A patient with diabetes, who has had the condition for 20 years, has struggled to maintain stable blood glucose levels. His fasting blood glucose typically ranges between 7-8 mmol/L, while postprandial readings often reach 12-13 mmol/L, fluctuating unpredictably. After watching my videos, he reached out to me privately, saying, "Dr. Wu, I’ve watched all your videos, and they truly resonate with us diabetics. Could you please help me figure out what’s going on? Even with insulin, my blood glucose remains unstable and increasingly difficult to control. My weight has dropped rapidly, from 70 kg to 55 kg in the past six months. I’m afraid to eat even a bite more, as my blood sugar spikes if I do, but I feel hungry if I don’t. I’m constantly fatigued and weak. To simplify things, I now only take a single dose of insulin glargine before bed."

Let’s analyze why this patient is experiencing these issues.

First, with a 20-year history of poorly controlled blood glucose, his pancreatic islet function is significantly impaired. Insulin secretion is undoubtedly insufficient, and his ability to synthesize fat has declined, leading to erratic blood glucose levels and rapid weight loss.

Second, inadequate dietary management.

The primary issue lies in abnormal postprandial blood glucose levels, largely due to an unbalanced diet. Many people misunderstand diabetes dietary management, thinking it simply means eating less, which is too simplistic. Proper dietary management for diabetes is comprehensive, requiring a balanced structure tailored to the individual’s needs. Proteins, vegetables, and staple foods should be proportioned appropriately to ensure comprehensive nutrition. It’s not about starving oneself.

This patient, fearing postprandial spikes, avoided eating and relied on hunger, which contributed to his weight loss.

Third, symptoms like fatigue and weakness indicate insufficient intracellular glucose.

Glucose is a vital energy source for the human body. Managing blood sugar involves appropriately controlling excessive glucose intake while enhancing the body’s utilization of glucose. The goal is to allow glucose in the blood to enter cells and nourish various organs, not merely reducing food intake or relying on hunger.

These are the three fundamental aspects of diabetes: impaired pancreatic islet function, insufficient intracellular glucose, and elevated blood glucose levels.

Fourth, inappropriate medication use.

Insulin glargine is a long-acting insulin with a slow release rate and low dosage, averaging about 1-1.5 units per hour. It primarily controls basal and fasting blood glucose but has limited effect on postprandial levels. Thus, the overall medication regimen is suboptimal, lacking agents to manage postprandial spikes.

After incorporating him into our out-of-hospital management program, I personally adjusted his treatment. Within days, his blood glucose normalized, and symptoms like fatigue and weakness disappeared. Over three months, his weight gradually recovered to around 62.5 kg, and his overall condition improved significantly. Below is the treatment plan I provided:

1. Resume a normal diet, eating until satisfied but not overly full, with a balanced structure.

2. Add short-acting insulin aspart before each meal to control postprandial blood glucose.

Some might ask, "Doesn’t this increase the medication burden, requiring four insulin injections daily?"

I want to emphasize that patients with severely impaired pancreatic islet function and insufficient insulin secretion must use insulin adequately under medical guidance, not for convenience. Importantly, as this patient’s pancreatic islet function improved and his blood glucose stabilized, I reduced his insulin injections from four times daily to two. The outcome was excellent, and the patient was very satisfied.

In summary: Diabetes treatment must prioritize improving pancreatic islet function and ensuring sufficient intracellular glucose. Merely focusing on lowering blood glucose numbers by any means may lead to misconceptions.

Moving forward, our educational videos will follow this model, helping everyone learn blood glucose management knowledge from the experiences of other patients with diabetes.