1. WHAT IS INSULIN RESISTANCE AND WHO CAN GET IT?
Obesity is one of the most important components of metabolic syndrome and is closely related to insulin resistance. Most individuals with metabolic syndrome are either overweight or extremely obese, and most people with insulin resistance have abdominal obesity. Insulin resistance, which is seen frequently (90%) in patients with type 2 diabetes, can also be seen in individuals with normal glucose tolerance and without diabetes.
2. INSULIN RESISTANCE COMES WITH WHICH DISEASES?
Insulin resistance is seen together with diabetes (90%) and hypertension (50%). Polycystic ovary syndrome -PCOS is one of the clinical pictures with insulin resistance. In addition to these, NASH (Non-alcoholic steatohepatitis), and some cancers may be accompanied by insulin resistance.
3. WHAT IS PREDIABETATION?
Prediabetes is called pre-diabetes condition. If the fasting blood sugar is between 100-125mg/dl, “impaired fasting glucose” (IFG), the 2nd hour postprandial blood glucose is between 140-190mg/dl and the fasting blood glucose is below 100mg/dl, “impaired glucose tolerance” ( BGT). Sometimes these two conditions can coexist – called combined BAG+BGT, this category refers to further disturbance of glucose metabolism. HBA1C value in prediabetes ranges between 5.7-6.4. In these patients, overt diabetes develops within 5-10 years.
4. WHO SHOULD BE INVESTIGATION FOR INSULIN RESISTANCE?
a) people who have recently started to gain weight despite not eating much,
b) people who cannot lose weight despite dieting,
c) excessive desire to eat sweets especially at night people with increased body hair
d) people whose hands and feet tremble when they are hungry
e) people with increased body hair growth
f) people who start to get acne in different parts of the face and body,
g) women with menstrual irregularity,
h) people with diabetes in their families should be evaluated for insulin resistance.
5. HOW IS DIABETES DIAGNOSED AND WHAT ARE THE COMPLAINTS OF THESE PATIENTS?
If the blood glucose measured after 8 hours of fasting is above 126mg/dl, or the 75gr OGTT 2nd hour blood glucose is above 200mg/dl, or the random blood glucose is above 200mg/dl with accompanying diabetes symptoms and HBA1C 6.5 A diagnosis of overt diabetes is made.
Classic symptoms: polyuria (excessive urination), polydipsia (excessive drinking), polyphagia (overeating) or loss of appetite, weakness, fatigue, dry mouth, nocturia (voiding at night)
less common symptoms: blurred vision, unexplained weight loss, persistent infections, recurrent fungal infections, itching
6. WHAT IS THE FREQUENCY OF DIABETES IN TURKEY?
In the TURDEP1 (Turkish Diabetes Epidemiology) study conducted in 1997, diabetes was found in 7.2% of our adults, glucose intolerance disorder in 6.8%, and obesity in 22%.
In the TURDEP2 study conducted in 2010, the prevalence of diabetes increased from 7.2% to 13.7%. Between 1997 and 2010, the average weight in Turkish society increased from 69kg to 75kg (6kg) for women and from 74kg to 82kg (8kg) for men.
According to the research conducted by the World Diabetes Association (IDF) in 2013, there are 382 million diabetics. It is listed as China, India, USA and Turkey is not in the top ten of this list. However, according to estimations, in 2035 (20-79 years old), Turkey will rise to 9th place in the world with 11.8 million in diabetes prevalence.
7. WHO SHOULD BE SCREENED FOR DIABETES
– People who are obese or overweight (BMI greater than 25kg/m2) and especially central obesity (waist circumference greater than 88cm in women, 102cm in men); From the age of 40, diabetes screening should be done every 3 years, preferably with fasting blood sugar.
– In addition, people with a BMI of 25kg/m2 should be investigated from a younger age if they belong to one of the following risk groups:
1. People with diabetes in their first degree relative,
2. people from ethnic groups with a high prevalence of diabetes,
3. people who gave birth to a large baby or previously diagnosed with gestational diabetes,
4. hypertensive individuals,
5. dyslipidemics HDL-C below 35mg/dl, or TG above 250mg/dl,
6. individuals with previous IFG or IGT,
7. women with polycystic ovary syndrome (PCOS),
8. those with insulin resistance,
9. those with coronary, peripheral or cerebral vascular diseases,
10. babies born with low birth weight,
11. physical people with low activity,
12. schizophrenic patients,
(98) 00705) 13. kidney transplant patients
8. WHAT IS UNCONTROLLED DIABETES?
– Resistant to outpatient treatment, recurrent fasting hyperglycemia above 300mg/dl or HBA1C above 11,
– Recurrent severe hypoglycemia under 50mg/dl despite treatment,
-Metabolic imbalance: frequent recurrent hypoglycemia and fasting hyperglycemia,
– Recurrent episodes of diabetic ketoacidosis without a cause such as infection or trauma,
– Hyperglycemia accompanied by fluid loss
9. WHAT ARE THE GLYSEMIC TARGETS ?
Treatment targets: ADA (American Diabetes Society) targets
HBA1C below 7
Preprandial glucose: 70-130 mg/dl
Postprandial glucose : Below 180mg/dl
Former targets:
Fasting blood glucose: 70-110mg/dl
Postprandial blood glucose: 110-140mg/dl
Acceptable targets:
Fasting blood glucose: Below 140mg/dl
Postprandial blood glucose: Below 180mg/dl
10. WHAT ARE THE INDICATIONS FOR INSULIN THERAPY IN TYPE 2 DIABETES?
1. Failure to achieve good metabolic control with oral antidiabetics,
2. Excessive weight loss,
3. Severe hyperglycemic symptoms,
4. Acute heart attack ,
5. Acute fever, systemic diseases,
6. Hyperosmolar nonketotic coma or diabetic ketoacidosis,
7. Major surgery,
8 Pregnancy and lactation,
9. Kidney or liver failure,
10. Allergy or severe side effects to oral antidiabetics
