Metabolic syndrome nursing issues

The core essence of metabolic syndrome care is "dynamic individualized balanced management of multiple metabolic abnormality risks." There is no universal care plan. The core contradiction is always the adaptability of standardized clinical intervention paths and patients' real-life scenarios, which cannot be covered by a simple slogan of "keep your mouth open and open your legs."

Last week, I met a 42-year-old building materials boss at the outpatient clinic. He is 175cm tall, weighs 92kg, has a waist circumference of 98cm, fasting blood sugar of 6.7mmol/L, and triglycerides that are also over the line, just at the critical point of high risk for metabolic syndrome. When he got the report, he felt dizzy and said that he knew he had to control it, but he had at least four drinking parties a week, meals were never on time, and he had a gym membership and went to the gym three times in half a year. How do you decide on this care plan?

At present, the industry's nursing ideas for this type of patients are not yet completely unified. One group is a typical "indicator first" group, which believes that the waist circumference must be reduced to below 90cm, and blood sugar and blood lipids should be reduced to normal thresholds. It does not matter even if some short-term drug assistance is used. After all, the ultimate risk of metabolic syndrome is critical illness such as myocardial infarction and cerebral infarction. The risk must be reduced first. The other group prefers "quality of life first". They feel that most of these patients are the backbone of society and are already full of work pressure. If they are forced to completely give up socializing and exercise for an hour a day, they will be in a long-term state of anxiety. Increased cortisol will aggravate insulin resistance. It is better to start with small things that can be done. For example, try to choose low-alcohol wine when drinking, eat less braised vegetables, even if you only take 10 minutes to stand and walk for 10 minutes a day, first establish a habit and then slowly tighten the requirements. My own experience is that there is nothing wrong with either of these ideas. The key depends on the patient's own wishes. If you force a plan on him that he can't do, it will be in vain in the end.

Oh, by the way, many people’s understanding of metabolic syndrome care is still limited to diet and exercise. In fact, sleep and mood have a much greater impact than many people think. I took care of a 61-year-old aunt before. To what extent did she follow the doctor's instructions? I use a scale to weigh how many grams of rice and vegetables I eat every day, and I walk 5,000 steps after dinner. However, my fasting blood sugar has been hovering around 6.5 for three consecutive months, and I can’t get it down no matter what. After chatting with her for half an hour, I found out that her son and daughter-in-law were working out of town, and she was raising her two-year-old grandson by herself. She had to wake up at least three or four times a night to make milk and cover herself with a quilt, and she slept less than three hours a day. Later, she asked her to discuss with her husband and divide her workday. She would let her husband sleep with her three days a week, and she would sleep in the next room by herself. Only two weeks later, her fasting blood sugar dropped to 5.9mmol/L. Do you think it's magical or not?

Another particularly common pitfall is that many people only monitor fasting blood sugar when nursing, and don't even bother to check glycated hemoglobin. I have seen several patients whose fasting blood sugar is within the normal range every time, but their blood sugar has reached more than 11mmol/L 2 hours after a meal. They have no idea at all, and they feel that they have very good control. When symptoms of fatigue and blurred vision appear, they will be checked again, and they have been diagnosed with diabetes. In fact, according to the standards of the Endocrinology Branch of the Chinese Medical Association, the core of the diagnosis of metabolic syndrome is a series of chain reactions caused by insulin resistance. Abdominal obesity, hyperglycemia, hypertension, and dyslipidemia can be diagnosed with three out of four. However, many high-risk "prospective patients" often only have one or two abnormalities. Nursing intervention at this time is actually much more effective than intervention after diagnosis, but most people do not take it seriously.

To be honest, metabolic syndrome is like an old circuit in your house. Normally this light is on and that socket is working, but when you plug in the electric water heater, induction cooker, and air conditioner at the same time, the main switch suddenly trips. It's not a problem with a certain electrical appliance, it's that the load on the entire line has reached its peak. You can't just repair the tripped main switch, nor can you unplug all the electrical appliances. You have to slowly adjust the use time of each electrical appliance and spread the load evenly so that it can be used normally for a long time. The same principle applies to the care of metabolic syndrome. You cannot suddenly replace all the heavy-tasting dishes that have been eaten for decades with boiled vegetables, nor can you ask a person who has never exercised to run 5 kilometers all at once. You have to take your time and find a balance point that he can stick to for a long time.

In fact, after working as a clinical nurse for so long, my biggest feeling is that there has never been a “standard answer” to the care of metabolic syndrome. Just take a look at the "7 ways to reverse metabolic syndrome" that are mentioned every day on the Internet, but they may not necessarily work for you if you actually use them. Some people's blood sugar spikes after one sip of milk tea, some people are fine if they drink it once a week, some people have a stable target if they walk 3,000 steps a day, and some people have to walk 10,000 steps to be effective. Instead of staring at other people's standard papers, it is better to spend more time to understand the temperament of your own body. Stable indicators and a comfortable life are better than anything else.