DIEBETES
MELITUS
Dr. apt. Tri Murti Andayani, Sp.FRS
Contoh kasus
Tn B, 62 tahun dengan tinggi badan 170 cm dan berat badan 90 kg
melakukan pemeriksaan rutin di Poliklinik. Tn B mempunyai
riwayat hipertensi. Hasil pemeriksaan kadar glukosa darah puasa
192 mg/dL, HbA1c 9,6%, total cholesterol 202 mg/dL, low-density
lipoprotein (LDL) 140 mg/dL, high-density lipoprotein (HDL) 30
mg/dL and triglyceride 190 mg/dL. Vital sign : tekanan darah 154/96
mmHg, heart rate 82 beats/menit, dan respiratory rate 18
kali/menit.Terapi yang diberikan Propranolol 40 mg, 2 kali sehari
dan Fenofibrate 160 mg, sekali sehari.
Diabetes is a group of metabolic
Definition disorders characterized by chronic
hyperglycemia associated with
disturbances of carbohydrate, fat,
and protein metabolism due to
absolute or relative deficiency in
insulin secretion and/or action
Diabetes causes long term
damage, dysfunction & failure of
various organ
Patofisiologi
Type 1
Classification
due to autoimmune b-cell destruction,
usually leading to absolute insulin
diabetes
deficiency
Type 2 due to a progressive loss of adequate b-
diabetes cell insulin secretion frequently on the
background of insulin resistance
Gestational diabetes diagnosed in the second or third
diabetes trimester of pregnancy that was not clearly
mellitus overt diabetes prior to gestation
Specific e.g.,monogenic diabetes syndromes (such
types of as neonatal diabetes and maturity-onset
diabetes due diabetes of the young), diseases of the
to other exocrine pancreas (such as cystic fibrosis
causes and pancreatitis), and drug- or chemical-
induced diabetes (such as with
glucocorticoid use, in the treatment of
HIV/AIDS, or after organ transplantation)
Criteria for
the diagnosis
of diabetes
Criteria for testing for
diabetes or prediabetes in
asymptomatic adults
Criteria
defining
prediabetes
Pencegahan
Goals of treatment
● Achieve near normal glycaemia
● Alleviate the symptoms related to
hyperglycemia
● Prevent or reduce the acute and
chronic complications of diabetes
● Good quality of life, near normal life
expectancy
Glycemic recommendations for
many nonpregnant adults with
diabetes
Classification of hypoglycemia
Management of Glycemic control
Diet/lifestyle
diabetes Exercise
Medication
Treat associated
Dyslipidemia
conditions
Hypertension
Obesity
CV disease
Screen
Retinopathy
for/manage
Cardiovascular disease
complication
Neuropathy
of diabetes
Nephropathy
Other complications
Lifestyle
therapy
Nonpharmacologic
therapy • Medical nutrition therapy for
individuals with type 1 DM
• Maintain a healthy body
weight
• Balanced meals-moderate in
carbohidrates and low in
saturated fat
• Type 2 DM – caloric
restriction for weight loss
Describing the diabetes disease
process and treatment options Diabetes self-management
Incorporating nutritional management into education
lifestyle
Incorporating physical activity into lifestyle
Using medication(s) safely and for maximum
therapeutic effectiveness
Monitoring blood glucose and other
parameters and interpreting and using the
results for self-management decision
making
Preventing, detecting, and treating acute
complications
Preventing detecting, and treating chronic
complications
Developing personal strategies to address
psychosocial issues and concerns
Developing personal strategies to promote
health and behavior change
Tatalaksana terapi
Perencanaan Injeksi insulin beberapa kali sehari
DM Tipe 1
terapi atau infusion pump
Monitoring glukosa darah 4-8 kali
sehari
Perencanaan makan
Tujuan terapi Individual
Tujuan glikemia ideal :
sebelum makan 70-120 mg/dL
sesudah makan < 150 mg/dL
waktu tidur 100 – 300 mg/dL
03.00 am > 70 mg/dL
Terapi insulin
Carbohydrate ↑ Transport of glucose inside the cell
pemberian insulin metabolism ↑ Peripheral utilization of glucose
menirukan sekresi ↑ Glycogen synthesis
insulin normal, baik ↓ Glycogenolysis
↓ Neoglucogenesis
pasal, prandial
maupun post
prandial Lipid ↓ Lypolisis
metabolism ↑ Lypogenesis
↑ Glycerogenesis
↓ Ketogenesis
↑ Clearance of VLDL & chylomicrons
from blood through enzyme vascular
endothelial lipoprotein lipase
Protein Protein synthesis
metabolism ↑ Entry of amino acids in cell
Insulin
secretion
Action profiles
of insulins
Common • Abdominal
Insulin sites of • Posterior upper arm
injection • Lateral thigh area
• Superior buttocks area
Macam insulin
Tatalaksana Terapi DM Tipe 1 –
Regimen Insulin
Tatalaksana Terapi DM Tipe 1 –
Regimen Insulin
Tatalaksana Terapi DM Tipe 1 –
Regimen Insulin
Tatalaksana Terapi DM Tipe 1 –
Regimen Insulin
Tatalaksana Terapi DM Tipe 1 –
Regimen Insulin
Efek samping insulin
Glucose-
lowering
medication
in type 2
diabetes:
overall
approach
Drug-specific
and patient
factors to
consider when
selecting
antihyperglyce
mic treatment
in adults with
type 2
diabetes
Efek
Antidiabetika
sulfonilurea
Nama Dosis Awal Dosis (mg/hari) Dosis max per Dosis/hari
hari
Generasi I
Tolbutamide 500-1500 500-3000 3000 2-3
Chlorpropamide 100-250 100-500 500 1
Tolazamide 100-250 100-1000 1000 1-2
Acetohexamide 250-500 250-1500 1500 1-2 sulfonilurea
Generasi II
Glyburide 1.25-2.50 1.25-20 20 1-2
Glibenclamide 1.25-2.50 1.25-2.50 20 1-2
Glipizide 2.5-5 2.5-40 40 1-2
Glipizide XL 5 5-20 20 1
Gliclazide 40 40-320 320 1-2
Glimepiride 1-2 4-8 8 1
sulfonylurea
meglitinid
biguanid
metformin
metformin
Alfa-
glucosidase
inhibitor
Thiazolidinedion
Thiazolidinedion
Efikasi
relative
OHO
Terapi
incretin
Efek
glucagon
like
peptide
Perbandingan
terapi incretin
Mekanisme
Kerja Sodium
Glucose
Cotransporter-2
Intensifying to
injectable
therapies
Intensifying
to injectable
therapies
Adding/
intensifying
insulin
AACE, 2019
Komplikasi
jangka panjang
Komplikasi DM
Komplikasi
kardiovaskuler
Kardiovaskuler
New customers by
source
New customers by
source
Terapi
hiperlipidemia
nephropathy
nephropathy
retinopathy
Neuropathy
Peripheral
arterial disease
Pencegahan
komplikasi
DM
Terima
kasih
