According to the rest of each patient, the total calories of light physical labor, medium physical labor, heavy physical labor and extremely heavy physical labor are above 25% ~ 30%, 30% ~ 35%, 35% ~ 40% and 40% respectively. The total calories must meet the physiological needs to ensure nutrition, which requires the calculation of meal timing and the quantification and estimation of total calories according to age, gender, height and standard weight. 10% is overweight and 20% is obese.

According to the different conditions of patients, such as patients with height 165cm, the standard weight is165-105 = 60 kg, and the total calorie of extremely light manual labor is 60×30%= 1800kcal/d, with protein, fat and carbohydrates accounting for the total. Limit high-fat and high-cholesterol foods, such as egg yolk, animal offal, roe, fat, pork, cattle and sheep oil, and eat less fried foods, because high temperature will destroy unsaturated fatty acids. Before moderate physical labor and physical exercise, we should pay attention to increasing a small amount of food to avoid hypoglycemia (1 diabetic patients should not take moderate physical exercise).

Psychological nursing

Most diabetics feel very sad when they think that the disease will accompany them all their lives, which is manifested as depression and bad mood. This mentality will naturally weaken the body's immune function and reduce resistance, which is not conducive to the control of diabetes and seriously affects the therapeutic effect. Therefore, psychological treatment and nursing are very important in the treatment of diabetes. Based on the above-mentioned psychological characteristics of patients, medical staff should enthusiastically provide quality services, actively and sincerely explain related problems to patients, and objectively introduce the development process and prognosis knowledge of the disease to patients, so that patients can realize that diabetes is a chronic disease that cannot be cured at present, but it is also a preventable disease, so that patients can persist in treatment and establish confidence in overcoming the disease.

Medication guidance

1, oral medication instruction

Explain the pharmacological effects of oral hypoglycemic drugs to patients and their families, and guide patients to take drugs on time. Sulfonylurea drugs, such as damekang, can promote insulin secretion, and the onset time is 30min after taking the drug. Therefore, drugs are usually taken about 30 minutes before meals. Biguanidine drugs, such as metformin and phenformin (Jiangtangling), are the only hypoglycemic drugs taken during or after meals. This is because metformin can penetrate into gastric mucosa and cause stomach discomfort. If you take the medicine in the middle of every meal or immediately after meals, you can avoid the irritation of the medicine to the stomach and reduce the side effects.

α -glucosidase inhibitors, such as betapin and bechin, are mainly used to reduce postprandial hyperglycemia. When taking this medicine, you must chew it at the first bite of every meal. There is also a kind of insulin sensitizer, such as rosiglitazone and pioglitazone. These drugs mainly reduce blood sugar by enhancing the effect of insulin for a long time. Once taken, the hypoglycemic effect can be maintained for 24 hours. Therefore, you only need to take it once a day, and the best effect is 1min before breakfast every day.

2. Instructions for insulin injection

Insulin preparations should be stored in the refrigerator at 2℃ ~ 8℃ as far as possible. Take it out 30 minutes before injection and heat it at room temperature to avoid discomfort during injection. The injection site should be changed frequently to avoid subcutaneous tissue atrophy caused by frequent injection at the same site and affect drug absorption. With the development of insulin therapy technology, a variety of treatment schemes have emerged. Diabetic patients should receive professional guidance from endocrinologists in regular hospitals and determine the treatment plan according to their personal situation.

At present, the world's leading diabetes treatment scheme is insulin that mimics islet work: low-dose insulin is continuously injected into the body day and night, and then pre-prandial insulin is injected according to meals and activities, which can balance blood sugar for 24 hours and delay the occurrence of complications on average 15. Three years. For patients treated with insulin, if their blood sugar has reached the standard, their life is regular and there are no special circumstances, they must check their blood sugar regularly every 2 weeks (that is, before and after meals).

3 hypoglycemia. nurse

All diabetic patients should be closely observed, and hypoglycemia should be thought of when symptoms such as hunger, palpitation, dizziness, hyperhidrosis, pallor coma appear. In particular, the perception of hypoglycemia symptoms in elderly diabetic patients is reduced, and sometimes there will be unconsciousness without any precursor symptoms. Therefore, all comatose diabetic patients should think of the possibility of hypoglycemia. Blood sugar should be measured immediately, and blood sugar can be reported after blood drawing, that is, sugar water, fruit juice or intravenous glucose should be given to save time as much as possible.

Exercise therapy guidance

1, safety assessment during exercise

(1) Comprehensive physical examination, especially blood sugar monitoring, with blood sugar at 5. 5~6。 7mmol/L can basically ensure sports safety. When using urine ketone, it is not suitable for exercise. When the blood sugar is >: 6 .7mmol/L, exercise is prohibited.

(2) For those with good blood sugar control, reduce the dosage by 20% before exercise to avoid hypoglycemia. If blood sugar remains after exercise

(3) Choose safe non-competitive aerobic exercise, such as walking, running, cycling, swimming, housework, Tai Ji Chuan, playing tennis, dancing, mountain climbing, etc. And exercise regularly, quantitatively and step by step. It is not advisable to do strenuous exercise.

(4) Be accompanied during exercise, and carry diabetes rescue cards, blood glucose meters, sugar cubes, sweet juice, etc. If you feel unwell, monitor your blood sugar in time. If you have hypoglycemia, you should supplement sugar as soon as possible.

(5) Exercise after meals 1 ~ 2h. When the fasting time is too long and the effect of insulin or hypoglycemic agents reaches the peak, exercise is prohibited.

(6) Exercise is prohibited when suffering from other diseases, serious injuries, numbness and tingling in both feet, neck and chest pain, shortness of breath, dizziness, nausea, blurred vision or blind spots.

(7) Try not to engage in strenuous activities at dusk or at night to avoid hypoglycemia after sleep.

(8) Check the sports ground to avoid bad weather and accidents.

2. How to master the amount of exercise

(1) 1 type diabetes is best to exercise at a fixed time every day, at least three times a week for 30 minutes each time, and the exercise intensity is 60% ~ 80% of the individual's maximum heartbeat (individual's maximum heartbeat = 220- age).

(2) Type 2 diabetes mellitus should exercise at least 5 times a week for 30 ~ 60 min each time, so as to increase calorie consumption and help to lose weight. Because of its long exercise time, the intensity can be slightly lower, reaching 60% ~ 70% of the maximum heartbeat of an individual.

(3) The complete exercise process includes 10 ~ 15 min warm-up exercise and 5 ~ 10 min finishing exercise. The real exercise time is 20~30min, at least 20 ~ 30 min, but we should also master it flexibly and stop sweating slightly on the principle of not being tired.