Guidance on rational drug use for elderly diabetic patients

  Diabetes is a metabolic disease with a high incidence in clinical, mainly due to the secretion or effect of insulin in the body Defects, or both at the same time, lead to the occurrence and development of diabetes. The disease easily causes disorders of sugar, protein and fat metabolism during the occurrence, which makes the blood glucose level of the patient present an abnormally elevated trend. According to research data, older people over 60 are more likely to develop diabetes than people of other age groups, and have a longer course of disease, incurable, and more comorbidities. Among them, cardiovascular disease Common, with a certain mortality rate. Therefore, considering the characteristics of the onset of diabetes, it is necessary for elderly diabetic patients to adopt an active and effective comprehensive method of treatment, including diet, exercise, awareness education, blood glucose monitoring and hypoglycemic drugs, etc., to ensure that the patient’s blood sugar can be maintained in many aspects. Within the normal range, it is necessary to avoid unnecessary damage to important organs of the heart, brain and kidney. Therefore, some points for attention in the rational use of drugs for elderly diabetes are summarized as follows:
  First, the safety of drugs should be considered before choosing drugs. For example, although sulfonylurea drugs have good safety and economic efficiency, they are not suitable for some patients with kidney disease. For elderly diabetic patients with disease, overdose of the drug can easily cause drug accumulation or hypoglycemia, especially glibenclamide.
  Second, compared with sulfonylurea drugs, non-sulfonylurea insulin secretagogues have a faster effect, hardly need to be metabolized by the kidneys, and are less likely to cause hypoglycemia. They are more suitable for elderly people with renal insufficiency. Diabetics.
  Third, biguanide drugs can exert significant clinical effects on patients with diabetes and obesity, but elderly patients over 80 years old are prone to cause lactic acidosis, which requires sufficient attention.
  Fourth, there are certain interactions between some hypoglycemic drugs. For example, when salicylic acid, phenylbutazone, beta blockers and sulfonylureas are used in combination, they will not only fail to exert a stronger effect on reducing blood sugar. The sugar effect can even easily affect the binding rate of sulfonylureas and plasma proteins, or affect glycogenogenesis.
  Fifth, note that when using hypoglycemic drugs, you need to strictly follow the doctor’s prescription based on your own blood sugar level and disease characteristics. The dosage should not be too large to avoid the occurrence of hypoglycemia.
  Sixth, formulate a strict time for the administration of hypoglycemic drugs. Depending on the type of medication, the choice is to take the medication before meals, take the medication after meals, take the medication at regular intervals, or take the medication before going to bed.
  Seventh, to achieve better blood glucose control through reliable combination medications. The more common combination regimens in current clinical work include sulfonylureas + biguanides, sulfonylureas + α-glycosidase inhibitors, etc.
  Eighth, children should not take a hypoglycemic agent for a long time, and the drug cannot be stopped after the blood sugar is normal. If the effect of glucose treatment is not satisfactory, insulin injection is needed.
  Ninth, treatment is also needed in the early stage of diabetes. When the fasting blood sugar level is high but the blood sugar after a meal is normal, it can be regarded as impaired fasting blood sugar. On the contrary, it can be regarded as impaired glucose tolerance, which needs to cause enough Pay attention to and accurately identify. According to survey data, early diabetic patients can also develop a variety of diseases, including various types of heart, brain, liver and kidney dysfunction, or hypofunction of pancreatic β-cells and insulin resistance. Insulin sensitizers, α- glucosidase inhibitors or metformin therapy is able to help some patients returned to normal, blood glucose control below normal levels
  tenth, in guiding the elderly patients treated with drugs, attention to be closely monitored for blood glucose levels to avoid the use of Excessive medication can cause hypoglycemia, or avoid excessive insulin doses and cause a significant decrease in blood glucose levels.
  Eleventh, attention should be paid to the occurrence of nocturnal hypoglycemia, especially for elderly patients, whose metabolic level is low, coupled with slow response, not only is it difficult to detect night hypoglycemia, but also has a high rate of misdiagnosis.
  Twelfth, when applying hypoglycemic drugs and insulin, attention should be paid to liver function to avoid adverse drug reactions.
  Thirteenth, give insulin as soon as possible based on the patient’s condition.
  Fourteenth, pay attention to protecting large blood vessels to prevent atherosclerosis.
  Fifteenth, control multiple risk factors that can cause elevated blood sugar, including hypertension, lipid metabolism, obesity, etc.
  Sixteenth, actively prevent complications.
  In addition, the following principles are recommended for the treatment of elderly diabetic patients: (1) Rational use of drugs based on etiology: ① For patients whose fasting blood glucose levels continue to be above 16.7mmol/L, it is recommended to choose short-term insulin therapy to achieve faster correction of glucose For the purpose of toxicity, oral hypoglycemic drugs were changed later to maintain blood glucose at a normal level. ②The fasting blood glucose level is maintained between 11.1 and 16.7mmol/L, but the patients who are thin are judged to be related to insulin deficiency, and need to supplement exogenous insulin in time to correct their deficiency. ③For diabetic patients with obesity, insulin resistance is often present. The choice of sensitizer and insulin therapy can achieve satisfactory results. ④If the fasting blood glucose reaches a satisfactory level but the postprandial blood glucose does not meet the target, the α-glycosidase inhibitor that inhibits the sugar absorption can be selectively used for treatment to exert a good hypoglycemic effect. ⑵ Flexible medication: Approximately 70% of elderly diabetic patients do not know their own disease. Most of them are found in routine physical examinations. Once blood sugar is found to be excessive, they will be treated with powerful hypoglycemic drugs, which is at risk of severe hypoglycemia. Therefore, when using sulfonylureas, the dose should be reduced in time, and attention should be paid to food intake and regular follow-up visits.