How to adjust hypoglycemic drugs for diabetic patients?
The current type 2 diabetic prevention guidelines explained the adaptation, contraindications, surgical methods, surgical risks and postoperative management of weight loss surgery, but there is no detailed explanation of the drug adjustment during weight loss surgery for diabetic patients. The “Expert Consensus (2019 Edition)” issued by the Chinese Research Hospital Society of Diabetes and Obesity Surgery Professional Committee explained the management of various combined state of weight loss surgery in various combined states of weight loss surgery. What is the blood glucose management of surgery?
Blood glucose control target before surgery
Before the weight loss, the patient’s metabolic indicators are mainly optimized, and the goal of sugar control is referred to the “China Type 2 Diabetes Guide (2017 Edition)”, which is 6.5%-7.0%of the level of glycated hemoglobin, and the empty blood glucose <6.1mmol/L/L, 2h after meal meals. Blood glucose <7.8mmol/L. Patients with complications of diabetes or poor blood glucose control are <8.0 %.
Adjustment of drug schemes before surgery and during the operation
Glitone, gliney, and di-peptide-4 inhibitors should be discontinued 24 hours before surgery and reduced the amount of basic insulin to 0.3U/kg.
Disposal dual -dual -dual -duplex was discontinued on the day of surgery. On the day of the operation, the blood glucose should be controlled by 7.8 mmol/L, the blood glucose value exceeds 2.2 mmol/L blood glucose value is corrected by 1U short insulin.
It is recommended to use glucose? Insulin? Potassium combined with venous infusion, and adjust the proportion of glucose to insulin in time according to blood sugar changes. At the same time, you need to pay attention to hypoglycemia during surgery, and you can infusion of 5 % glucose liquid (100-125ml/h) to prevent hypoglycemia.
Postoperative drug use strategy
Early treatment: The principle of replenishment of liquid and prevention of antibacterial drugs after weight loss surgery is the same as conventional gastrointestinal and enteric surgery. Usually there is no need to supplement fat milk or amino acids, but it should be paid to monitoring the blood glucose level of patients. It is necessary to determine individualized daily liquid volume according to the patient’s weight.
Patient’s renal function has been controlled under the control, it is recommended to restore the use of dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-dual-duty dosage every day after surgery, 1-2 times a day. For postproofing patients by the gastric, the biological utilization of the dual -dual -dual -duality increase increased by 50%, so the dose should be reduced. On the 7th-10th day after surgery, the blood glucose value should be adjusted at least 2 times a day. Among them, the target value of the blood glucose of the morning on the morning is 5.6-6.7mmol/L. Avoid the use of sulfur crickets and other drugs that can cause hypoglycemia risks.
Long -term treatment: Some patients with type 2 diabetes are relieved after weight loss, but some patients still need to use diabetic drugs. The principle of drug use of these patients follows the “China Type 2 Diabetes Guide (2017 Edition)” to control blood sugar, control blood glucose, and Indexes such as blood pressure and blood lipids.
Postoperative blood glucose monitoring plan
Patients should monitor blood glucose levels after discharge. It is recommended to monitor 2-4 times a day, including the morning blood glucose to understand the law of blood sugar. The regular detection of blood glucose levels can help patients build and adapt to new lifestyle.
After surgery, the target of the blood glucose control is 4.0-7.0 mmol/L before the meal, the 2H blood glucose 5.0-10.0 mmol/L, and the glycated hemoglobin <7.0%, the incidence of long-term complications after surgery is significantly reduced.
It is recommended that within one year after surgery, evaluate glycosin, blood glucose, insulin, and C peptide levels every 3 months, 2 H blood glucose, insulin and C peptide levels after meals; Peptide level) clearly evaluate the function of islet β cells. If there is still obvious insulin resistance, the two -meta dual -dual -dual -dual -bonus treatment can be applied. Since then, the follow -up interval was decided based on the patient’s sugar metabolic status. It should be noted that very few patients who accept SG may have recurrent hypoglycemia after surgery. At this time, non -insulin tumor pancreatic hypoglycemia syndrome, human factors, medical derived factors, dump syndrome and insulin tumor tumor tumors should be performed. Screening for the cause.
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How to prevent hypoglycemia after weight loss surgery
How to deal with hypoglycemia after surgery should be treated in time, but it is also important to prevent blood sugar fluctuations and hypoglycemia in patients. Pay attention to the following diet after surgery: 1) slowing the speed of eating and eating less meals. 2) Avoid eating concentrated sweets to prevent dumping syndrome and severe blood sugar fluctuations. 3) Avoid food fried and difficult to digest. 4) Avoid irritating foods such as ice water, coffee, tea, alcohol and other irritating foods within 3 months after surgery.
