Diabetes Mellitus

Henry Sangapta Christian

Diabetes melitus

• Sindrom homeostasis gangguan energi yg disebabkan oleh defisiensi insulin atau oleh defisiensi kerjanya dan mengakibatkan metabolisme karbohidrat, protein dan lemak tidak normal

• Secara umum dibagi menjadi DM tipe 1 dan tipe 2

Gejala khas

• Poliuri• Polidipsi• Polifagi• BB turun tanpa sebab yg jelas

PEMERIKSAAN GLUKOSA DARAH ABNORMAL SATU KALI SUDAH CUKUP UNTUK MENEGAKKAN

DIAGNOSIS

Gejala tidak khas

• Lemas• Kesemutan• Luka sulit sembuh• Gatal• Mata kabur• Disfungsi ereksi(pria)• Pruritus vulva(wanita)

DIPERLUKAN 2X

PEMERIKSAAN GLUKOSA

DARAH ABNORMAL

DM 2

•Overeating•Inactivity•Smoking•Diabetogenic drugs

•Pregnancy•Endocrine diseases•Diabetogenic drugs•Malnutrition in utero

Unknown Unknown

B- cell defectsInsulin resistance

Genetic factorsGenetic factors

Glucose toxicity

Hyperglycaemia

Worsening B-cell functions• ? Amyloid deposition• Malnutrition in utero

Impaired glucose tolerance

NIDDM

Environmental factorsEnvironmental factors

PatogenesisDM Tipe 2

Aksi / KerjaInsulin

Defisiensi Insulin

Hiperglikemi

DeFronzo RA. Diabetes .37:667,1988Saltiel J. Diabetes. 45:1661 - 1669,1996

Robertson RP. Diabetes .43:1085,1994Tokuyama Y. Diabetes 44:1447,1995

DiabetesMelitus

hypoX-jsk-7-99

IGT Postprandial Hyperglycemia Type 2

DiabetesPhase 1 Type 2

DiabetesPhase 2

Type 2DiabetesPhase 3

- 12 - 10 - 6 - 2 0 2 6 10 14Years from diagnosis

Bet

a ce

ll fu

nctio

n (%

)Stages of type 2 Diabetes in relationship to Stages of type 2 Diabetes in relationship to

--cell functioncell function

25

0

50

75

100

b-celldysfunction

(Expert Committee on the Diagnosis and Classification of Diabetes mellitus 2002)

Diabetes MellitusDiabetes Mellitus

IRIR Insulinresistance

Genetic susceptibility,obesity, Western lifestyle

Type 2 diabetesMacrovascular

complication

Microvascular

complication

Diagnosis Diabetes melitus

Diagnosis DM

• Hb A1C >6,5%• Gula darah puasa > 126 mg/dL• Gula darah 2 jam postprandial setelah beban

glukosa 75 gr >200 mg/dL• Gula darah sewaktu disertai gejala klinis khas

>200mg/dL

ADA 2010

Diagnosis Pre Diabetes

• Pemeriksaan gula darah puasa 100-125 mg/dL Glukosa Darah Puasa Terganggu (GDPT)• Pemeriksaan gula darah 2 jam post

prandial pada TTGO 140-199 mg/dl Toleransi Glukosa Terganggu (TGT)

Risk factors for type 2 diabetes• Umur >45 tahun• Obese• inaktifitas fisik• ibu/bapa diabetes•Sebelumnya sudah TGT atau GDPT• Pernah diabetes waktu hami (DM Gestasi) atau melahirkan bayi >4kg• Hipertensi (> 140/90 mm Hg)• HDL cholesterol < 35 mg/dl and/or trigliseride level > 250 mg/dl• Polycystic ovary syndrome• Hystory of vascular disease________________________________________________________* May not be correct for all ethnic groups.

Diabetes care 2002;25 suppl1: S22

Diabetes care 2004;27:S12

Classification of Diabetes Mellitus

• Type 1 diabetes– Immune-mediated– Idiopathic

• Type 2 diabetes• Gestational Diabetes

Mellitus (GDM)

• Other Specific Types– Genetic defects/syndromes– Diseases of the exocrine

pancreas– Endocrinopathies– Drug-induced– Infections– Uncommon immune-mediated

Manifestasi klinis

• 3 P (Poliuri, Polifagi, Polidipsi)• BB turun• Gatal-gatal• Lesu, loyo• Kesemutan• Impotensi• Luka sukarsembuh

Tujuan pengobatan DM tipe 2:

• Menekan/mengurangi gejala klinik hiperglikemia

• Mencegah onset / progresivitas komplikasi vaskuler diabetik dengan kontrol metabolik jangka lama

Charbonnel V Therapeutique des Entretitiens1997;187-192

Targets for Glycemic Control

* Treatment goals and strategies must be tailored to the patient, with consideration given to individual risk factors

To achieve an A1C 7.0%, patients should aim for FPG, preprandial and postprandial PG targets

Target A1C (%)

FPG/preprandial (mg/dl)

2h-postprandial

(mg/dl)

Target for most patients

<7 80 - 130 100 - 180

Normal range (if it can be safely achieved)

< 6.0 80 – 110 100 - 140

DIABETISI

PENYAKIT JANTUNG KORONER

GAGAL GINJAL

KEBUTAAN

STROKE

LUKA KAKI

TBC PARU

KENDALIKAN GULA DARAH

LEMAK DARAH

ROKOK

HIPERTENSI

OLAHRAGA

BERAT BADAN

DIET

TABLET

INSULIN

PRIORITAS PENGOBATAN

Kendalikan glukosa darah

Kendalikan sindroma metabolik: Obesitas,dislipidemia,hipertensi, intoleransi glukosa, hiperinsulinemia

Gangguan mikrovaskul

er

Gangguan makrovaskul

er

OBAT OBAT ANTI DIABETES

• Tablet: Kerja pendek:3 kali perhari: Novonorm, Starlix, Glucobay, Glucophage Kerja sedang 2 kali perhari Glibenklamid, Daonil,Gluronerm Kerja lama 1 kali perhari Glucotrol XL, Diamicron MR

• Suntik insulin: Kerja pendek : Actrapid, Humulin R, novorapid, apidra

Kerja sedang : Insulitard, Humulin N, Kerja lama Lantus,levemir

Kombinasi humalo mix, novomix

Mikroangiopati diabetik

Makroangiopati diabetik

Koma diabetik

Koma hiperglikemik

Koma hipoglikemik

Major clinical manifestations of atherothrombosis

Adapted from: Drouet L. Cerebrovasc Dis 2002; 13(suppl 1): 1–6.

Transient ischemic attack

Angina:• Stable• Unstable

Ischemicstroke

Myocardial infarction

Peripheral arterialdisease:• Intermittent claudication• Rest Pain• Gangrene• Necrosis

Hiperglikemia

Glycation

Osmotic Effect

Oxidants Cytokines

AGES

Polyol Pathway

Tissue damage

Endothelial Cell Dysfunction

Chronic Complication (Atherosclerosis,etc)

DAG-PKC Pathway

DAG = Diacyl glycerol PKC = Proteinkinase

PENCEGAHAN DM

• Pencegahan primer• Pencegahan sekunder• Pencegahan tertiair

Pencegahan Primer• Pola hidup olahraga, diet, stress Exersice intensif mengurangi DM• Obat-obat : glucobay, metformin,

pioglitazone. Obat penurun berat badan

Pencegahan sekunder

• Edukasi• Diet• Olahraga• Obat anti diabetes ( oral atau insulin)• Kontrol teratur

Normal

prediabetes

Diabetes

TGT, GDPT

Hiperglikemia

Komplikasi

Kronis Akut

P. Primer

P.Sekunder

P.Tertier

Koma diabetik Jantung, kaki, otak, mata, ginjal

Thank You