dr. auriela szekelyobezitatea si diabetul zaharat în sindromul prader willi english
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8/8/2019 Dr. Auriela SzekelyObezitatea si diabetul zaharat în Sindromul Prader Willi english
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Dr. Székely Aurelia
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Obesity
yIs a defining characteristic of Prader Willi Syndrome (PWS)
y
An important clue for the suspicion of diagnoses
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Obesity
y Body weight exceeds ideal weight by 20%
y BMI - weight (kg) / height 2 (m2)y Normal: 19-25
y Overweight: 25-30
y Obesity I: 30-35
y Obesity II: 35-40
y Severe obesity (morbid): 40
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Venus of Willendorf
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Rubens The Three Graces
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Picasso The Young Ladies of Avignon
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Twiggy
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Oana
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Complicationsy Cardio-pulmonary deficiencies
y Diabetes mellitus type II
y Thrombophlebitis
y Chronic Edema
y
Hernias
y Eczema
y Arthrosis
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In PWSy The essence of care for patients with PWS = fight against
obesity
y The main cause of obesity in PWS = hyperphagia
y Adjusting the sensation of hunger - the hypothalamusy Feedbacks :
Blood glucose
Fats
Leptin
Cholecy stokinin PYY
Serotonin
Endorphins
etc..
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In PWSy Decreases the sensitivity of the hypothalamus to
regulating substances
In obesity
y I
t is
a deficit of leptin and melanocortin
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Other mechanisms of obesity in PWS
yMuscle hypotonia
yPs ychological structure
y A possible hypothyroidism orhypogonadism
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Treatment with growth hormone
yHelps to normalize weight
y Increases muscle mass
yR educes the risk of diabetes
y I
ncreas
es
immunores
is
tance
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In the fight for normal weight participate
yThe patient
yThe family
yThe medical component
yT
hes
ocial component
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Obesity is realized only by excessivefood intake.
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Energetic imbalance...... from positive has to be changed to negative by:
1. Lifestyle
2. Diety Doctor
y Nutritionist
y Support groups
y
Documentation provided by patient organizations
3. Monitoring access to food
4. Phy sical activity
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Physical activity
y Free phy sical activities - 1 hour per day, 5-6 times a
week, regularly:y Walk
y Bicycle
y Swimming
y
Gamesy In specialized institutions
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Speed of weight loss
y 0,5 0,6 kg per week
y 1 2 kg per month
Preventing obesity, weight loss of obese patients with PWS ensure a better quality of life and
prevents complications.
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Diabetes mellitus type IIy Is not the consequence of PWS
y It is the complication of obesity in PWS
Signs of developing diabetes mellitus
y Weakening
y
Polydips
iay Polyuria
y Low energy
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Diagnosis of diabetes mellitus
y Hyperglycemia
y Glycosuria
Altered metabolism of lipids and proteins.
R esult: degenerative damage of large and smallarteries.
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Complications
y Ischemic cardiomyopathy
y Atherosclerosis
y Obliterative arteriopathy
y Nephropathy
y R etinopathy
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Causes of decompensations
y Not respecting the diet
y Discontinuation of medicationy Excessive phy sical effort
y Exhaustion, ps ychical stress
y Surgery y Infections
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Treatment of diabetes mellitusy Diet planned by the DOCTOR
y Number of Kcal
yMeal composition
y Schedule of the meals
y Exercise
y Body hygiene
y Wounds
y Teeth
y Foot hygiene
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Treatment of diabetes mellitus
yMedications
y To be initiated only in hospitalsy Antidiabetic tablets
y Insulin Injections
y Lifelong duration
y Hydro-mineral therapy
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Conclusion
With early diagnosis, by uniting all forces andresources that are available to care for people with
PWS, morbid obesity can be prevented, can bereduced and this way diabetes mellitus and its
complications can be avoided.
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I wish you success in this fight!