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8/13/2019 DM Pd Usia Lanjut
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Diabetes melitus padausia lanjut
Alfi Syahar Yakub
1 Alfi Syahar Yakub, SKp.,M.Kes
8/13/2019 DM Pd Usia Lanjut
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Diabetes melitus
• Prevalensi semakin meningkat
• Dampak usia lanjut + DM tipe 2
•
Indonesia
ledakan DM tipe 2, nomor 4
2 Alfi Syahar Yakub, SKp.,M.Kes
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28/01/2014 3
Endocrine glands release hormones (chemical messengers) into the bloodstream to
be transported to various organs and tissues throughout the body. For instance, the
pancreas secretes insulin, which allows the body to regulate levels of sugar in the
blood. The thyroid gets instructions from the pituitary to secrete hormones which
determine the pace of chemical activity in the body (the more hormone in thebloodstream, the faster the chemical activity; the less hormone, the slower the activity
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28/01/2014 4
The pancreas is located behind the liver and is where the
hormone insulin is produced. Insulin is used by the bodyto store and utilize glucose .
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28/01/2014 5
Islets of Langerhans containbeta cells and are locatedwithin the pancreas. Betacells produce insulin whichis needed to metabolize
glucose within the body.
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28/01/2014 6
Insulin is a hormone secreted bythe pancreas in response to
increased glucose levels in theblood.
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28/01/2014 7
Insulin is a hormoneproduced by the pancreasthat is necessary for cells tobe able to use blood sugar .
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28/01/2014 8
In response to high levels of glucose in the blood, theinsulin-producing cells in the pancreas secrete thehormone insulin. Type I diabetes occurs when these cells
are destroyed by the body’s own immune system.
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Blindness
Renal failure
Disability Amputations
Epidemiology of Diabetes Worldwide
• 151 million patients with diabetes
• 2.1% of worldwide population
• 97% are NIDDM patients
• 221 million estimated by 2010
• Complications of diabetes include :
Coronary artery disease
Peripheral vascular disease
Diabetic nephropathyStroke
9 Alfi Syahar Yakub, SKp.,M.Kes
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Patogenesis
•Proses ketuaan Faktor risiko independentintoleransi glukosa
• Patogenesis = DM tipe 2
Faktor keturunan & Faktor genetikDisfungsi sel beta, resistensi insulin, inkretin,
lipolisis, neurotransmitter dysfunction,
glukagonDM\Diabetes, Type 1, Type 2, Glucose, Insulin.mp4
DM\Type 2 Diabetes Overview .wmv
What is Type 1 Diabetes_.mp4
10 Alfi Syahar Yakub, SKp.,M.Kes
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Increased lipolysisDecreased glucose uptake intomuscle and adipose tissue and
increased hepatic glucose
output
Hyperglycemia
Insulin resistance
-cell dysfunction
Elevated
circulating FFA
Insulin resistance and -celldysfunction are linked
11 Alfi Syahar Yakub, SKp.,M.Kes
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Faktor risiko DM usia lanjut
• Umur tua
• Obesitas
•
Aktifitas fisik kurang• Obat-obatan
• Genetik
• Penyakit lain
12 Alfi Syahar Yakub, SKp.,M.Kes
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Gejala/kelainan DM usia lanjut
• Katarak, glaukoma, retinopati diabetik
• Pruritus / gatal pada kulit t/u vulva
• Kontraktur dupuytren
•
Infeksi bakteri kulit,sal kemih• Infeksi jamur
• Neuropati perifer/visceral
• Amiotropi Ulkusneurotropik
•PAP
• PJK
• Hipertensi
13 Alfi Syahar Yakub, SKp.,M.Kes
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Managing Diabetes
Don’t be
Glucose – centric
We must treat the entire metabolicsystem
14 Alfi Syahar Yakub, SKp.,M.Kes
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Pengobatan DM usia lanjut
• Diet dan olahraga
• Obat oral : – Sulfonilurea, non sulfonilurea
– Biguanid (metformin)
– Akarbose
– Tiazolidindion
• Insulin
15 Alfi Syahar Yakub, SKp.,M.Kes
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Interaksi obat dengansulfonilurea
• Meningkatkan hipoglikemia – Aspirin, fibrat, trimetoprim menggantikan
sulfonilurea dr ikatan albumin
– Alkohol, penyekat H2, antikoagulanmenghambat met. Sulfonilurea
– AntaPenyekat beta, simpatolitik antagonis
counter regulatory hormon
• Memperburuk kontrol glukosa darah
16 Alfi Syahar Yakub, SKp.,M.Kes
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Interaksi obat dengansulfonilurea
• Memperburuk kontrol glukosa darah – Rifampicin, barbiturat meningkatkan
metabolisme Sulfonilurea
– Beta bloker antagonis sulfonilurea
– HCT, Beta bloker, kortikosteroid, estrogen,
phenitoin menghambat sekresi atau kerja
insulin
17 Alfi Syahar Yakub, SKp.,M.Kes
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Insulin
• Indikasi = DM tipe 2 lain
• Pemantauan glukosa plasma ketat
•
Perlu bantuan orang lain• Hipoglikemia klirens insulin menurun,
sekresi glukagon menurun, sekresi
epinefrin biasa terlambat
18 Alfi Syahar Yakub, SKp.,M.Kes