Metabolic Syndrome and Type II DM Flashcards
What two disease states does metabolic syndrome identify?
risk of developing diabetes and patients at high risk of developing CVD
What are the factors that comprise metabolic syndrome?
insulin resistance, low HDL, elevated triglycerides, HTN, visceral obesity
What is the NCEP/ATP III criteria for metabolic syndrome?
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
What is the IDF criteria for diagnosis of metabolic syndrome?
The same as the NCEP/ATP III criteria except the increased waist circumference is ethnic specific.
How does obesity harm the body tissues?
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
What are other risk factors for metabolic syndrome?
postmenopause, smoking, low income, high carb diet, sedentary, soft drinks, family h/o
What are other obesity related disorders associated with metabolic syndrome?
Fatty liver disease, hepatocellular and intrahepatic cholangiocarcinoma, chronic kidney disease, polycystic ovarian syndrome, sleep apnea, hyperuricemia and gout
What is the mainstay of treatment for metabolic syndrome?
Lifestyle modification focused on weight loss and increased physical activity. Treat cardiovascular risk factors. Weight reduction and metformin improve insulin sensitivity
How do you reduce CVD risk factors associated with metabolic syndrome?
lipid management with niacin, Tricor, treatment of HTN, tobacco cessation
When is metformin recommended in addition to lifestyle changes for the treatment of metabolic syndrome?
< 60 years old. BMI ≥ 35. Family hx of DM in 1st degree relative. Elevated triglycerides. Reduced HDL cholesterol. Hypertension. A1C > 6 %
What are the two pathogenic defects that characterize type 2 diabetes?
Impaired insulin secretion and insulin resistance
Describe what happens to the body as it goes from metabolic syndrome to type II diabetes
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
What are risk factors for type II diabetes?
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
What is the criteria for the diagnosis of type II diabetes?
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
What are treatment goals for the A1C of type II diabetics?
A1C < 7%. If history of severe hypoglycemia consider A1C goal of < 8 %
What is the recommended pharmacotherapy for type II diabetes?
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
What are the diet recommendations for type II diabetics?
no soda or trans fats, limit alcohol intake, and intake 14g/1000 kcal of fiber per day
What are the physical activity recommendations for type II diabetics?
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
What education needs to be provided to type II diabetics?
Self blood glucose monitoring. Treatment and recognition of hypoglycemia. Continual dietary and physical activity support and reinforcement
How should an episode of hypoglycemia be treated?
15-20 g glucose or any form of carbohydrate. Recheck BG in 15 min and repeat treatment if necessary. Meal post episode
What immunizations does a type II diabetic need?
Influenza, pneumococcal, hepatitis B
How is HTN of type II diabetics managed?
Goal SBP < 130-140 mmHg. Goal DBP < 80 mmHg. ACE inhibitor or angiotensin receptor blocker first line therapy
When should statin therapy be initiated in type II diabetics regardless of baseline lipid levels?
CVD. Without CVD and > 40 + one or more of the following: Family history of CVD, HTN, Smoking, Dyslipidemia, Albuminuria
How is coronary disease managed in type II diabetics?
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
