PRESENTED BY:Mrs.S.Nirmala Nadanasabapathi M.Pharm.,(Ph.D)

DIABETES AND METABOLIC SYNDROME

Metabolic syndrome

The metabolic syndrome is a group of risk factors that occur together and increases the risk of coronary artery disease, stroke and diabetes.

In most people with glucose intolerance or type 2 diabetes , there is a multiple set of risk factors that commonly appear together, forming what is now known as the ‘Metabolic Syndrome’..

According to the Third National Health and Nutrition Examination Survey (NHANES III)

47 million people have metabolic syndrome 44% of those in the ≥ 50-year age group. Metabolic syndrome is present in 10% of women and 15% of men with

normal glucose tolerance; 42% and 64% of those with impaired fasting glucose 78% and 84% of those with type 2 diabetes.

Etiology :

Etiology of the metabolic syndrome has not been established definitively.

Primary cause is insulin resistance. Secondary cause is hormonal changes for the development of abdominal

obesity.

The link between insulin resistance and cardiovascular disease probably is mediated by the following:

Oxidative stress endothelial cell dysfunction, promoting vascular damage atheroma formation. 

Major symptoms

1.Obesity and abdominal fat

2.High Blood Pressure..

3.High Cholesterol..

4.High Blood Sugar..

5. Gout..

Obesity, now thought to affect 50 to 60 per cent of a nation’s population, it is associated with insulin resistance and the metabolic syndrome.

Obesity contributes to the following: Hypertension high serum cholesterol low HDL-c hyperglycaemia

BMI :Body Mass Index is a calculation that uses your height and weight to estimate how much body fat is present.

CAUSES OF METABOLIC SYNDROME

Central obesity:

Increase in body mass index (BMI) but it is an excess of body fat in the abdomen, measured simply by waist circumference, that is more indicative of the metabolic syndrome profile than BMI.

Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is a chronic medical condition in which the blood pressure in the arteries is elevated.

-> It is the condition in which systolic and diastolic blood pressure exceeds above 140/90 mm Hg

Classification: primary (essential) hypertension secondary hypertension

about 90–95% of cases are categorized as "primary hypertension" which means high blood pressure with no obvious underlying medical cause.

The remaining 5–10% of cases categorized as secondary hypertension are caused by other conditions that affect the kidneys, arteries, heart or endocrine system.

Hypertension

 

Target Organs :

CVS (Heart and Blood Vessels) The kidneys Nervous system The Eyes

Gout:

Heterogeneous group of diseases involving : An elevated serum urate concentration (hyperuricemia) Recurrent attacks of acute arthritis in which monosodium urate

monohydrate crystals are demonstrable in synovial fluid leukocytes Aggregates of sodium urate monohydrate crystals (tophi) deposited

chiefly in and around joints, which sometimes lead to deformity and crippling

Renal disease involving glomerular, tubular, and interstitial tissues and blood vessels

Uric acid nephrolithiasis

Hyperuricemia : serum uric acid level>7mg% (males) >6mg% (females)

PATHOGENESIS: 1. Hyperuricemia leads to extracellular accumulation of urate

2. Urate crystals form

3. Urate crystals deposit in joint(s)

4. Inflammatory process initiated

5. Acute flare

RISK Factors: • Male gender• Female gender postmenopause• Advanced age• Drugs - Diuretics, low-dose aspirin (ASA), cyclosporine• Hypertension

Diabetes mellitus is a condition in which pancreas no longer produces enough insulin or cells stop responding to insulin that is produced. So that glucose in the blood cannot be absorbed in to the cells of the body.

Insulin- a hormone made in the pancreas that turns sugar (glucose) into energy for the body to use

What happens without insulin?Lack of insulin

Build up of glucose in the blood

(hyperglycemia)

Symptoms of Diabetes Mellitus

Diabetes Mellitus

Complications : - Stroke

- Heart attack

- Kidney disease

- Eye Disease

- Nerve Damage

Types:1) Type 1 diabetes

2) Type 2 diabetes

3) Type 3 diabetes

4) Gestational diabetes

5) Double diabetes

Symptoms: Frequent urination Excessive thirst Extreme hunger

- Cells are starved for energy Unexplained weight loss

- Insulin can not trigger the storage of fat Fatigue Delayed wound healing

Type I Diabetes Mellitus• Juvenile diabetes • Autoimmune disorder• -body immune system attacks and kills off its

own insulin producing cells. Thus, the body can no longer produce insulin

• results in insulin dependence• commonly detected before 30

• RISK factors:- Genetics- Autoimmune history

Type I is not preventable

Type II Diabetes Mellitus

- blood glucose levels rise due to

1) Lack of insulin production

2) Insufficient insulin action (resistant cells)

- commonly detected after 40

- effects > 90%

- eventually leads to β-cell failure (resulting in insulin dependence)

Non-insulin dependent diabetes mellitus

- Body makes insulin but most cells do not use insulin properly

Slowly, the pancreas stops making insulin.

Insulin resistance: => Insulin resistance occurs when cells in the body

become less sensitive and eventually resistant to insulin. Insulin resistance results in:

Glucose can no longer be absorbed by the cells

Glucose remains in the blood triggering the need for more and more insulin

hyperinsulinaemia

The production of ever-increasing amounts of insulin wear out the beta cells

pancreas is no longer able to produce enough insulin

Hyperglycaemic

RISK factors:- Older age- Family history- Obesity- Physical Inactivity- Race and Ethnicity

Type III Diabetes Mellitus:

This covers a wide range of specific types of diabetes including various genetic defects in insulin action, and diseases of the exocrine pancreas.

Pancreas related diabetes mellitus is not dependent on age. It is also not influenced by the ordinary diabetes mellitus triggering conditions such as diet, lifestyle, age, heredity.

Double diabetes:

• Childrens are more prone to double diabetes.• It occurs when type 1 diabetes develops resistance to insulin.• Insulin dependent

Gestational Diabetes:

A pregnant woman who is not tolerating glucose may be diagnosed with gestational diabetes.

This needs to be controlled in order to prevent complications and problems for the mother and child.

Pregnant women who have gestational diabetes are more at risk for developing diabetes in the future, according to the CDC. Insulin resistance, or inability for the mother to use insulin, is the cause of gestational diabetes. This can cause the baby to have increased levels of sugar, gain too much weight or have breathing problems at birth

Fasting Plasma Glucose Test (FPG) - (cheap, fast)

*fasting B.G.L. 100-125 mg/dl signals pre-diabetes

*>126 mg/dl signals diabetes

Oral Glucose Tolerance Test (OGTT)

*tested for 2 hrs after glucose-

rich drink

*140-199 mg/dl signals pre-

diabetes

*>200 mg/dl signals diabetes

Diagnosis:

Diagnosis of gestational diabetes:

• A standard OGTT should be performed afterovernight fasting (8–14 hours) by giving 75 g anhydrousglucose in 250–300 ml water

• Plasma glucose ismeasured fasting and after 2 hours.

Type I Treatment Glucose monitoring often Insulin injections Exercise Diet

Type II Treatment Glucose monitoring often Oral medicine / Insulin injections Diet Exercise / Weight management

Treatment:

Oral Hypoglycaemic Medications

Eat starchy foods regularly Eat more fruit and vegetables Reduce animal or saturated fat Cut down on sugar Reduce salt Focus on ‘sugar free’

Diet for diabetes:

Still raise in blood glucose levels ???

Still contain same calories???

=>Exercise / Weight management <=

Test for metabolic syndrome:

Blood pressure equal to or higher than 130/85 mm HgGlucose test: Fasting blood sugar (glucose) level equal to or

higher than 100mg/dlLarge waist circumferance:

• Men: 40 inches or more• Women : 35 inches or more

Triglycerides level test: Triglycerides equal to or higher than 150 mg/dl

Cholesterol level test:• HDL Cholesterol level test • LDL Cholesterol level test • Total cholesterol level test

THANK YOUTHANK YOU