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class="Remark"> <span>2018年11月14日 09:18 | 作者:陈晶 | 来源：<a target="_blank">人民政协网</a></span> <span id="i2i2jyu4k" class="fr"> <div id="i2i2jyu4k" class="bdsharebuttonbox"><a href="#" class="bds_more" data-cmd="more"></a><a href="#" class="bds_qzone" data-cmd="qzone" title="分享到QQ空间"></a><a href="#" class="bds_tsina" data-cmd="tsina" title="分享到新浪微博"></a><a href="#" class="bds_tqq" data-cmd="tqq" title="分享到腾讯微博"></a><a href="#" class="bds_renren" data-cmd="renren" title="分享到人人网"></a><a href="#" class="bds_weixin" data-cmd="weixin" title="分享到微信"></a></div> <script>window._bd_share_config={"common":{"bdSnsKey":{},"bdText":"","bdMini":"2","bdMiniList":false,"bdPic":"","bdStyle":"0","bdSize":"16"},"share":{}};with(document)0[(getElementsByTagName('head')[0]||body).appendChild(createElement('script')).src='http://bdimg.share.baidu.com/static/api/js/share.js?v=89860593.js?cdnversion='+~(-new Date()/36e5)];</script> </span><span id="i2i2jyu4k" class="fr">分享到：<img src="/images/fx.jpg" /> </span> </div> <div id="i2i2jyu4k" class="text_box"> <p align="center"> <p style="text-indent: 2em; text-align: left;">■新闻背景</p><p style="text-indent: 2em; text-align: left;">11月14日，世界糖尿病日。根据国际糖尿病联盟（IDF）公布的最新数据显示，我国现有糖尿病患者约1.1亿，已成为全球糖尿病第一大国，且患病人数呈持续上涨趋势。那么，糖尿病因何而起？是因为吃甜食引起的吗？又有哪些分类呢？</p><p style="text-indent: 2em; text-align: left;">■约访专家</p><p style="text-indent: 2em; text-align: left;">马晋平：中山大学附属第一医院主任医师</p><p style="text-align:center"><img src="/upload/resources/image/2018/11/14/2214137.jpg" title="C2018-11-14zx601_P_1_409_461_1265_926" alt="C2018-11-14zx601_P_1_409_461_1265_926" suffix="jpg"/></p><p style="text-indent: 2em; text-align: left;">糖尿病，顾名思义就是尿里有糖，是以血液中葡萄糖水平升高(简称高血糖）为主要特征的慢性代谢性疾病。在胰腺中合成，释放胰岛素的细胞叫胰岛β细胞，起调节血糖水平的作用。胰岛β细胞功能受损，胰岛素分泌绝对或相对不足，从而引发糖尿病。长期高血糖会导致眼、肾、心脏、大血管、神经等多种器官组织的损害和功能障碍。</p><p style="text-indent: 2em; text-align: left;"><strong>尿糖阳性不等于是糖尿病</strong></p><p style="text-indent: 2em; text-align: left;">尿糖有生理性和病理性之分，遗传易感性及环境因素共同参与糖尿病的发生。生理性尿糖发生于摄食大量糖类食物后，身体吸收太快，胰岛素来不及反应，血糖升高过快，暂时超过肾脏重吸收能力（血糖高于180mg/dl），或者在脑外伤、情绪激动等因素下尿出糖尿。但这种糖尿属于应激状况下暂时性的，空腹血糖及糖耐量试验正常。病理性的尿糖分真性的、肾性的或者是其他的尿糖，需结合其他糖的检测指标，综合来考虑是否有典型的或者是诊断能够完全明确的糖尿病。因此，糖尿是糖尿病的一个症状，并非所有糖尿都是糖尿病。</p><p style="text-indent: 2em; text-align: left;"><strong>常见Ⅰ型和Ⅱ型糖尿病的区别</strong></p><p style="text-indent: 2em; text-align: left;">糖尿病分为Ⅰ型糖尿病、Ⅱ型糖尿病、妊娠期糖尿病和其他一些特殊类型的糖尿病，主要是Ⅰ、Ⅱ型糖尿病，其中Ⅱ型糖尿病患者人数最多。Ⅰ型糖尿病绝大多数是自身免疫性疾病，自身的免疫细胞选择性攻击胰岛β细胞，造成胰岛功能衰竭、胰岛素分泌不足，进而导致糖尿病。Ⅱ型糖尿病的两个主要环节是组织的胰岛素抵抗和胰岛素缺乏，除了遗传易感性、向心性肥胖，环境影响还可包括年龄、生活方式、营养过剩、体力活动不足、化学毒物等。</p><p style="text-indent: 2em; text-align: left;">从年龄来看，Ⅰ型糖尿病的发病年龄通常偏年轻，大多数都不到30岁，20岁以下的青少年及儿童绝大多数糖尿病患者为Ⅰ型糖尿病，但也有极少数是例外。如今随着物质生活水平提高及食品安全等问题，Ⅱ型糖尿病的发病年龄也越来越呈年轻化趋势，有些患者十几岁就得了Ⅱ型糖尿病，甚至有些几岁就被确诊为Ⅱ型糖尿病。通常情况下，患Ⅱ型糖尿病的大多数为40岁以上的中老年人，而50岁以上的人很少患Ⅰ型糖尿病。</p><p style="text-indent: 2em; text-align: left;">从患病症状来看，Ⅰ型糖尿病通常是因为糖尿病酮症酸中毒急性起病而第一次就诊被发现，而Ⅱ型糖尿病急性发病比较少见，通常是在体检中发现血糖升高或者因为其他疾病到医院就诊时发现血糖异常。Ⅰ型糖尿病患者普遍吃得多、尿得多、喝得多，但体重却越来越轻，甚至体型消瘦。Ⅱ型糖尿病患者大多初期症状不明显，体型多为超重、肥胖，还有较强的Ⅱ型糖尿病家族史。</p><p style="text-indent: 2em; text-align: left;">很多糖尿病患者都有这样的疑惑：自己究竟需不需要打胰岛素，一旦打上胰岛素会不会产生依赖性，一辈子都戒不掉了？其实，Ⅰ型和Ⅱ型糖尿病的治疗方法明显有区别。Ⅰ型糖尿病患者通常很早开始就处于自身胰岛素绝对缺乏状态，属于胰岛素依赖型，口服降糖药通常效果不佳，只有注射胰岛素才能控制住高血糖，稳定病情，否则血糖控制一般难以达到满意状态，血糖控制效果差又容易引发各种并发症。而Ⅱ型糖尿病患者一般从被发现后的病情严重程度来分析，如果病情较轻，可在医生指导下接受饮食加运动的血糖控制方案，效果不佳时再慢慢使用药物调整血糖；如果病情较重，已经出现胰岛素缺乏了，而且非胰岛素治疗的方案效果均不好、胰岛β细胞功能趋于衰竭或出现严重的急慢性并发症时，则需考虑进行胰岛素治疗。无论有没有进行胰岛素治疗，适量的运动对于糖尿病患者都非常有益。对Ⅰ型糖尿病患者而言，体育运动宜在餐后进行，运动量不宜过大，持续时间不宜过长。对于Ⅱ型糖尿病患者尤其肥胖患者，适当运动有利于提高胰岛素的敏感性，改善血糖控制；同时可以加速脂肪分解，减轻体重，改善脂代谢。</p><p style="text-indent: 2em; text-align: left;"><strong>糖尿病与甜食没有必然联系</strong></p><p style="text-indent: 2em; text-align: left;">首先，我们需弄清楚一个概念，医学上的“糖”和我们平时所食的“糖”不完全等同。医学上的糖类，指碳水化合物，是生命体重要的营养素，最主要的供能物质，主要包括单糖、双糖和多糖。人们所说的“糖”是指具有甜味的单糖（如葡萄糖、果糖）和双糖（如蔗糖、麦芽糖、乳糖），是狭义的糖，它们是“简单糖”。食物的含糖量不能按其甜度来衡量，比如我们吃的面粉、米饭等粮食，虽没有甜味，但它们是淀粉类食物，淀粉属于多糖，同样可以让血糖升高，是“隐形甜食”。</p><p style="text-indent: 2em; text-align: left;">食物进入人体后，糖类会被消化吸收为葡萄糖，进入血液成为血糖。升高的血糖刺激胰岛β细胞分泌胰岛素，促进血糖代谢。正常人体内，血糖能在胰岛素的监督下进入组织细胞中被代谢利用，多余的则被储存起来成为脂肪，这样葡萄糖有了合理的去路，故能维持一个较平稳的水平。而糖尿病的发病机制为胰岛素量绝对不足（如胰岛β细胞破坏）或相对不足（作用缺陷，即胰岛素抵抗），导致组织细胞无法充分利用葡萄糖。葡萄糖失去了去路，都囤积在血液中，血糖因此居高不下。由此可见，糖尿病和吃糖类多少无因果联系，而是身体利用糖的机能出现了问题。但如果因长期摄取糖类过多造成肥胖，则患糖尿病的风险提高。</p><p style="text-indent: 2em; text-align: left;"><strong>糖尿病患者如何正确吃糖类食物</strong></p><p style="text-indent: 2em; text-align: left;">糖类是人体必需的三大营养素之一，是人体的主要能量来源，膳食中糖类所提供的能量需占总能量的50%～60%。在合理控制总热量的基础上，保持适当比例的碳水化合物摄入可提高胰岛素的敏感性、改善葡萄糖耐量。</p><p style="text-indent: 2em; text-align: left;">不同糖类引起血糖升高的速度和程度有很大差异，可用升糖指数（GI）衡量。单糖和双糖吸收快，GI值高；淀粉需要被分解成单糖才能被人体应用，吸收慢，GI值低。GI〈50为低升糖指数，50～70为中升糖指数，〉70为高升糖指数。糖尿病患者选择食物应看其总热量和升糖指数。总热量需根据身高体重计算，一般每日所需总热量在1400～1800kcal。那么，糖友们该如何正确吃糖呢？</p><p style="text-indent: 2em; text-align: left;">提倡吃的糖类：五谷杂粮，如高粱、燕麦、玉米、各种豆子等，这些食物升糖指数值低，且富含膳食纤维、蛋白质、各种维生素及微量元素等，长期食用可以起到降血糖、血脂的作用。建议糖尿病患者多使用粗杂粮替代精细粮，尽量吃米饭，少喝粥（粮食烹饪得越稀烂升血糖越快）。</p><p style="text-indent: 2em; text-align: left;">尽量避免的糖类：糖果、糕点、巧克力、雪糕、果酱之类的食物，因其添加了大量的蔗糖加工而成，不利于血糖稳定且营养价值较低，应尽量避免。糖尿病患者血糖容易波动，如出现低血糖时，可适量食用这类食物缓解症状。</p><p style="text-indent: 2em; text-align: left;">如果糖尿病患者想吃些甜食，建议可以从天然食物中获取。一些水果的甜味来源主要是果糖，果糖对血糖影响较小，营养价值较高，是满足味蕾的好选择。</p><p style="text-indent: 2em; text-align: left;">低升糖指数的水果有苹果、梨、桃子、橙子、柚子、草莓、木瓜、猕猴桃等，而香蕉、荔枝、龙眼、冬枣等高升糖指数的水果应少量食用。建议每日可食用水果100～200g，在限制总热量的前提下，摄入水果后，应相应减少主食的摄入。水果放在两餐之间吃，这样可以避免血糖的过大波动，即上午10点或下午三四点左右。此外需注意，果干含糖量高，不宜食用。</p> </div> <p class="Editor">编辑：赵彦 </p> <div id="i2i2jyu4k" class="Paging"> </div> <p class="Keyword">关键词：甜蜜负担糖尿病世界糖尿病日</p> <h1 class="pv_title_2 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