- Focusing only on fasting blood glucose while ignoring postprandial hyperglycemia
Patients are familiar with elevated fasting blood glucose, but postprandial hyperglycemia is often overlooked.
Postprandial hyperglycemia occurs in two situations: Prediabetes: Fasting blood glucose is normal or slightly high (<7.0 mmol/L), but postprandial blood glucose is elevated (7.8–11.1 mmol/L).Patients may have no symptoms, but cardiovascular damage has already begun. Higher postprandial glucose increases the risk of angina, myocardial infarction, and stroke.However, impaired glucose tolerance can often be reversed back to normal.High-risk groups — those with a family history of diabetes, hypertension, obesity, gestational diabetes, dyslipidemia, or people over 40 — should regularly monitor both fasting and postprandial blood glucose for early diagnosis and intervention with diet, exercise, or medication.
Established diabetes: Fasting glucose is high plus postprandial hyperglycemia, or normal fasting but high postprandial glucose (common).Postprandial hyperglycemia disrupts overall control and causes excessive glucose fluctuations, which significantly raise the risk of chronic diabetic complications.Patients should regularly check fasting glucose, postprandial glucose, and HbA1c based on their condition and treatment plan. - Seeing only high blood glucose while ignoring other risks
Affected by the traditional glucose-centered approach, patients often focus solely on blood glucose and ignore other risk factors, assuming that good glucose control completes treatment.
In fact, people with type 2 diabetes have multiple vascular risk factors:hyperglycemia, hypertension, dyslipidemia, obesity, and hyperinsulinemia.These factors interact and further increase cardiovascular risk.Type 2 diabetes is now recognized as a metabolic syndrome, not just a disease of high blood sugar.
Therefore, controlling glucose alone is insufficient.A comprehensive approach is required: managing blood pressure, regulating lipids, reducing weight, antiplatelet therapy, quitting smoking, and limiting alcohol.This reduces the morbidity and mortality of cardiovascular diseases in type 2 diabetes. - Relying only on oral drugs and refusing insulin
Many patients believe insulin is a last resort for type 2 diabetes.
In reality, hyperglycemia implies insulin deficiency (absolute or relative).A landmark UK prospective diabetes study gave an important lesson:“We did not use insulin early enough or intensively enough, which is one major reason for low glycemic control rates worldwide.”
The concept of early insulin use is underpromoted and misunderstood (e.g., fear of addiction or dependence).Studies show diabetic complications are closely linked to glucose control: in the absence of hypoglycemia, the closer to normal, the better.When oral agents fail, adding insulin promptly improves control and delays beta‑cell failure.There are almost no absolute contraindications to starting insulin in type 2 diabetes.
Recommendation: One oral drug insufficient → consider insulin
Two oral drugs insufficient → should use insulin
Three oral drugs insufficient → must use insulin
Insulin regimens should be patient-centered, with individualized initiation and titration.
- Overemphasizing medication while neglecting diet and exercise
Many patients believe medicine alone can manage diabetes, which reflects poor understanding of the disease.
Diet and exercise are the foundation of glucose control; medications are for when lifestyle changes are not enough.All patients, regardless of diabetes type, need a scientific diet plan at all times.Without proper diet therapy, ideal diabetes control is nearly impossible.Individualized plans should consider diabetes type, complications, activity level, and weight.
Exercise is equally critical:it improves insulin sensitivity, increases glucose uptake and utilization, lowers blood glucose and LDL‑C, raises HDL‑C, strengthens cardiopulmonary function, and improves peripheral circulation. - Unreasonable eating leading to nutritional imbalance
Some patients eat freely before diagnosis, then overly restrict or eat improperly afterward. Some eat only noodles and vegetables without controlling total intake, not realizing many grains are 60%–70% carbohydrates; excess still raises glucose.
Others eat large amounts of soy products but little staple food, which over time may damage renal function and harm glucose control.
Scientific diabetes diet principles:Maintain a normal diet structure, control total calories, eat small frequent meals, and choose high-fiber foods.Eat regularly with balanced nutrition.
When blood glucose is well-controlled, patients can have moderate amounts of low-sugar fruits:apples, pears, strawberries, kiwifruit.Cucumbers and tomatoes can also serve as fruit alternatives.