Metabolic Syndrome & T2D Flashcards
(30 cards)
Metabolic Syndrome identifies risk of developing diabetes, True or False?
TRUE! The prevalence of metabolic syndrome also increases with age and BMI.
What are the 5 elements of Metabolic Syndrome? How many do you need to have metabolic syndrome?
- Insulin resistance: Fasting glucose greater than or equal to 100.
- Low HDL: less than 40 men and 50 women
- Elevated Triglycerides greater than 150
- HTN greater than 130/85
- Visceral Obesity: greater than 40 Men and 35 women
-require three of the five elements to be dx with metabolic syndrome.
What is the difference between National Cholesterol Education Progam(NCEP) and International Diabetes Federation (IDF)?
the major difference is that the IDF adjusts for race in the waist circumference measurement.
What are the fasting plasma glucose ranges for:
- normal
- prediabetes
- diabetes
- Normal: less than 100
- Prediabetes: 100-125
- Diabetes: greater than 126
what are the oral glucose tolerance ranges for:
- normal
- prediabetes
- diabetes
- Normal: less than 140
- Prediabetes: 140-199
- Diabetes: greater than 200
Prediabetes aka?
“impairment”
What is the A1C criteria for DM, Pre-DM, and Normal?
Normal: less than 5.7%
Prediabetes: greater than 5.7 - 6.4%
Diabetes: greater than 6.5%
Obesity causes metabolic chaos, what are some examples?
- reduction in mitochondrial ATP generation from glycolysis
- Triglyceride formation
- Free Fatty Acid Accumulation
- Proinflammatory: increased CRP, IL-6
- Prothrombotic
Up to 50% of people with metabolic syndrome have a positive family history, true or false?
-FALSE
hahaha jokes on you!
its true!!
Treatment of metabolic syndrome?
- risk factor reduction and weight loss
- lifestyle modification (weight loss and increased physical activity)
- treat cardiovascular risk factors:
- -lipid management
- –improve HDL with Niacin or Tricor
- –Improve triglycerides with Gemibrizol or fibrofibrate
- -HTN treatment
- -Tobacco Cessation
-30minutes of physical activity a day at minimum moderate intensity.
Can weight reduction improve insulin sensitivity?
yes!! you can reverse this process for a period of time.
Tx for Impaired fasting glucose/impaired glucose tolerance?
- intensive lifestyle interventions:
- -dietary counseling
- -exercise
- -weight loss (10%)
- -Possible Metformin (improves insulin sensitivity)
*lifestyle is superior to drug therapy.
If choosing to use Metformin for tx of T2D what are some of the qualifications for use?
- less than 60yo
- BMI greater than 35
- elevated triglycerides
- reduced HDL cholesterol
- Hypertension
- A1C greater than 6%
what are the requirements before use of metformin prior to diagnosis of DM?
-need to document both impaired fasting glucose and impaired glucose tolerance test.
What are the two pathogenic defects characterized by T2D?
impaired insulin secretion: pancreas not working as well as it should, over time the beta cells of the pancreas wear out.
insulin resistance; insulin that is secreted is not as effective.
What fasting glucose levels indicate almost complete loss of beta cell function?
-levels above 180-200mg/dL
Sx T2D
- blurry vision
- increased thirst
- polyuria
- fatigue
- skin, gum, and bladder infections
- dry itchy skin
- slow-healing cuts and bruises
- loss of feelin in the feet
- asymptomatic
Risk Factor for T2D
- Impaired glucose tolerance
- impaired fasting glucose
- age greater than 45
- family hx
- overweight/obese
- lack of exercise
- HTN
- low HDL
- high triglycerides
- Gestational DM
- Baby greater than 9 lbs at birth.
Criteria for dx of T2D
- A1C greater than 6.5%
- Fasting plasma glucose greater than 126mg/dL
- 2 h plasma glucose greater than 200mg/dL during OGTT
- sx hyperglycemia or random plasma glucose of greater than 200mg/dL
- need to have 2 test to have dx
T2D treatment goals for adults
- A1C less than 7%
- A1C less than 6.5% intensive tx
- Hx of hypglycemia A1C goal less than 8%
Tx T2D
- medications: Biguanides (Metformin)
- nutritional therapy
- exercise
- weight loss
- manage CV risk factors
- -exercise
- -management BP and lipids
- -weight loss
Monitor:
- peridontal disease=refer to dentist
- retinopathy=refer to specialist
- nephropathy= urine albumin/creatinine ratio
- neuropathy: foot exam, monofilament testing, vibration, and proprioception testing
- Vascular disease: foot exam for ulcers, pulse exam feet, ground, and B/L brachial BP
All patients eventually end up on insulin, true or false?
True, important to inform them of this in the beginning.
How often do you need to follow up with an A1C?
every 3 months
Bariatric surgery is considered at what BMI?
-greater than 35
