Understand in one article: How can patients with diabetic nephropathy effectively lower blood sugar?

Diabetic nephropathy (DN) is kidney damage caused by diabetes. The incidence of the disease is growing rapidly in developed countries and has also shown a clear upward trend in my country. Smoking, obesity, and poor blood sugar control are important risk factors for DN. Patients often have symptoms such as frequent urination, foamy urine, dizziness, and edema. Hypoglycemic agents are an effective method for treating DN and can significantly slow down its progression. At present, there are a variety of drugs used clinically for hypoglycemic agents. How to choose drugs that can effectively improve the blood sugar level of DN patients is worthy of clinical attention.

How DN can effectively lower blood sugar

DN is mainly controlled by lifestyle adjustment and drug treatment. In terms of life, we should pay attention to diet, limit salt intake, appropriately reduce carbohydrate intake, and eat mainly meat, eggs, and milk. We should also pay attention to controlling the total calorie intake, 30 to 35 kcal per kilogram of standard body weight per day (standard weight = height - 105). In addition, moderate physical exercise can effectively reduce blood sugar by increasing the consumption of sugar in the body through exercise.

In terms of drug treatment, hypoglycemic drugs that are less harmful to the kidneys are generally used. If the condition is mild, metformin is the first choice. If the condition progresses rapidly and the kidney damage is severe, metformin should not be taken, as it easily increases the risk of lactic acidosis. How DN patients choose hypoglycemic drugs also needs to be used rationally according to their renal function.

(1) Metformin: This drug not only has the effect of lowering blood sugar, but may also have the effect of reducing weight and hyperinsulinemia. It can also be used for patients treated with insulin to reduce the amount of insulin. Metformin itself does not cause kidney damage, but when the patient has other serious diseases, it should be discontinued and restarted under the guidance of a specialist.

(2) Pioglitazone: Pioglitazone is excreted mainly in the bile as the original drug and its metabolites. It can be safely used in patients with impaired renal function and the elderly. However, if fluid retention occurs, it should not be used. This drug can be used in combination with diet control and physical exercise to achieve the purpose of improving and controlling blood sugar, and can be used alone. If diet control, physical exercise and monotherapy cannot satisfactorily control blood sugar, it can be used in combination with sulfonylurea, metformin or insulin.

(3) Repaglinide: Repaglinide is mainly metabolized by the liver and excreted in the urine. The active metabolites do not increase with the decline of renal function. In the case of reduced renal function, there is no need to adjust the dose. However, be alert to the risk of hypoglycemia. This drug is commonly used for patients with type 2 diabetes who cannot effectively control hyperglycemia through diet control, weight loss, exercise or metformin alone.

(4) Dipeptidyl peptidase-4 (DPP-4) inhibitors: DPP-4 inhibitors are a new type of oral hypoglycemic drug that can promote insulin secretion and inhibit the secretion of glucagon by pancreatic α cells, effectively lowering blood sugar. DPP-4 inhibitors can be used alone or in combination with other oral hypoglycemic drugs. In addition, the drug can also reduce appetite and food intake, thereby achieving the goal of effectively controlling weight. It should be noted that when patients with chronic kidney disease progress from stage 3 to stage 4, the dose of this type of drug needs to be adjusted.

(5) Insulin: The principle of insulin in lowering blood sugar is that it can promote the conversion and utilization of blood sugar, thereby achieving the effect of lowering blood sugar. However, as renal function declines, its dosage needs to be adjusted to avoid hypoglycemia.

Precautions for DN patients in the process of hypoglycemic treatment

DN treatment is a long process and should not be rushed. The following points should be noted during the treatment.

(1) Quit smoking

Frequent smoking will accelerate the decline of kidney function. The kidney function of diabetic patients who smoke also declines faster. Therefore, they should quit smoking immediately at the beginning of treatment.

(2) Healthy diet

Limiting protein intake is an important means of treating DN. In addition, a low-salt diet and more iron and calcium supplementation should be adopted to help treat the disease.

(3) Regular physical examination

There are no symptoms in the early stages of DN, so regular physical examinations are helpful for the detection and timely treatment of the disease.

(4) Prevention and treatment of infection

Diabetic patients are prone to urinary tract infections. If infected, they must receive regular antibiotic treatment, otherwise it will make kidney disease worse.