Metabolic Syndrome and Type II DM

Question 1

What two disease states does metabolic syndrome identify?

Answer 1

risk of developing diabetes and patients at high risk of developing CVD

Question 2

What are the factors that comprise metabolic syndrome?

Answer 2

insulin resistance, low HDL, elevated triglycerides, HTN, visceral obesity

Question 3

What is the NCEP/ATP III criteria for metabolic syndrome?

Answer 3

Waist ≥ 40 inches (102 cm) men or waist ≥ 35 inches (88cm) women. Triglycerides ≥ 150 mg/dL. HDL cholesterol < 40 mg/dL men, < 50 mg/dL women. BP ≥ 130/85. Fasting plasma glucose ≥ 100 mg/dL

Question 4

What is the IDF criteria for diagnosis of metabolic syndrome?

Answer 4

The same as the NCEP/ATP III criteria except the increased waist circumference is ethnic specific.

Question 5

How does obesity harm the body tissues?

Answer 5

Reduction in mitochondrial ATP generation from glycolysis. Triglyceride accumulation. Free fatty acid accumulation-Proinflammatory leads to increased CRP, IL-6 and prothrombotic leads to increased plasminogen activator inhibitor

Question 6

What are other risk factors for metabolic syndrome?

Answer 6

postmenopause, smoking, low income, high carb diet, sedentary, soft drinks, family h/o

Question 7

What are other obesity related disorders associated with metabolic syndrome?

Answer 7

Fatty liver disease, hepatocellular and intrahepatic cholangiocarcinoma, chronic kidney disease, polycystic ovarian syndrome, sleep apnea, hyperuricemia and gout

Question 8

What is the mainstay of treatment for metabolic syndrome?

Answer 8

Lifestyle modification focused on weight loss and increased physical activity. Treat cardiovascular risk factors. Weight reduction and metformin improve insulin sensitivity

Question 9

How do you reduce CVD risk factors associated with metabolic syndrome?

Answer 9

lipid management with niacin, Tricor, treatment of HTN, tobacco cessation

Question 10

When is metformin recommended in addition to lifestyle changes for the treatment of metabolic syndrome?

Answer 10

< 60 years old. BMI ≥ 35. Family hx of DM in 1st degree relative. Elevated triglycerides. Reduced HDL cholesterol. Hypertension. A1C > 6 %

Question 11

What are the two pathogenic defects that characterize type 2 diabetes?

Answer 11

Impaired insulin secretion and insulin resistance

Question 12

Describe what happens to the body as it goes from metabolic syndrome to type II diabetes

Answer 12

Endocrine system compensates by increasing insulin secretion. Over time the beta cells of the pancreas wear out. Liver then loses the inhibitory effect of insulin and increases production of glucose=> diagnosis of diabetes

Question 13

What are risk factors for type II diabetes?

Answer 13

Impaired glucose tolerance, impaired fasting glucose, age > 45, family history, overweight, Lack of exercise, HTN, low HDL, high triglycerides, gestational DM, baby 9 ≥ pounds at birth

Question 14

What is the criteria for the diagnosis of type II diabetes?

Answer 14

A1C ≥ 6.5%. Fasting plasma glucose ≥ 126 mg/dL, 2 h plasma glucose ≥ 200 mg/dL during an OGTT, classic symptoms of hyperglycemia or hyperglycemic crisis and a random plasma glucose of ≥ 200 mg/dL

Question 15

What are treatment goals for the A1C of type II diabetics?

Answer 15

A1C < 7%. If history of severe hypoglycemia consider A1C goal of < 8 %

Question 16

What is the recommended pharmacotherapy for type II diabetes?

Answer 16

First line drug therapy is metformin. Severe symptoms or markedly elevated A1C consider insulin therapy to start. Not to goal with max noninsulin monotherapy in 3-6 months then add another agent

Question 17

What are the diet recommendations for type II diabetics?

Answer 17

no soda or trans fats, limit alcohol intake, and intake 14g/1000 kcal of fiber per day

Question 18

What are the physical activity recommendations for type II diabetics?

Answer 18

150 min/week moderate intensity exercise. 50-70% of Max heart rate (220 x age). Spread over 3 days per week. Resistance training 2 X per week

Question 19

What education needs to be provided to type II diabetics?

Answer 19

Self blood glucose monitoring. Treatment and recognition of hypoglycemia. Continual dietary and physical activity support and reinforcement

Question 20

How should an episode of hypoglycemia be treated?

Answer 20

15-20 g glucose or any form of carbohydrate. Recheck BG in 15 min and repeat treatment if necessary. Meal post episode

Question 21

What immunizations does a type II diabetic need?

Answer 21

Influenza, pneumococcal, hepatitis B

Question 22

How is HTN of type II diabetics managed?

Answer 22

Goal SBP < 130-140 mmHg. Goal DBP < 80 mmHg. ACE inhibitor or angiotensin receptor blocker first line therapy

Question 23

When should statin therapy be initiated in type II diabetics regardless of baseline lipid levels?

Answer 23

CVD. Without CVD and > 40 + one or more of the following: Family history of CVD, HTN, Smoking, Dyslipidemia, Albuminuria

Question 24

How is coronary disease managed in type II diabetics?

Answer 24

ACEI and statin therapy. B-blocker for at least 2 years post MI. Avoid thiazolidineodine (Actos) treatment with heart failure. Metformin ok if CHF with normal renal function

Question 25

How is nephropathy prevented in type II diabetics?

Answer 25

blood pressure and blood glucose control, Yearly albumin and creatinine checks.

Question 26

What is the treatment of albuminuria in type II diabetics?

Answer 26

if > 30 mg/day urinary albumin excretion then ACE inhibitor or angiotensin receptor blocker (ARB). Reduction of dietary protein intake

Question 27

How is retinopathy prevented in type II diabetics?

Answer 27

Blood pressure and blood sugar control. At diagnosis need dilated fundoscopic exam and yearly

Question 28

How is neuropathy screened for in type II diabetics?

Answer 28

Inspection, Pulses- Screen for symptoms of peripheral vascular disease. Consider ABIs. Sensation. Monofilament test and 1 of the following: Vibration, Pin prick, Ankle reflexes