Home health guidance for patients with diabetes

Health Guidance

With the global population increase and the deepening of the aging process, the prevalence of diabetes is still at a high level, and related complications arise, seriously affecting the quality of life of patients. my country is the country with the largest number of adult diabetes patients, about 140.9 million people, of which about 78.13 million are elderly people, accounting for 1/3 to 1/2 of the total number of patients, with a prevalence rate as high as 30%, and it is on the rise. Diabetes self-management education and support are considered to be key factors in diabetes care management.

**A healthy lifestyle is a compulsory course for every diabetic patient,**especially for elderly diabetic patients whose physical functions and immunity are gradually declining, it is an important measure to maintain stable blood sugar, relieve negative emotions and improve the quality of life. Elderly patients with type 2 diabetes are prone to muscle loss, decreased muscle strength and bone strength, osteoporosis, and thus prone to falls. Malnourished elderly patients with type 2 diabetes should be identified early to ensure adequate energy supply and increase protein intake appropriately. Some elderly patients with type 2 diabetes have decreased metabolism and reduced exercise, and experience muscle loss, overweight or obesity with muscle loss. On the premise of ensuring a balanced diet, weight loss and muscle gain can be achieved through diet control and exercise therapy.

Blood glucose monitoring

Blood glucose monitoring is a necessary measure to understand the state of blood glucose control and promote blood glucose control to the target. Multi-point or continuous blood glucose monitoring can provide necessary information for adjusting hypoglycemic treatment. The baseline blood glucose monitoring mode before breakfast and dinner can help elderly diabetic patients who have difficulty in operating themselves and need to go to community medical stations to meet the most basic blood glucose monitoring requirements.

The "7-point blood sugar" monitoring mode can help patients understand the impact of diet, exercise and medication on blood sugar fluctuations, guide them to adjust their lifestyles in a timely manner, and promote the establishment of healthy behaviors.

The 24-hour continuous blood glucose monitoring mode can help patients with large blood glucose fluctuations and unstable conditions understand their blood glucose changes, help identify latent hyperglycemia or hypoglycemia, and reduce the risk of acute and chronic complications.

Drug treatment

Studies have shown that most elderly patients with diabetes have irregular medication phenomena such as missing or repeating insulin injections and arbitrary insulin injection time. It is recommended that elderly patients with diabetes can use a simplified and easy-to-operate insulin treatment model for routine hypoglycemic treatment. In this regard, it is possible to consider using smart insulin injection pens with functions such as insulin dose adjustment and reminder of stay time after insulin injection to help patients with insulin injection treatment. It is recommended that patients with diabetes combined with atherosclerotic cardiovascular disease or heart failure give priority to glucagon-like peptide-1 receptor agonists, and pay attention to drug side effects (including gastrointestinal reactions, hypoglycemia, etc.) after taking the medicine. At the same time, for those with large blood sugar fluctuations and poor management, the blood sugar control range can be appropriately relaxed. Sulfonylurea drugs have the characteristics of fast and large blood sugar lowering speed. Due to the decreased ability of the liver to metabolize drugs, the body's tolerance and blood sugar regulation ability are limited, the elderly should use this type of drug with caution to prevent hypoglycemia. Elderly diabetic patients at risk of fractures should use glitazone hypoglycemic drugs with caution to avoid aggravating osteoporosis and causing falls or fractures. Incretin drugs can delay gastric emptying and gastrointestinal motility, which may aggravate gastrointestinal diseases. They should be used with caution in elderly diabetic patients with gastroparesis. Patients and their families should be aware of the importance of standardized medication and management for elderly diabetic patients, and should master medication methods, precautions, and drug storage, so as to strengthen patients' medication compliance and seek medical attention in a timely manner if adverse drug reactions occur.

Healthy eating

The basic principle is to increase the intake of fruits and vegetables, and choose foods with minimal processing, high energy density, high dietary fiber and low glycemic index. It is recommended to use the "ten fists" principle, that is, "meat: cereals: milk beans: vegetables and fruits = 1:2:2:5". Eat soup first and then staple food to reduce postprandial blood sugar fluctuations. At the same time, elderly patients themselves are prone to direct or indirect protein synthesis disorders, enhanced decomposition, and are prone to lack of multiple micronutrients, secondary malnutrition, and should be appropriately supplemented to meet nutritional needs. Under the guidance of experts, specific dietary patterns, such as the Mediterranean diet, can be adopted, which is more conducive to blood sugar control and reducing the risk of cardiovascular disease.

Regular exercise

Exercise is good medicine. It is recommended that every elderly diabetic patient should actively exercise. Exercise can improve blood sugar control and physical function, and is also beneficial for type 2 diabetic patients to prevent and treat lower limb vascular diseases and foot diseases. Elderly type 2 diabetic patients often have multiple diseases. After a comprehensive assessment of cardiopulmonary function, muscle strength, joint mobility and balance ability, a suitable exercise plan should be formulated. Perform light to moderate aerobic exercise after meals to improve blood sugar control. Elderly type 2 diabetic patients can also perform resistance exercise. The combination of aerobic exercise and resistance exercise can further improve glycated hemoglobin. Do warm-up exercises before exercise, and pay attention to preventing falls and fractures during exercise. If you need to exercise before meals, you can consume appropriate carbohydrates to avoid hypoglycemia.

A personalized exercise plan can be developed in combination with the "1, 3, 5, 7, 9" exercise principle, that is, exercise 1 hour after a meal, at least 30 minutes each time, at least 5 times a week, and the pulse rate during exercise should not exceed (170-age) times/min, and exercise should be adhered to. For elderly patients with good exercise ability, multi-component exercise training is recommended, including aerobic, static and flexible exercises; for those with partially impaired motor ability, bedside strength training and balance/flexibility training are the main methods; for those with completely impaired motor ability, passive limb activities are the main methods to maintain limb movement function. The target heart rate that elderly patients should maintain is 60%~80% of the maximum heart rate [usually 180 (weak people) or 170 (strong people)-age].

Sleep management

Elderly patients with type 2 diabetes may suffer from increased nocturia, painful neuropathy, and emotional disorders, which can affect their sleep quality. In addition, both old age and diabetes are risk factors for sleep apnea syndrome, and sleep apnea can lead to fragmented sleep, affecting sleep quality and blood sugar control. Therefore, it is recommended to conduct routine sleep assessment and screening for sleep apnea syndrome. In terms of TCM nursing, sleep care can be carried out by using Chinese medicine foot bath, ear acupoint pressing beans, and foot massage to help patients quickly enter a sleep state. In addition, according to the requirements of TCM dietary care, patients can be guided to eat less spicy and irritating foods, and increase the intake of foods with calming and tranquilizing effects to shorten the duration of sleep disorders. Appropriate exercise can play a certain role in helping sleep, and patients can be guided to improve the circulation of Wei Qi and improve sleep quality through sports such as Ba Duan Jin and Tai Chi. In addition, according to the principle of five sounds entering the five internal organs, the five elements of music can be used for treatment according to the TCM syndrome of the patient to achieve the effect of soothing emotions, calming the mind and helping sleep.

Weight Management

Elderly patients with type 2 diabetes have reduced muscle content and increased visceral fat. Therefore, simply using weight or BMI as a criterion for judging obesity in the elderly has certain limitations. Waist circumference seems to be a better reflection of body fat deposition. Weight loss in elderly patients with type 2 diabetes should aim to reduce excess visceral fat in the body and increase skeletal muscle content and quality.

For elderly patients with type 2 diabetes who are underweight, they should increase their weight by appropriately increasing dietary energy intake, increasing protein intake, exercising, and controlling chronic diseases. They can use hypoglycemic drugs that increase weight or adjust to insulin, use hypoglycemic drugs that have a weight-loss effect with caution, and supplement vitamin D appropriately.

Quit smoking and limit alcohol consumption

The smoking rate among the elderly in my country is as high as 22.4%, the dangerous drinking rate is 9.3%, and the harmful drinking rate is 11.4%, which leads to a significantly increased risk of insulin resistance and chronic complications. Studies have shown that the prevalence of diabetes in the elderly who are active or passive smokers is twice that of those who have never been active or passive smokers. At the same time, drinking and the occurrence and development of diabetes have a J-shaped relationship, that is, improper drinking will significantly increase the incidence of diabetes and worsen the condition in some people. Elderly diabetic patients are encouraged to actively quit smoking (including e-cigarettes), drink moderately [1 cup (12.6g ethanol) per day for women, 2 cups per day for men, or less or no drinking], and the number of drinking should not exceed 2 times/week.

Regular work and rest

Elderly diabetic patients are very prone to sleep disorders due to long-term self-restraint, reduced daily activities, medication and physiological factors. Studies have shown that up to 66.7% of elderly patients have sleep problems, which aggravates sugar metabolism disorders and is very likely to aggravate the condition. It is recommended that elderly diabetic patients should ensure a daily sleep time of 7h/d to meet the body's recovery needs. Follow-up visits on time, continue to pay attention to the medication and treatment plans of elderly patients, establish good sleep habits and behaviors (such as daytime sleep time <1h, maintain a calm state of mind and appropriately increase daytime exercise, etc.), and wear sleep monitoring bracelets and other equipment for daily management.

Health Tips

Elderly diabetic patients are a special population with declining cognitive function and coexisting multiple diseases. It is often difficult to change their healthy behavior overnight, which brings great challenges to disease treatment. Comprehensive assessment and timely intervention are important ways to prevent the occurrence and development of diabetes and related accompanying symptoms.

References

[1] Chinese Society of Gerontology and Geriatrics. Guidelines for chronic disease management of type 2 diabetes mellitus in the elderly (2023 edition)[J]. Journal of Integrated Traditional Chinese and Western Medicine, 2023, 15(4): 239-252.

[2] Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly Compilation Group, Chinese Society of Geriatrics Geriatric Endocrinology and Metabolism Branch, Chinese Geriatric Health Research Association Geriatric Endocrinology and Metabolism Branch, etc. Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 Edition) [J]. Chinese Journal of Internal Medicine, 2022, 61(1): 12-50.

[3] Wang Shuang, Zhan Junkun, Cheng Mei, et al. 0 (2021)[J]. Chinese Journal of Geriatrics, 2021, 40(6): 683-694.

[4] Wang Yiru, Bai Jiaojiao. Interpretation of the key points of nursing practice in the Chinese clinical guidelines for the prevention and treatment of type 2 diabetes in the elderly (2022) [J]. Shanghai Nursing, 2022, 22(11): 1-5.

Author: Shen Hongbin (Zhongshan Street Community Health Service Center, Songjiang District, Shanghai)

Gao Caiping, Wu Yunfeng (Shanghai Tongji University Affiliated Yangzhi Rehabilitation Hospital)

Chief Judge: Zhai Hua (Shanghai Yangzhi Rehabilitation Hospital Affiliated to Tongji University, Vice Chairman of the Science Popularization Working Committee of the Chinese Rehabilitation Medicine Association)