Metabolic Sydrome

Question 1

a constellation of metabolic derangements that increases the risk of developing type 2 diabetes mellitus and cardiovascular disease.

Answer 1

metabolic syndromes

Question 2

The key feature of metabolic syndrome is

Answer 2

insulin resistance

Question 3

Insulin resistance (IR) and the resultant hyperinsulinemia lead directly or indirectly to the development of

Answer 3

hypertension, glucose intolerance and dyslipidemia.

Question 4

Obesity, especially____ obesity, exacerbates the insulin resistance. Insulin resistance has a strong genetic component.

Answer 4

central

Question 5

What three factors define metabolic syndrome?

Answer 5

1. Abdominal obesity: waist circumference with >40 men and >35 women
2. Hypertriglycidemia: >150 with LOW HLD
3. HYpertentsion: > 130/85

Question 7

What is the role of increased adiposity in insulin resistance?

Answer 7

big fat cells make lots of endocrine hormones, increase FFA, impair glucose uptake to muscles (bc muscles take up fat instead) and leads to insulin resistance

Question 8

Increases in circulating glucose, and to some extent FFA, increase pancreatic insulin secretion, resulting in ______ which may result in enhanced sodium reabsorption and increased sympathetic nervous system (SNS) activity

Answer 8

hyperinsulinemia

Question 9

The enhanced secretion of ______ and _______ produced by adipocytes and monocyte-derived macrophages results in more insulin resistance and lipolysis of adipose tissue triglyceride stores to circulating FFAs.

Answer 9

interleukin 6 (IL-6)

tumor necrosis factor (TNF- )

Question 10

Insulin resistance and hyperinsulinemia are considered to be the key pathogenic factors in the development of the

Answer 10

metabolic syndrome.

Question 11

-Insulin resistance tends to involve primarily

Answer 11

fat and muscle tissue.

Question 12

The ________ can often delay the development of diabetes (at least early on) by producing enough insulin to overcome the insulin resistance (hyperinsulinemia)

Answer 12

endocrine pancreas

Question 13

production of several ______ by adipose tissue in obese people is abnormal and contributes to insulin resistance and cardiovascular disease risk.

Answer 13

adipokines (including inflammatory cytokines)

Question 14

. Initially, the β-cells of the pancreas compensate for insulin resistance by increasing ______ and release (hyperinsulinemia).

However, prolonged stimulation of beta-cell leads to____such that insulin levels decrease – this leads to frank hyperglycemia (type 2 diabetes mellitus).

Answer 14

insulin synthesis

“beta-cell failure”

Question 15

Adiponectin and leptin_____ with insulin resistance.

TNFα and resistin_____ with insulin resistance.

Answer 15

decrease

increase

Question 16

What are the two possible mechanisms for insulin resistance?

Answer 16

Inflammation: lipids make cytokines which attrack shit to block the insulin receptor substrate

Lipid overload: see increase fat uptake into the muscles with produce DAGS that will block insulin receptor

Question 17

decreases in ____function leads to a decrease in insulin-mediated glucose uptake leading to hyperglycemia

Answer 17

IRS-1

Question 18

Insulin resistance leads to hyperinsulinemia causing: HTN, thrombosis, dyslipidemia and glucose tolerace all contributing to:

Answer 18

Vascular/heart disease

Question 19

Risk factors for obesity:

Answer 19

Low socioeconomic status

Lack of physical activity/sedentary lifestyle

High carbohydrate diet

Smoking

Genetic predisposition

Use of atypical antipsychotics,

Question 20

Complications associated with metabolic syndrome

Answer 20

• Fatty liver disease (nonalcoholic steatohepatitis or NASH)\
• Polycystic ovary syndrome
• Obstructive sleep apnea
• Gout (Hyperuricemia)
• Increased risk of cancer

Question 21

-The typical lipid profile in the metabolic syndrome is a___ HDL,___ triglycerides and ______ in the LDL cholesterol. The LDL particles are smaller and more atherogenic

Answer 21

low

elevated

mild or moderate increase

Question 22

What do we see with VLDL levels and lipoprotein lipase in people with insulin suppresion

Answer 22

The suppression of lipoprotein lipase and very-low-density lipoprotein (VLDL) production by insulin is defective in insulin resistance, leading to increased flux of free fatty acids (FFAs) to the liver and increased VLDL production, which results in increased circulating triglyceride concentrations.

Question 23

In insulin resistance, the inability of insulin to suppress lipolysis in adipose tissue and glucagon secretion by alpha cells in the islet results in

Answer 23

increased gluconeogenesis

Question 24

Key lifestyle modifications to tx metabolic syndrome

Answer 24

diet, exercise, stop smoking, physical activity, bariatric surgery

Question 25

a reversible inhibitor of gastric and pancreatic lipases. It can inhibit the absorption of dietary fats by 30%. It is used for the management of obesity, including weight loss and weight management

Answer 25

orlistat

Question 26

What are our first line therapies to tx hypertesion?

Answer 26

Consider angiotensin-converting enzyme inhibitors (ACE-inhibitors) or angiotensin II receptor blocker (ARB) as first-line therapy

Question 27

Recommended therapy for tx elevated LDL cholesterol

Answer 27

HMG-CoA reductase inhibitors (statins) are used as first-line agents.

Ezetimibe as second line therapy.

Question 28

What do we use to tx Hypertriglyceridemia

Answer 28

Fibric acid derivatives to achieve secondary non-HDL cholesterol target (LDL goal + 30), usually <130.

Niacin

Question 29

Tx for pre-diabetes

Answer 29

Diet, exercise and weight loss.

Nutrition counseling.

Metformin in select groups of patients

Aspirin to help with thrombotic risks