04-15 L1 Metabolic syndrome Pt 1

Question 1

What is metabolic syndrome def according to

WHO & ATP

Answer 1

• Who
  
  • diabetes
  • insulin resistances
  • mix and match bt the 2
• ATP (3 or more)
  
  • Waist circumference
  • serum triglycerides
  • blood pressure
  • HDL cholesterol
  • serum glucose

Question 2

Metabolic syndrome offical def

Answer 2

• sugar
  
  • high fasting glucose
• fat
  
  • high TG
  • low HDL
  • high waist circumference
• BP
  
  • high blood pressure

Question 3

Metabolic syndrome is a precursor for what 3 conditions?

Answer 3

• CAD
• obestiy
• diabetes

Question 4

describe the natural history of T2 DM?

refer to graph from notes

Answer 4

• Insulin increases
• your tissues develop resistance b/c of the increase in insulin
• the beta cells from the pancreas start to fail b/c they are working overtime, so they are unable to keep up with the insulin demand
• upon failure now you have developed T2DM: this takes about 5-10 years

Question 5

what is the 1997 diabetes diagnosis according to the ADA guidlines

Answer 5

• Fasting plasma
  
  • normal (<100)
  • IFG or IGT (100-125)
  • Diabetes (>126)
• OGTT (2 hr post load glucose)
  
  • normal <140
  • IFG or IGT (140-199)
  • Diabetes (>200)

Question 6

Metformin

MOA

Advantages

disadvantages

cost

Answer 6

Metformin

• MOA: activates AMP kinase (dec hepatic glucose production)
• Advantages: estensive experience, no hypoglycemia, weight neutral
• disadvantages: IG lactic acidosis, B-12 def, CI (renal failure, caridac failure)
• **cost: **low

Question 7

Sulfonylureas/Megalitinides

MOA

Advantages

disadvantages

cost

Answer 7

Sulfonylureas/Megalitinides

• MOA: Closes K ATP channels (increase insulin secretion)
• Advantages: extensive experience, dec microvascular risk
• Disadvantages: hypoglycemia, weight gain, low durability
• cost: low

Question 8

**TZDs/pioglitazone **

MOA

Advantages

disadvantages

cost

Answer 8

**TZDs/pioglitazone **

• MOA: activates PPARgamam, increase insulin sensitivity
• Advantages: no hypoglycemia, durability, decrease TG, increase HDL-C
• Disadvantages: weight gain, edema/heart failure, bone fractures
• cost: high

Question 9

DDP-4 inhibitors

MOA

Advantages

disadvantages

cost

Answer 9

DDP-4 inhibitors

• MOA: inhibits DPP-4, increase GLP-1, GIP
• Advantages: no hypoglycemia, wel tolerated
• disadvantages: modest decrease A1c, uriticaria
• cost: high

Question 10

alpha-glucosidase inhibitors

MOA

Advantages

Disadvantages

Cost

Answer 10

alpha-glucosidase inhibtors

• MOA: inhibits alpha-glucosidase, slows carbohydrate absorption
• Advantages: no hypoglycemia, nonsystemic, decrease post-prandial glucose
• Disadvantages: GI, dosing freq, modest dec A1c
• Cost: mod

Question 11

combo pills

Answer 11

• two in one pills.
• reduce cost, and the number of pills you have to take.
• source: the internet