潛伏性成人自體免疫糖尿病 (LADA),一篇來自不同國家的專家會議共識。
https://pubmed.ncbi.nlm.nih.gov/32847960/
✔ 所有新診斷第 2 型糖尿病的病人,都篩檢 GAD 抗體 (GADA)。
如果有經濟考量,就選有第 1 型糖尿病或自體免疫疾病家族史、BMI 小於 27、發病年齡小於 60 歲和血糖控制不好的。
如果 GADA 是陰性,但是真的很懷疑 LADA,應該再驗其他抗體 (ICA、IA-2A、ZT8A)
✔ GADA 陽性的病人,驗 C-peptide 來決定不同治療方向。C-peptide 的抽血時間可以是空腹、隨機、或餐後,只要血糖是在 80-180mg/dL 之間即可。
🔹 C-peptide 小於 0.3 nmol/L
建議胰島素治療。如果是新診斷的話,應該就當作是第 1 型糖尿病。
🔹 C-peptide 在 0.3 和 0.7 nmol/L 之間
屬於灰色地帶,用口服藥 metformin,血糖高的可以合併使用胰島素。
不要用 sulfonylurea (SU),因為可能會使得胰島素分泌能力下降。
至少每隔 6 個月追蹤 C-peptide 濃度。
許多成人發病的第 1 型糖尿病的 C-peptide 也在這個範圍,所以血糖真的很高的,可能就需要開始使用胰島素治療。
🔹 C-peptide 大於 0.7 nmol/L
跟一般第 2 型糖尿病的治療一樣,只是避免用 SU。如果血糖變差,就要追蹤 C-peptide 濃度。
有些人的 GADA 是假陽性,是單純的第 2 型糖尿病。
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LADA 因為發病年齡比典型的第 1 型糖尿病晚,初期又不須用胰島素治療,常常會被當作第 2 型糖尿病。不過隨著病程進展,β 細胞分泌胰島素的能力越來越弱之後,就會變成依賴胰島素才能控制血糖。
這篇專家共識只是給大家參考,目前不同醫師應該還是以病人的臨床狀況來決定。
同時也有7部Youtube影片,追蹤數超過1,030的網紅Daily Health Wellness Center,也在其Youtube影片中提到,More Info Connect with Me in Instagram : https://www.instagram.com/drshsbd/ PROBLEM: Skipping breakfast is strongly correlated with weight gain. "Sta...
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type 2 diabetes treatment 在 薛宇哲老師醫學教育知識區 Facebook 的最讚貼文
ADA guidelines recommend insulin for type 2 DM if metformin is ineffective. But strong evidence supports use of intensive insulin therapy as 1st-line treatment, before a trial of metformin, for newly diagnosed patients whose HbA1c levels are > 9.0%. In these patients, early insulin can improve β cell function and actually result in diabetes remission.
type 2 diabetes treatment 在 CheckCheckCin Facebook 的最佳解答
【營養師.中醫師Q&A】米水會令血糖增高?
Q:糖尿病人可以飲米水嗎?
(T:註冊營養師 @tsheknutritionTiffany Shek,C:註冊中醫師Cinci EC)
T:其實糖尿病患者都一樣可以進食含有澱粉質的食物,包括喝米水,重點是進食碳水化合物的分量和時間。此外,保持理想體重亦是關鍵。若對碳水化合物的計算法或進食時間上的配合有疑問,可以諮詢註冊營養師。
C:中醫稱糖尿病為消渴病。常見症狀為多飲、多食、多尿,消瘦而無力。中醫理論裡消渴分為上消、中消及下消三種不同的類別,上消者主要為肺熱,病徵是經常都會覺得口渴;而中消者多胃火熾盛,吃得多而且易覺飢餓;下消者多為腎陰不足,虛火內熱,症狀為尿頻。
飲食上,患者要戒掉高糖分水果及糕點、少吃澱粉質、避免進食辛辣、煎炸油膩、溫補性等食物。中醫對於消渴的調理為平衡陰陽氣血,調理還是要配合體質,不同症狀配合不同食療。
米水成分為紅米、白米及薏米,一人每天分量的原材料約為兩湯匙米飯,而且只喝米水澱粉質更少,屬性為平和。於中醫角度而言,飲用有健脾養胃袪濕的功效,建議糖尿病朋友飲用前先諮詢註冊營養師更穩妥!
Can diabetic patients have rice water?
(T: Tiffany Shek, Registered Dietitian, C: Cinci EC, Registered Chinese Medicine Practitioner)
T: Individuals with diabetes are allowed to consume carbohydrate-rich foods, including rice water. The key is to control the amount of carbohydrates ingested per meal and the timing of meals. Additionally, weight management is required for optimal management of diabetes. You can inquire with a dietitian to find out what might suit you best.
C: Chinese medicine believes diabetes is accompanied by excessive eating and drinking but still very slim and weak, as well as excessive urination. Diabetes exhausts three parts of the body usually. Upper exhaustion would have lung heat, and the symptoms would be excessive thirst. Middle exhaustion would have stomach heat, and the symptom is hunger even after a full meal. Lower exhaustion would be deficiency in kidney yin and the symptom is frequent urination.
From a dietary perspective, diabetic people should stop eating high sugar fruits and cakes, decrease carbohydrate intake, avoid spicy, fried, oily and tonic foods. Chinese medicine manages diabetes by balancing yin and yang, qi and blood. Treatment course should be determined based on body type and symptoms.
The ingredients of rice water are red rice, white rice and coix seeds. The raw ingredients serving for one person per day is about two tablespoons of rice. The starch intake is less when drinking rice water, and rice water is mild in nature. From the perspective of Chinese medicine, drinking rice water can strengthen spleen and stomach and dispel dampness. It is recommended that the patients with diabetes should consult the registered dietitian before drinking rice water!
type 2 diabetes treatment 在 Daily Health Wellness Center Youtube 的最讚貼文
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PROBLEM: Skipping breakfast is strongly correlated with weight gain. "Start your day off right," right? Still, young people eat nearly half of their daily calories between 4 p.m. and midnight. So, eat breakfast, but what's best?
MEDICAL RESEARCH: An experiment out of the University of Missouri involved overweight or obese females, aged 18 to 20, who identified as infrequent breakfast eaters. Each morning for a week, the researchers had the participants eat either 350 calories of cereal (13 grams of protein), 350 calories of eggs and beef (35 grams of protein), or skip breakfast entirely.
RESULT: Eating any breakfast was associated with increased feelings of fullness, a reduced desire to eat, and lower levels of ghrelin (a hunger-stimulating hormone) throughout the morning. But meaty, eggy breakfast was associated with these benefits over the course of the entire day. Participants who had a lot of protein in the morning also had reductions in their "cravings-related" brain activity, and increased levels of a hormone associated with satiety. They snacked less on fatty foods in the evening, as compared to those who ate cereal or nothing.
CONCLUSION: This makes a pretty good MEDICAL PROOF that we should take a high-protein breakfast
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Obesity is in the rising trend in both developing and developed countries leading to several chronic diseases like diabetes, hypertension, heart attack, and stroke. In our eat-and-run, massive-portion-sized culture, maintaining a healthy weight can be tough—and losing weight, even tougher. If you’ve tried and failed to lose weight before, you may believe that diets don’t work for you. You’re probably right: traditional diets don’t work—at least not in the long term. However, there are plenty of small but powerful ways to avoid common dieting pitfalls, achieve lasting weight loss success, and develop a healthier relationship with food.
Our brain is structured to find happiness at every level. Happiness as the state of fulfillment, and everyone wants to be fulfilled. If you keep your eye on this, your most basic motivation, then the choices you make come down to a single question: “What am I hungry for?” Your true desire will lead you in the right direction. False desires lead in the wrong direction. You can take a simple test to prove this to yourself: The next time you go to the refrigerator for something to eat, stop for a second. What’s making you reach for food? There are only two answers:
You’re hungry and need to eat.
You’re trying to fill a hole, and food has become the quickest way to do that.
If you have a hole (unhappiness or dissatisfaction) in your mind (may be deep seated in your subconscious mind), you will subconsciously or consciously look for happiness. And, guess what will you be looking for? It’s food definitely.
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Diabetes
Type 2 Diabetes
Diabetes Cure
Diabetes Diet
Diabetes Diet Menu
Diabetes Diet Plan
Diabetes and Exercise
Diabetes Diet Recipes
Diabetes Mellitus
Diabetes Treatment
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【補充資料】
大型研究證實素食降糖尿病機率 https://goo.gl/ohCJdg
1. 糖尿病的世界趨勢
IDF - 2015 Diabetes Atla.
2. 引發糖尿病的食物排行
Ley, S. H., et al. (2014). "Prevention and management of type 2 diabetes: dietary components and nutritional strategies." Lancet 383(9933): 1999-2007.
3. 戰勝糖尿病:馬希爾島的經驗
Davis, Brenda (2008). Defeating Diabetes: Lessons From the Marshall Islands. Today’s Dietitian. Vol. 10 No. 8 P. 24
4. 素食預防糖尿病 (台灣研究)
Chiu, T. H., et al. (2014). "Taiwanese vegetarians and omnivores: dietary composition, prevalence of diabetes and IFG." PLoS One 9(2): e88547.
5. 素食預防糖尿病 (美國研究)
Tonstad, S., et al. (2013). "Vegetarian diets and incidence of diabetes in the Adventist Health Study-2." Nutr Metab Cardiovasc Dis 23(4): 292 - 299.
6. 低脂純素飲食,可改善第二型糖尿病的血糖控制、心血管疾病危險因子
Barnard, N. D., et al. (2006). "A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes." Diabetes Care 29(8): 1777-1783.
7. 逆轉心血管疾病
Ornish, D., et al. (1990). "Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial." Lancet 336(8708): 129-133.
8. 素食對糖尿病的預防與治療
Kahleova, H. and T. Pelikanova (2015). "Vegetarian Diets in the Prevention and Treatment of Type 2 Diabetes." J Am Coll Nutr 34(5): 448-458.
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type 2 diabetes treatment 在 Type 2 Diabetes: Treatment & Routine – Family Medicine 的推薦與評價
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