View source for 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)
[[File:Main symptoms of diabetes.svg|thumb|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:
# Normalization of fasting and postprandial glycemia (Regulation of carbohydrate content in the food and rate of [[carbohydrate]] absorption − glycemic index)
# Achieving optimal levels of lipids in blood (TAG, HDL)
# Ensuring sufficient energy supply
# 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
[[File:Insulin pen.jpg|thumb|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 ==
[[File:Sindrome metabolica2.jpg|thumb|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:
# Isolated hypercholesterolemia
#* Increased total [[Cholesterol]] (TC), mostly in the LDL-cholesterol fraction (LDL−C), with a normal concentration of triacylglycerides (TAG);
# Isolated hypertriacylglycerolemia
#* Increased TAG in combination with a normal cholesterol concentration (TC);
# 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 ==
[[File:Obesity & BMI.png|thumb|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)<sup>2</sup>.

=== 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
<noinclude>

== Links ==
Original text is from Wikiskripta – https://www.wikiskripta.eu/index.php?curid=36984
=== Related articles ===
* [[Diabetes mellitus]]
* [[Dyslipidemia]]
* [[Obesity]]
* [[Metabolic syndrome]]
=== Source ===
* {{Cite
| type = web
| surname1 = Dušejovská
| name1 = M.
| url = https://el.lf1.cuni.cz/att00082/
| source_name = Diabetes mellitus, dyslipidemie, obezita
| cited = 2012-03-11
}}
* {{Cite
| type = book
| isbn = 978-80-904899-8-1
| surname1 = Karen
| name1 = Igor
| surname2 = Svačina
| name2 = Štěpán
| title = Diabetes mellitus v primární péči
| edition = 2
| location = Prague
| Publisher = Axonite CZ
| year = 2014
}}
* {{Cite
| type = book
| isbn = 80-85787-36-9
| surname1 = Ganong
| name1 = William F
| collection = yes
| title = Přehled lékařské fysiologie
| edition = 1
| location = Jinočany
| publisher = H & H
| year = 1995
| range = 681
}}
*{{Cite
| type = book
| isbn = 978-80-7262-676-2
| surname1 = Svačina
| name1 = Štěpán
| title = Poruchy metabolismu a výživy
| edition = 1
| location = Praha
| publisher = Galén
| year = 2010
| range = 505
}}



</noinclude>

[[Category:Nutritional therapy]]
[[Category:Pathophysiology]]