Metabolic syndrome and Type 2 DM Flashcards Preview

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Flashcards in Metabolic syndrome and Type 2 DM Deck (64):

Why is ID of metabolic syndrome so important?

- because ID risk of developing diabetes
- Id pts at high risk of developing CVD


When does prevalence of metabolic syndrome increase?

- with age and obesity
- 44% of those in 60-69 age range


What ethnicity has highest % of metabolic syndrome?

- mexican Americans (both men and women)


What 3 out of 5 elements are needed for dx of metabolic syndrome?

- visceral obesity
- insulin resistance
- elevated TGs
- low HDL


How do these elements of metabolic syndrome increase CVD?

- abdominal obesity: impaired glucose and fatty acid utilization (hyperglycemia and dyslipidemia are also related to abdominal obesity)
- hyperglycemia: insulin resistance = increased blood sugar
- dyslipidemia: elevated TGs and low HDL
- HTN: endothelial dysfunction -> lead to increase likelihood of thrombotic events


NCEP/ATP III criteria for dx of metabolic syndrome? (3 out of 5)

abdominal obesity: for men - waist of 40 inches or greater
women - waist of 35 or greater

- TGs: more than 150 mg/dL
- HDL cholesterol: less than 40 in men and less than 50 in women
- BP: greater than 130/85
- fasting plasma glucose greater or equal to 100 mg/dL


IDF criteria for dx of metabolic syndrome?

- increased waist circumference (ethnic specific) plus 2 of the following:
TGs greater than 150
HDL less than 40 men, less than 50 women
BP greater than 130/85
fasting glucose: greater than 100


Fasting plasma glucose levels?

- greater or = to 126: diabetes
- less than 125 and greater or equal to 100 - prediabetes
- normal: less than 100


Oral glucose tolerance levels?

- greater or equal to 200: diabetes
- greater or equal to 140 and less than 199: prediabetes
- normal: less than 140


A1C criteria for DM and pre-DM?

- diabetes - equal or greater than 6.%
- prediabetes - 5.7-6.4%
- normal: less than 5.7%


How does obesity cause metabolic chaos?

- reduction in mito ATP generation from glycolysis
- TG acccum
- Free FA accumulation
- proinflammatory: increased CRP, IL-6
- prothrombic: increased plasminogen activator inhibitor


Prevalence of metabolic sydrome increases with increasing BMI, stats?

- 5% of pts with normal wt
- 22% of overweight pts
- 60% of obese pts


What are other obesity related disorders that are associated with metabolic syndrome?

- fatty liver disease
- hepatocellular and intrahepatic cholangiocarcinoma
- polycystic ovarian syndrome
- sleep apnea
- hyperuricemia and gout


What are other risk factors to metabolic syndrome?

- postmenopausal status
- smoking
- low household income ( low education, can't afford healthy food)
- high carb diet
- no alcohol consumption
- physical activity
- soft drink consumption
- family history


How impt is family hx risk factor for metabolic syndrome?

- up to 50% of people with metabolic syndrome have positive family hx
- 39% of people with type 2 DM have at least 1 parent with the disease


Tx of metabolic syndrome foucses on what?

- on RF reduction and wt loss
- lifestyle modification: focused on wt loss and increased physical activity
- Tx cardiovascular risk factors


What improves insulin sensitivity?

- weight reduction
- doesn't matter what kind of diet as long as it is tailored towards weight loss
- mediterranean diet
- DASH diet
- low glycemic index foods


How much exercise is needed daily?

- 30 minutes at minimum moderate intensity (break a sweat, hard to hold a conversation)
- or a goal of 10,000 steps a day
- reduction in abdominal obesity (liposuction isn't beneficial) -process of weight loss: exercise is what improves metabolism of glucose
- exercise: improves insulin sensitivity (for up to 48 hrs after exercise)


How can you reduce CVD risk factors?

- lipid management: improve HDL - lifestyle: eat healthy, exercise, take Niacin, Tricor, statins
improve TG levels: take fibric acids - tricor

- tx hypertension
- tobacco cessation


How does IGT prevent disease progression?

- intensive lifestyle interventions
- goal is to delay/prevent development of diabetes
- tx may reduce long term CVD events
- delay the onset of diabetes


Tx of impaired glucose metabolism (IGT/IFG)?

- dietary counseling
- exercise
- wt loss: goal to start is 10% of baseline
- role for metformin is that it improves insulin sensitivity (can be used in pre diabetic state)


Tx of impaired glucose metabolism? Goals?

- wt loss of 5-10%
- moderate physical activity of 30 minutes per day


Who qualifies for metformin that has IFG/IFT?

- less than 60
- BMI of 35 or more
- family hx of DM in first degree relative
- elevated TGs
- reduced HDL cholesterol
- A1C >6%

Metformin + lifestyle changes


What is more effective: drug therapy or lifestyle modification for DM prevention?

Studies show that lifestyle modification more effective at reduction of BG then metformin alone
- Drug therapy seems to be more beneficial in younger pts


what needs to be done if pt going to receive metformin for pre-diabetes?

- need to complete OGTT
- need to doculemtn both IFG and IGT if metformin used prior to dx of DM


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

- imparied insulin secretion
- insulin resistance


What organs are involved in type 2 diabetes?

- pancreas (alpha and beta cells)
- liver (gluconeogenesis, liver can manufacture glucose, gets feedback from peripheral tissues to shut production off)
- peripheral tissues: adipose tissue, muscle uptake of glucose


Natural hx of type 2 DM in years preceding dx?

- endocrine system compensates by increasing insulin secretion
- over time the beta cells of pancreas wear out because of resistance
- liver then loses the inhibitory effect of insulin and increases production of glucose
= dx of diabetes


What fasting glucose level indicates almost complete loss of beta cell function?

- levels above 180-200


Sxs of type II diabetes?

- blurry vision
- increased thirst or need to urinate
- feeling tired or ill
- recurring skin, gum or bladder infections
- dry, itchy skin
- unexpected wt loss
- slow healing cuts or bruises
- loss of feeling or tingling in the feet


RFs of type 2 DM?

- impaired glucose tolerance
- impaired fasting glucose
- age over 45
- family hx
- overweight
- obese
- lack of exercise
- low HDL, high TG
- gestation DM ( 50% lifetime risk of developing DM 2 after pregnancy)
- baby thats 9 or more pounds at birth


beta blockers effect on blood sugar?

(propanolol, metoprolol)
- Mech: decreased insulin sensitivity


hypolipidemic effect on blood sugar?

- niacin (at higher doses)
- altered hepatic metabolism of glucose


Thiazide diuretic effect on blood sugar?

- HCTZ, chlorthalidone
- mech: decreased K, decreased insulin secretion, increased insulin resistance


Glucocorticoid effect on blood sugar?

- increased glucose production and increased glucose resistance


Oral contraceptive effect on blood sugar?

- altered hepatic glucose metabolism
- increased insulin resistance


Criteria for dx of DM II?

- A1C has to be equal or greater than 6.5%
- fasting plasma glucose is equal or greater than 126 mg/dL
- 2 hr plasma glucose has to be equal or greater than 200 during OGTT
- classic sxs of hyperglycemia or hyperglycemic crisis and random plasma glucose of 200 or greater (polydypsia, polyuria)


Tx goals for adults?

- A1C less than 7%
- intensive tx in some pts to an A1C goal of 6.5 or less
- if hx of severe hypoglycemia consider A1C of less than 8%
(in some pts like the elderly you don't want A1C to get too low because they are more likely to have hypoglycemic episodes and have worse outcomes


Tx of DMII?

- target tx of elevated glucose:
meds, medicatl nutritional therapy, exercise, wt loss
- management of CV RFs: exercise, management of BP and lipids, wt loss


What disease complications should you monitor for in pts with DM II?

- peridontal disease: refer to dentist
- retinopathy: dilated fundoscopic exam yearly with specialist
- nephropathy: urine albumin to creatinine ratio yearly (ACEI or ARB)
- neuropathy: foot exam, monofilament testing, vibration and propioception testing
- vascular disease: foot exam for ulcers, pulse exa for feet, groin, and B/L brachial BP


Pharmacotherapy for type 2 DM Drug classes?

- biguanides: first line therapy, metformin
- sulfonylureas
- meglitinides
- TZDs
- alpha-glucosidase inhibitors
- DPP-4 inhibitors
- SGLT2 inhibitors
- GLP-1 receptor agonists
- Amylin memetics
- insulin


First line drug therapy for T2DM?

- metformin (biguanide drug class)


If pt has severe sxs or markedly elevated A1C what tx should you consider starting?

- insulin
(have blood glucose of 180-200)
-- if not to goal with max noninsulin montherapy in 3-6 months then add another agent


what should you inform pts of when they are dx of diabetes? what med will they end up on?

- all pts will eventually end up on insulin
- natural progression of disease leads to eventual lack of beta cell function


How often should you follow up with DMII pt?

- F/U with A1C every 3 months
- if at goal and therapy isn't changing may move checks to every 6 months
- monitor for complications of DM and tx comorbidities


What kind of medical therapy for DM and prediabetes should be done with pt?

- meet with registered dietician
- wt loss if overweight or obese
- low carb, low fat, calorie restricted or mediterranean diet
- physical activity


What kind of diet should you follow being pre diabetic or diabetic?

- limit sugar sweetened drinks
- limit alcohol intake
- fiber 14g/1000 kcal
- no trans fats


What are the physical activity recommendations for diabetics?

- 150 min/week moderate intensity exercise
- 50-70% of max heart rate
- spread over 3 days/week
- resistance training 2x per week
- exercise Rx - agreed upon exercise regimen


Psychosocial assessment of diabetic pt?

- screen and tx depression, anxiety, and eating disorders


What is key to successful diabetes tx?

- ongoing pt education
- self blood glucose monitoring (if on insulin)
- tx and recognize hypoglycemia
- continual dietary and physical activity support and reinforcement


What are the sxs of hypoglycemia?

- confusion, diaphoresis, tachycardia, palpitations, weakness
- need to give 15-20 g of glucose or any form of carb
- recheck BG in 15 min and repeat tx if necessary
- meal post episode


Who is recommended for bariatric surgery?

- BMI of 35 or more
- especially for difficult to control DM with assoc comorbidities
- does make a difference in blood sugar afterwards, and can reverse diabetes for period after surgery
- pt has to be motivated


Immunization that diabetics need?

- influenza: all persons older then 6 months
- pneumococcal: older than 2 years, revaccination one time if vaccine giver before 64 and it has been more than 5 years
- PCV13 and PSSV23
- Hep B


Complications of DM?

- Dyslipidemia
- nephropathy
- retinopathy
- neuropathy
- foot ulcers or charcot foot


Tx of HTN?

- goal SBP is less than 140
- goal DBP: less than 90
- ACEI or angiotensin receptor blocker is first line therapy if no CIs


Lipid control and tx?

- evaluate fasting lipids at least once yearly
- want LDLs less than 100
- LDL if CVD less than 70
- TGs less than 150
- HDLs greater than 40 in men, 50 in women
- LDL is the main target for tx
- combo therapy: studies shown that it doesn't reduce CVD risk, and may icnrease risk for myopathy


Whe are statins indicated in DM pts?

- pts with CVD
- w/o CVD and older than 40 and one of the following:
family hx of CVD
smoking dyslipidemia


Who should be taking aspirin?

- 75-162 mg/ day
- men older than 50 and women older than 60 if:
family hx of CVD
albuminuria (indicates renal failure)


Coronary disease screening and therapy?

- not recommended to screen asx pts
- ACEI and statin therapy
- B blocker for at least 2 years post MI
- avoid thiazolidineodine tx with heart failure
- metformin ok if CHF with normal renal function: not for unstable CHF or renal compromised pts


Nephropathy prevention?

prevention: BP and blood glucose control
- yearly albumin excretion (need baseline at dx)
- at least yearly creatinine and BUN levels


Tx of albuminuria?

- more than 30 mg/day urinary albumin excretion - take ACEI or ARB


Retinopathy prevention?

-- BP and blood sugar control for prevention
- at dx need dilated fundoscopic exam and need this done yearly - want to have ophtho look at them yearly


Neuropathy screening?

- screening for distal polyneuropathy at dx and yearly
- monofilament test
- autonomic neuropathy:
gastroparesis (delayed gastric empytying)
erectile dysfunction
cardiovascular autonomic dysfuntion (ortho hypotension)


Foot care for diabetics?

- inspection
- pulses: screen for sxs of PVD, consider ABIs
- sensation: monofilament test and 1 of the following:
vibration, pin prick, ankle reflexes