Diabetes hypertriglyceridemia

Low LPL activity can also be found secondary to metabolic dysregulation, notably in insulin resistance and type 2 diabetes mellitus. In fact, diabetic hypertriglyceridemia is caused in part by decreased LPL secretion in response to reduced insulin action. Another preanalytical pitfall results from the high affinity of LPL for triglyceride-rich lipoproteins. When extremely hypertriglyceridemic plasma is prepared by cen-... 

Intravenous lipid emulsions are also a source of calories. The typical daily dose in adults is approximately 0.5 to 1 g/kg per day. In the absence of hypertriglyceridemia, substituting a portion of dextrose calories with lipid calories may be beneficial in situations where dextrose infusion may lead to complications (e.g., hyperglycemia). Some examples include patients with diabetes mellitus or pancreatic disease and patients under severe stress (e.g., trauma or burns) who are at risk for hyperglycemia. The maximum of dose of lipid emulsions is 2.5 g/kg per day,7 or 60% of total daily calories, although doses this high are used rarely in practice. 

The principal use of niacin is for mixed hyperlipidemia or as a second-line agent in combination therapy for hypercholesterolemia. It is a first-line agent or alternative for the treatment of hypertriglyceridemia and diabetic dyslipidemia. 

Diabetic dyslipidemia is characterized by hypertriglyceridemia, low HDL, and minimally elevated LDL. Small, dense LDL (pattern B) in diabetes is more atherogenic than larger, more buoyant forms of LDL (pattern A). 

Does the patient have hypertriglyceridemia or type 2 diabetes mellitus ... 

Diabetes, alcoholism, and glucose 6-phosphatase deficiency all can produce less severe hypertriglyceridemia with an increase in VLDL and chylomicrons. Factors contributing to the hyperlipidemia are ... 

These effects are reversible after cessation of therapy. Patients who are at high risk of developing hypertriglyceridemia include those with diabetes, obesity, increased alcohol intake, a lipid metabolism disorder, and a familial history. 

Abdominal adiposity, hypertriglyceridemia, low high-density lipoprotein and hypertension are the key elements of this syndrome, formerly called Syndrome X. Patients who satisfy 3 of the diagnostic criteria are considered to be at risk for HF. This syndrome is a kind of pre-diabetic state, which means that we might have to start to treat these abnormalities earlier than was recognized before. Several studies are still on-going to clarify the effect of treating this syndrome, thus we have to pay attention to the outcomes of these studies. 

The fibrates are mainly used to treat two hyperlipi-demias, familial hypertriglyceridemia (type IV) and dysbetalipoproteinemia (type III). They are also useful in the treatment of hypertriglyceridemia associated with type II diabetes (secondary hyperlipidemia). The fibrates are the drugs of choice in treating hypertriglyceridemias, particularly those associated with low levels of HDL cholesterol. The fibrates additionally appear to... 

It is indicated as an adjunct to diet to reduce elevated total cholesterol, LDL-cholesterol and TG levels in patients with primary hypercholesterolemia, diabetic dyslipidaemia or mixed hyperlipidemia, hypertriglyceridemia, dysbetalipo-proteinemia and familial hypercholesterolemia. 

However, very low plasma levels of HDL cholesterol are also found in patients with genetically disturbed metabolic pathways that are indirectly linked to HDL metabolism. For example, many patients with lipid storage diseases like Gaucher s disease (glucocerobrosidase deficiency, OMIM 230800-231000), Nieman-Pick disease types A or (sphingomyelinase deficiency, OMIM 257200 and 607616, respectively), Niemann-Pick disease type C (OMIM 257220), hypertriglyceridemia, or diabetes mellitus present with low HDL cholesterol [22]. 

In a placebo-controlled study in 108 non-diabetic adults with HIV-1 infection and lipoatrophy, rosiglitazone 4 mg/ day for 48 weeks had no beneficial effect on the lipoatrophy (87). However 30 of those who took rosiglitazone developed hypertriglyceridemia, compared with 20 taking placebo, and 11 developed hypercholesterolemia, compared with four taking placebo. 

A 76-year-old woman with type 2 diabetes taking gemfibrozil for pronounced hypertriglyceridemia had recurrent episodes of hypoglycemia her insulin requirements fell by 65 % and her HbAic concentration fell from 9 to 6.5% over 5 months (7). 

Low-dose bezafibrate was associated with myositis in a patient with mild chronic renal insufficiency (serum creatinine 210 pmol/l) (59). She was a 58-year-old obese diabetic with isolated hypertriglyceridemia. 

The consequences of hypertriglyceridemia are not well understood, but there may be an increased risk of cardiovascular disease and pancreatitis (SEDA-13, 123). Patients with an increased tendency to develop hypertriglyceridemia include those with diabetes mellitus, obesity, increased alcohol intake, and a positive family history. With a short course (16 weeks) of isotretinoin it is sufficient to ensure there is no hyperlipidemia before the start of therapy, and to determine the triglyceride response to therapy on one occasion after 4 weeks (1207). 

Yamagishi S, Abe T, Sawada T. Human recombinant interferon alpha-2a (r IFN alpha-2a) therapy suppresses hepatic triglyceride lipase, leading to severe hypertriglyceridemia in a diabetic patient. Am J Gastroenterol 1994 89(12) 2280. 

A wide spectrum of thiazolidinedione compounds have been synthesized and characterized over the past 15 years. In general, these compounds were shown to be active in obese rodent models of type 2 diabetes but were not active in insulin-deficient diabetes, as in streptozo-tocin-treated rats. Thus, the compounds were shown to be insulin sensitizers with little or no potential to evoke hypoglycemia. In addition to potent insulin-sensitizing and glucose-lowering effects, the thiazolidinediones also showed substantial efficacy with respect to hypertriglyceridemia in animal models. A small number of thiazolidinediones have... 

An effect of diabetes. Insulin-dependent diabetes is often accompanied by hypertriglyceridemia, which is an excess blood level of triacylglycerides in the form of very low density lipoproteins. Suggest a biochemical explanation. 

Lipoprotein and hepatic lipases are important enzymes involved in the metabolism of chylomicrons and various fractions of lipoproteins. Both have been the subject of attention, as evidenced by numerous reviews (e.g., Garfinkel and Schotz, 1987 Wang eta/., 1992). This interest stems from the fact that abnormal lipoprotein metabolism has been linked to various disorders, including hyperchylomicronemia, hypercholesterolemia, hypertriglyceridemia, obesity, diabetes, and premature atherosclerosis. Genetic defects in both HL and LPL are now known to be the cause of at least some familial disorders of lipoprotein metabolism. 

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