いま、1型糖尿病は
2010年03月31日
I played tennis in the morning. After that, I had lunch later than usual in a rush. In the afternoon, I enjoyed my hobby, making ceramics that I had not had time to do for a long time, and became totally absorbed in it. Around 5 p.m., I seemed to have fallen into coma-like state, and I was in a hospital when I came back to myself. A case like this could happen due to various causes.
In the above-mentioned case, the patient played tennis in the morning, which is not his routine. He ate lunch at a later time than usual, and because of that, his blood glucose level before lunch may have been quite low. As he wanted to finish the meal fast, the size of his lunch (especially the amount of carbohydrate) may have been smaller. In the afternoon, because he was completely absorbed in making ceramics, he may not have realized his glucose level becoming low. These are main reasons that could cause a case like this example. In this particular case, it was probably caused by the mixture of these three reasons.
Lessons to be learnt from developing hypoglycemia
It was not desirable that the patient accidentally developed hypoglycemia, but what is important is to analyze “why hypoglycemia occurred”. Every hypoglycemia has a cause. Hypoglycemia would never occur unless there is a cause. Therefore, having accidentally developed hypoglycemia is a good opportunity to ponder why hypoglycemia occurred.
Think about possible reasons for hypoglycemia or hyperglycemia in the order of frequency
Many patients have a hard time analyzing reasons for hypo- or hyperglycemia because there are too many possible reasons. However, if observing carefully, you should have a rough idea why a certain event is likely to cause hypoglycemia and certain food is likely to lead to hyperglycemia. But you probably cannot tell your doctor such reasons with confidence just because they are not always the case. That is exactly normal. But if you think based on frequency, you should be able to realize approximately, for example, “In my case, when I eat udon noodle, my blood glucose level tends to become lower than usual” or “I tend to develop hypoglycemia when walking my dog to walk in the evening though I am ok if I do it in the morning”.
Let’s think in the order of frequency
Thinking based on frequency is very important. In the area of medicine, the principle is to think of reasons in the order of frequency, and this is a shortcut to analysis of reasons. And with diabetes, there is cause and effect in almost all cases just as there is some kind of cause for hyperglycemia, for example.
©2010 Yasuko Uchigata
高頻度におこるか、低頻度におこるか
- いつもはやらないテニスを午前中にやって昼食が遅くなったことから、昼食前の血糖がかなり下がっていたかもしれない、
- 早く食事を済ませたかったので昼食の量(特に炭水化物)がいつもより少なかったかもしれない、
- 午後はお楽しみの陶芸を一心不乱にやっていたので低くなっていたのに気付かなかったかもしれない、
『原因がなくて低血糖になる』ことはけっしてありません。はからずも『低血糖になった』ことは、なぜ低血糖をおこしたかを考える良い機会なのですね。
ただ、「いつもそうではない」という理由で、「はっきりと主治医に言えないのです」ということでしょう。
その通りなのです。「どうも自分の場合、うどんを食べるといつもより血糖が下がることが多い」とか、「夕方犬の散歩に出ると低血糖になりやすい、朝前の散歩は大丈夫」などと、なんとなくわかっていることがあるでしょう。
医療においては、原因を頻度の高いものから考えていくのが原則で、これがもっとも近道なのですね。
そして、糖尿病には、すべてといっていいほど、原因と結果があります。
高血糖になったのなら、その原因があるように。
※ヘモグロビンA1c(HbA1c)等の表記は記事の公開時期の値を表示しています。
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