Diabetes mellitus, dyslipidemia, obesity

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Diabetes mellitus (DM)[edit | edit source]

  • 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
  • GestationalHyperglycemia 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[edit | edit source]

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

Examination of the patient for diabetic complications[edit | edit source]

Anamnesis, examination[edit | edit source]

  • 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[edit | edit source]

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[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

Lifestyle changes

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


  • 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.


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

Conclusion[edit | edit source]

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

Obesity[edit | edit source]

  • 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[edit | edit source]


  • 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[edit | edit source]

  • 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[edit | edit source]

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[edit | edit source]

  • 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[edit | edit source]

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

Links[edit | edit source]

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

Related articles[edit | edit source]

Source[edit | edit source]

  • 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.