Metabolic Syndrome Care Plan

The core nursing logic of metabolic syndrome is by no means "according to a unified template to lose weight and hard-card indicators"; A hierarchical dynamic intervention based on the individual's original living habits, taking into account the four core dimensions of abdominal circumference, blood sugar, blood lipids, and blood pressure, to gradually reduce the risk of chronic diseases without reducing the quality of life. ——This is the most practical conclusion I have come to after working in community chronic disease care for 7 years and following nearly a thousand patients.

The 42-year-old Internet company programmer I just picked up last week is a typical example. His abdominal circumference is 98cm, fasting blood sugar is 6.3mmol/L, triglyceride is 2.8mmol/L, and blood pressure is hovering at 135/86mmHg, which fully meets the diagnostic criteria for metabolic syndrome. He previously searched for strategies and carried on by running 5 kilometers every day. He lost 8 pounds in two months. As a result, his uric acid soared to 520 μmol/L. He suffered from a gout attack on crutches. The first thing he said to me when he saw me was, "I'm so self-disciplined, why am I still having problems?" ”

To be honest, there are currently two different directions in academic intervention for metabolic syndrome: one is the "indicator-first" group, which advocates that all abnormal indicators must be reduced to normal thresholds within 3 months, requiring carbohydrates to account for less than 30% of energy supply, and at least 150 minutes of moderate-intensity aerobic exercise per week. The results are indeed quick, but after follow-up, less than 20% of patients can persist for a full year, and the rebound rate exceeds 60%； The other group is the "habits-first group" that we prefer in primary care. They do not pursue sudden drops in short-term indicators, but first change 1-2 small habits that can be implemented. Even if the indicators only move 0.1 in the first two months, as long as they persist for a long time, the risk of cardiovascular events can be reduced by 40% in 5 years. This data is based on the results of a 3-year follow-up in our community, which is more grounded than the figures in the paper.

Don’t get a headache when you hear that you need to change your habits. It really doesn’t mean that you need to eat multi-grain rice every day or get up for a run before dawn. I have met many patients who ask me if they can no longer eat hot pot and drink milk tea. Every time, I ask them to make a list of their meals for the week. If they originally drink a cup of full-sugar milk tea a day, first change it to half-sugar, then to sugar-free, and finally to once a week, it is much better than quitting it completely and enduring an outbreak of three cups for half a month. I once had a 60-year-old aunt who loved to eat watermelon and grapes. She had been told that people with diabetes should not eat fruit. She had endured it for three months and her blood sugar did not drop much. She was almost depressed. I asked her to eat a fist-sized amount at a time in between meals and not to nibble immediately after the meal. Two months later, she found that her glycosylated hemoglobin had dropped by 0.2%. She couldn't believe it. Oh, by the way, I have to mention the low-carb ketogenic diet that has become popular recently. It is true that some endocrinology doctors will recommend short-term use for severely obese patients. However, we in primary care have encountered too many people who try it on their own. They either suffer from severe hair loss, or have aunt disorder, and some like the programmer mentioned above have soaring uric acid. Ordinary people should not try it casually, as the gain outweighs the gain.

Many people have deeper misunderstandings about exercise than eating. I once had a patient who worked as an accountant. She got home after get off work every day after 8 o'clock. She slumped on the sofa and didn't even want to wash the dishes. I asked her to get off the bus two stops before get off work and walk for 15 minutes. After eating, she should stand and use her mobile phone for 20 minutes instead of lying down. With just these changes, her abdominal circumference has decreased by 4cm in three months, and her blood pressure has stabilized at around 120/80mmHg. It’s not that the combination of aerobic and anaerobic is not good, but when you can’t walk for even 10 minutes, breaking the “sedentary” state first is better than anything else. We have argued with the doctors in the sports department several times. They think that the heart rate must reach the target to be considered effective exercise. However, we have seen too many patients who train hard at the beginning and either hurt their knees or give up after half a month. On the contrary, those who take their time can see the effect.

Don’t make it your own fault when it comes to monitoring. Many people buy a blood glucose meter as soon as they are diagnosed and prick their fingers four times a day until they are full of holes. After two weeks, they get fed up and never test again. In fact, if the indicator is just critical, it is enough to pick two days a week and measure fasting and two-hour postprandial blood sugar. Measure the abdominal circumference once a week, and measure it flatly around the navel in the morning on an empty stomach. This is much more reliable than weighing yourself. Many people just start exercising, and when their muscle mass increases and the weight is not moved, they feel that they have exercised in vain.

There is another point that everyone is most confused about: Should I take medicine? I have seen two extremes. One is that people think that "the medicine is only three parts poisonous" and refuse to take it even if their blood pressure has reached 150/100mmHg. The other is that they think that everything will be fine after taking the medicine, so they still drink and stay up late. To be honest, if you have adjusted your lifestyle for 3 months and still haven’t reached the target, you have to eat what you should. Medication is to help you bring the indicator back to a safe level and avoid organ damage. It is not a scourge, but don’t expect that taking medicine will solve all problems. There was a patient in business who took antihypertensive medicine and drank with clients every day. He was found to have proteinuria in half a year, and it was too late to regret.

To put it bluntly, metabolic syndrome is really not a terminal disease, it is an early warning sign accumulated by your bad living habits for more than ten years. It does not have to be like going to jail. You can't touch this or do that. Find a rhythm that you can comfortably stick to. Drink one less cup of milk tea today and walk ten minutes more tomorrow. Adjusting slowly will be more effective than any extreme method. Oh, by the way, if you have immediate family members with hyperlipidemia or diabetes, it is best to check your abdominal circumference and fasting blood sugar once a year after the age of 30. Early detection and early intervention will make everything possible.