发症的发生率。

 

当然，尽管有了更多、更好的药物，但是糖尿病的治疗不能仅靠药物，控制饮食、增加运动、减轻体重是又安全又有效的措施，应该成为治疗糖尿病的基础。与此同时，还要积极控制血压、严格控制胆固醇，这些措施都能够显著降低糖尿病患者心梗、脑梗的发生率。

 

新药虽然好，价格却很高。如果不降价，将会给患者增加很大的经济负担，大大限制了这些药物的广泛应用。

 


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吡格列酮心脏病患者能服用吗？ 2019年国际卒中大会期间，刚刚报道了IRIS研究的亚组分析结果或许能解答大家的疑问。

\"吡格列酮心脏病患者能服用吗\"

分析结果显示伴糖尿病前期的卒中或TIA后患者，接受吡格列酮治疗可使卒中与心肌梗死发生率降低43%，卒中发生率降低36%，急性冠脉综合征减少53%，由卒中、心肌梗死和因心衰住院所组成的复合终点事件发生率降低39%，新发糖尿病降低82%。

 

于3年前结束的IRIS研究采用多中心随机化双盲安慰剂对照设计，共纳入3876例近期发生卒中或短暂脑缺血发作、且存在胰岛素抵抗的患者，随机纳入吡格列酮（45 mg/日）或安慰剂治疗组，平均随访4.8年。主要终点为致死性或非致死性卒中或心肌梗死。随访结果显示，与安慰剂组相比，吡格列酮治疗组患者主要终点发生率显著降低（11.8%对9.0%，HR=0.76，p=0.007）。安慰剂组与吡格列酮组患者分别有3.8%和7.7%发生糖尿病（p<0.001）。吡格列酮组患者体重增加、水肿、需要住院或手术治疗的骨折风险显著增高。该研究结论认为，对于伴有胰岛素抵抗且近期发生卒中/短暂脑缺血发作的患者，应用吡格列酮治疗可以显著降低卒中与心肌梗死风险，显著减少新发糖尿病的发生，但体重增加、水肿与骨折风险增高。

 

由于该研究受试者为胰岛素抵抗患者，其评估方法为HOMA-IR评分，而这一评分方法在临床实践中较少应用。为了解该研究结论的具体临床意义，研究者进行了此项事后分析。这项亚组分析共纳入2885例糖尿病前期患者（HbA1C 5.7%-6.4%，或空腹血糖5.6-7.0），结果显示这组患者接受吡格列酮治疗获益更为显著。

 

既往多项临床试验显示降低血糖水平难以改善2型糖尿病的患者的大血管预后，提示对于2型糖尿病患者不应仅仅着眼于降糖本身。胰岛素抵抗是2型糖尿病的主要病理生理机制，也是糖尿病患者发生大血管并发症的重要机制之一。因此，胰岛素抵抗可能是2型糖尿病与动脉粥样硬化性心血管病发生发展的“共同土壤”。研究发现，胰岛素抵抗人群发生不良心血管事件的风险明显高于非胰岛素抵抗人群。正因如此，干预胰岛素抵抗被认为是防治糖尿病及其心血管合并症的重要靶点。对于以胰岛素抵抗为主要机制的糖尿病前期患者，改善胰岛素敏感性，有助于从更早期阶段预防糖尿病并减少其心血管并发症的发生。




","barId":"1935","topicTypeId":"1","topicThemeId":"1028","readLevel":1,"files":"[]","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1499,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1555153285573,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1555153285573,"metaSearch":null,"rn":0,"barTitle":null,"checkcode":null,"forumUser":{"id":"84404015eff611e6a61c00163e04584d","isDel":0,"createAt":1486775274108,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"13911686944","password":"000000","level":0,"nickName":"赵金亮","realName":null,"signName":"c","head":null,"phone":"13911686944","mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":6,"userType":2,"isPhoneBind":1,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"","userLevel":0,"modifyNameCount":1},"lyTopicReply":null,"createAtStr":null,"lyBar":null,"lyTopic":null},{"id":"2905","isDel":0,"createAt":1486387007026,"createBy":"6aad1b12ea7211e6a61c00163e04584d","createName":"茉莉花","updateAt":0,"updateBy":null,"updateName":null,"userId":"6aad1b12ea7211e6a61c00163e04584d","title":"糖尿病患者如何保护好你的脚","content":"

\"845630426.jpg\"/

糖尿病足是糖尿病常见的慢性并发症，是由于糖尿病引起的下肢血管病变导致局部血液供应不足、下肢的神经病变导致感觉减退和神经营养不良，在此基础上受到外伤以及继发感染之后，引起足部皮肤的破损、溃疡甚至坏死，严重的需要截肢，造成致残、致死，给患者和家属带来沉重的精神和经济负担。糖尿病足一旦发生，治疗非常麻烦，每当我们在临床工作中看到有些患者由于没有及时到医院就诊，一个小小的皮肤破损可能导致脚发黑发臭而不得不截肢时，感到非常惋惜和痛心。因此糖尿病病友一定要高度重视你的脚，防患于未然。

首先良好的血糖控制是有效预防糖尿病足的基础，如果口服降糖药不能很好地控制血糖，应及时更换胰岛素治疗。

其次要选择合适的鞋袜。足是身体负重最强的部位，易受外力挤压而损害。鞋要宽松舒适，穿鞋前应仔细检查鞋中是否有石子、铁钉等异物，以免损伤脚底；袜子要透气，最好是全棉的。尽量避免长时间站立和行走，因为足是下肢的末梢，供血供氧较其他组织少，尤其是当患者血糖控制不良时，会使足部微循环发生障碍，供血供氧明显减少，易造成糖尿病足发生。特别是在寒冷的冬季，下肢毛细血管收缩较为明显，皮肤血运会受到一定的影响，应注意保暖。 

第三、因为脚感觉神经受到损伤，对疼痛感觉不敏感，因此要养成每天晚上睡觉前仔细检查脚的习惯，以尽早发现一些细小的损伤。洗脚水的水温要低于38℃，应该先由家人试水温，睡觉时不要使用热水袋，以免造成烫伤。如有足癣、皮肤皲裂等疾患要及时治疗。千万别小看脚气(足癣)，如果没有及时治疗，因为搔痒而抓破皮肤，在此基础上继发细菌感染，进而引起组织局部破溃、坏疽，造成严重后果。 

第四、一旦发现足部有损伤或感染，应尽早到医院就诊，早发现、早治疗完全可以避免更严重的后果。

糖尿病足的治疗是一种综合治疗，单纯在门诊换药无济于事，反而会耽误病情，一旦发现应立即住院治疗，包括使用胰岛素强化控制血糖、活血化淤药或血管介入治疗改善全身及局部的血液循环、静脉输注恰当的抗生素抗感染治疗、局部的清创消毒换药等综合措施。再次强调糖尿病足重在预防、早期发现和早期治疗，大多数患者通过及时合理的治疗，完全可以避免截肢。


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糖尿病足是糖尿病最严重的并发症之一，也是糖尿病致残致死的重要原因。糖尿病周围血管及神经病变，导致足部供血不足，感觉减弱，对疼痛、高温等刺激的敏感性减低，缺乏有效的自我保护。因此，正确的日常护理对于糖尿病患者的脚的预防具有重要意义。
错误的日常护理是导致糖尿病足的重要诱因：
1.“热宝宝”——糖足患者的致命“杀手”
糖尿病患者合并周围血管病变时，常感觉足部发凉，用“热宝宝”热敷或热水“泡脚”会感觉舒适。但由于患者常同时伴有周围神经病变，患者足部感觉减弱、麻木，容易导致足部烫伤。一旦皮肤破溃、感染，会导致肢体坏疽。
2. “挖鸡眼”要小心
糖尿病合并严重周围神经病变时，足部感觉减弱或消失，足部处于“麻醉”状态，对于外伤无疼痛感。“挖鸡眼”，甚至“拔指甲”，都不会有明显痛觉。但皮肤破溃后，因血供不足，足部伤口不愈合，细菌感染扩散，可致骨髓炎甚至截肢后果。
3．鞋袜要“合脚”
“糖足”患者足部感觉减弱，容易受外伤，选择宽松舒适的鞋袜，避免足部皮肤磨损非常重要。高跟鞋，尖头鞋或质地较硬的鞋容易造成足部皮肤破损。因鞋袜不合适，致足部皮肤破溃感染的患者在临床中亦十分常见。
4. 谨慎剪趾甲，当心“一剪没”
糖尿病患者合并周围神经病变时，剪趾甲需谨慎。因足部感觉减弱，即使剪刀伤及皮肤或甲床也不会有明显痛觉。一旦皮肤破损，或甲床外露，易导致足部感染。感染扩散致骨髓炎，足趾坏疽，甚至严重的肢体坏疽时，需截肢手术治疗。

为何“糖尿病足”如此可怕？
“泡脚”、“修甲”、“挖鸡眼”，这些生活中不经意间的细节所致的足部微小损伤，对于健康人不会造成伤害，但对糖尿病患者为何能导致足趾坏疽，足部严重感染，甚至全身感染，脓毒血症致患者死亡呢？
导致严重后果的“元凶”是糖尿病周围血管病变及神经病变。血管及神经病变，使足部的血供不足，感觉减弱。对疼痛、高温等刺激的敏感性减低，缺乏有效的自我保护。因此，糖尿病患者的足部较正常人更易受到伤害。另一方面，足部感染后，自身抗感染及组织修复能力差。完整的皮肤对细菌有良好的防御能力，糖足患者在皮肤无破溃时，足部血供不足，但仍可维持组织代谢的基本需求，不会发生组织坏死。一旦皮肤破溃，继发感染，足部需要大量血液抗感染，并进行组织修复，此时足部血供不足就会导致感染扩散，组织坏死，肢体坏疽。

糖尿病患者足部护理与保健
糖尿病足所导致的严重后果，并非不可“防治”，关键在于早期发现，早期预防，早期治疗。严重的糖尿病足感染发生之前，患者常早已出现下肢缺血或神经病变症状：下肢发凉，感觉异常，肌肉萎缩，皮肤干燥、易皲裂等。如能早期察觉，并给予正确的日常护理，可有效预防糖尿病足并发症的发生。常见预防措施包括：
1. 控制高血糖，高脂血症，高血压等基础疾病。定期检查，评估下肢血供及神经病变，如有严重下肢供血不足或神经病变，及时诊治。
2. 选择合适的鞋袜，不宜穿高跟鞋及尖头鞋，避免因局部受压或摩擦造成皮肤破损。
3. 适当进行下肢的锻炼，改善下肢血液循环。
4. 注意足部卫生，适宜用温水和中性肥皂洗脚。可使用润滑乳液或营养霜保持皮肤湿润，防止皮肤干燥、皲裂。
5. 避免足部冻伤及烫伤。冬季注意保暖。禁止热水烫脚或使用热水袋热敷。
6. 正确修剪指甲。洗脚后，使用专门指甲刀修甲，注意不要剪得太短，损伤皮肤。
7. 定期检查足部有无鸡眼，胼胝、足癣、擦伤、水泡等。如发现，应在专业医师的指导下处理。

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从事糖尿病诊疗工作20多年，后来主要研究胃转流手术在糖尿病方面的治疗，之前由于种种原因我个人网站一直没有开通，近期受好大夫平台的邀请开通了个人网站，近期一直都在和大家分享我在手术方面的一些经验，学术观点，大多都是关于胃转流手术方面的，因为糖尿病手术对于那些符合手术条件的病人效果确实是可以的，要比一辈子吃药打针强多了，避免了并发症的出现。如果是用传统吃药打针控制血糖，事实上不管你血糖控制再好并发症随着糖尿病病史的增加一定会出现的，我经历了太多严重糖尿病并发症的治疗，尤其是糖尿病足，痛苦程度难以言表。所以我一直倡导在符合手术条件的时候选择手术不要等到出现并发症后悔。今天我想和大家聊聊糖尿病足溃烂，糖尿病引起的其他部位的疮疡该如何治疗。糖尿病足是不是可以不截肢，糖尿病烂脚还能还能治好吗？类似这样的问题每天都有不少患者家属追问，看着他们推着轮椅脸上绝望的表情，我除了尽力救治没有其他办法。其实我想说的是这些并发症是完全可以避免的。退一万步说，现在已经除了糖尿病足应该这么治疗。

已经出现糖尿病烂脚怎么治疗？

很多患者家属说当地医院要给截肢，我们不想截。糖尿病足分干性坏疽、湿性溃烂和混合性坏疽三种，其中干性坏疽治疗难度最大，从严重程度上可以划分为0—5，六个级别，很多3级以下患者找到我的时候都说要截肢，真的是很痛心，其实对于并发糖尿病烂脚的患者经过科学系统的治疗是完全能治好的，不需要截肢。但是糖尿病足的治疗它一定是一个系统综合的治疗过程，不是买个药膏抹抹就能好的。糖尿病足是糖尿病发展到一定程度在局部的一个体现，糖尿病足是周围血管病变和周围神经病变共同作用下形成的，那么在治疗的时候一定要局部和整体结合，内治和外治结合，中医和西医结合，具体步骤我大致有清创，清创也是有大学问的，清创过度了对后期愈合不利，清创不到位控制不住感染，所以对医生临床经验要求很高。第二个步骤：控制感染，很多医院对于糖尿病足患者控制感染就是大量的用抗生素静脉滴注，当然输液是必须的，但是光输液是远远不够的，为什么呢？因为糖尿病足患者下肢存在不同程度的血管闭塞，药效根本到不了足部的创面，最多是控制炎症的上行，不至于引起肺部感染血液感染，我们可以把这个治疗叫做整体，真正要控制创面的感染就必须结合局部的治疗，具体局部如何用药，根据不同的创面感染程度不同，各有差异。第三个步骤：改善微循环，第四步：营养创面 第五步：肌肤再生。

糖尿病足完全可以治好的，千万不要一截了之，更糟糕的是，有不少患者截肢后创面也不见得能愈合需要二次截肢。我们早在十几年前就倡导并且践行的不截肢治疗糖尿病足，到今天还是看到那么多被截肢的糖尿病足患者深感痛心。


一个刚到院的患者，打开层层包裹的纱布，味道刺鼻难闻，看到的黄色的粉末是当地一个门诊给的偏方。


黄色粉末下面全是脓液，很多患者问有什么药能让创面愈合，这就是我不说的原因，到目前为止还真没有一种这么神奇的药，一抹就好，因为必须进行清创，试想把再好的药抹在脓液聚集的地方能有什么效果？

经过几天的治疗，感染已经完全得到控制，已经有新鲜的肉芽组织开始生长。


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多少人觉得糖尿病距离自己异常遥远，因而年少轻狂，任性妄为，年轻就是本钱，生活就是资本，自己潇洒，得病还早得很哪！那么看看以下的数据：

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全世界每5秒钟就产生1个糖尿病患者，每10秒钟就会有1人因糖尿病和其并发症死亡，每30秒就会有1人因糖尿病足而截至。

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单单看着数字已经很震撼了吧！那么再来看看糖尿病的并发症究竟会严重到什么地步！

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可怕的糖尿病足

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甚者足部发黑坏死，最后形成坏疽，不得不截肢保存生命！从此生活质量每况愈下，不仅患者每日愁苦度日，更是成为家里沉重的负担！

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那么，究竟是何原因？为什么现如今的糖尿病患者越来越多，越来越年轻化？

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我们被这个物产丰富的年代蒙蔽了，我们已然走上了迈向糖尿病的道路！

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诱人的美食

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我们的味蕾每天都在品尝着各色的美食，这些美味真的就有益处吗？

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看看我们的美食都是由什么构成！相信随便逛逛超市，玲琅满目的货架上摆满了调味品，更不用说烹饪出的美食用到的调味品，不但质量次等，更是充满了各种违规添加剂！

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诱人的美食也使我们的口味变得越来越重。家常便饭变得味同嚼蜡，非得自己加点儿佐料才能下咽，哪知我们实际上摄入了超量的盐、油以及各样的食品添加剂。

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如果你到一间餐馆的后厨瞅瞅，相信会看到大厨们肆意挥洒的“泼墨画面”，不知你会不会对自己面前的佳肴望而生畏。高盐、高脂以及富含添加剂，只要走出家门，你所遇到的各样美食基本都会被贴上如此的标签，时常处在如此美味的享受之中，相信距离糖尿病等慢性疾病也就不远了！

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温馨提示：每日推荐摄入量：盐

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我们都吃超了！

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对于经历过几千年文明演化史的人类来说，兵荒马乱，物资匮乏，大家都挺过来了，凭的是什么？凭的就是我们基础代谢水平低，对于能量的摄入需求要求低，否则如何抵得过困难时代！

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可现如今的我们却常常是这样，过量的饮食，都会转化为血糖，而血糖越高，胰岛就得分泌更多的胰岛素参与降低血糖。

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长此以往，就会成为胰岛细胞巨大的负担，胰岛超负荷运转，最后不听使唤了，我们也就患上了糖尿病！

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无数的家庭都在经历血的教训，希望大家都能早日重视起自己的健康，莫要前半生拿命换钱，后半生拿钱买命！你买得到吗？

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最后愿大家务必做到以下三点！

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1.每天锻炼6000步！能坐着别躺着，能站着别坐着，能走着别站着。

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2.回归家庭的低盐低脂饮食。

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3.重视睡眠，早睡早起！

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愿大家都能在健康中享受人生！

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　　前不久，我院糖尿病诊疗中心收治了来自吉林某县的刘姓父子，父亲36岁，儿子12岁。父亲是在当地县医院化验尿常规时偶然发现尿糖4个“+”，但其本人没有任何自觉症状，随后又化验了血糖，结果正常。当地医生考虑是早期2型糖尿病，嘱咐患者严格控制饮食并给予消渴丸等降糖药物治疗，其间患者多次出现心慌、手颤、头晕、出汗等症状，血糖忽高忽低。老刘听人讲糖尿病能遗传，于是又带着儿子去医院做了血糖、尿糖化验，化验结果和他的情况差不多，医生的诊断结论也跟他的一样。想到儿子这么小的年纪就患上糖尿病，老刘心里压力很大，忧心如焚。通过别人的介绍，他领着儿子千里迢迢来我院求医。在详细了解了父子俩的病史之后，我让他俩暂停一切降糖药，并分别做了糖耐量试验及胰岛功能，肾功能、肾糖阈等多项检查，结果除了肾糖阈明显降低、尿糖阳性以外未发现其他异常。结合患者既往无慢性肾病史，无骨痛及骨骼发育异常，尿化验无蛋白、氨基酸及磷酸盐结晶，故可排除“慢性肾病”及“范可尼综合征”等原因所致的肾性糖尿，考虑到父子同病，遗传倾向明显，最终确诊为“家族性肾性糖尿”，糖尿病则被彻底排除。 
中国论文网 http://www.xzbu.com/6/view-2706878.htm
　　“家族性肾性糖尿”多呈良性经过，患者一般无自觉症状，也不会产生严重后果，本病预后良好，通常不需要治疗。但因有少数肾性糖尿者日后会转为真正的糖尿病，故对肾性糖尿者要随访观察。当我将这番话告诉他们时，爷儿俩如释重负，次日便高高兴兴地踏上了归程。 
　　事实上，类似刘氏父子这样被误诊误治的例子并不少见，尤其是在基层农村。在此需要强调的是，诊断糖尿病依据的是血糖而不是尿糖，尿糖阳性并非一定就是糖尿病，因为除了糖尿病之外，还有其他多种原因，例如： 
　　1　食后糖尿(也称“滋养性糖尿”)：糖尿发生于摄食大量糖类食物后，或因吸收太快，导致血糖浓度暂时性升高超过肾糖阈而发生一过性糖尿，但其空腹血糖及糖耐量试验正常。 
　　2　饥饿性糖尿：长期饥饿的人突然饱餐一顿，尤其是进食大量甜食后，往往尿糖会呈阳性。这是因为在饥饿期内，由于血糖偏低，胰岛B细胞基本处于半休息状态。当突然大量进食后，胰岛B细胞一时不能适应，胰岛素分泌相对不足而导致血糖暂时性升高和糖尿。另外，饥饿时生长激素分泌也增多，可使糖耐量减低，这也会促使血糖升高而出现糖尿。鉴别时应注意询问近期饮食史，必要时可给足量的食物(每日250克以上)，三日后重复糖耐量试验即可鉴别。 
　　3　应激性糖尿：常见于急性脑中风、脑外伤、颅骨骨折、脑肿瘤、麻醉等。在上述这些应激状态下，有时血糖会暂时性过高，伴有糖尿；随着应激状态结束或麻醉药失效，血糖会恢复正常，尿糖转为阴性。 
　　4　肾性糖尿：由于肾小管再吸收葡萄糖的能力减低(而肾小球滤过率仍然正常)，肾糖阈下降，故血糖正常而尿糖阳性。肾性糖尿主要是由于肾脏近曲小管受损所致，常见于：①妊娠期妇女，少数(10％～15％)妇女在妊娠中晚期，可因暂时性肾糖阈低下而出现糖尿，其机制可能是由于细胞外液容量增加而抑制肾小管重吸收葡萄糖的功能，使肾糖阈下降所致；②家族性肾性糖尿(又称“原发性肾性糖尿”或“良性糖尿”)，这种疾病与遗传有关，且多为显性遗传，家系中往往有多位成员患病，患者除了肾小管重吸收功能减退外，其他肾功能均正常，不伴有脂肪、蛋白质代谢异常，预后良好；③慢性肾脏疾病，如慢性肾炎、肾病等，有时可因肾小管对葡萄糖重吸收功能障碍而出现糖尿；④其他一些少见的遗传或获得性肾小管疾病，如“范可尼综合征”，也可出现糖尿，但这种患者除尿糖阳性以外，尿中还含有大量氨基酸、磷酸盐及碳酸盐结晶等，患者往往有骨痛、病理性骨折、佝偻病及生长发育落后等。肾性糖尿往往与某些肾小管缺陷有关，其特点是有糖尿而不伴有高血糖，患者无论空腹或饭后，任何一次尿液标本均含有尿糖，但空腹血糖及葡萄糖耐量试验均正常。 
　　5，假性糖尿(尿糖假阳性)：通常测定尿糖的硫酸铜试验是利用糖的还原性显色。但尿中有不少物质具有还原性，如葡萄糖醛酸、尿酸、维生素C，或是一些随尿排泄的药物如异烟肼、水合氯醛、吗啡、洋地黄、噻嗪类利尿剂等，当它们在尿中浓度升高时，也可以出现尿糖假阳性，称为“假性糖尿”。临床可通过特殊的葡萄糖试验，如葡萄糖氧化酶试验，与其他尿中有还原性物质排出的疾病相鉴别。 
　　由此可知，凡尿糖阳性者，均应做糖尿病相关检查(如“糖耐量试验”)，以求明确诊断，切不可单凭一项尿糖结果阳性就轻易得出糖尿病的结论，否则，将会导致误诊、误治，使患者蒙受不应有的损失和伤害。

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