What is acanthosis Negricans by Images

an Important sign of Insulin Resistance 

Signs of insulin resistance or conditions associated with insulin resistance

 • acanthosis nigricans 

• Hypertension 

• Dyslipidemia 

• PCOS 

• birth weight small for gestational age

Diabetes Risk factors in overweight children

  obesity = (BMI >85th percentile for age and sex, weight for height >85th percentile, or weight >120% of ideal for height)
• FH of type2 DM in first- or second-degree relative
 • Race/ethnicity
 • Signs of insulin resistance or conditions associated with insulin resistance
 • Maternal history of diabetes or GDM during child’s gestation
 • Age of initiation: 10 years or at onset of puberty, if puberty occurs at a younger age
• Frequency: every 3 years

Categories of increased risk for diabetes prediabetes

FPG 100 me/dl (5.6 mmol/L) to 125 mg/dL (6.9 mmol/L) (IFG)

OR

2-h PG in the 75-g OGTT 140 mg/dL (7.8 mmol/L) to 199 mg/dL (11.0 mmol/L} (IGT)

OR

A1C 5.7-6.4% (39-46 mmol/mol)

*For all three tests, risk is continuous, extending below the lower limit of the range and

becoming disproportionately greater at the higher end of the range.

¢ A1C between 5.7 and 6.0% had a substantially

increased risk of diabetes with 5-year incidences

ranging from 9-25%.

¢ An A1C range of 6.0 to 6.5% had a 5-year risk of

developing diabetes between 25 to 50% and relative

risk 20 times higher compared with an AlCof 5.0%

Additional Risk factors in Patients with Diabetes Mellitus

Additional Risk Factors

Decreased Physical Activity

First Degree Relative with Diabetes Mellitus

High Risk Race or Ethinity

Women who was diagnosed with Gestational DM

Hypertension or Therapy for HTN

HDL Cholesterol level below 35 mg/dl or triglycrides over 250 mg/dl

Women with poly cystic ovary disease PCOD

HBA1C more than 5.7

Clinical conditions associated with increased Insulin Resistance

History of Cardiovascular Disease

Recommended treatment for Metabolic Syndrome

 • Preventing the development of type 2 DM and coronary vascular disease.
• Focus on lifestyle modifications (diet, weight loss, exercise),
 • if needed, medication for treatment of insulin resistance.

Guidelines for Screening for Type 2 Diabetes

Testing to assess risk for future diabetes in asymptomatic people should be considered in adults of any age who are overweight or obese (BMI ≥ 25 kg/m2 or ≥ 23 kg/m2 in Asian Americans) and who have one or more additional risk factors for diabetes. 

 • For all patients, testing should begin at age 45 years.  

If tests are normal, repeat test at a minimum of 3- year intervals.  

To test for prediabetes, fasting plasma glucose, 2-h plasma glucose after 75-g oral glucose tolerance test, and A1C are equally appropriate. 

In patients with prediabetes, identify and treat other cardiovascular disease risk factors.  •

 Testing should be considered in children and adolescents who are overweight or obese and who have two or more additional risk factors for diabetes 

Why we have to lose Weight asap ?

Why you have to lose weight as soon as possible 

To avoid all these Health risk factors 

Click the image to read all risk associated with Obesity and Over Weight

Metabolic Syndrome Insulin resistance syndrome – Syndrome X

• A combination of insulin resistance and ↑ risk of 2 DM

Diagnosis is based on any 3 of the following Adult Treatment Panel III criteria

Abdominal obesity  waist circumference > 40 inches in men, > 35 inches in women

TG ≥ 150 mg/dL

HDL < 40 mg/dL in men and < 50 mg/dL in women

BP ≥ 130/85 mmHg

Fasting glucose ≥ 110 mg/dL

Treatment

 • Preventing the development of type 2 DM and coronary vascular disease

. • Focus on lifestyle modifications (diet, weight loss, exercise)

, • if needed, medication for treatment of insulin resistance

Advantages and Disadvantages of HB A1C test for Diagnosis of Diabetes Mellitus DM

Advantages and Disadvantages of HB A1C test for Diagnosis of Diabetes Mellitus DM

 Other Disadvantages due to inaccuracy in some medical conditions

anemia and hemo-globinopathies. Conditions with abnormal red cell turnover, such as: Pregnancy 

Recent blood loss Blood transfusion 

Perform A1C 2 times yearly in Stable patients meeting treatment goals

Perform A1C every 3 months for unstable patients 

A1C between 5.7 and 6.0% had a substantially increased risk of diabetes with 5-year incidences ranging from 9–25

An A1C range of 6.0 to 6.5% had a 5-year risk of developing diabetes between 25 to 50% and relative risk 20 times higher compared with an A1Cof 5.0%

Diagnosis of Diabetes Mellitus

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If two different tests (such as A1C and FPG) are both above the diagnostic thresholds, the diagnosis of diabetes is confirmed

If the results of two different tests are discordant, the test whose result is above the diagnostic cut point should be repeated, and the diagnosis is made on the basis of the confirmed test

Definition & Classification of Diabetes Mellitus

Diabetes is a complex, chronic illness requiring continuous medical care with multifactorial riskreduction strategies beyond glycemic control.
 • Ongoing patient self-management education and support are critical to preventing acute
complications and reducing the risk of long-term complications
Diabetes is the 4th or 5th leading cause of death in most developed countries
• Epidemic in developing countries.
One in two adults with diabetes is undiagnosed
One in seven births is affected by gestational diabetes

Classification


 Type 1 diabetes (results from b-cell destruction, usually leading to absolute insulin deficiency)

  Type 2 diabetes (results from a progressive insulin secretory defect on the background of insulin resistance) 3. Other specific types of diabetes 4. Gestational diabetes mellitus (GDM) (diabetes diagnosed during pregnancy)

Classification  Other specific types of diabetes:
. Genetic defects in b-cell function 2. Genetic defects in insulin action
3. Diseases of the exocrine pancreas (such as cystic fibrosis)
 4. Drug- or chemical induced (such as in the treatment of HIV/AIDS or after organ transplantation)