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*For medical professionals only
Five key points, grasp in one article!
AuthorWang Weibo
For patients with diabetes and new crown, unreasonable medication will affect the treatment effect and even increase the risk of
adverse reactions.
What misunderstandings often exist in the choice of drugs for patients with diabetes and new crown? Let's take a look together today~
First, do not pay attention to monitoring blood sugar
Diabetes mellitus and new crown patients with new crown are the most common blood glucose rise, and blood glucose needs to be closely monitored to avoid ketoacidosis and hyperosmolar hyperglycemic states
.
Some new crown patients will experience symptoms such as nausea, vomiting, diarrhea, etc.
, while loss of appetite, which will increase the risk of
hypoglycemia.
Therefore, when the above symptoms occur, the amount of hypoglycemic drugs can be appropriately reduced, or the type
of hypoglycemic drugs can be adjusted according to the needs of the condition.
In the early stage of diabetic patients infected with the new coronavirus, increase the frequency of blood glucose monitoring, combined with their own blood glucose situation, you can choose multiple of these time points according to time points (before meals, after three meals, before going to bed) for monitoring to find out the pattern
of blood sugar fluctuations.
If the blood sugar is stable, the frequency of monitoring can be extended and methods such as monitoring every other day can be adopted
.
Once the blood sugar is severely elevated (fasting or preprandial blood glucose exceeds 13.
9mmol/L), seek medical attention
in time.
If symptoms of hypoglycemia occur, supplement carbohydrates in time, and seek medical treatment
in time if it does not improve.
In addition, some antipyretic drugs are in the form of syrups, which generally contain sucrose, and diabetics should pay attention to monitoring blood sugar
after using syrups.
Second, do not pay attention to the precautions
of the drug (1) metformin: closely observe blood oxygen saturation and renal function level
during use.
eGFR<45ml/min/1.
73m<b21>.
Patients with severe diarrhea and vomiting should not be used;
(2) α-glycosidase inhibitors: severe diarrhea, vomiting, and dietary can not ensure regular intake of carbohydrates should not be used;
(3) Sulfonylureas: severe diarrhea, vomiting, irregular diet should be used with caution to prevent hypoglycemia;
(4) Thiazolidinediones (TZDs): patients with dyspnea, edema, myocardial infarction, angina, cardiomyopathy, etc.
should be used with caution;
(5) Glucagon-like peptide-1 receptor agonist (GLP-1RA): patients with severe diarrhea, vomiting, and low food should be used with caution;
(6) Sodium-glucose co-transporter-2 inhibitor (SGLT-2i): patients with severe dehydration, diarrhea, vomiting, and low food should not be used to avoid the risk of ketoacidosis, evaluate blood volume status and renal function during medication, and increase water
intake.
Third, do not evaluate liver and kidney function medication
For people with diabetes mellitus and hepatic insufficiency, ibuprofen
can be preferred for antipyretic drugs.
Do not take two antipyretics at the same time, because acetaminophen is hepatotoxic, especially when the daily dosage is greater than 2 g, which increases the risk of
liver failure.
People with diabetes mellitus and renal insufficiency should not use the nematevir/ritonavir tablet combination pack when the eGFR < 30 ml/min<b12>.
Fourth, adjust the dose of self-adjustment Some diabetic patients, after being infected with the new crown, will suspend the taking of hypoglycemic drugs or adjust the dose of hypoglycemic drugs by themselves, which can easily cause blood sugar fluctuations, do not stop the drug or adjust the dosage
by yourself.
For example, some hypoglycemic drugs such as acarbose, if you do not eat staple foods at the meal, you can temporarily not take them; SGLT-2i, when the body's carbohydrate intake is significantly reduced, can induce ketoacidosis (manifested as normal blood sugar), and it is also necessary to temporarily stop this class of drugs
.
Whether hypoglycemic drugs need to be discontinued requires consultation with a physician
.
Fifth, do not pay attention to the interaction of drugs, sulfonylurea hypoglycemic drugs combined with ibuprofen, can replace the sulfonylurea hypoglycemic drugs and plasma protein binding sites, causing an increase in the free concentration of sulfonylureas, which will increase the risk of
hypoglycemia.
Sulfonylurea hypoglycemic drugs and Hui Xiang zhengqi water can cause disulfiram-like reactions
.
Because Huo Xiang Zhengqi water contains ethanol, ethanol can induce hypoglycemia (especially under fasting symptoms) by inhibiting hepatic gluconeogenesis, and can hinder the recovery of hypoglycemia caused by sulfonylurea hypoglycemia, which can cause blood glucose fluctuations and cause disulfiram-like reactions
when used in combination.
References:
[1] Diagnosis and treatment plan for novel coronavirus pneumonia (trial version 9).
[2] Diabetes Branch of Chinese Medical Association.
Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2020 Edition).
Chinese Journal of Diabetes,2021,13(4):315-409.
)
[3] Hypoglycemic drug insert.
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