Christian: Metabolic Syndrome

Question 1

How do you dx metabolic syndrome? (at least 3)

Answer 1

waistline of 40 inches or more in men, 35 inches or more in women

BP of 130/85 mm Hg or higher or are taking BP medications to treat HTN

triglycerides above 150 mg/dL

fasting blood glucose of 100 mg/dL or more, or are taking glucose-lowering medications

High density lipoprotein level less than 40 mg/dL (men) 50 mg/dL (women)

Question 2

MG is a 50 year old obese man who presents for his annual physical. He is was told at a health fair that his random blood sugar level was 114 mg/dL. He was told he could have metabolic syndrome. He asks what symptoms he should look for. You answer:

Answer 2

a. polyuria, polydipsia
b. weight loss
c. candidiasis – especially in the skin folds
* d. NO SXS

Question 3

MG is found to have an A1c of 6.0%, a waist circumference of 41 inches, and a blood pressure of 139/86 mm Hg. His triglycerides are 368 mg/dL. You tell him that he does, indeed, qualify for metabolic syndrome. He wants to reverse this situation. You advise him:

a. limit drinking alcohol
b. loose weight – shoot for 5 or 10% of current body weight
c. exercise - 30 minute daily brisk walk is enough
d. keep carbohydrates to no more than 50 percent of total calories

Answer 3

ALL OF THEM

Question 4

What do you do if lifestyle modifications are not enough?

Answer 4

Drugs to control cholesterol levels/lipids (statins), and high blood pressure (ACE-i) may be considered

Drugs used to treat high blood sugar and insulin resistance may have beneficial effects on blood pressure and cholesterol profiles.

Thiazolidinediones (pioglitazone [Actos] and rosiglitazone [Avandia]) also reduce the thickness of the walls of the carotid arteries; although restrictions have been placed by the US FDA on the use of rosiglitazone (Avandia) due to a reported increase in heart attack and other cardiovascular events in patients taking this drug.

Metformin (Glucophage), usually used to treat type 2 diabetes, also has been found to help prevent the onset of diabetes in people with metabolic syndrome. However, there are currently no established guidelines on treating metabolic syndrome patients with metformin if they do not have overt diabetes.

Question 5

Why worry about metabolic syndrome?

Answer 5

risk for HD, diabetes and stroke increases

TWICE as likely to develop HD

Five x as likely to develop diabetes

Question 6

Can metabolic syndrome present in ppl w/ normal body weight?

Answer 6

present in about 5% of people with normal body weight,
22% of those who are overweight and
60% of those considered obese.
Adults who continue to gain five or more pounds per year raise their risk of developing metabolic syndrome by up to 45%.

Question 7

What percentage of hte population has metabolic syndrome?

Answer 7

32%

Question 8

What ethnic group has hte highest prevalence of MS?

Answer 8

Mexican Americans

Question 9

Basics to know…

Answer 9

1. start Metformin unless there is an elevated Cr
2. Add sulfonylureal
3. add insulin (leave sulfonylreal for first 6 mos, tehn take away med)