Juan is a 44-year-old who works in a warehouse. He is 5?8?, weighs 185 pounds, and has a waist circumference of 41?. At his last visit to the health clinic, Juan's blood pressure was 140/60 mm Hg
Shortly after having a series of blood tests, his physician called him in to talk about the results. Juan had a fasting plasma glucose level of 107 mg/dL, an HDL level of 37 mg/dL, and a serum triglyceride level of 210 mg/dL.
What condition is Juan likely presenting with? What are the spectrum of physiological abnormalities that occur with this disorder?
What is the significance of Juan's waist diameter? How is truncal obesity hypothesized to increase insulin resistance in the body?
In type 1 diabetes, there are hypoinsulinemia and hyperglycemia. In type 2 diabetes, it is common to see hyperinsulinemia and hyperglycemia. Why do the differences exist?
Metabolic syndrome is a condition having multisystem manifestations. Serum lipid abnormalities include elevated triglyceride and low HDL levels. Systemic inflammation is seen together with abnormal fibrinolysis, defective endothelium function, and macrovascular disease. The patient presenting with metabolic syndrome is usually obese with hypertension and elevated serum glucose levels.
An increased waist circumference (as opposed to peripheral or lower body obesity) correlates with insulin resistance in the body and poor suppression of glucose production by the liver. It is thought that truncal obesity contributes to an increased concentration of free fatty acids (FFAs). The chronic elevation of FFAs creates beta cell dysfunction in the pancreas and insulin resistance in peripheral cells. Free fatty acids also inhibit peripheral cells from uptaking and storing glucose. Finally, hepatocytes respond to excess FFA levels by becoming less sensitive to the effects of insulin. The result is an increase in glucose production by the liver and subsequent hyperglycemia.
In type 1 diabetes, there is destruction of the pancreatic beta cells and subsequent loss of insulin production. Cellular uptake of glucose does not occur, and hyperglycemia results. In type 2 diabetes, insulin resistance by tissue cells occurs in tandem with an increase in glucose production by the liver. In the early course of the disease, the pancreas secretes excess insulin in an attempt to lower serum glucose levels. The result is an increase in both insulin and glucose levels in the blood.
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