Diabetes mellitus, dyslipidemia, obesity

Diabetes mellitus (DM)

• Type 1 − Selective destruction of β-cells of Pancreas (autoimmunity, LADA) − absolute lack of insulin
• Type 2 − Insulin resistance with a relative deficiency of insulin
• Secondary − Pancreatogenic (surgical removal of pancreas, destruction by inflammation, tumor, injury) − insufficient or no insulin secretion
• Gestational − Hyperglycemia during pregnancy (excessive size of the fetus)

Main symptoms of diabetes

Impaired glucose tolerance (IFG − impaired fasting glucose 5,6 − 6,9 mmol/l, IPG − impaired postprandial glycemia after 2 hours 7,8 − 10,9 mmol/l) DM (2).

• The disease is characterized by hyperglycemia
• Physiological range of glycemia 3,9–5,5 mmol/l
• Determination of glycemia, insulin, C-peptide, glycated hemoglobin (HbA1c), possibly antibodies (anti GAD, ICA) − differential diagnosis DM.

Diagnostic criteria

• Fasting glycemia > 7 mmol/l, postprandial glycemia after 2 hours > 11 mmol/l.

Examination of the patient for diabetic complications

• Macrovascular (Stroke, acute M.I., ischemic diseases of the lower limbs)
• Microvascular (retinopathy, nephropathy, neuropathy)

Anamnesis, examination

• Polydipsia — excessive thirst associated with excessive fluid intake
• Polyuria — excessive urination
• Recurrent bacterial and fungal infections — Urogynecological, respiratory, skin;
• Complications of DM — ophthalmic, neurological, nephrological, vascular, cardiological.

Therapy

Dietary measures − basic therapeutic modality:

1. Normalization of fasting and postprandial glycemia (Regulation of carbohydrate content in the food and rate of carbohydrate absorption − glycemic index)
2. Achieving optimal levels of lipids in blood (TAG, HDL)
3. Ensuring sufficient energy supply
4. Prevention and treatment of late complications

Diet

• 5 − 6 meals per day − second dinner
• Bread units (interchangeable unit)
  • 1 BU corresponds to 10 − 12 g of carbohydrates = 2 cubes of sugar (Reducing diabetic diet to 175 g of carbohydrates per day = 16 BU = 32 cubes of sugar)
• Differences in the diet for type 1 and type 2 DM

Insulin pen

Pharmacotherapy

• Oral antidiabetics
  • Influencing the insulin resistance − Biquanides, Thiazolidinediones (glitazones)
• Secretagogues − Derivatives of sulfonylurea, Non-sulfonylureas (glinides)
  • Inhibition of digestive enzymes in the GIT (α-glucosidase, lipase)
  • Dipeptidyl peptidase-IV inhibitors (gliptins)
• Insulins (human, recombinant, analogues)

Dyslipidemia

Dyslipidemia

• Synonyms − Dyslipoproteinemia, hyperlipidemia, hyperlipoproteinemia
• Lipidogram (lipid profile) − total cholesterol TC, triacylglycerols TAG, low density lipoprotein LDL, high density lipoprotein HDL, apolipoprotein B (apo B), apolipoprotein AI (apo AI)
• Dyslipidemia is characterized by an altered Cholesterol level and/or triacylglycerides and/or HDL cholesterol
• Atherogenic lipid phenotype − TAG, jLDLsd, J.HDL.

Division

• Etiology
  • Primary − Genetic and lifestyle factors (composition and amount of food, smoking, alcohol, physical activity and body weight)
  • Secondary − Other diseases are involved in the development of dyslipidemia

From the clinical and therapeutic perspective, dyslipidemia is divided into three groups:

1. Isolated hypercholesterolemia
   • Increased total Cholesterol (TC), mostly in the LDL-cholesterol fraction (LDL−C), with a normal concentration of triacylglycerides (TAG);
2. Isolated hypertriacylglycerolemia
   • Increased TAG in combination with a normal cholesterol concentration (TC);
3. Combined hyperlipidemia
   • Simultaneously increased levels of both TC and TAG.

Therapy

Lifestyle changes

• Restricted diet, no consumption of alcohol, smoking, physical activity

Diet

• Limiting intake of fat to 60 g/day, cholesterol intake 300 mg/day (egg yolk contains 250 mg), consumption of fiber 30 g/day − 500 g of fruits and vegetables, processed foods.

Pharmacotherapy

• Statins (atorvastatin, simvastatin, fluvastatin, rosuvastatin)
• Fibrates (fenofibrate)
• Ezetimibe
• Bile acid resins (Questran)
• Combination of medications (simvastatin/ezetimibe)

Conclusion

Aiming to reach optimal levels of lipids, weight, and blood pressure to reduce the risk for cardiovascular diseases and mortality.

Obesity

Obesity

• Excessive storage of fat in the organism
• Classification according to quantity (BMI) and quality (android type, gynoid type)
• Physiologic amount of fat in women is 25−30 % and in men 20−25 %
• BMI = weight (kg)/height (m)².

Classification of body weight according to BMI

Anthropometry

• Waist circumference − site of measurement: visible waist, respectively at the level of iliac crest and last rib
  • Physiologic value − men up to 94 cm, women up to 80 cm
• Measurement of skin folds − bicipital, tricipital, subscapular, suprailiac
• Bioelectrical impedance analysis for percentage of fat.

Therapy

• Aiming to reduce weight by 5−10 % and maintaining this weight
• Significant reduction of risk for DM, hypertension, and cancer
• Reduction of risk for complications of obesity − diseases of the musculoskeletal system, dyspnea and sleep apnea syndrome.

Diet therapy

• Restricted diet − regular meals, 5 − 6 times per day, regulated amount of proteins, less fat and sugar, limited amount of table salt (605 − 1770 kcal/day)
• Pharmacotherapy − Anti-obesity drugs: sibutramin, orlistat, rimonabant
• Physical activity − Exercise test (ergometry)

Metabolic syndrome

Raven syndrome, syndrome X

• According to IDF 2005: waist M 94 cm and more, F 80 cm and more, increased TAG, arterial hypertension, DM or impaired glucose tolerance
• Significant impact on quality of life, increased morbidity (complications of DM, dyslipidemia...), mortality (CVD)

Anamnesis

• Family history: DM, endocrinopathies, CVD, Metabolic syndrome
• Personal history: co-morbidities − DM + complications, CVD, nephropathy, endocrinopathies, infections
• Gynecological history: deliveries, fetal weight (more than 4 kg), abortions
• Addictions: smoking, alcohol consumption, drugs
• Pharmacological history: corticoids, oral contraceptives, hormone replacement therapy, thyroid hormones, psychiatric drugs, oral antidiabetics, insulin

Conclusion

• Complex approach − psychology, psychopathology, patient habits, background
• Adjustment of lifestyle − physical activity
• Diet therapy − planning of meals

Links

Original text is from Wikiskripta – https://www.wikiskripta.eu/index.php?curid=36984

Related articles

• Diabetes mellitus
• Dyslipidemia
• Obesity
• Metabolic syndrome

Source

• DUŠEJOVSKÁ, M.. Diabetes mellitus, dyslipidemie, obezita [online]. [cit. 2012-03-11]. <https://el.lf1.cuni.cz/att00082/>.

• KAREN, Igor – SVAČINA, Štěpán. Diabetes mellitus v primární péči. 2. edition. Prague. 2014. ISBN 978-80-904899-8-1.

• GANONG, William F. Přehled lékařské fysiologie. 1. edition. Jinočany : H & H, 1995. 681 pp. ISBN 80-85787-36-9.

• SVAČINA, Štěpán. Poruchy metabolismu a výživy. 1. edition. Praha : Galén, 2010. 505 pp. ISBN 978-80-7262-676-2.