Obesity, Diabetes, and the Metabolic Syndrome Flashcards
Components of the metabolic syndrome
- Obesity
- Hyperlipidemia
- Coronary artery disease
- Fatty heart (also liver)
- Hypertension (high blood pressure)
- Insulin resistance
- Diabetes type II
Diabetes = High blood glucose levels
> ?
126 mg/dl or greater with fasting
glucose test
- supposed to be 24 hours
(guidelines) , but most go by 12 hours*
What is metabolic syndrome?
Insulin resistant syndrome linked to obesity
What is BMI?
Body weight in KG divided by height in meters squared
Formulas used in determining risk (?)
- BMI
- WHR (waist hip ratio)
- abdominal circumference only
- liver fat content
WHR
how to measure
- Waist measured at the most narrow part of torso above umbilicus and below xiphoid
- Hip measured at the max circumference of hips or buttocks
BMI
underweight
< 18.5
BMI
normal
18.5-24.9
BMI
overweight
25-29.9
BMI
obese (Class I)
30-34.9
BMI
obese (Class II)
35-39.9
BMI
obese (Class III)
>40
unused energy →
fat deposition
doesn’t matter what type of intake
How many calories in a pound?
3500
Cals per gram
fat
9
Cals per gram
carbs
4
Cals per gram
protein
4
Cals per gram
alcohol
7
diabetes
Casual plasma glucose
above 200 mg/dl
casual, not fasted
diabetes diagnosis
Fasting plasma glucose
above 126 mg/dl
75g glucose load test
2 hour test
measure at the end of an hour and then after 2 hours
measure above 200 mg/dl
Pre-diabetic numbers
above 100 mg/dl
Hb1ac is a measure of:
measure of average blood glucose over 2-3 months (6% = 126 mg/dl)
better to see the big picture
Hb1ac
normal value
below 5.7%
Hb1ac
pre-diabetic value
5.7 to 6.4%
Hb1ac
diabetic
6.5% or higher
What is type I
used to be called juvenile diabetes
IDDM: insulin dependent diabetes mellitus
Autoimmune destruction of β cells
Type II diabetes
- NIDDM
- Relationship with obesity
- Decreased number of insulin receptors
- Mobilization of fat in the body
- Protein depletion for energy
Diabetes:
kidney effects
- increased kidney filtration of glucose (DAMAGES KIDNEYS, large molecules going through)
↓↓↓↓↓
- increased thirst
- increased urination
acidosis
increase acidity in the blood
Fat metabolism replacing carbohydrate- increases acidity from 1 to 10 mEq/liter
acidosis
S/S
- Rapid and deep breathing
- fruity breath
- ketone formation
- coma
- death
pancreas functions
- endocrine (glands)
- digestive (fat storage)
pancreas
digestion
- acinar cells
- secrete digestive enzymes
pancreas
hormone secretion
- Islets of Langerhans
- Insulin and glucagon
Islets of Langerhaans
3 major types of cells
- Alpha- secrete glucagon
- Beta- secrete insulin
- Delta- secrete somatostatin
Effects of Insulin binding to cell
(glucose, membrane, transcription, metabolic activity)
- Glucose permeable to 80% of cells within seconds
- Membrane permeable to amino acids, potassium, phosphate
- DNA and RNA transcription of new proteins
- Slower process
- Intracellular metabolic activity
- Slower process
normal blood glucose
fasting
- 80-90 mg/dl
- Minimal insulin secretion-25 ng/min/kg weight
blood glucose
Increased glucose- 2 to 3 X normal
- Results in 10 fold increase in insulin in 3 to 5 minutes, returns to resting after 5 to 10 minutes
- Negative feedback loop- triggered at 100 mg/dl
- 15 minutes after initial secretion second increase which will plateau in 2 to 3 hours
insulin resistance due to obesity
glucose absorption
- Cells that normally use insulin to allow entrance of glucose do not function properly- insulin resistance
insulin resistance due to obesity
lipid synthesis
However, insulin stimulated lipid synthesis (another role of insulin) occurs at increased rate due to an increase in lipid producing enzymes
treatment goals
BMI
below 25%
treatment goals
BP
below 125/75
treatment goals
LDL
below 100 mg/dl
treatment goals
triglycerides
below 150 mg/dl
treatment goals
HDL
- HDL above (men) 40 mg/dl (women) 50 mg/dl
- HDL above 60 mg/dl for all
treatment goals
blood glucose
below 100 mg/dl
