1.WHAT IS INSULIN RESISTANCE AND WHO SHOULD IT SEE?
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 morbidly obese, and most people with insulin resistance have abdominal obesity. Insulin resistance, which is frequently seen (90%) in patients with type 2 diabetes, can also be seen in individuals with normal glucose tolerance and without diabetes.
2.WITH WHAT DISEASES IS INSULIN RESISTANCE OCCURRED?
Insulin resistance is seen together with diabetes (90%) and hypertension (50%). Polycystic ovary syndrome -PCOS is one of the clinical conditions that progresses with insulin resistance. In addition to these, insulin resistance may accompany NASH (Nonalcoholic steatohepatitis) and some cancers.
3. WHAT IS PREDIABETES?
Prediabetes is called the condition before diabetes. If the fasting blood sugar is between 100-125mg/dl, it is called "impaired fasting glucose" (IFG), and if the 2nd hour postprandial blood sugar is between 140-190mg/dl and the fasting blood sugar is below 100mg/dl, it is called "impaired glucose tolerance" (impaired glucose tolerance). It is called BGT). Sometimes these two conditions can occur together - called combined BAG + IGT, this category refers to further impairment of glucose metabolism. In prediabetes, HBA1C value remains between 5.7-6.4. Overt diabetes develops in these patients within 5-10 years.
4.WHO SHOULD BE INVESTIGATED FOR INSULIN RESISTANCE?
a) more People who have recently started to gain weight despite not eating,
b) People who cannot lose weight despite dieting,
c) people who have an excessive desire to eat sweets, especially at night,
d) people who tremble when they are hungry,
e) body hair growth people with acne,
f) people who start to get acne in different parts of the face and body,
g) women who experience menstrual irregularities,
h) I recommend that people with diabetes in their families be evaluated for insulin resistance.
5.HOW IS DIAGNOSIS AND THESE PATIENTS? WHAT ARE THEIR COMPLAINTS?
8 Overt diabetes is diagnosed if the blood sugar measured after one hour of fasting is over 126mg/dl, or if the 75g OGTT 2nd hour blood sugar is over 200mg/dl, or if the randomly measured blood sugar is over 200mg/dl and there are accompanying symptoms of diabetes and HBA1C is over 6.5. .
Classic symptoms: polyuria (excessive urination), polydipsia (excessive water drinking), polyphagia (overeating) or loss of appetite, weakness, easy fatigue, dry mouth, nocturia. (urination 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, 7.2% of our adults had diabetes, 6.8% had glucose intolerance disorder, 22% had diabetes. obesity was detected.
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.
World in 2013 According to the research conducted by the Diabetes Association (IDF), there are 382 million diabetic patients. They are listed as China, India and the USA, and Turkey is not in the top ten of this list. However, according to estimates, Turkey will rank 9th in the world with 11.8 million in the prevalence of diabetes in 2035 (20-79 years of age).
7.WHO SHOULD BE SCREENED FOR DIABETES
- People who are obese or overweight (BKI greater than 25kg/m2) and especially central obesity (waist circumference greater than 88cm in women and 102cm in men); Diabetes screening should be performed every 3 years, preferably with fasting blood sugar, starting from the age of 40.
- Additionally, people with a BMI of 25kg/m2 should be screened for diabetes at a younger age if they belong to one of the risk groups below. They need to be investigated:
1. People with diabetes in their first degree relatives,
2. People belonging to ethnic groups with a high prevalence of diabetes,
3. People who gave birth to large babies or were previously diagnosed with gestational diabetes,
4. hypertensive individuals,
5. dyslipidemics HDL-K below 35mg/dl, or TG above 250mg/dl,
6. Individuals with previously detected BAG 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. people with low physical activity,
12. schizophrenia patients,
13. patients who have undergone kidney transplantation
8. WHAT IS UNCONTROLLED DIABETES?
- If recurrent fasting hyperglycemia resistant to outpatient treatment is over 300mg/dl or HBA1C is over 11,
- Recurrent, severe hypoglycemia below 50mg/dl despite treatment,
-Metabolic imbalance: frequently recurring hypoglycemia and fasting hyperglycemia,
- Recurrent diabetic ketoacidosis attacks without a cause such as infection or trauma,
- Hyperglycemia accompanying fluid loss
9. WHAT ARE GLYCEMIC TARGETS?
Targets in treatment: ADA (American Diabetes Association) targets
HBA1C is below 7
Preprandial glucose: 70-130 mg/dl
Postprandial glucose: below 180mg/dl
Previous targets:
Fasting blood sugar: 70-110mg/dl
Postprandial blood sugar: 110 -140mg/dl
Acceptable targets:
Fasting blood sugar: below 140mg/dl
Postprandial blood sugar: below 180mg/dl
10. WHAT ARE THE INDICATIONS FOR INSULIN THERAPY IN TYPE 2 DIABETES?
1. Inability to achieve good metabolic control with oral antidiabetics,
2. Excessive weight loss,
3. Severe hyperglycemic symptoms,
4. Acute heart attack,
5. Acute febrile, systemic diseases,
6. Hyperosmolar nonketotic coma or diabetic ketoacidosis,
7. A major surgical operation,
8. Pregnancy and lactation,
9. Kidney or liver failure,
10. Allergy or severe side effects to oral antidiabetics
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