Individualized blood glucose management in stroke patients with diabetes

*Only for medical professionals to read and reference, quickly collect it! After the National Health Commission issued the 2021 version of the "Guiding Standards for China's Stroke Care", colleagues from relevant departments have started learning, checking their daily work, and checking for deficiencies
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In addition to emphasizing the professional knowledge of stroke, the guidelines also involve the management of blood pressure, blood lipids, and blood sugar, which can be described as very meticulous
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Clinically, patients with cerebral infarction and diabetes are often encountered
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So, if a patient with cerebral infarction has a history of diabetes and has a problem of unsatisfactory blood sugar control, how should clinical personalized care be? Here is a relatively simple medical record, for the convenience of discussion and explanation, only part of the key course of the disease and nursing records are listed: The patient in this case is a 75-year-old man who was diagnosed with "cerebral infarction", with "left limb weakness" , Numb" was admitted to the hospital for more than a day
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The patient’s past history: He suffered from “cerebral infarction” more than 20 years ago; the secondary preventive treatment of cerebrovascular disease was not routinely performed; there was a history of diabetes, and the recent use of “metformin 1 capsule three times a day, 4U insulin aspart, before three meals, Insulin 8U before going to bed" blood sugar control is acceptable
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Let's take a look at this grandfather's blood sugar control situation: The patient's random blood sugar at 9:00 am on the day of admission was 21.
3mmol/L, his breath smell was normal, and he did not complain of discomfort
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Report to the doctor immediately and follow the doctor's instructions to give a small dose of insulin group solution (6U insulin + 0.
9% NS250ml) intravenously
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One hour later, the blood glucose was retested at 16.
2mmol/L, and the intravenous drip was suspended
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The second day after the patient was admitted to the hospital: about 300g scallion pancakes + one rice roll for breakfast, blood sugar 20.
2mmol/L after breakfast, normal breathing odor, no complaints of nausea and other discomforts, advised to drink more water and conduct dietary education
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On the fourth day of admission: The patient ate 1 vegetable bun and 2 meat buns for breakfast, and the blood sugar after breakfast was 18.
0 mmol/L
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On the eighth day of admission: blood glucose was 4.
7mmol/L after breakfast for 1 steamed bun, food was ordered, and blood glucose before lunch was measured according to the doctor's advice: 9.
7mmol/L
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On the ninth day of admission: A chicken leg was eaten for breakfast.
After breakfast, the blood sugar was 3.
6mmol/L.
The patient had no discomfort such as hunger, flustered and trembling hands.
He was given an oral 50% high-sugar 40ml immediately
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After 15 minutes, the blood glucose was measured again at 6.
7mmol/L
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… Overall, this diabetic patient has not only the problem of high blood sugar, but also the risk of low blood sugar
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 For this case, we put forward some nursing questions and assessments for reference.
Our nursing measures are as follows: Regarding the practice of patients eating three steamed buns per meal, I am more concerned about which steamed buns are so delicious? Hahaha
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One more bun has high blood sugar and one less bun has low blood sugar.
Baozi: I am too difficult.
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However, it is certain that after a carbohydrate-based meal, blood sugar tends to rise
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 We often say that low GI has nothing to do with sweetness or not
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Here are some more intuitive comparisons of common food GI values: (Image source: Reference [2]) What is a mixed diet? Simply put, eat a little bit of all kinds of nutrients
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The effect of mixed dietary composition on the digestion of GI and food during in vitro digestion: (Image source: Reference [2]) After reading it, the difficulty of choice becomes more entangled in what to eat tomorrow.
.
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However, the patient lamented and said that blood glucose was measured every day , All five fingers are pierced.
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Does blood sugar really have to be so strict? The guidelines indicate that insulin hypoglycemic therapy can be given according to doctor's instructions for blood glucose greater than 10mmol/L, blood glucose monitoring should be strengthened, and blood glucose of patients with hyperglycemia should be controlled at 7.
8-10.
0mmol/L; if blood glucose is lower than 3.
3mmol/L, 10% can be given according to doctor's advice.
Oral or injection treatment with 20% glucose, the goal is to achieve normal blood sugar levels
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 Hypoglycemia can directly lead to cerebral ischemia damage and aggravate cerebral edema, and it is also potentially connected with hemorrhage transformation in stroke patients.
Therefore, while seeking blood glucose standards, attention should be paid to safety, effectively avoiding blood glucose fluctuations, and reducing hypoglycemia.
Especially the occurrence of severe acute hypoglycemia
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 The guidelines put forward that diabetes is an independent risk factor for stroke recurrence or death in patients with ischemic stroke, and the importance of blood glucose management in patients with ischemic stroke should be increased
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Customize individualized blood sugar control goals and blood sugar lowering plans for patients, and recommend HbA1c treatment goals of less than 7% (level 5 evidence, level B recommendation)
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 Life>
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For type 2 diabetic patients who have a long course of diabetes, are elderly, and have had cardiovascular disease, they should continue to take comprehensive management measures such as lowering blood sugar, regulating blood pressure, and applying aspirin therapy
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 Of course, in addition to diet, there is also a comprehensive management of "five carriages" such as drug intervention, exercise, and health education
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(For physical rehabilitation exercises, etc.
, please refer to the previously posted article "Nursing Rounds | Nursing Measures for Acute Cerebral Infarction") In short, comprehensive nursing intervention can effectively improve the quality of life and comfort of patients with cerebral infarction and diabetes, and strengthen the effect of blood sugar control , Reduce the incidence of complications
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References: [1] Chinese Guidelines for Stroke Prevention and Treatment (2021 edition) electronic version [2] Kang Jingyan, Fu Nan, Wang Yong, Dong Zhizhong, Chen Xiaodong.
The effect of mixed dietary composition on GI and food digestion during in vitro digestion[J] .
Modern Food Science and Technology,2018,34(02):102-109.
[3].
Efficacy analysis of low-dose insulin in the treatment of diabetic ketoacidosis[J].
Guide to Chinese Medicine,2012(20):501- 502.
[4].
The application of food glycemic index in dietary guidance for elderly diabetic patients[J].
Nursing Research,2009,23(25):2316-2317[5].
Comprehensive nursing care in cerebral infarction with diabetes The effect of application in patient care[J].
New World of Diabetes,2020(7):98-100.
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