Metabolic syndrome care measures

With individualized lifestyle intervention as the core, it controls metabolic indicators such as blood pressure, blood sugar, blood lipids, and uric acid in layers. In the long term, the prevention of cardiovascular, cerebrovascular, kidney and other target organ damage is the bottom line. There is no universal plan, and all measures need to be adjusted based on the patient's individual situation.

Last week, I met a 42-year-old Internet salesperson in the chronic disease clinic. His belly was almost touching his desk. The blood pressure, fasting blood sugar, and triglycerides in the physical examination report were all above the critical values. He was also accompanied by high uric acid, a typical metabolic syndrome. He said that in the "counterattack tutorials" that he had posted on the Internet, he either ate boiled vegetables every meal and gave up carbon dioxide, or ran 5 kilometers every day. As a result, he went on to gout for half a month, and his indicators did not drop at all but went up a lot. This is also the easiest pitfall for many patients: they always want to find a unified standard answer, ignoring that there is no fixed method for the care of metabolic syndrome.

Take dietary intervention as an example. There are currently two mainstream voices in the academic community: one group supports short-term low-carbohydrate diet, believing that rapidly reducing carbohydrate intake can quickly improve insulin resistance and is suitable for young patients with no history of gout and normal liver and kidney functions. We had a 28-year-old patient before who used this method to reduce his body fat rate by 6 points in 3 months, and his fasting blood sugar returned to the normal range.； The other group insists that a low-GI balanced diet is a long-term plan that can be adhered to. It is more suitable for middle-aged and elderly people, and people with a history of renal dysfunction or gout. There is no need to deliberately abstain from certain types of food. As long as the intake ratio of refined sugar, high-oil and high-salt foods is controlled, for example, half of the white rice is replaced by grains, and an extra pound of green leafy vegetables is eaten every day, it will not be easy to rebound. When I usually prescribe a diet plan to patients, I will first ask, "What time do you usually get home from get off work?" Is there time to cook? 」If he can only eat takeout every day, I won't force him to make fat-reducing meals every time. I will only teach him how to order takeout: half a portion of multigrain rice, don't order braised or sweet and sour dishes, and ask for an extra portion of stir-fried vegetables. It is much more effective than setting a bunch of unachievable goals.

Now that the issue of eating has been explained clearly, many people turn around and stumble on exercise. Many people set themselves a goal of running 5 kilometers a day when they first started. As a result, not only did they injure their knees, but their stress-induced blood sugar rose a lot. There are now different practical directions for exercise intervention: the American College of Sports Medicine’s standard protocol is 150 minutes of moderate-intensity aerobics per week, combined with two times of resistance training. Its effect on improving body fat rate and insulin resistance has been repeatedly verified. ； However, domestic research on office workers in the past two years also found that the effect of fragmented exercise is not bad - every half hour of sitting, you stand up to get a glass of water and stretch for 2 minutes. If you exercise for 30 minutes in a day, the improvement rate of waist circumference and fasting blood sugar is almost the same as that of people who exercise full time every week. We have followed 12 Internet patients in our outpatient clinic. Using this fragmented method, the average waist circumference dropped by 3.2 cm in 3 months, and no one suffered sports injuries.

Many patients also struggle with the question of "should they take medicine or not?" There is no unified answer to this. Some people believe that as long as the metabolic syndrome is in the early stage and there is no target organ damage, it can be completely reversed by lifestyle adjustments in 3 months, and there is no need to rush to take medicine. ； There is also a view that if the indicators are too high above the threshold, such as fasting blood sugar exceeding 7mmol/L and triglycerides exceeding 5 times the normal value, it is safer to first stabilize the indicators with hypoglycemic and lipid-lowering drugs as prescribed by the doctor to avoid irreversible damage to blood vessels and kidneys. It is safer to rely on lifestyle to maintain the indicators after the indicators fall back. I usually advise patients to have a carotid artery color Doppler ultrasound done first. If there is already plaque, don’t insist on not taking medicine, and intervene when it is necessary.

There are also many care details that are easily overlooked, such as sleep. I once had a patient who worked as an e-commerce operator. He controlled his diet and exercise very strictly, but his waist circumference just couldn't be reduced. After questioning, I found out that he watched live broadcasts until two or three in the morning every day and only slept for five hours. The peak of leptin secretion occurs during deep sleep. Staying up late for a long time will directly lead to leptin resistance and increased ghrelin secretion. No matter how you control your diet, it will be useless. Later, he forced himself to go to bed before 11 o'clock and slept for 7 hours a day. In two months, his waist circumference dropped by 4 centimeters, and his fasting blood sugar dropped to below 5.6. There are also emotional problems. I stare anxiously at the indicators every day. Cortisol is always at a high level, and fat will be piled on my belly. On the contrary, I will lose more and more weight.

In fact, metabolic syndrome is, to put it bluntly, a "chronic disease" caused by long-term bad living habits. There is really no need to suffer from nursing care. There is no need to force yourself to completely quit milk tea hot pot. It's okay to have an occasional meal. There is no need to worry about a single index fluctuation for several days. After all, everyone's life rhythm and physical tolerance are different. Finding a rhythm that you can stick to for a long time is much more reliable than following online tutorials. After all, the ultimate goal of nursing is to let you live a good life, not to make your life revolve around indicators.