4-6/2017
地點:香港糖尿康健協會
活動名稱 : 糖尿病講座及改善療程
主辦機構 : 香港糖尿康健協會
活動內容 : 免費為公眾提供糖尿病知識,檢測血壓血糖及改善療程
活動人數 : 約50人
4-6/2017
地點:香港糖尿康健協會
活動名稱 : 糖尿病講座及改善療程
主辦機構 : 香港糖尿康健協會
活動內容 : 免費為公眾提供糖尿病知識,檢測血壓血糖及改善療程
活動人數 : 約50人
Aerobic exercise, which can increase the use of oxygen to meet adequately energy demands during exercise via aerobic metabolism, is recommended for patients with diabetes. Aerobic exercise refers to a long duration (15 minutes or more), rhythmic, light-to-moderate intensity activities, such as walking, brisk walking, jogging, aerobic dance, hiking, swimming, cycling. These types of exercise are suitable for diabetic patients. On the contrary, short-term high-intensity exercise, anaerobic exercise, including all weight-bearing exercises, is relatively unsuitable for diabetics. Hormone, such as adrenaline, is secreted when doing such kinds of exercise, causing the breakdown of glycogen, which causes the blood glucose level to rise faster than the consumption of sugar. Healthy people also have transient hyperglycemia. For diabetic patients, hyperglycemia will last longer and higher.
For patients with type II diabetes, exercise is an indispensable part. The main cause of type II diabetes is insulin resistance. That is, normal concentrations of insulin are not enough to stimulate our body cells to react. Exercise can improve the body’s sensitivity to insulin, which helps the control of blood glucose. On the other hand, exercise can effectively increase the production of glycoproteins, which facilitate the sugar molecules entering muscular cells. Under normal circumstances, the number of glycoproteins increases or decreases with the amount of insulin secreted. If the patient’s insulin secretion is insufficient, the production of glycoprotein is not enough, so the sugar cannot be effectively brought into the muscular cells. During exercise, the glycoprotein is no longer restricted by insulin secretion and will increase with the exercise itself. Therefore, it can speed up the entry of sugar into muscle cells and help control blood glucose level. ¹²
Eating vegetables first can increase the feeling of fullness, reduce excessive intake of meat and grains, and can also achieve better control of blood glucose.
Instead of cream soup, it is advisable to choose a vegetable soup, which has less fat. Some kinds of sauces contain a lot of fat, such as gravy and cream sauce, should be avoided. While soy sauce, salad dressing, tomato sauce, chili sauce, etc., will increase the calories and fat of the food. Besides, they contain a lot of additives, which are harmful to health, should also be avoided. Fried rice or fried noodles are added with a lot of oil and sauce during cooking. The calories contain are far more than a healthy person needs, and these dishes are not the ideal choice for diabetics.
It is recommended to remove all visible fat or poultry skin from the meat before cooking. Low-fat cooking methods such as steaming, stewing, braising, boiling or frying with less oil should be used. Healthy vegetable oil is preferred to butter and lard. Animal fat contains a lot of saturated fat, it will increase the risk of cardiovascular disease. Try to remove all fat and oil from the surface of soup after cooking.
Fresh ingredients are the best choices, including meat, vegetables, fruits, and even seasonings. Canned and preserved foods are stored for a long time, and the nutrition of the food is inevitably lost. A large amount of sugar, oil, and preservatives are added during the manufacturing process. Such chemicals are harmful to the body. When choosing meat, lean meat should be the mainstay and fatty meat should be avoided. Eating more vegetables with various kinds increase the feeling of fullness, which can help to reduce the excessive intake of meat and carbohydrate. At least three servings (around 240 grams) of vegetables a day are recommended. Fresh ginger, onion, garlic, pepper, etc., are preferred for seasoning, pickled and preserved sauce should be avoided.
“Glycated hemoglobin” (HbA1c) is formed when glucose in the blood enters red blood cells and combines with hemoglobin. Once attached, glucose is not easily detached from hemoglobin. The average lifespan of red blood cells is 120 days. Therefore, checking the concentration of glycated hemoglobin in the blood can reflect the blood sugar control in the last 2-3 months.
Oral Glucose Tolerance Test is used to understand the body’s ability to regulate glucose metabolism and is one of the main diagnostic methods for diabetes. Normally, after taking a certain amount of glucose orally, the temporarily elevated blood sugar stimulates the increase of insulin secretion, which causes the blood sugar to drop to a normal level in a short time. When glucose metabolism is disordered, the glucose level cannot be lowered to a normal level in a short time. The amount of glucose recommended by WHO to detect glucose tolerance is 75g and the test should be made at 30 min, 1h, 2h, and 3h after taking the glucose ⁵.
Fasting blood glucose refers to the blood sugar level before breakfast (at least 8-10 hours with no food, except water), which is the most commonly used test for diagnosis of diabetes. Blood sugar refers to glucose in the blood. The blood sugar level of an individual fluctuates with eating and activities, and the blood sugar level is relatively constant on fasting, which can reflect the basic function of insulin secretion from islet β cells.
The Urine Glucose Test is a preliminary method for the diagnosis of diabetes. The method is to collect all day urine (except the first urination every day) to test with a dipstick. The glucose level in the urine of diabetes will be higher than normal.
Gestational diabetes is diabetes diagnosed for the first time during pregnancy. If it has been confirmed before pregnancy, it is not included in this category. It is similar to type II diabetes but its insulin resistance is caused by hormones (hormones) secreted during pregnancy. After the onset of gestational diabetes, the chances of developing type II diabetes will increase significantly in the future.
Type II diabetes is caused by insulin resistance in cells (in short, cells are resistant to insulin, resulting in a decrease in glucose that is involved in the production of energy inside the cell, an increase in glucose remaining in the blood), or the function of β cells are declined, or a variety of other reasons lead to insufficient insulin secretion. The age of onset of type II diabetes are usually older, typically over 40 years old, but young people suffer from obesity are also at high risk.
Type I diabetes is generally caused by the destruction of insulin-producing beta cells by the autoimmune system., or partly due to the effects of viruses, leading to the destruction of insulin-secreting cells, resulting in an extreme lack of insulin secretion, relying on external insulin (mainly given by subcutaneous injection) to control blood sugar.
The study subjects included 100 patients* with confirmed type 2 diabetes. These patients are recruited by the Association and Hefei Changgeng Hospital. The joining are voluntary and they are required to prior consult their personal doctors for the suitability to participate the study. They have to sign a “Consent Form” ensuring that they understand the entire clinical trial process, the purposes and the data collection, and the right to cancel their participation anytime at their own wish. The criteria for screening participants are as follows:
Type of Disease: Type 2 Diabetes
Age Range : 18-65 Years
Patient Gender: Not Limited
HbA1c Value: >8.5%
Other Conditions:No other serious illness except diabetes and related sickness, such as high blood pressure, high cholesterol and high triglycerides.
Each participant will go through a detailed physical examination and will be assigned a computerized patient ID number before the commencement of clinical trial. All indexes are recorded by this number and will be used as the basis for this clinical trial. All testing during the clinical trial will be performed by responsible nursing staff. On the 20th, 70th and 90th days, the patients will be required to go to the designated laboratory to verify their glycosylated hemoglobin and other indexes. Personal background, family history and all other information are processed anonymously.
*59 patients with type 2 diabetes from China and Hong Kong were eventually recruited to participate the study. Figure (A) below shows the number and age distribution of patients taking part in clinical trial research project :
Applying a science-based data analysis study of the “Natural Herbal Tea” on the prevention and treatment of type 2 diabetes under a standardized procedure and strict monitoring.
(a) Prove that the “Natural Herbal Tea” has a significant effect on improving the quality and glycosylation value of glycated hemoglobin.
(ii) Study the effectiveness of the “Natural Herbal Tea” on other body indexes such as cholesterol, triglycerides, liver function and kidney function.
During the clinical trial period, the whole process will be systematically recorded, detailed programs are set to improve the application of the “Natural Herbal Tea”, with healthy diet and appropriate exercise. The study result will be promoted to “Belt and Road” countries to benefit type 2 diabetes patients worldwide.
對於II型糖尿病患者,運動更是不可或缺的一環,II型糖尿病其中的主要成因是胰島素抵抗,即正常濃度的胰島素不足以令脂肪細胞、肌肉細胞和肝細胞產生反應,運動能提高身體對胰島素的敏感度,有助於血糖的控制;另一方面,運動能有效增加協助糖份進入肌肉細胞的攜糖蛋白的製造,在正常情況下,攜糖蛋白的數量隨胰島素的分泌量增減,若患者胰島素分泌不足,攜糖蛋白的製造也不足,因此不能有效把糖份帶進肌肉細胞;但在運動時,攜糖蛋白不再受制於胰島素的分泌,隨著運動會自行有所增加,因此能加快糖份進入肌肉細胞的速度,有助控制血糖。¹,²
口服葡萄糖測試是一種葡萄糖負荷試驗,用以瞭解身體對葡萄糖代謝的調節能力,是糖尿病的主要診斷方法之一。正常人口服一定量的葡萄糖後,暫時升高的血糖刺激了胰島素分泌增加,使血糖在短時間內降至正常水平;當糖代謝出現紊亂時,便不能在短時間內降至正常水平。現多採用WHO推薦的75g葡萄糖標準,分別檢測口服葡萄糖後30min、1h、2h、3h的血糖⁵。
(5) https://kknews.cc/zh-tw/health/2xnqoy.html
• 1970 英國大律師資格
• 1984 任大律師公會執行委員會成員
• 1994 律政署首位擔任刑事檢控專員的華人
• 1998 獲委任為香港高等法院原訟法庭法官
• 2016 獲頒授銀紫荊星章
• 退休高等法院法官
• 御用大律師、資深大律師
• 前長期監禁刑罰覆核委員會主席
• 前公眾集會及遊行上訴委員會主席
• 前監管釋囚委員會主席
• 酷刑聲請上訴委員會委員
• 前北京清華大學訪問教授
• 前香港城市大學兼任教授
• 國際警察協會法律顧問
• 香港保安業協會永遠名譽法律顧問
• 香港童軍總會童軍知友社名譽顧問
• 關顧更生人士會贊助人
• 香港足球總會球員合約糾紛決議庭主席
• 2017獲香港特區政府頒授香港銀紫荊星章
• 2014-2017被委任為懲教署署長
• 2010出任懲教署副署長
• 2010獲香港特區政府頒授香港懲教事務卓越奬章
糖尿病患者需選擇能增加肌肉使用氧氣的帶氧運動,有氧運動是指長時間(15分鐘以上)、有節奏、會令心跳率上升的大肌肉運動,例如散步、快走、慢跑、有氧舞蹈、行山、游泳、騎腳踏車等都是適合糖尿病患者的運動類型; 相反,短時間高強度運動,也就是無氧運動, 包括所有負重運動相對不太適合糖尿病人,因為在進行此類運動時,腎上腺素等賀爾蒙會分泌,造成肝醣分解,使得血糖上升的速度比醣類的消耗還要快,正常人在這種情況下,也會有短暫的高血糖發生,對於糖尿病患者,高血糖會持續得更久且更高。
先吃蔬菜既可增加飽肚感,亦能得到更好的血糖控制效果,減少過量進食肉類和穀物。
在湯類選擇方面,宜選擇菜湯或清湯,忌廉湯的脂肪含量較高。伴食的很多醬汁都含大量脂肪,例如肉汁和奶油製成的白汁,盡量避免食用,同時醬油、沙律醬、茄汁、辣椒醬等都會增加食物的熱量和脂肪且含大量添加劑,也應避免食用。炒飯或炒麵在烹調時加入大量的油和醬料,其熱量遠超出一般人所需,絕不是糖尿病人的理想選擇。
在烹調前最好先除肉類中所有可見的脂肪或禽肉的皮。應採用蒸、燉、炆、白焯或少油快炒等低脂肪烹調方法。盡量選用健康植物油,可以考慮以用低脂食材熬製的清湯作汁料,能減少烹調時使用的油分,避免用牛油和豬油等動物脂肪,因為動物脂肪含大量飽和脂肪,會增加患上心血管疾病的風險。烹調後盡量撇去湯表面所有脂肪與油分。
以新鮮食物為主, 包括肉類、蔬菜、水果、以至調味料,罐頭及加工食物經長時間儲存後,食物的營養無可避免會流失,且在製造過程中添加了大量糖、油、防腐劑等化學品,對身體有害無益。 在選擇肉類時應以瘦肉為主,盡量應避免購買腩肉、排骨等高脂肪肉類。 應多購買不同種類的蔬菜。多吃蔬菜能增加食物的體積,增加飽肚感,有助減少進食過量的情況。我們建議每天進食最少三份(約240克或6兩)蔬菜。調味料應以新鮮的薑、蔥 、蒜、胡椒等為主,避免用醃製的醬油、醬料。
「糖化血色素」(HbA1c)是指人體血液中的紅血球含有血色素,當血液中的葡萄糖進入紅血球,和血紅素結合後,就形成糖化血色素。一般紅血球平均壽命爲120天,葡萄糖附在血色素上不容易脫落,因此檢查血中糖化血色素的濃度,可以反映體內最近2-3個月的血糖控制情况。
空腹血糖是指在隔夜空腹(至少8~10小時未進任何食物,飲水除外)後、早餐前的血糖值,是診斷糖尿病最常用的檢測指標。血糖指血液中的葡萄糖,每個個體全天血糖含量會隨著進食、活動等有所波動,而在空腹時血糖的水平相對較爲恒定,能反映胰島β細胞分泌胰島素的基礎功能。
尿糖測試法是一個糖尿病的初步診斷方法,檢測尿液中含糖量的高低,做法是收集全天的尿液(除了每天的第一次排尿)以試紙進行測試,糖尿病人尿液中的葡萄糖會較正常人爲高。
妊娠期糖尿病則與II型糖尿病相似,也是源於細胞的胰島素抵抗,不過其胰島素抵抗是由於妊娠期婦女分泌的激素(荷爾蒙)所導致的,而且是在懷孕期間首次被診断出来的糖尿病。如懷孕前已確認患有糖尿病,則不納入此類別。發生妊娠性糖尿病後,將來發展成第II型糖尿病的機率大為增加。
II型糖尿病是由於組織細胞的胰島素抵抗(簡易地說,就是細胞對胰島素產生抗性,因而導致進入細胞內部參與生成熱量的葡萄糖减少,留在血液中的葡萄糖增多)、或是β細胞功能衰退或其他多種原因令致胰島素分秘不足;這類患者通常病發於年長時,一般超過40歲,但年輕人或會因爲肥胖而罹患此病,包括肥胖的兒童亦然。
I型糖尿病一般是由於自體免疫系統破壞産生胰島素的β細胞導致的,通常病發於年輕時 (小於40歲), 根據統計,這種類型僅佔糖尿病患者中的10%,由於胰臟不能産生胰島素,這種類型的患者通常需要接受胰島素注射。
可用於糖尿病藥膳的中藥有黃芪 、黨參、西洋參 、麥冬、北沙參、石斛、 玉竹、 生地黃、 枸杞子、 山藥、薏苡仁、 玉米鬚 、葛根 、三七 、杜仲等, 但這些藥物的藥性有寒熱溫涼之分, 具體功效亦有所不同, 因此應用時要諮詢註冊中醫師的意見, 根據患者的體質、證型來選用,並與適當的食物共同組成藥膳方。
針灸治療是指在中醫理論的指導下, 運用針刺和灸法以治療疾病的方法。 其中針刺包括毫針、 皮膚針、 耳針等方法,灸法包括艾條悬灸、艾柱灸等。 針灸治療糖尿病已有較長的歷史, 國內外都有有關的研究與臨床報道。 絕大多數是在藥物治療的基礎上配合針灸治療。 除了在糖尿病的早、中期可以應用針灸治療外, 某些糖尿病的併發症, 如併發心腦血管病、 下肢神經炎、 視網膜病變等亦可以用針灸治療。 對糖尿病已有皮膚感染或出現痈疽潰瘍者,則應慎用。
糖尿病患者可能會逐漸出現各種各樣的情志失調,特別是當缺乏有關糖尿病知識,或者糖尿病知識不正確時,會產生較大的壓力和焦慮,或會覺得灰心喪氣。或會有自卑、低落及悲觀的情緒,或會感到痛苦、不安、抑鬱等。這些不良的情緒都不利於糖尿病的治療和病情的控制。因此,糖尿病患者的情志調攝是相當重要的。
推拿古稱按摩,它是一種運用各種不同手法作用於人體肌表( 經絡、穴位、關節、血管、神經等部位) 進行刺激, 以防治疾病的療法。 該療法只要掌握得當, 則安全有效, 簡便易行, 既可以由專業的推拿醫師進行, 亦可以是患者及其家屬學習掌握後自行於家中實施。 該法配合藥物治療能改善糖尿病的症狀, 減緩病情發展。 例如, 糖尿病推拿療法 常用的穴位有少府、 心俞、肺俞、 太淵、內庭、三陰交 、脾俞、胃俞、太溪、太衝、 腎俞、關元、 讚竹、太陽、 晴明、風池、足三里等, 需在中醫師的指導下根據病情選擇應用。
從事運動鍛煉要適量與安全, 便於長期堅持, 如散步、 急行、慢跑、太極拳、 做操、游泳等均可, 其中散步為最安全、最可行、 最容易堅持, 每日步行2-3公里即可。 運動量是否合適, 還應視患者運動後的反應作為標準。
辨證論治糖尿病較常見的證型有肺熱津傷證、胃熱炽盛證、氣陰虧虛證、腎陰虧虛證、陰陽兩虛證與瘀血阻滯證,這些證型可單獨出現或兩個以上的證型同時出現。因此 在通過運用中醫理論對病人的年齡、體質、生活習慣、 精神狀態以及臨床症狀進行分析、辨別,確認了其證型後,就要分別採用不同的治療方藥與調理方法進行有針對性的治療。
〝凡治消之法,最當先辨虛實,若察其脉正,果為實火致耗津液者,但去其火則津液自生,而消渴自止。若由真水不足,則悉属陰虛,無論上、中、下,急宜治腎,必使陰氣漸充,精血漸复,則病必自愈。若但知清火, 則陰無以生, 而日漸清敗, 益以困矣。〞
清代醫學著作《辯證冰鑑》 描述了進食對解除消渴的意義:〝 得食則渴減, 飢則渴尤甚。〝 這些寶貴的經驗, 為今天的糖尿病行為研究奠定了基礎。 為當代學者發現谷物保護下的血糖曲線提供了文獻支持。 這是中國古代記述碳水化合物對胰島功能保護意義的臨床經驗記載。
〝凡治消之法,最當先辨虛實,若察其脉正,果為實火致耗津液者,但去其火則津液自生,而消渴自止。若由真水不足,則悉属陰虛,無論上、中、下,急宜治腎,必使陰氣漸充,精血漸复,則病必自愈。若但知清火, 則陰無以生, 而日漸清敗, 益以困矣。〞
明代李時珍撰《本草綱目》中指出,梨有治風熱、 潤肺涼心、 消痰降火和解毒之功效, 是一味治療消渴症的良藥。
唐代醫學著作《千金方》中記載了行為方式不僅是疾病的起因,也是疾病復發的原因:
〝不減滋味, 不戒嗜欲, 不節喜怒, 病已而可复作。〞
這裏的〝已〞是解決的意思 , 也就是治癒。 關於古代是否者的治癒過糖尿病的爭議, 基於錯誤控制碳水化合物後見不到康復的糖尿病患者。
在中醫經典文獻《黃帝內經●奇病論》中已經明確從行為方式上闡述消渴:〝 此肥美之所發也, 此人必數食甘美而多肥也〞 肥者, 令人內熱, 甘者令人中溝, 顧其氣上溢, 轉位消渴。《黃帝內經●奇病論》 不僅早關注行為問題近二千年, 確定消渴為行為方式疾病, 並且認為是脂肪類物質攝入過多, 主食攝入過少造成的。
最代醫學最著《諸病源候論》 在防治糖尿病的指導中直接指出了運動與進餐時間安排問題:〝 先行一百二十步, 多者千步, 然後食。 這不僅提出了通過運動治療和飲食治療來康復消渴,而且首次關注了運動量和吃飯時間的關係。 一千多年後的今天, 全世界所有的糖尿病康復指南都把運動治療和飲食治療作為最先手段。
本項目研究對象為100名証實患有II型糖尿病患者,病患經由協會及合肥長庚醫院各招募50名病患者,所有病患均為自願性,並需徵詢其個人醫生意見適合參與是項研究,並簽定 「同意書」,確保所有參與研究者了解整個實証過程、目的及所收集數據會作何用途,以及認知他們可隨時終止參與的權力,而篩選參與者的條件準則如下:
疾病種類: II型糖尿病
年齡範圍: 18-65歲
病患性別: 不限制
HbA1c值: >8.5%
其它條件: 除糖尿病及相關連的健康病歷 (如高血壓、高膽固醇及高三酸甘油脂等),無其它嚴重疾病。
每位參加者於臨床實証開始前先進行一次詳細身體檢查及由電腦編配病者編號,各項指數均以此編號作記錄,並作為本次實証的基數,臨床期間的檢查會由負責的護理人員進行,完成臨床實証後,第20天、70天及90天,參加者需再次到指定化驗所進行檢查,以驗證參加者之糖化血色素值及其它指數情況;另參加者需填寫一份個人背景資料,包括家族病史,所有資料於統計時均會以匿名方式處理。
HbA1c臨床實証研究項目最終招募了59位來自中國及香港的II型糖尿病患者參與,圖(A)是參與臨床實証的病人數目及年齡分佈:
在規範的程序和嚴謹的監控情況下,以科學為基礎的數據分析來証明“天然草本茶”對防治II型糖尿病的效用。
在臨床實証期間,系統化地記錄整個過程,並整理出一套完善應用“天然草本茶”配合健康飲食及適當運動的方案,向“一帶一路”沿線國家進行推廣,惠及全球廣大之II型糖尿病患者。