Diabetes mellitus

Diabetes mellitusDisusun oleh: - Angginamita Amalia - Ayu Himmatul Falah - Ayu Siti Muthmainah Hanif - Istiqomah - M. Rizky Nugraha - M. Suhanda - Rahardi FebryantoDosen Pembimbing Puskesmas : dr. H. WalyanahL/O/G/OKasus Seorang wanita berusia 60 tahun mengeluh sering lemas sejak sebulan yang lalu. Ia merasa berat badannya semakin menurun, hal itu terlihat dari penggunaan celana yang semakin longgar. Ia belum pernah berobat sebelumnya, selama ini ia hanya mendapat informasi dari tetangga mengenai keluhannnya.

Anamnesis Data Pribadi PasienNama: Ny. SnUmur: 60 tahunAlamat: KuranjiPekerjaan: Pedagang jangananStatus: Sudah menikahLokasi Home VisitKediaman Ny. S di Kuranji

Lanjutan ..Keluhan utama: Sering lemas

Riwayat penyakit sekarang: Sering makan, sering minum, sering haus, sering kencing, frekuensi kencing banyak, sering terbangun pada malam hari karena ingin kencing, mudah capek, sering pegal, sering ngantuk, gejala timbul setelah 1 bulan yang lalu.

Lanjutan ..Riwayat pengobatan: Pernah diperiksa ke dokter sebelumnya dan dilakukan pemeriksaan gula darah puasa dan gula darah sewaktu.- Gula darah puasa: 288- Gula darah sewaktu: 497

Riwayat penyakit dahulu: Diabetes (-), hipertensi (-), kolesterol (-), asam urat (-).Riwayat penyakit keluarga: Diabetes (-), hipertensi (-), kolesterol (-), asam urat (-).

Riwayat pribadi: Jarang mengkonsumsi makanan manis, gula, daging, jeroan, dan kacang-kacangan.

Tinjuan sistem tubuh: Dalam keadaan normal.

Pemeriksaan fisikKesadaran: ComposmentisKeadaan umum: Tampak sakit ringan Suhu: 36CTekanan darah: 130/80Nadi: 100x/menitFrekuensi pernapasan: 20x/menitKepala dan leher: Dalam batas normalThoraks: Dalam batas normalAbdomen: Dalam batas normalEkstremitas: Dalam batas normal.

Komplikasi: (-)

Diagnosis banding: Diabetes MellitusMyalgia

Diagnosis kerja: Diabetes Mellitus

GERIATRIC ASSESSMENT CENTER ACTIVITIES OF DAILY LIVIN PHYSICAL SELF-MAINTENANCE SCALENoActivityValue1TOILET4 Cares for self at toilet completely, no incontinence 3 Needs to be reminded, or needs help in cleaning self, or has rare (weekly at most) accidents2 Soiling or wetting while asleep, more than once a week1 Soiling or wetting while awake, more than once a week0 No control of bowels or bladder42FEEDING4 Eats without assistance 3 Eats with minor assistance at meal times, with help preparing food or with help in cleaning up after meals2 Feeds self with moderate assistance and is untidy1 Requires extensive assistance for all meals0 Does not feed self at all and resists efforts of others to feed him43DRESSING4 Dresses, undressed and selects clothes from own wardrobe3 Dresses and undresses self, with minor assistance2 Needs moderate assistance in dressing or selection of clothes1 Needs major assistance in dressing but cooperated with efforts of other to help0 Completely unable to dress self and resists efforts of others to help4GERIATRIC ASSESSMENT CENTER ACTIVITIES OF DAILY LIVIN PHYSICAL SELF-MAINTENANCE SCALE

3DRESSING4 Dresses, undressed and selects clothes from own wardrobe3 Dresses and undresses self, with minor assistance2 Needs moderate assistance in dressing or selection of clothes1 Needs major assistance in dressing but cooperated with efforts of other to help0 Completely unable to dress self and resists efforts of others to help44GROOMING4 Always neatly dressed and well-groomed, without assistance 3 Grooms self adequately, with occasional minor assistance2 Needs moderate and regular assistance or supervision in grooming1 Needs major assistance in dressing but cooperates with efforts of others to help0 Actively negates all efforts to others to maintain grooming45PHYSICAL AMBULATION4 Goes about .grounds or city 3 Ambulates within residence or about one block distant2 Ambulates with assistance of (check one): another person, railing, cane, walker,or wheelchair: gets in and out without help needs help in getting in and out1 Sits unsupported in chair or wheelchair, but cannot propel self without help0 Bedridden more than half the time4GERIATRIC ASSESSMENT CENTER ACTIVITIES OF DAILY LIVIN PHYSICAL SELF-MAINTENANCE SCALE6BATHING4 Bathes self (tub, shower, sponge bath) without help3 Bathes self, with help in getting in and out of tub2 Washes face and hands only, but cannot bathe rest of body1 Does not wash self but is cooperative with those who bathe him0 Does not travel at all47RESPONSIBILITY FOR OWN MEDICATION2 Is responsible for taking medication in correct dosage at correct time 1 Takes responsibility if medication is prepared in advance in separate dosages0 Does not try to wash self, and resists efforts to keep him clean2SCORE26GERIATRIC ASSESSMENT CENTER SCALE FOR INSTRUMENTAL ACTIVITIES OF DAILY LIVINGNoActivityValue1ABILITY TO USE TELEPHONE3 Operates telephone on own initiative; looks up and dials numbers, etc.2 Dials a few well known numbers1 Answers telephone but does not dial0 Does not use telephone at all22SHOPPING3 Takes care of all shopping needs independently2 Shops independently for small purchases1 Needs to be accompanied on any shopping trip0 Needs to have meals prepared and served33FOOD PREPARATION3 Plans, prepares and serves adequate meals independently2 Prepares adequate meals if supplied with ingredients1 Heats and serves prepared meals, or prepares meals but does not maintain adequate diet0 Needs to have meals prepared and served3GERIATRIC ASSESSMENT CENTER SCALE FOR INSTRUMENTAL ACTIVITIES OF DAILY LIVING4HOUSE KEEPING4 Maintains house alone or with occasional assistance (e.g., heavy-work domestic help)`3 Performs light daily tasks such as dish-washing and bed-making2 Performs light daily tasks but cannot maintain acceptable \ level of cleanliness1 Needs help with all home maintenance tasks0 Does not participate in any housekeeping tasks45LAUNDRY2 Does personal laundry completely 1 Launders small items; rinses socks, stockings, etc.0 All laundry must be done by others26MODE OF TRANSPORTATION4 Travels independently on public transportation or drives own car 3 Arranges own travel via taxi, but does not otherwise use public transportation2 Travels on public transportation when assisted or accompanied by another1 Travel limited to taxi or automobile, with assistance of another0 Does not travel at all4GERIATRIC ASSESSMENT CENTER SCALE FOR INSTRUMENTAL ACTIVITIES OF DAILY LIVING7RESPONSIBILITY OF OWN MEDICATION2 Is responsible for taking medication in correct dosages at correct time 1 Takes responsibility if medication is prepared in advance in separate dosages 0 Is not capable of dispensing own medication28ABILITY TO HANDLE FINANCE2 Manages financial matters independently (budgets, write checks, pays rent and bills, goes to Bank) collects and keeps track of income1 Manages day-to-day purchases, but needs help with banking, major purchases, etc.0 Incapable of handling money2score22DefinisiMenurut American Diabetes Association (ADA) 2005, diabetes melitus merupakan suatu kelompok penyakit metabolik dengan karakteristik hiperglikemia yang terjadi karena kelainan sekresi insulin, kerja insulin atau kedua-duanya. EpidemiologiHasil riset kesehatan dasar (RISKESDAS) pada tahun 2007, menunjukkan bahwa prevalensi DM secara nasional berdasarkan diagnosis tenaga kesehatan dan gejala adalah 1.1%, sedangkan prevalensi DM berdasarkan pemeriksaan kadar gula darah pada penduduk berumur >15 tahun yang bertempat tinggal di perkotaan adalah 5.7%. Riset ini juga menghasilkan angka Toleransi Glukosa Terganggu (TGT) secara nasional berdasarkan pemeriksaan kadar gula darah pada penduduk berumur >15 tahun yang bertempat tinggal di perkotaan adalah 10.2% (Depkes, 2008).

EtiologiInsulin Dependent Diabetes Mellitus (IDDM) atau Diabetes Melitus Tergantung Insulin (DMTI) disebabkan oleh destruksi sel pulau Langerhans akibat proses autoimun. Sedangkan Non Insulin Dependent Diabetes Melitus (NIDDM) atau Diabetes Melitus Tidak Tergantung Insulin (DMTTI) disebabkan kegagalan relatif sel dan resistensi insulinKlasifikasiKlasifikasi etiologis diabetes melitus menurut PERKENI (ADA,1997): Diabetes melitus tipe IDiabetes melitus tipe IIDiabetes melitus tipe lainDefek genetik fungsi sel beta Defek genetik kerja insulin Penyakit eksokrin pankreas Endokrinopati Obat atau zat kimia: vacor, pentamidin, asam nikotinat, lukokortikoid, hormon tiroid, tiazid, dilantin, interferon-alfa, dll Infeksi Sebab imunologi yang jarang Sindrom genetik lain yang berkaitan dengan DM Diabetes melitus gestasional (DMG)

Patofisiologi Diabetes Tipe IDiabetes Tipe II Resistensi insulin pada diabetes tipe II disertai dengan penurunan reaksi intrasel, dengan demikian insulin menjadi tidak efektif untuk menstimulasi pengambilan glukosa oleh jaringan.Diabetes GestasionalTerjadi pada wanita yang tidak menderita diabetes sebelum kehamilannya. Hiperglikemia terjadi selama kehamilan akibat sekresi hormone-hormon plasenta. Sesudah melahirkan bayi, kadar glukosa darah pada wanita yang menderita diabetes gestasional akan kembali normal.

AnamnesisKecurigaan adanya DM perlu dipikirkan apabila terdapat keluhan klasik seperti tersebut dibawah ini:Keluhan khas DM berupa: poliuria, polidipsia, polifagia, penurunan berat badan yang tidak dapat dijelaskan sebabnya.Keluhan tidak khas DM: lemah badan, kesemutan, gatal, mata kabur, dan disfungsi ereksi pada pria, serta pruritus vulva pada wanita.

PemeriksaanPemeriksaan penyaring dikerjakan pada kelompok dengan salah satu risiko DM sebagai berikut:a.Usia >45 tahunb.Berat badan lebih >110% BB ideal atau IMT >23 kg/m2 c.Hipertensi (>140/90 mmHg)d.Riwayat DM dalam garis keturunane.Riwayat abortus berulang, melahirkan bayi cacat atau BB lahir bayi >4000 gramf.Kolesterol HDL 35 mg/dl dan atau trigliserida 150 mg/dl

Diagnosis DM dapat ditegakan dengan 3 cara: 1. Gejala klasik DM + GDS 200mg/dlGlukosa sewaktu merupakan hasil pemeriksaan sesaat pada suatu hari tanpa memperhatikan waktu makan terakhir2. Gejala klasik DM + GDP 126mg/DlPuasa diartikan pasien tidak mendapatkan kalori tambahan sedikitnya 8jam3. Kadar glukosa darah 2 jam pada TTGO200mg/dlTTGO dilakukan dengan standar WHO menggunakan beban glukosa yang setara dengan 75g glukosa anhidrus yang dilarutkan ke dalam air

Kadar Glukosa Darah Sewaktu dan Puasa Sebagai Patokan Penyaring dan Diagnosis DMKadar glukosa (mg/dl )Bukan DMBelum pastiDMDMSewaktuPlasma Vena< 110110 199 200Darah Kapiler< 9090 199 200PuasaPlasma Vena< 110110 125126Darah Kapiler< 9090 109110

PenatalaksanaanPilar Pengelolaan DMEdukasiTerapi Gizi MedisLatihan Jasmani Prinsip latihan jasmani yang dilakukan:ContinousRhytmicalIntervalProgresiveEnduranceIntervensi FarmakologisIndikasi pemakaian obat hiperglikemik oral:Diabetes setelah umur 40 tahun Diabetes kurang dari 5 tahunMemerlukan insulin dengan dosis