Mr. R is a 48-year-old Hispanic man who has worked the past 10 years as a wareho

Question

Mr. R is a 48-year-old Hispanic man who has worked the past 10 years as a warehouse worker. He is 5’6”, weighs 175 pounds, and has a waist circumference of 38”. At his last visit at your office, his blood pressure was 140/60 mm Hg. Prior to the visit, he had fasting blood work done, and his primary care provider plans to review the results with him today. The pertinent diagnostic results are as follows: a fasting plasma glucose level of 137 mg/dL, an HDL level of 27 mg/dL, LDL level of 247 mg/dL, a serum triglyceride level of 210 mg/dL. Please help me to identify what this individual is most at risk for based on the information presented in this case above. Explain the significance of this individual’s weight and waist diameter. Explain how this individual is at increased risk for insulin resistance. Explain briefly the differences between hypoinsulinemia, hyperinsulinemia, hyperglycemia, and hypoglycemia as each relate to an individual with type 1 diabetes mellitus and type 2 diabetes mellitus.

Explanation / Answer

1. Age of the patient is 48 years.

2. waist circumference of 38 means increased central adiposity.

3. The patient is OBESE as he has HIGH BMI which can be derived from his height and weight ratio.

4. Fasting blood glucose of 137mg/dl is diagnostic of DIABETES MELLITUS.

5. Serum triglycerides levels of 210 suggests HYPERTRIGLYCERIDEMIA.

6. Considering all the above parameters, the patient has TYPE 2 DIABETES MELLITUS.

7. It is characterized by HIGH INSULIN RESISTANCE.

8. HIGH INSULIN RESISTANCE is caused due to HYPERTRIGLYCERIDEMIA.

9. TRIGLYCERIDES cover GLUT 4 receptors which are needed by adipose tissue and muscle to TRANSPORT GLUCOSE within a cell. Insulin thus fails to act on GLUT 4 receptors causing RESISTANCE.

10. Hypoinsulinemia : absolute decrease in insulin seen in TYPE 1 ,diabetes.

hyperinsulinism: increased insulin due to resistance seen in TYPE 2 diabetes

Hyperglycemia: increased blood glucose seen in both the types.

Hypoglycemia : decreased blood glucose may occur due to exaggerated insulin therapy.

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