Metabolic Syndrome and Diabetes

Question 1

What is the definition of insulin resistance?

Answer 1

A subnormal glucose response for a given concentration of insulin

Question 2

Which pathologies can cause pre receptor insulin resistance?

Answer 2

Cushing’s syndrome and acromegaly

Question 3

Which environmental factors can cause insulin resistance?

Answer 3

• Intrauterine

- Obesity

Question 4

What is the pathophysiology of insulin resistance?

Answer 4

• Increased visceral fat and stored triglycerides
• Adipocytes increase in size
• Large adipocytes resistant to ability of insulin to suppress lipolysis
• Inc. lipolysis -> inc. NEFA and glycerol
• NEFA + glycerol + inflammatory cytokines released by viceral adipose tissue aggravates insulin resistance in muscle and liver

Question 5

Which conditions are associated with insulin resistance?

Answer 5

• Obesity
• Type 2 diabetes
• Endocrine disorders
• Metabolic syndrome

Question 6

___ dysfunction is a critical step in the pathogenesis of type 2 diabetes

Answer 6

Beta cell

Question 7

How do you diagnose metabolic syndrome?

Answer 7

• Cluster of syndromes

- Central obesity + 2 of hypertension, abnormal glucose, high triglycerides, low HDL

Question 8

How do you recognise a patient with insulin resistance?

Answer 8

• Metabolic syndrome
• Acanthosis nigricans
• PCOS

Question 9

What is acanthosis nigricans?

Answer 9

Increase in skin pigmentation and roughness due to excess growth factor

Question 10

How do you diagnose diabetes mellitus?

• HbA1c
• Fasting glucose

Answer 10

HbA1c >= 50 mmol/mol

Fasting glucose >= 7mmol/l

Question 11

What are the microvascular consequences of diabetes?

Answer 11

• Retinopathy
• Peripheral neuropathy
• Nephropathy

Question 12

What is the most common presentation if diabetic retinopathy?

Answer 12

Sudden blindness from haemorrhage

Question 13

What are the macrovascular consequences of diabetes?

Answer 13

• IHD
• PVD
• CVA

Question 14

What are the typical features of a patient with type II diabetes?

Answer 14

• Obese
• Features of metabolic syndrome
• Family history of type II diabetes
• Older

Question 15

How do you manage type II diabetes?

Answer 15

• Lifestyle factors: diet, exercise
• Medication
	• Insulin in type 1 and +/- 50% type 2
	• Metformin
	• Sulphonylurea
	• Insulin incretin therapy
	• SGLT2 inhibitors in kidney
Attend to BP, lipids, smoking etc.