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00:00:03

Good afternoon, dear friends, today we have a

00:00:05

live broadcast, a live broadcast on the topic of diabetes

00:00:09

mellitus, blood vessels, cholesterol, we are talking about

00:00:12

how to reduce sugar, how to reduce

00:00:15

cholesterol in diabetes mellitus in order

00:00:18

to maximally preserve healthy

00:00:20

blood vessels, a healthy heart and, of course,

00:00:23

keep yourself in excellent active

00:00:25

health for a long time years and the company

00:00:28

together with the endocrinologist

00:00:31

Doctor of Sciences Ovsyannikova

00:00:33

Konstantinovna, as usual, the first 20-30

00:00:37

minutes we talk about the topic of the broadcast and

00:00:40

then answer your questions. We see

00:00:43

that there are already a lot of questions in the chat. As usual,

00:00:45

we will answer from the first question and

00:00:47

further. Therefore, we actually start the

00:00:49

live broadcast and we start with blood sugar

00:00:52

Why does blood sugar directly affect blood

00:00:56

vessels? If we look at the vessel as

00:00:59

usual, draw it, I’ll actually look

00:01:02

at the structure of the blood vessels, the vessel has an

00:01:05

internal exhibition, this is the endothelium. And the

00:01:09

state of the endothelium, the internal

00:01:11

lining of the blood vessels, is directly affected by

00:01:15

blood sugar. That is, when we have normal

00:01:17

sugar. five Six seven eight

00:01:21

then, accordingly, it in no way

00:01:24

affects the endothelium of blood vessels when sugar

00:01:27

rises 9 10 sugar begins to

00:01:30

damage the endothelium of blood vessels The higher the

00:01:35

level of blood sugar, the more active

00:01:37

the damage to the endothelium is internal

00:01:40

Vascular removal blood sugar 10 is

00:01:43

actually the sugar that damages blood vessels,

00:01:45

that’s why it is called

00:01:46

renal threshold, that is, we see sugar in the

00:01:49

urine because due to damage to the

00:01:51

kidney vessels, sugar passes through the urine,

00:01:54

so ten is the renal threshold,

00:01:56

sugar level 13

00:01:58

is the so-called level of Glucose

00:02:01

toxicity, that is, intoxication

00:02:03

of the body with increased sugar, that is,

00:02:06

sugar 13 above actively damages the

00:02:09

endothelium, respectively damaged

00:02:12

endotheliums begin to deposit cholesterol in us.

00:02:14

That is, this is the very

00:02:17

damage to blood vessels from atherosclerosis,

00:02:19

coronary heart disease, stroke, heart

00:02:22

attack, this is largely

00:02:24

due to damage,

00:02:25

we understand that not only sugar is also

00:02:28

inflammatory processes, intoxication, all

00:02:31

this also defeats endotheliums, but in

00:02:32

diabetes the main damaging factor is a

00:02:36

high level of blood sugar, that is, the

00:02:38

first

00:02:39

damage is the second, an increased level of

00:02:42

blood sugar, the blood is thicker, viscous,

00:02:45

like sugar syrup, that is,

00:02:48

blood circulation is disrupted, respectively, the risks

00:02:51

of strokes, heart attacks, all

00:02:53

cardiovascular events. They, of

00:02:55

course, grow along with the increase in blood sugar,

00:02:58

that is, the first is the level Blood sugar,

00:03:01

what else is important, not only the sugar itself is important,

00:03:05

but the stability of sugars is also important. There is

00:03:08

such a thing as

00:03:10

glycemic variability. What is

00:03:12

glycemic variability? This is the difference between the maximum

00:03:15

and minimum sugar during the day, that

00:03:19

is, if our sugar is stable five,

00:03:22

six, seven, eight, that is,

00:03:25

the variability is small ideal

00:03:28

variability is 3 millimoles per liter,

00:03:30

for example, when we have a minimum sugar level of

00:03:32

five during the day, a maximum of

00:03:34

eight. That is, constantly stable

00:03:36

sugar with a stable Sugar state of

00:03:39

the blood vessels, the state of the nerves is simply

00:03:42

excellent, there will be no complications

00:03:44

even if our sugar is slightly higher than

00:03:46

optimal, for example, seven eight

00:03:49

nine ten Yes, it is not ideal, it

00:03:52

reaches 10, but in general there are jumps in sugar

00:03:56

up and down hypoglycemia We do not, that

00:03:59

is, we have stable sugar, stable

00:04:02

sugar preserves blood vessels and nerves. If the

00:04:04

variability of glycemia is huge, that is,

00:04:07

we have sugar, then 3 millimoles per liter, then 15

00:04:10

millimoles per liter, that is, we go into

00:04:12

hypoglycemia, we shake Yes, if we

00:04:15

feel it, then our sugar is wildly

00:04:18

high 15 17 these sugar surges

00:04:21

damage the blood vessels to the maximum,

00:04:23

damage the nerves to the maximum As a result,

00:04:26

we have both damage to the cardiovascular

00:04:28

system and damage to the nervous system that is,

00:04:30

we are moving by leaps and bounds towards

00:04:32

complications of diabetes, so when we

00:04:35

donate glycated hemoglobin to the

00:04:37

average blood sugar indicator for the

00:04:39

last three months, it is important for us not

00:04:42

only the numbers of glycated glycated glycated

00:04:44

cannot be a good example of six 6

00:04:47

and 3 to what corresponds to

00:04:49

compensated diabetes if with this

00:04:51

Our glycines are tight, we are shaking, our

00:04:55

sugar is three or 25 to God forbid,

00:04:58

our sugar is 15,

00:05:00

that is, a wild range of sugars, huge

00:05:03

variability, complications of diabetes

00:05:05

will break down very quickly 35 years Why are

00:05:08

many people who are diagnosed with

00:05:10

type 2 diabetes already at diagnosis have

00:05:14

polyneuropathy damage to the nervous system,

00:05:17

for example, polyneuropathy of the lower

00:05:18

extremities when they are less cold legs,

00:05:22

tingling sensations, poor sensitivity

00:05:24

in the legs because a person has

00:05:27

not seen a doctor for several years with these

00:05:29

increases in sugar, he has eaten enough carbohydrates to the point of

00:05:33

buckwheat porridge or potatoes 13

00:05:36

we often don’t feel high sugar and in the end

00:05:39

when he comes to the doctor he is just

00:05:42

diagnosed with diabetes, he already has

00:05:44

complications of diabetes, it’s just

00:05:46

these spikes in sugar, so friends,

00:05:49

when we talk about compensated

00:05:51

diabetes, it’s not just

00:05:53

blood sugar testing every three months, it’s

00:05:55

sugar control both on an empty stomach and after meals, and

00:05:59

this is not only two hours after

00:06:01

eating When you have a Blind spot 3060 90 120

00:06:05

minutes these are more frequent measurements of sugars

00:06:08

Why when we select a diet we will

00:06:10

now install either dex.com monitors

00:06:13

continuous monitoring of glycemia

00:06:15

delicacy Constantly working with Libra will give

00:06:17

it to patients because what

00:06:19

will be 30-40 60 minutes after eating

00:06:23

affects the blood vessels in exactly the same way as it will be

00:06:26

after two hours if your diet is not

00:06:29

selected, after 30 minutes you have a

00:06:31

jump in sugar complications of diabetes

00:06:34

you will get even with good glycation,

00:06:36

that is, it is very important to choose the right

00:06:38

diet and therefore We are so popular at the

00:06:41

diabetes school where the doctor selects a diet

00:06:44

for you according to your type of diabetes and your type of stress,

00:06:47

then he guides you through this diet and

00:06:48

adjusts your therapy to achieve

00:06:51

ideal Sugars both before meals and immediately after

00:06:55

meals two hours after meals so that you

00:06:57

have sugar throughout the day

00:07:00

sugar was determined sugar on an empty stomach

00:07:02

sugar after eating 30-60 90 120 minutes

00:07:06

normal parameters and glycated

00:07:09

hemoglobin this all directly affects the

00:07:12

condition of the heart and the condition of blood vessels

00:07:16

Good afternoon,

00:07:18

but except for what Olga Mikhailovna

00:07:22

said absolutely everything was correct in reality Glucose

00:07:24

itself Glucose, of course, on the condition of the

00:07:27

state of the blood vessels also affects the development of

00:07:29

cardiovascular complications of

00:07:30

diseases and other

00:07:32

parameters, this is primarily the

00:07:35

state of lipid metabolism. Unfortunately,

00:07:39

most people who have a

00:07:42

disorder of carbohydrate metabolism, that is,

00:07:43

diabetes mellitus. Unfortunately,

00:07:46

almost all of them also have a

00:07:49

disorder of lipid metabolism.

00:07:51

together, especially with

00:07:55

overweight, in only one percent of

00:07:58

overweight patients we see a

00:08:01

normal lipid profile, that is,

00:08:03

normal lipid levels. Unfortunately,

00:08:05

99 percent of patients have lipid changes,

00:08:09

friends. I want to say right away that when I

00:08:12

say lipids, I mean

00:08:14

that we look at all fractions of cholesterol,

00:08:17

just total cholesterol as unfortunately, they are

00:08:19

still looking at several

00:08:22

clinics are not indicative Why

00:08:24

total cholesterol consists of good and

00:08:28

bad bad cholesterol is LDL, in

00:08:31

short, what you see on

00:08:34

low-density printouts This is a bad amount of

00:08:37

HDL or high-

00:08:40

density proteins, these are good protective

00:08:42

cholesterol, the more there is, the more better.

00:08:45

It is desirable, of course, that it be higher than

00:08:47

one and a half. Well, at least higher there are 1.

00:08:50

Below 1, this is considered to be low and the

00:08:54

LP The lower the better for each

00:08:59

person, when we see the first time

00:09:02

a patient comes to us, we tell him what the goals are,

00:09:05

what sugar goals you should have

00:09:07

sugar on an empty stomach Two hours after eating, the

00:09:10

public's goal for hemoglobin and, of course,

00:09:13

also goals for lipids and blood

00:09:16

pressure, so for lipids, the average

00:09:19

LDL goal that we want to see is less than

00:09:22

two and six if the

00:09:24

patient is in the average

00:09:27

risk group, that is, this is for young people less than

00:09:29

one and eight if the patient is at

00:09:32

high risk for the development of

00:09:34

cardiovascular diseases That is,

00:09:37

if he has Multiple factors of

00:09:42

vascular pathology, that is, smoking,

00:09:46

overweight, aversion,

00:09:49

heredity for cardiovascular

00:09:51

disease and others, or already

00:09:53

identified vascular suppression,

00:09:57

climatic plaques and less one out of

00:10:00

three if the patient has recently had a heart attack

00:10:03

within a year the patient has had a

00:10:05

myocardial infarction very strict goals less than one

00:10:07

and four and of course we want our

00:10:11

patients to achieve these goals the

00:10:14

question arises Is it always necessary to

00:10:16

use satin because well, a

00:10:19

lot of people when you tell them prostatino

00:10:23

negative reaction No, statins are not always

00:10:27

prescribed only by a doctor We ourselves

00:10:29

do not self-medicate, articles on

00:10:31

this are official

00:10:33

medications Yes, of course We have

00:10:36

dietary supplements that lower

00:10:39

sugar and medications other than

00:10:41

statins We have some Fields of

00:10:45

unsaturated acids, among which this is a

00:10:49

medication U We have

00:10:51

drugs that also act on the 3

00:10:54

facial

00:11:00

for those people who eat a lot of

00:11:02

fatty foods, of course they can be

00:11:04

adjusted in their diets if they are not very

00:11:06

high. But if the drugs act

00:11:09

specifically on the engine, it is a fenofibrator and

00:11:12

will darken

00:11:14

which acts on both LDL and 3

00:11:18

facial drugs. We also

00:11:22

prescribe statins, but here the analysis depends

00:11:26

on the patient, for example, two cases, I’ll

00:11:29

quickly tell you everything. One patient

00:11:32

comes in overweight, for example, in

00:11:35

the environment, weight is 90 kilograms, he has

00:11:39

slightly elevated

00:11:42

total cholesterol or low density 4 When the goal,

00:11:46

for example, is below 26, of course, I tell him

00:11:50

that we first, we will try

00:11:51

to adjust your diet, adjust your

00:11:54

lifestyle, add physical exercise for three

00:11:56

months, we will observe and see whether the

00:12:00

lilac goes down for almost all

00:12:02

those who follow the recommendations, cholesterol

00:12:05

decreases, if necessary, we will add

00:12:07

more

00:12:08

biologically active supplements and after

00:12:11

three months we will do the control; the second

00:12:13

option comes a thin patient and

00:12:17

we see cholesterol, for example 7 8 or

00:12:20

covered with Deniska density about

00:12:22

Pyaterochka, a thin patient where

00:12:25

he has high cholesterol from, you begin

00:12:28

to communicate, he says, my father was 45 years old, it is a

00:12:30

fact that means there is a hereditary

00:12:33

factor here and most likely there is a

00:12:37

mutation in which was passed on to this

00:12:40

Patient that led to high

00:12:42

cholesterol levels Of course, we will

00:12:45

already give this Patient statins, that is, we will look at

00:12:47

his blood vessels. There will probably be an

00:12:50

atherosclerotic plaque; we

00:12:52

won’t wait until this patient

00:12:54

has a heart attack just like his father at a

00:12:56

young age, right away with

00:13:00

our articles, then a lot

00:13:02

depends on the patient; there is no such thing that

00:13:06

we give to everyone statins, so friends, please

00:13:08

watch your lipids How often at

00:13:11

least once a year is better than once six months,

00:13:14

if we see high levels then once three

00:13:18

months But besides cholesterol, the

00:13:21

inflammatory factor also affects the

00:13:23

condition of the vascular wall, as

00:13:25

for the condition of the vessels, why are now the

00:13:28

last 2- For 3 years on the Internet we have been reading

00:13:31

a lot of articles about how it is that

00:13:33

one person’s cholesterol is seven to

00:13:35

eight, that is, high, inadequately

00:13:37

high, healthy and he has no strokes or

00:13:40

heart attacks, we have been living comfortably for 80 years

00:13:43

with such high cholesterol,

00:13:45

while another person has cholesterol, for example a

00:13:48

four or even a three, even with

00:13:50

statins, he has strokes, repeated

00:13:53

heart attacks, repeated That is, how is it that

00:13:56

everything seems to depend on cholesterol, why does

00:13:59

one with a high 4 name have no heart attacks, strokes,

00:14:01

and the other, with good

00:14:03

cholesterol, have heart attacks, strokes because it

00:14:06

depends not only on cholesterol

00:14:09

cardiovascular events, that is, before

00:14:11

cholesterol is one of the factors,

00:14:14

blood sugar is what we discussed with you, this is

00:14:17

also one of the factors, but we must

00:14:19

understand that the vessel wall It is not only

00:14:25

exposed to the influence of cholesterol and sugar, it is also the direct

00:14:28

state of the vessel wall, that is, the

00:14:30

muscular endothelium layer of elasticity of the

00:14:34

vessel, that is, the vessel is calcified Yes,

00:14:38

it is hard It ruptures easily due to this

00:14:40

stroke as one of the factors is either the

00:14:43

soft elastic wall of the vessel and then there is

00:14:46

the level of protein the level of vitamins

00:14:48

microelements vitamins

00:14:52

affect the condition of the vessels frequent

00:14:56

bruises often people come say

00:14:58

doctor I’m just I have

00:15:01

a bruise on my chair Why a bruise because And this is the

00:15:04

viscosity of the blood about this what is much

00:15:06

more important is the vascular wall if the

00:15:09

vascular wall is weak a person really has

00:15:12

bruises That is why Yes, one person

00:15:14

goes to training, goes to a hard

00:15:17

massage and at least henna in general everything is

00:15:18

fine another literally yesterday

00:15:20

the patient said I went to a

00:15:22

hydromassage. I came home and all my

00:15:25

legs are blue, all my legs are bruised. But

00:15:28

what does this mean that the vessels are so weak

00:15:30

that even minor damage has a

00:15:33

significant effect, a light massage

00:15:35

damages the wall of the vessel, that is,

00:15:38

hello Yes, this is a candidate for strokes

00:15:40

future

00:15:42

vessel wall plus pressure suppression

00:15:45

to the distance Shala Konstantinovna will tell that

00:15:48

pressure surges also defeat the

00:15:50

walls of blood vessels, these are also the risks of strokes

00:15:52

But what is also important is

00:15:56

inflammation, that is, many

00:16:00

overweight patients look at their tests before a

00:16:03

general blood test ESR rate here is

00:16:05

not red blood cells one of main markers of

00:16:09

inflammation reactive protein fibrinogen

00:16:12

marker inflammation homocyst marker

00:16:14

state of the endothelium we look at these

00:16:17

parameters and see just scale

00:16:19

inflammation the person says I didn’t

00:16:21

have a cold my joints don’t hurt Yes Everything is

00:16:24

fine my throat doesn’t hurt

00:16:26

where our fatty

00:16:29

tissue actually comes from metabolically active

00:16:31

tissue that produces not only

00:16:34

hormones, which also produces

00:16:37

biologically active substances,

00:16:40

including markers of inflammation, and in many

00:16:42

overweight people,

00:16:45

excess weight provokes

00:16:47

inflammatory processes and that is why

00:16:50

many overweight people are

00:16:52

candidates for coronary heart disease and

00:16:56

strokes. heart attacks Because there are many

00:16:58

inflammatory markers that damage the

00:17:01

endothelium, the inner lining of the vessel, and

00:17:04

why now they say that your weight mixture,

00:17:07

your heart attack leaf will decrease five times, but

00:17:09

because this is really how we lose

00:17:11

weight, our level of inflammatory markers decreases,

00:17:14

this is very clearly visible from the

00:17:16

analyzes this is very cool, the patient

00:17:18

comes there soy scale scale fibrinogen

00:17:22

scale scale we are losing weight and the person comes

00:17:24

in six months says the doctor look

00:17:27

everything is back to normal I didn’t go anywhere

00:17:29

or do anything I just followed

00:17:31

your diet the drug is real so these are

00:17:34

markers of inflammation plus when decreasing

00:17:37

weight decreases, insulin resistance levels

00:17:39

out, sugar levels out if we lose weight

00:17:43

against the backdrop of an adequate diet, we also have the advantage

00:17:45

of decreasing cholesterol and also blood pressure.

00:17:47

The greater the body weight, the higher the

00:17:50

level of pressure. A weight loss of 10

00:17:52

kilograms on average leads to a decrease in

00:17:55

pressure by 10 millimeters here per column.

00:17:58

there are all the risks that affect

00:18:01

the vessels of the heart

00:18:03

decrease with weight loss, this is

00:18:07

very important when it comes to the treatment of atherosclerosis.

00:18:09

We not only look at cholesterol

00:18:12

markers of inflammation, but we must definitely

00:18:15

look at the condition of the vessels, ultrasound of the vessels of

00:18:18

the neck, ultrasound of the coronary vessels of the vessels of

00:18:21

the heart, ultrasound of the vessels of the lower extremities

00:18:23

if we see that the vessels already have plaques, that

00:18:27

is, cholesterol is already deposited on the

00:18:29

vessels, then you need to work quickly,

00:18:32

you need to actively level out the cholesterol.

00:18:34

Clearly, we level out the sugar, and so

00:18:36

it is if we see that the vessels are clean, that

00:18:39

is, there are no plaques, everything is fine in the vessels, we

00:18:43

can change the diet more slowly, take

00:18:46

Omega, take

00:18:48

garlic and so on and with softer

00:18:51

methods, that is, the choice of tactics for

00:18:54

cholesterol will directly depend on

00:18:56

what is happening in the vessels, that is, an ultrasound is

00:18:59

not necessary. And of course,

00:19:01

if you already have damage to blood vessels

00:19:04

or atherosclerosis, then we do an ultrasound once a

00:19:07

year. That is, in principle We must monitor any conditions

00:19:08

that are already pathological,

00:19:11

but in particular, ultrasound

00:19:13

is once a year if it is clear that sugar is

00:19:15

glycated to sugar every day,

00:19:17

in diabetes, glycated cholesterol is monitored

00:19:19

once three months, depending on the

00:19:22

degree of increase, once twice every three months,

00:19:25

we also monitor this, ideally we

00:19:28

really reduce the good They think

00:19:32

that something itself will not fall I

00:19:34

really liked Olga Mikhailovna

00:19:36

told you in great detail about the vessels and

00:19:40

friends I want to say I love the phrase of our

00:19:42

cardiologists that the

00:19:44

quarantine vessels are the carotid arteries, then

00:19:48

we look at this mirror of the vessels

00:19:52

the heart if there are plaques in the vessels necks they

00:19:57

Surely have a look

00:19:59

It’s just like she’s rogafil this is, let’s say,

00:20:02

more complex studies

00:20:05

Therefore, it’s better for all patients

00:20:09

who have an epidemic, that is, a

00:20:11

cholesterol disorder in the exchange, there is once a year

00:20:13

necessarily Come follow to leave

00:20:17

Ultrasound of the vessels of the neck Especially to the increase in

00:20:21

smokers several times higher risk

00:20:24

of education Therefore, if you want

00:20:26

to understand if you have plaques, many

00:20:28

patients, when

00:20:30

prescribed, doubt whether they are needed. I

00:20:33

always advise let's look at the ultrasound of

00:20:36

sleepy actors, there are plaques, they have

00:20:40

a heart, well, then why wait?

00:20:42

So, besides lipid metabolism, inflammation of

00:20:46

normal Sugars, of course we need What is

00:20:48

also important is the normal level,

00:20:51

friends, the level of blood pressure

00:20:54

very much depends on age; for

00:20:57

older patients, this is 80 plus years,

00:21:02

we do not try to achieve pressure below

00:21:05

120, as well as the ideal Sugars, about

00:21:08

six. That is, what we want to

00:21:10

see in young active ones. For

00:21:13

older ones, what are we We are not striving for goals

00:21:16

here, it is important that the main thing is

00:21:18

stability, that is, for people under 80 years old, the

00:21:22

ideal blood pressure level

00:21:24

that we want to see is up to 130

00:21:28

systolic up to 85 and remain Upper

00:21:33

Lower pulse frequency of sitting contractions

00:21:36

up to 70 ideally without stress in a quiet

00:21:40

body position for five minutes we sit, we do

00:21:44

n’t talk to anyone, we don’t watch

00:21:46

TV, we don’t get distracted, we don’t eat, we don’t

00:21:49

drink tea, and then we only measure

00:21:51

blood pressure, that is, then we

00:21:53

can say that these indicators are

00:21:55

adequate; we definitely

00:21:57

record

00:21:59

the pulse in the morning and evening on the dominant hand;

00:22:02

unfortunately, most patients do

00:22:04

not I know this concept: What is a

00:22:05

dominant squirrel? This is the one on which the

00:22:08

pressure is higher, that is, believe me, everyone

00:22:10

at home, the pressure is three times on the right hand,

00:22:13

three times on the left hand, according to the rules

00:22:16

that I just said.

00:22:17

Look on which hand your pressure is

00:22:20

higher and on this hand it is always death and

00:22:22

the doctor you say when you come to the

00:22:24

appointment that on this arm my pressure is

00:22:26

higher than normal, in all people the pressure

00:22:30

on the arms is a little different up to 10

00:22:33

millimeters if it’s higher than 10. So there is, let’s

00:22:36

say, more severe

00:22:38

vascular damage on this side

00:22:41

for young people, I’ll repeat it again we want to

00:22:44

see the pressure, ideally, about 120 for those

00:22:48

who do not have

00:22:49

any diseases. Oh, for example, those who do

00:22:53

not have renal

00:22:59

vascular diseases, the goals are somewhat different. But

00:23:03

for the general mass, for the general population,

00:23:06

which accounts for 95 percent of people,

00:23:08

these are exactly such goals and friends again

00:23:11

I repeat that the main thing in everything is stability,

00:23:14

that is, for us, pressure. It is also important that

00:23:17

during the day, not only during the day, not only

00:23:20

in the morning, but throughout the whole day, it

00:23:23

remains. At this level, jumps from 110

00:23:26

there to 160 are not physiological, no worse

00:23:30

than the pressure is constantly around 130 and

00:23:34

Of course, blood pressure therapy is selected

00:23:36

only by doctors, not I heard it from a friend, I

00:23:39

heard it on TV Unfortunately,

00:23:41

self-medication is very common. Why Because there are a

00:23:44

lot of antihypertensive drugs and

00:23:48

each group has its own indications,

00:23:49

paid indications, so please

00:23:51

monitor the level of sugar, lipids,

00:23:55

markers of

00:23:57

inflammation in this condition in the end

00:24:00

active protein in a biochemical

00:24:02

blood test and in a general blood test is a litter of

00:24:05

main indicators. In general, there are a

00:24:08

lot of them, but the main three and the level of

00:24:10

blood pressure, all this together

00:24:12

leads to good health and

00:24:15

reduces the risk of developing

00:24:16

cardiovascular complications, that is, heart

00:24:18

attacks, stroke and mixed

00:24:21

Let's move on to answers to questions

00:24:24

who ask about diets and schools

00:24:27

Go to the website Olga Pavlova of the Russian Federation for three

00:24:29

days we have opened a discount on the diabetes school,

00:24:31

including on the tariff, I will consult a

00:24:33

doctor with a doctor so who needs it

00:24:36

Go to the site only Pavlova register there

00:24:40

I’ll be on the next one month too Olga

00:24:42

Mikhailovna has opened a few places by registering,

00:24:45

but if you want, have time, and who wants

00:24:48

money, including a doctor of sciences,

00:24:51

please have time with us, because they’re

00:24:52

not old, they converge quickly, he’s already here who

00:24:54

managed to get money from a cool

00:24:57

doctor, so Valentina writes for diabetes

00:25:00

II like if you fast for one day,

00:25:02

take or head the Farsi estimate, you as

00:25:04

usual or not, but as

00:25:06

for fasting, we have said many times

00:25:08

that with diabetes, especially if

00:25:10

there is a concomitant pathology, fasting

00:25:13

is better, soft fasting days, if you

00:25:16

are thinking about complete fasting, this is

00:25:18

fasting on water or this is a complete

00:25:21

exclusion of digestible carbohydrates, that is, 0

00:25:24

bread units before such fasting, a

00:25:26

full examination, consultation with the

00:25:28

attending physician because most often

00:25:31

fasting with diabetes will give you more

00:25:34

negative effects in the form of a drop in sugar

00:25:36

Cortisol surges Insulin surges

00:25:39

Pressure surges than mild

00:25:41

fasting days, so

00:25:43

I would fast for diabetes still, I wouldn’t recommend it

00:25:46

only if you have very mild diabetes, if there are no

00:25:48

concomitant pathologies, if your attending

00:25:50

physician allows you to fast on

00:25:52

glucose-lowering medications, Galvus honey is a

00:25:55

mild drug, if there is no hypothyroidism,

00:25:57

if there is no adrenal gland or

00:25:59

insufficiency of liver disease, it does not

00:26:01

drop sugar, we are not canceling it anywhere, the

00:26:03

same thing is forcing the forcely effect goes

00:26:06

through the kidneys, the excretion of sugar in the urine,

00:26:09

the glucose-dependent forceful effect begins

00:26:11

to work, expelling blood in the urine when the

00:26:14

Sugar is above six. That is, even if

00:26:16

you have a restrictive diet, a fasting

00:26:19

day or you are fasting,

00:26:22

the doctor who saw your tests of the forcey

00:26:26

when the Sugar is below six does not give a special

00:26:28

effect, therefore it doesn’t go anywhere

00:26:30

even if we don’t sit there or God forbid it

00:26:33

goes hungry

00:26:34

further Diana

00:26:36

fioletin 20 fioletin low If

00:26:40

you have the usual standard

00:26:42

laboratory reference values from

00:26:45

10-15 there up to 150 usually then of course 20

00:26:49

for these values is very nice B12

00:26:52

is not bad but you can higher Folic low

00:26:55

also with standard Can this affect the

00:26:59

functioning of the thyroid gland increase

00:27:01

TSH Yes, again the question may be how much does

00:27:04

your TSH increase if you have

00:27:06

advanced

00:27:07

hypothyroidism Well, let's say TSH is straight

00:27:10

high closer to 10, then here you also need to

00:27:12

look at antibodies to TPO as the most a common

00:27:15

cause of hypothyroidism to rule out

00:27:17

autoimmune thyroiditis look at an ultrasound of the

00:27:19

thyroid glands if your TSH is in the

00:27:22

region of 4.5 to 5 then most likely you have a

00:27:26

deficiency

00:27:27

of microelements, there will probably also be a

00:27:31

deficiency of zinc and Selenium are often deficient.

00:27:34

They go together and your folic acid

00:27:37

is low Yes, maybe here it is necessary to close

00:27:39

these deficits by raising filitin That is,

00:27:43

this is firstly a correction of nutrition -

00:27:47

red meat One of the best, let's say,

00:27:51

means for saturating the body with

00:27:54

iron and ferritin 20 are already here and

00:27:57

iron preparations, at least

00:28:00

in tablets, you can think about intravenous

00:28:03

administration, but here you still need a general

00:28:06

blood test, you definitely need to look

00:28:08

at the hemoglobin level, there is no iron

00:28:10

deficiency and of course there is also the level of iron in the

00:28:14

serum. That is, you need to get

00:28:15

iron, a general blood test for hemoglobin

00:28:19

and if TSH is closer to 10, the

00:28:23

obligatory gland and with all these

00:28:26

examinations

00:28:28

Olga asks about tyrosine what kind of

00:28:31

supplement is this an amino acid from which A the

00:28:34

thyroid hormones

00:28:36

Thyroxine 3 tyranine are produced and B from tyrosine

00:28:38

neurotransmitters are produced, in

00:28:40

particular Dopamine, the neurotransmitter of

00:28:42

pleasure, motivation, therefore the

00:28:43

amino acid tyrosine is used both in

00:28:46

endocrinology, in particular in the treatment of

00:28:48

reduced thyroid function, syndrome of

00:28:51

minimal or mild hypothyroidism,

00:28:54

and in neurology when correcting various

00:28:56

neurological disorders with a decrease in the

00:28:59

emotional background, and so on

00:29:01

Olga also asks how amino acids

00:29:03

on an empty stomach start to hurt the stomach and a

00:29:05

strong burning sensation in the esophagus amino acids

00:29:08

are protein if there are no severe

00:29:11

problems in the gastrointestinal tract ulcer

00:29:13

exacerbation of gastritis exacerbation then there

00:29:15

should be no such reaction In general,

00:29:17

amino acids are normally taken 5-10 minutes

00:29:21

before meals, if on an empty stomach in the morning it causes

00:29:24

discomfort, we can please drink before

00:29:26

dinner in the evening, you don’t need to drink amino acids

00:29:29

because it gives a stimulating

00:29:31

invigorating effect, if they cause movement,

00:29:33

then this may be a reaction to a

00:29:36

specific Baht of a specific manufacturer

00:29:38

because they are different supplements, in addition to

00:29:40

amino acids, there is always a preservative

00:29:44

stabilizer capsule and very often a

00:29:46

reaction to vitamins to amino acids is

00:29:50

not a reaction to the active substance, but a

00:29:53

reaction to a low-quality preservative

00:29:55

stabilizer or shell. That is, when

00:29:58

you tried some vitamin or

00:30:00

some amino acid that

00:30:01

Dr. Poe prescribed to you the indications you see are

00:30:04

bad, just change it and the

00:30:06

manufacturer very often, depending

00:30:08

on the quality of the production and the

00:30:11

quality of the accompanying substances of the tablet,

00:30:14

there will be a reaction to the tablet the same or

00:30:16

another, there may be a negative reaction from the

00:30:19

gastrointestinal tract specifically to the shell on the

00:30:21

preservative drug they are to the

00:30:23

drug itself Although allergies can be on

00:30:25

any product

00:30:27

under densitometry,

00:30:30

hip

00:30:32

osteopin, I’ll get osteoporosis for being drunk.

00:30:36

Why is it exactly necessary to

00:30:39

eat as a class or is there something else,

00:30:41

look Firstly, we are

00:30:43

interested in age, and secondly,

00:30:45

you have already been diagnosed with osteoporosis

00:30:48

according to the criteria But usually we also

00:30:52

look at the third point this is

00:30:54

the spine, that is,

00:30:57

I’m surprised why you have two points, but at two

00:31:00

points you still already

00:31:02

have osteoporosis. Yes, in your case, treatment with

00:31:07

medication should definitely be started

00:31:09

according to the decision of the drug. Now there are a

00:31:12

lot of classes, and in addition to

00:31:15

injectable drugs, there are

00:31:17

tablet drugs. But which one

00:31:20

is right for you?

00:31:22

Only a doctor can decide after seeing all your tests here,

00:31:24

don’t forget to please also get calcium

00:31:27

before you drip A class Because

00:31:30

if you have hypocalcine, that is, a low

00:31:32

level of calcium in the blood and drip about

00:31:34

class which drives calcium into the bones

00:31:36

from the blood Well, you can get undesirable

00:31:41

effects and I remind you that it can very well

00:31:43

occur in the first two days. Run for a

00:31:46

similar syndrome, so of course

00:31:48

we only drip in a

00:31:51

day hospital or a 24-hour hospital,

00:31:54

not so much at home, to determine which

00:31:56

drug is right for you, you need to see a

00:31:59

more complete examination. This

00:32:01

can only decide, but the drip is already yes All

00:32:06

drugs for the treatment of osteoporosis are not

00:32:08

tough enough, they are strong and do not give a

00:32:10

definite reaction, that is, you need to

00:32:12

look at the liver function of the kidneys.

00:32:17

Serious drugs in no case

00:32:20

if only after a full

00:32:22

examination, this is

00:32:23

how the question turns out,

00:32:26

Ekaterina Olga Mikhailovna writes, hello,

00:32:28

40 years old insulin 19

00:32:31

insulin resistance we have vitamin d25

00:32:33

and 6 10 vitamin D peptin 187

00:32:36

resistance writes Ekaterina it’s difficult

00:32:38

to build weight insulin resistance

00:32:41

leptile resistance

00:32:43

vitamin D deficiency these are all three factors that

00:32:45

lead to an increase in hunger and

00:32:47

weight gain That is, you need to contact a

00:32:49

competent doctor to select medications,

00:32:52

this is a gentle low-carbohydrate diet or with a

00:32:55

doctor and develop or at my

00:32:58

school the treatment of insulin resistance

00:33:00

obesity on the website Olga Pavlov RF there

00:33:02

is already a ready-made menu for the treatment of

00:33:04

insulin resistance you can

00:33:05

register for school download that

00:33:07

is, we introduce drugs we introduce

00:33:10

nutrition of our own excellent

00:33:11

reduction when there are hormonal causes of

00:33:14

excess weight, just changing the diet is

00:33:17

extremely difficult because

00:33:18

insulin resistance

00:33:20

provokes a feeling of hunger when a person goes on a

00:33:24

diet, he has constant breakdowns. That is, he

00:33:26

simply cannot follow a diet and

00:33:29

therefore we introduce drugs that

00:33:31

correct hormonal imbalances for us and

00:33:34

then it is easy for us to follow a diet; it is easy for us to

00:33:36

lose weight, that is, there is no need to force yourself, you do not need to

00:33:38

close hormonal reasons,

00:33:41

then the weight is easy goes away, you know how you can do it like

00:33:43

this, it’s all a mess drag drag drag

00:33:46

drag drag ineffective go for

00:33:48

violence you can remove the problem Yes,

00:33:50

correct the hormonal levels and

00:33:52

actually walk easily and pleasantly

00:33:53

why do you need a doctor why do you need a doctor to

00:33:56

correct the

00:33:57

condition of your body in such a way so that you

00:33:59

feel comfortable and easy

00:34:01

sugar and cholesterol also concerns blood pressure,

00:34:04

that is, just competent selection of therapy,

00:34:07

he makes therapy and the patient’s life is

00:34:09

easy, pleasant, in fact, for this, a

00:34:11

doctor is needed

00:34:13

Elena wrote further, I think that she

00:34:16

will also hear your answer Well, yes,

00:34:19

you write about dietary supplements, of course there is such

00:34:22

advertising, you might think that the

00:34:24

remedy is better I’ve never seen in my life, you know,

00:34:26

dietary supplements for lowering sugar There

00:34:28

patients constantly send me every

00:34:30

day there are several patients there Olga

00:34:32

Mikhailovna I read about a miracle remedy that

00:34:34

costs 10 thousand rubles a box Look

00:34:36

I read the composition of chromium picoli for 200 there is

00:34:39

some kind of horsetail there

00:34:41

there are chia seeds there or there is something else

00:34:47

before the effects are prescribed as if I don’t mind it’s an

00:34:51

excellent remedy for treating

00:34:53

parasites I don’t mind black cumin oil

00:35:02

everyone is a guest this is black but they also

00:35:05

have side effects this is the first not

00:35:07

everyone will go black So maybe

00:35:09

the face I’m just not upset, mom Yes, if it

00:35:12

was introduced incorrectly, but these are things

00:35:14

that are very mild and you can expect

00:35:16

some kind of sugar-lowering effect, that

00:35:19

is, compared to medications. It’s

00:35:20

just funny. That is, just as

00:35:23

manufacturers of dietary supplements, they

00:35:25

make money from this; we don’t know where, due to lack of

00:35:27

awareness. population, the same

00:35:29

dietary supplements for weight loss, there are thousands of them, but

00:35:32

to say that the effect of some dietary supplement is at

00:35:34

least partially compared with the effect of

00:35:36

medications. I think you understand everything, yes,

00:35:40

I also want to add, friends, this comment is very

00:35:43

different in that the medication is

00:35:46

approved by Russian authorities.

00:35:53

that is, in order to approve it, it is necessary to

00:35:56

go through many stages. Wedge studies,

00:35:59

at least three, and only then is

00:36:02

it approved? For a huge number of people, the

00:36:04

working dosage should have side

00:36:07

effects that are enshrined in the instructions.

00:36:10

That is, this is a drug that has passed All the

00:36:13

studies, it’s just a person who

00:36:16

decided that these substances work without

00:36:19

examining without researching on anyone, the fact

00:36:24

that we are taking dietary supplements, we must understand

00:36:26

that this is not a proven drug,

00:36:29

not even a drug, it is just a mixture of additives,

00:36:32

so please, I completely agree, I

00:36:35

also constantly encounter this, there is no

00:36:38

need to

00:36:39

waste a lot of money on dietary supplements, they have

00:36:43

some dietary supplements that Yes they really

00:36:45

do work, but the tank and the medicine are

00:36:48

completely different things,

00:36:56

good bioavailability Yes, there is extremely

00:36:59

low availability, this is not always determined by the price tag,

00:37:01

that is, based on the price, you don’t always

00:37:03

choose the exact form of vitamins, the

00:37:05

doctor knows, the doctor who deals with dietetics,

00:37:08

the doctor will tell you some kind of methylated, non-

00:37:11

methylated form, what forms

00:37:13

microelements are better absorbed in the

00:37:15

human body in mice on which

00:37:18

Possibly they tested and all this is very

00:37:21

important to distinguish between

00:37:23

non-working workers, the

00:37:25

doctor knows the worker, that is, when you just

00:37:27

read some advertisement on the Internet Well,

00:37:30

as if you don’t always need to believe advertising, I

00:37:32

would even say you always need

00:37:33

critical thinking All this is subjected to

00:37:35

sugar after eating After 20 minutes 8 Igor

00:37:39

asks Or look After 20 minutes

00:37:42

we don’t we measure after two hours so

00:37:45

the norm We have on an empty stomach and Two

00:37:49

hours after eating for non-pregnant women for

00:37:51

pregnant women after an hour all other Norms

00:37:54

we don’t have it, so please try it

00:37:57

on an empty stomach Two hours after the

00:37:59

next time Write, we will answer you

00:38:01

with the norms And immediately glycated

00:38:03

hemoglobin 5.7 I read on the Internet

00:38:06

for diabetes, look friends We live in

00:38:08

Russia in Russia, we have normalized

00:38:11

hemoglobin in healthy people up to 5 9 from 6

00:38:15

to 6.5

00:38:17

impaired carbohydrate tolerance or

00:38:19

impaired fasting glycemia what is

00:38:22

written today comes

00:38:24

above six and a half, this is considered

00:38:27

diabetic values

00:38:29

5.7 This is already close to the top of the norm to the

00:38:33

upper limits of course I would like to

00:38:35

see here a little lower then here it is necessary you should

00:38:37

start adjusting your diet

00:38:40

watch carbohydrates carefully

00:38:42

eat them in the first half of the day under no

00:38:45

circumstances

00:38:46

exercise After 6 months

00:38:50

check hemoglobin again for America

00:38:53

slightly different norms there up to 5-7 what

00:38:57

you read is you probably read either

00:39:00

on American sites or from

00:39:02

an American, that is, for us, for the

00:39:04

Russian population, the norm is considered to be up to

00:39:06

5,

00:39:07

what you write. Yes, there is a concept of a

00:39:09

reference laboratory norm by which

00:39:11

the diagnosis is established; in fact, in Russia they are

00:39:14

glycated up to 5 9, the diagnosis is not made,

00:39:16

but yes, we understand that the ideal

00:39:19

glycated up to 5 4 is what you said we

00:39:23

don’t want less, we want up to 5 4 but

00:39:26

up to 5 9 we don’t have the right to write in the

00:39:28

diagnosis, that is, we understand that we need

00:39:30

lower, that optimally lower, but we ca

00:39:33

n’t stand it in the diagnosis and you’re saying now,

00:39:35

commenting, I think that Igor Just

00:39:37

watched the broadcast First this is what you write

00:39:39

After 20 minutes 8 yes this is normal but

00:39:42

when you write After 20 minutes you will be

00:39:44

on an empty stomach 20 30 40 an hour and two hours when we,

00:39:48

for example, put on a monitor, we watch

00:39:51

every minute for example Betting with us, we

00:39:53

look at how our sugar

00:39:55

curve is changing But that’s exactly what that we send

00:39:57

the doctor reporting points, these are 0 and 120, this is

00:40:00

precisely what is included in the

00:40:02

diagnosis criterion, all other sugars we

00:40:04

take them into account, but we take them into account in the

00:40:07

aggregate, sugar

00:40:09

after sugar, that is, precisely as components of the

00:40:11

sugar curve,

00:40:13

here I have me on me 44 years old, thin,

00:40:17

type 1 diabetes, I understand that Lada has diabetes, is

00:40:21

this a groan, there were two pluses a month ago, I

00:40:24

look, to diagnose Lada

00:40:27

diabetes, you need to have a positive

00:40:30

antibody titer. That is, you must

00:40:31

definitely check the body to

00:40:34

confirm or reject,

00:40:36

we have 4 types of antibodies available in the

00:40:40

majority cities these are antibodies bastard three

00:40:43

letters G A1

00:40:45

glutamate like this is the first type the second type

00:40:48

to insulin the third type beta cells of

00:40:51

the pancreas and the Fourth type is the

00:40:53

stereotype of phosphation these four types of

00:40:56

antibodies there are also antibodies to

00:40:59

transport zinc but they are made

00:41:00

only in large cities which are

00:41:02

not even made in Novosibirsk this is Moscow St. Petersburg

00:41:05

Ideally, of course, look at all five types of

00:41:08

antibodies Well, at least these four

00:41:10

main ones If at least one of those you have is

00:41:14

elevated, it is right to talk about Lada

00:41:16

diabetes if the antibodies are negative, then

00:41:19

you need to look further at the diagnosis That is,

00:41:23

you may actually have diabetes

00:41:25

1 like, well, there are reduced bird chains,

00:41:29

maybe 2 types happen with the

00:41:33

second type of kitos That is, just acetone

00:41:36

can be hereditary types, for example, in

00:41:39

fashion, fashion, we see acetone very rarely.

00:41:43

That is, you should first of all become

00:41:45

antibodies and bird chains and with these

00:41:47

results you should already see an

00:41:49

endocrinologist who generally knows

00:41:51

what Lada diabetes is and how to diagnose it

00:41:54

Galina asks that

00:41:57

when I wake up, dry mouth is the reason for

00:41:58

increased sugar, if you

00:42:00

really have diabetes, then increased

00:42:02

sugar gives dryness if you don’t have

00:42:04

diabetes, there are other causes of dry

00:42:07

mouth, these are diseases of the mucous membrane and

00:42:09

deficiency fats in food and

00:42:12

in some drugs also cause

00:42:14

thirst, including drugs for

00:42:16

weight loss. Therefore, yes, you need to

00:42:18

be examined first of all, pass the

00:42:20

blocked sugar correctly there.

00:42:21

Well done, write the answers. Wow, yes, indeed,

00:42:25

I will comment on how to compare sugars in

00:42:29

different European units of

00:42:32

our game, see You are dividing by 18 18 is

00:42:35

superfluous But 18

00:42:39

That is, you divide 140 by 18 you will see a

00:42:42

value of a million on cast ones, that is, the

00:42:45

milligram model is 18

00:42:48

European, we translate the Russian deduction system,

00:42:53

it writes that with age everything has worsened, you

00:42:56

see with age we have the

00:42:58

genetic rudiments that we had in

00:43:00

childhood, they naturally appear with age

00:43:02

if we don’t eat properly,

00:43:04

stress, and so on, it’s clear that

00:43:06

someone will develop diabetes at 30, someone will

00:43:08

develop diabetes at 50, and he’s been on the road all his life; his lifestyle will

00:43:12

never appear even if his mother

00:43:15

had diabetes. like look

00:43:16

at our topic today I am 59

00:43:20

years old type 2 diabetes polyneuropathy

00:43:23

atherosclerosis of the lower extremities severe

00:43:25

burning sensation 100 at night I take statins

00:43:28

cholesterol was 69 decreased to 3.7

00:43:32

further Look at the article about this

00:43:37

drug that has been understood for a long time not in

00:43:40

courses not so reduced cholesterol and

00:43:43

forgot, unfortunately, we often lower

00:43:45

the blood pressure this way; they removed the drug; they lowered the

00:43:48

cholesterol to the target; they removed no; your

00:43:51

results show that the doctor

00:43:54

chose the type of statin and

00:43:57

the dosage of the statin very correctly for you, so you have a good

00:44:00

reaction; the cholesterol reduction has already occurred; you

00:44:03

already have atherosclerosis of the lower extremities,

00:44:06

that is, a disorder blood circulation in the

00:44:08

lower extremities If you

00:44:10

finish now, you will start to grow again,

00:44:15

the symptoms will worsen and the efforts that

00:44:18

you have made will disappear,

00:44:21

so we take statins for a long time, we can stop the

00:44:24

drug for a long time, it can only be given when we

00:44:26

started, most likely it will be for a long time. As

00:44:29

for the burning of the feet at night

00:44:31

this is a typical syndrome of appearance along the line of

00:44:35

apathy That is, when more during

00:44:38

walking we say that

00:44:40

critical blood circulation is most likely impaired

00:44:42

when pain at night this is more data for the

00:44:45

field neuropathy here

00:44:47

metabolic therapy helps very well at least

00:44:50

once a year, preferably once six months we instill

00:44:52

lipoic acid preparations acid,

00:44:58

first 10 droppers of the body and then

00:45:01

we consolidate the effect in tablet form

00:45:03

for another two months. In general, for almost

00:45:06

all patients, if there is no contraindication,

00:45:08

such metabolic therapy is to

00:45:10

prevent the development of those

00:45:12

who have it, to reduce

00:45:15

symptoms and so that complications do not progress,

00:45:18

such therapy is for all patients,

00:45:20

regardless of the diagnosed

00:45:22

type of diabetes shown

00:45:25

Good question Federik writes

00:45:28

impaired glucose tolerance Is glucose

00:45:31

worse at normal weight than in obese people,

00:45:33

hypoglycemia happens at 35

00:45:36

millimoles per liter in healthy people or am

00:45:38

I just used to high sugar,

00:45:40

see impaired glucose tolerance

00:45:42

is this pre-diabetes as for those with

00:45:44

normal weight or overweight If a

00:45:47

person is overweight, then he

00:45:49

may have pre-diabetes against a background of obesity and

00:45:52

indeed weight loss, reducing

00:45:54

insulin resistance very often

00:45:56

allows you to normalize sugar and

00:45:58

glycated without drugs, on the one

00:46:00

hand,

00:46:01

sugar decreases. This is a plus, as for well

00:46:05

-adjusted people, well-adjusted people, sugar

00:46:07

increases against the background stress against the background of

00:46:10

genetics against the background of inadequate nutrition,

00:46:12

impaired body composition, that is, the percentage of

00:46:15

muscle fat in a person with normal weight

00:46:17

may be disturbed, that is, the person

00:46:19

does not play sports at all, he has

00:46:22

normal weight but little muscle mass,

00:46:25

a lot of fat mass, what is called

00:46:27

skinny Fat to thin A fat man is when

00:46:29

a person seems to be thin, but the whole body has

00:46:31

very little sagging muscle. That is, this is

00:46:33

also one of the reasons why we can say what is

00:46:35

better and what is worse. But in principle, pre-diabetes

00:46:38

is not good for anyone, not for a

00:46:39

slim person, not for a fat person, but

00:46:41

tactics in the form of proper nutrition

00:46:43

Changes in body composition, that is, an increase in the

00:46:46

percentage of muscle mass, it is

00:46:49

relevant for any person here; as for

00:46:51

sugar, 35 million, see the norm of

00:46:54

fasting sugar for a healthy person is from

00:46:57

3 to 5 million. That is, in a healthy

00:47:01

person, sugar above 3 is the norm. That is, in a

00:47:05

healthy person, hypoglycemia on sugar is 3 there

00:47:08

should not be moreover a healthy

00:47:11

person, sugar on an empty stomach can be released

00:47:14

up to two and 8 million if such a

00:47:18

decrease in sugar does not give symptoms, this is

00:47:22

also considered an option

00:47:24

a person reduces weight below his

00:47:27

physiological When we are already going to

00:47:29

cool down into a deficit of body weight there is a

00:47:31

modeling business and so on or just

00:47:34

a person decided to torture him with a diet, so to speak.

00:47:36

Yes, his sugar can drop

00:47:38

below 3. As you know, I

00:47:41

had a problem with weight for a very long time. I was overweight, I was

00:47:44

there all through my childhood teenage

00:47:46

male period. I experimented and

00:47:48

changed a lot when I got

00:47:52

below physiological weight without having

00:47:55

diabetes. I actually had hypoglycemia,

00:47:57

that is, my sugar dropped 2 and 527

00:48:00

27 is normal 2 and 5 are already symptoms, that is,

00:48:05

shaking, dizziness, weakness, and so

00:48:06

on, so when we lose weight, I

00:48:09

say there is a physiologically normal

00:48:11

weight for your body. When you

00:48:13

go below it, you start

00:48:16

sugar begins to fall, blood pressure begins to fall, that is, it

00:48:18

increases slightly, but sugar of 35 in a

00:48:22

healthy person should not give

00:48:24

thanks, that is, if you have 35 it gives hypo,

00:48:27

it means that you are used to higher

00:48:30

sugar. This is the first. Second, the symptoms of

00:48:32

hypoglycemia provoke impaired

00:48:35

thyroid function, hypothyroidism and

00:48:37

provoke impaired function.

00:48:39

otpochnikov or adrenal fatitis or

00:48:41

otpochnikov insufficiency Therefore, if

00:48:43

there are symptoms with good Sugar,

00:48:47

we check what’s next Olga asks

00:48:49

about reducing cortisol

00:48:52

cortisol more than a thousand high cortisol

00:48:55

or this is due to the stress of inadequate

00:48:57

blood sampling or it could be a

00:48:59

neoplasm of the adrenal glands that

00:49:01

produce cortisol and depending

00:49:03

on that This is a completely different therapy,

00:49:05

either working with stress or removing a

00:49:08

new formation, so follow

00:49:10

how much more I would highly recommend you

00:49:13

Check also because unfortunately

00:49:16

unfortunately lately

00:49:19

I see very often errors in the laboratory of my patients,

00:49:21

ideally check

00:49:24

love and urine we still have saliva saliva

00:49:27

This is a slightly different case, we are for the

00:49:30

profile, that is, in your case, check the blood and

00:49:32

urine in the early morning hours in the

00:49:36

morning. It is advisable that this is money the

00:49:38

night before there is no stress,

00:49:39

such a calm environment is enough.

00:49:42

If indeed, during the second test, you

00:49:45

will also have increased results,

00:49:47

then as Olga said Mikhailovna, then you

00:49:49

already need to be examined carefully,

00:49:51

look at me. CTG is a

00:49:53

hormone that is produced in the pituitary gland

00:49:56

and regulates the function of the adrenal glands and

00:49:59

topical diagnostics, that is, done at the

00:50:01

hotel either by scattering or without, this is

00:50:04

already the doctors, so the analogue solves the

00:50:05

adrenal glands, so retake it again

00:50:08

A Blood and urine are juicy

00:50:11

urine for me, this is not normal, this is not a

00:50:14

product of the breakdown of cortisol, too, we

00:50:16

are looking at all this, the doctor will tell you all this for a

00:50:18

premium, any endocrinologist, in fact,

00:50:19

how to say an examination for elevated

00:50:22

cortisol is one of the simplest that, in

00:50:24

principle, in endocrinology, any Doctor,

00:50:26

even free clinics, knows it all

00:50:28

here it’s not a secret it’s not so difficult

00:50:30

How to treat severe diabetes or severe

00:50:32

obesity to be honest

00:50:33

hyperparathyroidism symptoms of bone

00:50:35

muscle lightheadedness after surgery these

00:50:38

symptoms will go away see

00:50:41

hyperparathyroidism firstly its cause is

00:50:44

very many but most often it is still a

00:50:46

pathology of the

00:50:48

thyroid glands, that is, in most

00:50:51

cases it is either their increase is

00:50:52

hyperplasia or adenoma is small and

00:50:56

most likely you are glad the hormone is

00:50:59

high, since these symptoms are already present, the

00:51:02

hormone increases the level of calcium in

00:51:05

the blood, accordingly, calcium increases

00:51:07

and causes these symptoms of bone

00:51:10

and muscle to really dubnate in the head, there

00:51:13

may still be headaches when the

00:51:16

thyroid gland then there is a reason that

00:51:18

this is not removed immediately, not from the first day,

00:51:21

but after some time, when the

00:51:24

calcium level normalizes, these symptoms will become

00:51:28

less and less intense, then they will

00:51:30

completely go away. Here you will need to

00:51:31

monitor the level of the ring very well

00:51:34

so as not to go away. On the contrary, low

00:51:37

calcium levels because that other

00:51:39

symptoms appear, your task is to

00:51:41

be sure to monitor the calcium level

00:51:43

after the operation,

00:51:45

writes Ryan Good afternoon, 40 years and a half

00:51:49

411 32 and 63 during the year was

00:51:54

unstable 37 18 What to do Thyroxine did not

00:51:58

appear apathy excess weight I can’t

00:52:00

lose but look when our

00:52:02

thyroid function is not active

00:52:04

4 or low 3 our TSH is growing, then

00:52:08

we must improve the function of the

00:52:10

thyroid gland, that is,

00:52:12

hormone precursors, amino acids, vitamins,

00:52:14

microelements that affect the functioning of the

00:52:16

thyroid gland, a decrease in the level of antibodies Yes,

00:52:19

if there is

00:52:20

work with the immune system, factors

00:52:23

that influence the thyroid gland, a great

00:52:26

many of them, it is important to take into account all that that

00:52:29

TSH, thyroid-stimulating hormone, is unstable, it is

00:52:32

unstable because the function of the

00:52:34

thyroid gland is changing, more vitamins,

00:52:36

microelements, more sun, for example, in the

00:52:38

summer, the thyroid gland loves summer, that is, does it

00:52:40

work more actively there, then it

00:52:42

begins to decline? You feel a little better in

00:52:43

the winter, respectively, worse, that is, your

00:52:46

task is to equalize the function of the thyroid gland,

00:52:48

find a competent an endocrinologist

00:52:50

who works specifically with

00:52:52

hormone precursors with vitamins

00:52:54

and microelements TSH

00:52:56

one and a half to 37 do not need hormones That is, you do

00:52:59

n’t really need Thyroxine so

00:53:01

after what time does it start to act

00:53:04

here I don’t quite understand the question You

00:53:07

mean you only started the techniques when

00:53:09

to act if in this context the question is

00:53:12

then the reflection begins to act

00:53:14

after about two weeks, not earlier, that

00:53:17

is, this is not a facsimile, not a Jardin people who,

00:53:20

literally from the first tablets, need to

00:53:22

accumulate a little if you have

00:53:24

taken a tablet after what action

00:53:26

After what time does the reducing

00:53:30

action begin that citizen begins

00:53:31

to act in about one and a half to two

00:53:34

hours and this a daily action drug

00:53:36

is understood once a day, that is, it works for

00:53:39

a day, but you need to understand that by the end of the

00:53:41

action the hypoglycemic effect

00:53:44

decreases, so the knarik writes Good

00:53:47

morning sugar 4 7 on an empty stomach sugar good

00:53:50

insulin 143 increased index I understand

00:53:54

insulin resistance 0.33 to calcium

00:53:57

total magnesium calcium magnesium quite

00:53:59

decent d37

00:54:01

optimal with a laboratory norm of 30

00:54:04

to 100 for good carbohydrate metabolism

00:54:07

78 Upper

00:54:11

34 to tell us it is important to know

00:54:15

how old you are depending on your age

00:54:17

different goals for 4 free low 3

00:54:21

free low parade hormone here is

00:54:24

what your question is If the question is about

00:54:26

tests, but I want to lower the insulin;

00:54:28

I want to raise the thyroid gland; it

00:54:31

depends on your age. That is, as

00:54:33

for the parade hormone. When our D

00:54:36

starts to drop, the parade hormones begin

00:54:37

to rise because this is all the regulation of

00:54:39

calcium, that’s what they prescribed. They worked on these;

00:54:42

there was a looseness and heaviness in the left side

00:54:45

to continue Whether to drink it, see It wo

00:54:47

n’t be drunk Yes, it’s an injectable

00:54:52

drug that is given once a week, there are

00:54:54

a lot of questions here. First of all,

00:54:57

what dosage did they start? There are

00:54:58

0.75 and a half dosages for some reason,

00:55:01

there are cases when the patient confuses and

00:55:04

immediately buys a high dosage, check

00:55:07

the dosage if they started with one and a half then after

00:55:10

all, we start 75 And gradually

00:55:13

reach one and a half This is the first Second,

00:55:16

your symptoms are similar to signs of

00:55:20

pancreatitis, heaviness in the left side

00:55:22

especially

00:55:24

and intensifies after even a small

00:55:28

amount of fat, belching with a rotten face That

00:55:32

is, if you have pancreatitis, in principle,

00:55:34

and fairly frequent exacerbations, this you can

00:55:37

look at amila destinies from the blood If it is

00:55:40

elevated, then there is an exacerbation of pancreatitis,

00:55:43

then a drug of this class does not

00:55:46

show an

00:55:50

exacerbation of pancreatitis for you, so here you

00:55:52

need to be examined and understand whether

00:55:56

this drug is right for you or replace

00:55:58

it with another class.

00:56:00

How often can you use

00:56:02

vitamin B? that’s the question: Which vitamin db12

00:56:06

to B9 folic and so on the group was

00:56:09

quite large as for

00:56:11

group D against the background of the use of

00:56:13

metformin drugs Siofor Glucophage no

00:56:17

really very often drops 12

00:56:19

folic acid drops and we additionally

00:56:22

introduce them, but we introduce them in the case

00:56:25

when we saw a low level

00:56:26

group vitamins In the body Why

00:56:29

Because yes deficiency Folic deficiency

00:56:32

B12 essentially the whole group is neurology

00:56:35

memory speed of thinking emotional

00:56:38

background what the Central nervous

00:56:40

system and the peripheral nervous

00:56:42

system gives is when our back wedges our

00:56:44

legs go numb and so on all groups this is

00:56:46

if there is deficiency, but if there is an excess,

00:56:49

group B affects the cellular compartment, in

00:56:52

particular B12 folie and overdosing

00:56:55

the group is very dangerous. These are the risks of the growth of a

00:56:59

new formation. Therefore, to

00:57:01

talk about the use of vitamin B,

00:57:03

we create, we look if there is a deficiency,

00:57:06

we introduce them, if there is no deficiency when

00:57:09

high B12 is high In no

00:57:12

case do we increase the excess of folic for me because

00:57:15

this is a risk of growth of neoplasms and you are

00:57:18

gaining body weight because these are

00:57:19

anabolic vitamins, after all. Therefore,

00:57:21

with group B we always carefully saw

00:57:23

the deficiency, the deficiency was replenished There is no deficiency,

00:57:26

there is no need to increase it above the norm, never in

00:57:30

fact dangerous vitamins Nadezhda’s

00:57:33

husband, 52 years old, has sugar from 3.5 to 7

00:57:36

cholesterol 5.9 Should we reduce Nadezhda,

00:57:39

look, but sugar of course to 70 for 52

00:57:42

years old I want a little lower, that is, to 6.5

00:57:46

ideally Therefore, work with sugar but

00:57:50

not there was hypoglycemia

00:57:52

because three and a half This is already close for a

00:57:53

diabetic,

00:57:57

this is exactly what it is close to

00:58:00

correct the seven

00:58:02

cholesterol 5 and 9 depends on the ratio

00:58:04

bad good Maybe he has a good PVP

00:58:07

in the region of three and a bad lpnp in the region of

00:58:11

two and then 5.9 is for him

00:58:13

good value And if, on the contrary,

00:58:16

the good PVP is low and the bad one is high,

00:58:20

then yes, you need to work with lipid

00:58:24

metabolism, then here you need to look at the LDL And the

00:58:28

last two questions You will need to

00:58:30

run to a consultation, so Larisa

00:58:32

asks why the

00:58:35

heartbeat increases after eating, first of all it goes

00:58:37

changes in blood sugar and

00:58:40

insulin levels can affect summer;

00:58:42

secondly, our

00:58:44

blood flow is redistributed, that is, our blood flow goes to the

00:58:47

gastrointestinal tract. This

00:58:49

can also affect blood pressure and pulse. In

00:58:51

addition, there are some problems with the

00:58:54

gastrointestinal tract, gastritis and so

00:58:56

on, eating can give pain,

00:59:00

your sensations, a jump in stress hormones, an

00:59:03

increase in heart rate, that is, there are a lot of

00:59:04

factors Why

00:59:06

Oksana Is it possible to take Oksana during

00:59:10

pregnancy So we won’t

00:59:12

tell you here we need more data in general

00:59:14

Tibon in Russia, well, with a very large with

00:59:17

caution they quickly give

00:59:19

Tatyana another answer

00:59:21

to hemoglobin 10 and 8 the neck is blackened how to

00:59:25

eliminate Tatyana you are up to

00:59:26

compensated very compensated

00:59:29

diabetes mellitus

00:59:31

Bibles we are above 9 we are, in theory,

00:59:34

already considering insulin therapy but not

00:59:36

always That is, you need to urgently

00:59:39

run to an analogue to adjust the therapy

00:59:41

and the neck is blackened this is directly related to the presence

00:59:45

of insulin resistance, that is, probably the

00:59:49

armpits are still brown, there are probably

00:59:51

other skin manifestations on the elbows,

00:59:53

so we run, a competent

00:59:56

endocrinologist needs to work with the

00:59:58

insulin system And there are

01:00:01

actually a lot of related

01:00:03

things intact, but as for hormones in

01:00:05

pregnant women, at least an orange Free

01:00:08

only as prescribed by an endocrinologist,

01:00:11

and during pregnancy,

01:00:13

depending on the stage of pregnancy, we have

01:00:15

different target TSH values, that is,

01:00:17

pregnancy, a patient with hypothyroidism

01:00:19

regularly undergo tests, in fact, we

01:00:21

regularly adjust the therapy for

01:00:23

hypothyroidism, friends, we have run out of

01:00:25

broadcast time Thank you for your questions,

01:00:27

interesting questions Well done Thank you for being there It’s a

01:00:30

weekend with us that even on weekends

01:00:32

you take care of your health and increase your

01:00:34

knowledge Thank you very much I remind you for

01:00:36

three days of discounts at the diabetes school who wanted to

01:00:38

register next week On

01:00:41

Saturday We are also planning a live broadcast

01:00:43

Therefore, whoever has unanswered questions,

01:00:45

also come first because

01:00:47

whoever came first was the first wrote

01:00:49

a question We answer questions from top

01:00:50

to bottom Whoever wrote first

01:00:53

received the answer Have a good weekend everyone

01:00:56

Goodbye good health to you

Description:

❤️ ДИАБЕТ: КАК СОХРАНИТЬ ЗДОРОВЬЕ? САХАР КРОВИ, СЕРДЦЕ, СОСУДЫ. Прямой эфир, обсуждаем вопросы: ✅ Какой Сахар крови нужен для сохранения здоровых сосудов? ✅ Как снижать холестерин при диабете? ✅ Как удержать давление при диабете? ✅ Как избежать развитие осложнений диабета? Прямой эфир с ответами на вопросы подписчиков. Эфир проводит врач эндокринолог, диетолог Ольга Павлова, врач эндокринолог, доктор наук Алла Овсянникова. ⠀⠀👉НАУЧИТЬСЯ ✅ ПРАВИЛЬНО ПИТАТЬСЯ при Диабете, ✅ СНИЗИТЬ САХАР КРОВИ ДИЕТОЙ Вам поможет 📚ШКОЛА ПРАВИЛЬНОГО ПИТАНИЯ ПРИ ДИАБЕТЕ на сайте http://scool-diabet.ru/ 🌐 Школа научит Вас, как ✅ ПОДОБРАТЬ СЕБЕ ДИЕТУ, ✅ КАК ПОДБИРАТЬ💊ДИАБЕТА, ✅ как ПРИВЕСТИ ВЕС И САМОЧУВСТВИЕ В НОРМУ, ❗️РЕГИСТРИРУЙТЕСЬ В ШКОЛУ 👉 http://scool-diabet.ru/ 🏃♀️Займитесь своим здоровьем! 💕Здоровья, Красоты и счастья Вам!💚 ____________________________________________________________ ✅ Подписаться на мой канал https://www.youtube.com/channel/UCtCZlRDWPhZgrjicSgP8drQ ✅ Мой Инстаграм https://www.facebook.com/unsupportedbrowser ❤️ Записаться на он-лайн консультацию: 📌 По номеру телефона +7-913-913-35-54 Ватсап (Мария). 📌 Через сайт https://xn--80aaahac9cevgh7m.xn--p1ai/platnaya-konsultatsiya 📌 Через моего ассистента https://www.facebook.com/unsupportedbrowser ____________________________________________________________ ⠀⠀⠀⠀⠀⠀

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