Diabetes prevention of gout

The core logic for diabetic patients who want to prevent gout is actually very simple - by stabilizing sugar control while taking into account uric acid levels, and avoiding the common metabolic triggers of high purine, high fructose, and increased insulin resistance, the risk of gout attacks can be reduced by more than 80%.

Last week, I met 52-year-old Zhou Zhou in the outpatient clinic. He has type 2 diabetes for 6 years. He is considered a "model student" in normal sugar control. His fasting blood sugar is always around 5.5, and his glycated hemoglobin has never exceeded 6.2%. As a result, when he came in limping and holding on to the wall, his right big toe was so swollen that he had to cut off half of his sock before taking it off. The uric acid test was 570 μmol/L, which is a typical acute attack of gout. He himself was sitting in the consulting room, still confused: "I don't dare to touch even half of the sweetness. Why do I still have this problem?"

In fact, regarding the practical ideas for preventing gout for people with diabetes, there are indeed two different directions in the academic world. There is no absolute right or wrong. You just have to see whether it is suitable for you. One group advocates "glucose control first", believing that diabetes and gout belong to the category of metabolic syndrome, and the root cause is insulin resistance. As long as blood sugar is controlled stably and insulin sensitivity is improved, the kidney's uric acid excretion capacity will naturally improve, and clinical data will also improve. It can be proved that: for patients whose glycosylated hemoglobin drops from 8% to less than 6.5%, the average uric acid level will drop by 40-60 μmol/L. Many people with mild hyperuricemia do not even need to deliberately control their purine intake, and their uric acid can spontaneously return to the normal range. The other group emphasizes "individual control of uric acid" and believes that no matter how standard the sugar control is, if a long-term high-purine and high-fructose diet exceeds the body's metabolic load, uric acid will still accumulate. I have three patients with glycation stable within 6% all year round. Because they drink Laohuo Jingtang and eat braised duck every day, they still suffer from gout attacks two or three times a year.

To be honest, when I usually give advice to patients, I never stick to a certain school of thought. I always make adjustments based on his own uric acid baseline. If your uric acid level never exceeds 400 μmol/L, then you really don’t have to impose too many dietary restrictions on yourself. As long as you don’t show off two pounds of crayfish at one time, drink a whole bowl of hot pot soup, drink more water, and ensure an intake of more than 1500ml per day, you will basically not have any problems. But if you already have a problem with high uric acid, or even had gout before, then no matter how well you control your sugar, you still have to keep uric acid in mind.

Many people with diabetes have a misunderstanding: they think that if I don’t eat sweet things, everything will be fine. However, they don’t know that many non-sweet foods are the “invisible assassins” that increase uric acid. Let’s talk about Lao Zhou. He dared not eat fruit for fear of raising sugar, so he would grab a small bowl of boiled peanuts and boiled edamame as a snack every afternoon. He felt that they were neither sweet nor filling. Who knew that peanuts were a high-purine food, and edamame was also a medium-purine food. He ate half a catty a day, which was equivalent to Mimi giving uric acid a "snack" for more than half a month. It would be strange if he didn't have an attack. There are also sugar-free drinks that have been very popular in the past two years. I have a 28-year-old patient with diabetes who consumes at least two bottles of Coke Zero every day. His blood sugar is indeed very stable. As a result, his six-monthly physical examination showed that his uric acid increased directly from 390 to 510. Within three months after he stopped drinking, it dropped back to less than 400. Now the academic community is also doing relevant research. Although most sugar substitutes will not increase blood sugar, they may interfere with the purine metabolism pathway. For diabetes patients with their own metabolism problems, it is really not a safe option to "drink casually".

I have a little trick I have saved in my clinical practice and have tried it with many patients who are greedy. The feedback is good: If you really want to eat hot pot or barbecue, increase your daily water intake to more than 2000ml two days in advance. When eating, don’t touch long-cooked soup or drink beer. For wine, try to choose low-fat and high-purine ingredients such as lean beef and chicken, avoid animal offal and seafood, and drink less than half a cup of light soda after eating. As long as the uric acid is stable below 360, it will basically not induce gout or cause blood sugar to rise too much.

Actually, to put it bluntly, there really aren’t that many complicated rules and regulations for people with diabetes to prevent gout. You don’t have to make yourself afraid to eat or touch this. The key is not to worry about the beginning and the end. Every time you go to the hospital for a review, don’t just stare at the blood sugar column. Take another look at the uric acid value. If there is a problem, adjust it early. It is much more effective than waiting for the pain to make you unable to get out of bed and then trying to fix it temporarily.