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Caring for people with diabetes
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Overview of diabetes
Diabetes means that blood glucose inthe body (often called blood sugar) istoo high
Glucose comes from the food we eat Glucose is transported by the blood
stream to all the cells in the body.
G
G
G
G
G
G
GGG
Muscle
Bloodstream
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Overview of diabetes
Insulin helps the glucose fromfood get into your cells.
Insulin is a chemical (ahormone) made in a part of thebody called the pancreas.
PANCREAS
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insulin
Muscle
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Overview of diabetes
If your body doesn't makeenough insulin or if theinsulin doesn't work the way
it should, glucose can't getinto cells.
Glucose stays in the blood.
Blood glucose levels get too
high, causing diabetes.Bloodstream
Muscle
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Complications of diabetes
Diabetes can cause increased risk of:
Heart Problems
Stroke
Eye sight problems
Kidney problems
Foot problems
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Treatment goals
Symptom free
Prevent short term complications
Prevent long term complications
Quality of life =Lifestyle focus
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Healthy eating
To help control blood glucose,blood fats and adequate bodyweight
Healthy Eating
Regular carbohydrate High in fibre
Low in fat (particularly saturatedfat)
Low in added sugar Adequate energy
/protein/fluids/vits and mins
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Exercise / activity
30 minutes moderate intensity most days preferablyall
Helps to: Increased insulin sensitivity
Decreased insulin requirements
Weight reduction
Lipid control
Blood pressure control
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Insulin and tablets
Type 2 diabetes treatment may be Healthy eating Healthy eating + tablets (several different types of
tablets may be on combination of tablets
Healthy eating + tablets + insulin Healthy eating and insulin
Type 1 diabetes always require insulin
May have long acting 1-2 times a day Short and long acting 1-4 times a day Continuous insulin pump
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What you need to know!
Blood glucose level that is considered low
Signs and symptoms
Causes
Plan of action to treat Strategies to prevent hypoglycaemia
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Hypoglycaemia
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Definition of hypoglycaemia
in people with diabetes who are treated withinsulin or oral hypoglycaemic agents
Hipoglikemi bila :
kadar glukosa darah < 60 mg/dL, ataukadar glukosa darah , 80 mg/dl dengan gejalaklinis
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Penyebab
DPMI Workforce Development The Alfred
Workforce Development Team June 2005
Makan kurang dari aturan
Berat badan turun
Sesudah olahraga
Sesudah melahirkan Sembuh dari sakit
Makan obat yang sifatnya serupa
Pemberian suntikan insulin yang tidak tepat
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Tanda klinis hipoglikemi
Stadium parasimpatik : lapar, mual, TD turun
Stadium gangguan otak ringan : lemah,lesu, sulitbicara, kesulitan menghitung sementara
Stadium simpatik : keringat dingin pada muka, bibiratau tangan gemetar
Stadium gangguan otak berat : tidak sadar denganatau tanpa kejang.
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Symptoms
excessive hunger
headache
profuse sweatingfeeling dizzy/shaking
pins and needles
around mouth
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Cognitive impairment
Symptoms of cognitive impairment
Lack of concentrationAltered vision
Peculiar behaviour
Loss of consciousness
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Nocturnal hypoglycemia
Symptoms may include:
Sweating
Vivid dreaming
Restlessness
Incontinence
Waking with a headache
High or low fasting levels
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Act quickly
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PENATALAKSANAAN HIPOGLIKEMIA
beri larutan gula
murni 20-30gram
Minum gula-gula
(bukan pemanis
pengganti gula atau
guladiet/gula diabetes
Obat DM stop
sementara
Pantau glukosa darah12 jam
Pertahankan GD-200
mg/dL (apabila
sebelumnya tdk sadar)
Cari penyebab
Suntik 50 cc Dx 40% (atau glukagon
0,5-1 mg iv/im,bila penyebab insulin)
Infus Dx 10% 6 jam/kolf
Pantau GD tiap jam
Belum sadar
GD masih < 100 mg/dLUlangi suntik 50 mL Dx 40%
Pantau GD tiap 1/2jam
Belum sadar
Ulangi suntik 50 mL Dx 40%
Pantau GD tiap 1/2jam
Belum sadar GD ~ 200 mg/dL
Suntik hidrokortison 100 mg per 4 jam selama12 jamatau
Deksamethason 10 mg iv bolus dilanjutkan 2 mg tiap 6
jam dan manitol iv 1 - 2 g/kg BB setiap 68 jam.
Caripenyebab kesadaran menurun.
SADAR TIDAK SADAR
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Never
Never give food to an unconscious
person
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Treatment if unconscious
Position in the left lateral position and withholdany food or fluids. Seek further medical help.
If glucagon is available it can be administered
subcutaneously, intramuscularly orintravenously.
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Tugas kita bukanlah untuk berhasil.Tugas kitaadalah untuk mencoba,
karena didalam mencobaitulah kita menemukan dan belajar
membangun kesempatan untuk berhasil
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Hyperglycaemia
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What you need to know!
What is hyperglycaemia
Causes
Describe the main principles of the treatment
Diabetic Ketoacidosis Hyperosmolar non ketotic coma
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Hyperglycaemia
Persistent BGL over 10 mmol/L
Signs and symptoms of hyperglycaemia Polyuria
Polydipsia Blurred vision
Weight loss
Infections, thrush
Tired
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Kadar glukosa darah sewaktu dan puasa sebagai patokan penyaringdan diagnosis DM (mg/dl)
DPMI Workforce Development The Alfred
Workforce Development Team June 2005
Bukan DM Belum pasti DMDM
Kadar glukosa Plasma Vena < 100 100 199 200
darah sewaktu Darah kapiler < 90 90 199 200
Kadar glukosa Plasma vena < 100 100 125 126darah puasa Darah kapiler < 90 90 99 100
( Konsensus Pengelolaan dan Pencegahan DM tipe 2 di Indonesia,PERKENI, 2006)
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Causes of Hyperglycaemia
Increased weight
Incorrect foods or amount of foods
Forgetting or insufficient medication lack of physical
activity Stress
Certain medications
Illness /infections
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Treatment
Relieve symptoms
Increase monitoring
Identify cause treat accordingly
Observe for signs of concurrent illness or infection
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Ketoasidosis
Merupakan defisiensi berat dan akut darisuatu perjalanan penyakit diabetes melitus.
Peningkatan produksi gula, oleh hati,penurunan penggunaan gula, peningkatanmobilisasi lemak, dan pembentukan keton.
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4 masalah metabolik
Hiperosmolar (hiperglikemi dan dehidrasi) Metabolik asidosis (akumulasi keton)
Hilangnya volume ekstraseluler (diuresis osmotik)
Ketidakseimbangan elektrolitmLaboratorium :
Kadar glukosa darah > 250 mg/dL
pH
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Tanda klinis :
Dehidrasi : haus, hangat,turgor menurun, membranmukosa kering, kelemahan, hipotensi, nadi cepatdan lemah
Metabolik asidosis : mual,muntah, nafas bauketon,letargi, koma
Kinis lain : nyeri perut, pernafasan Kussmaul(kompensasi mencegah penurunan pH)
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Tindakan cepat
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Resusitasi A, B, C
1. Airway : pastikan jalan nafas paten
2. Breathing : oksigen masker
3. Circulation : monitor fungsi jantung (TD, nadi)
jika shok berikan 10ml/kg normal saline iv.
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Penanganan
1. Rehidrasi : Pemberian cairan sebanyak 1 liter pada 30menit pertama kemudian 0,5 liter pada 30 menit kedua.Setelah itu cairan diberikan sesuai tingkat dehidrasi. Bilakadar glukosa darah < 200 mg/dl, NaCl 0,9% segera
diganti dengan dextrose 5%.2. Insulin: Insulin mulai diberikan pada jam ke-2, dalam
bentuk bolus (intravena) dosis 180 mU/Kg BB,dilanjutkan dengan drip insulin 90 mU/jam/kgBB dalam
NaCl 0,9%. Bila glukosa darah < 200 mg/dL, kecepatandikurangi menjadi 45 mU/jam/g BB. Bila glukosa darahstabil sekitar 200-300 mg/dL selama 12 jam, dilanjutkandengan drip insulin 1 2 unit/jam dan dilakukan slidingscale setiap 6 jam.
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Penanganan
3. Bikarbonas : Koreksi natrium bikarbonat dilakukanbila pH
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Penanganan
Tujuan : mengkoreksi kelainan patofisiologis yangmendasari :
Gangguan keseimbangan elektrolit
Kadar glukosa darah Gangguan asam basa
Mengobati faktor pencetus
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Diagnosa Keperawatan
1. Defisit volume cairan berhubungan dengandiuresis osmotic sekunder akibat hyperglikemi,kehilangan gastric berlebihan;diare, muntah
2.Nutrisi kurang dari kebutuhan tubuh berhubungandengan ketidak cukupan insulin, penurunanmasukan oral, status hypermetbolisme
3. Resiko tinggi infeksi/ sepsis berhubungan dengan
kadar glukosa tinggi, penurunan fungsi leukosit
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Tindakan Manajemen cairan/ elektrolit
1. Pantau TTV, kaji pulsasi, mukosa membran danturgor kulit
2. Monitor intake dan out put / jam
3. Pertahankan cairan peroral maupun intravena(NaCl 0,9%)
4. Lakukan pemasangan kateter (sesuai kondisi klien)
5. Kolaborasi pemberian kalium, bikarbonas
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Tindakan manajemen hiperglikemi
1. Auskultasi bising usus
2. Catat keluhan kembung, mual, muntah
3. Beri makanan cair yang mengandung nutrien dan
elektrolit jika memungkinkan4. Observasi tanda hipoglikemi
5. Lakukan pemeriksaan GDS/jam
6. Lakukan pemeriksaan GD,aseton, pH, HCO3
7. Pemberian terapi insulin
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Tindakan kontrol infeksi
1. Observasi tanda-tanda infeksi
2. Tingkatkan universalprecaution
3. Berikan posisi semi fowler
4. Auskultasi bunyi nafas5. Antibiotik
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Bila anda belum menemkan pekerjaanyang sesuai
dengan bakat anda, bakatilah apapun
pekerjaananda sekarang. Anda akan tampil
secemerlang
yang berbakat