Diabetes prevention physical examination project

To effectively prevent diabetes through physical examination, the general population must do two basic screenings of fasting blood glucose and glycated hemoglobin every year. People at high risk of diabetes need to do an oral glucose tolerance test, insulin and C-peptide release test, and screen for related items such as blood lipids, urine routine, liver and kidney function. Qualified high-risk groups can choose dynamic blood glucose monitoring for supplementary evaluation as needed.

I met too many cheating people at the free endocrinology clinic in the community. Last month I met a 42-year-old Uncle Zhang. His belly circumference is almost 100cm. His annual physical examination fasting blood sugar is 5.4mmol/L. There is not even an arrow on the report. He himself feels that I'm far away from diabetes. Until the past two months, I always felt dry mouth. I couldn't quench my thirst no matter how much water I drank. I also lost three or four pounds. I came for further examination. After the oral glucose tolerance test, my blood sugar level reached 11.3mmol/L 2 hours after a meal. Diabetes can be diagnosed. Many people have this misunderstanding: they think that if fasting blood sugar is normal, everything will be fine. In fact, more than 60% of pre-diabetic people in my country have blood sugar that rises first after meals. If only fasting is checked, the missed diagnosis rate is alarmingly high.

The two most basic screenings are generally included in physical examinations in units, but many people do not understand the signals behind them. The normal range of fasting blood sugar is 3.9-6.1mmol/L. Don’t think that if it is less than 6.1, it will be fine. If it is above 5.6, it is actually a warning bell. It is a warning sign of pre-diabetes. At this time, quickly adjust your diet and take action, and you will most likely be able to return to normal levels. By the way, there are some things to pay attention to when checking this. Don't show off with hot pot milk tea the day before, and don't stay up late to catch up on plans until two or three o'clock, otherwise the high level may not necessarily be the true level. A while ago, there was a young man who runs the Internet. He drank three cups of full-sugar milk tea for three days in a row, and it was found that his fasting was 6.3. He was so scared that his face turned pale. He went back to his normal schedule for a week and checked again, and it went back to 5.2. It was purely because he was scaring himself.

Another very cost-effective indicator is glycated hemoglobin. This indicator reflects the average blood sugar level in the past 2-3 months. There is no need to fast. Even if you just ate a bowl of soy milk and fried dough sticks in the morning, the result will not be affected. The reference value is 4%-6%. If it exceeds 5.7, you must be vigilant. However, this is not a panacea. If patients have anemia or hemoglobinopathies, the results will be biased. At this time, you cannot judge based on this indicator alone.

If you belong to a high-risk group - for example, if your immediate family members have diabetes, if men have a waist circumference of more than 90cm and if women have a waist circumference of more than 85cm, if you have high blood pressure and high blood lipids, if you sit for a long time and eat takeaways and like to drink sweet drinks, or if you have gestational diabetes during pregnancy, just checking the above two is not enough, and it is easy to miss the diagnosis. You have to do an oral glucose tolerance test, which is what we often call the "sugar water test". Blood is drawn once on an empty stomach, and once 1 hour and 2 hours after drinking a prescribed amount of glucose water. This can directly see your body's sugar metabolism ability. Many people with normal fasting blood sugar have reached the abnormal glucose tolerance range of 7.8-11.1mmol/L 2 hours after a meal. Intervention at this time has a very high probability of reversal. If you want to know more about your pancreatic islet function, you can also do an insulin and C-peptide release test to see if your own insulin secretion is sufficient and whether you have insulin resistance, so that you can more accurately formulate subsequent intervention plans. I met a 28-year-old girl before. Her mother and grandmother both have diabetes. She checked her fasting blood sugar every year and it was 4.8. She felt that she was naturally fine. Later, I persuaded her to get glucose tolerance. Her blood sugar 2 hours after a meal was 10.2, which was already abnormal glucose tolerance. However, her insulin peak was three times that of normal people, indicating that she was still in the compensatory period. She went back to control her sugar and exercise for 3 months, and it was completely normal after another check.

Another item that is much discussed now is continuous blood glucose monitoring (CGM). Different doctors have different opinions. Some experts think that it is not necessary for ordinary people and high-risk groups. Regular screening projects are enough. This project costs more than 1,000 yuan and is not cost-effective. Some experts think that for those who usually drink milk tea and eat late-night snacks, and whose routine screening indicators are at the critical value, but often eat For people who are sleepy afterward, wearing a dynamic blood glucose meter for 3 days can catch many hidden blood sugar fluctuations. For example, some people's blood sugar soars to over 10 after eating a hot pot meal, but it cannot be detected by routine physical examination. If this situation is discovered early, adjustments can be made early, and it is not a waste of money.

In addition to blood sugar-related items, there are also some supporting examinations that are best done together, such as blood lipids (especially triglycerides and low-density lipoprotein). Most diabetic patients have dyslipidemia, and early control can greatly reduce the risk of complications; there is also a urine routine to see if there is urinary protein, which can detect diabetic kidney damage early; it is best for high-risk groups to have their fundus checked once a year. There are no symptoms at all in the early stages of diabetic retinopathy. By the time you feel blurred vision, the damage is often irreversible.

In fact, the more expensive the better for diabetes prevention physical examinations, and you don’t have to follow what others check. Just choose the appropriate items based on your own living habits and family history. After all, if you detect it half a year early, you may be able to get the disease ten years later. No matter how you calculate it, it is cost-effective.