Diabetes melitus pada usia lanjut

Alfi Syahar Yakub

Alfi Syahar Yakub, SKp.,M.Kes

Diabetes melitus
Prevalensi semakin meningkat Dampak usia lanjut + DM tipe 2 Indonesia ledakan DM tipe 2, nomor 4

Alfi Syahar Yakub, SKp.,M.Kes

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 the 28/01/2014 3 bloodstream, the faster the chemical activity; the less hormone, the slower the activity

The pancreas is located behind the liver and is where the 28/01/2014 hormone insulin is produced. Insulin is used by the body to store and utilize glucose .

Islets of Langerhans contain beta cells and are located within the pancreas. Beta cells produce insulin which is needed to metabolize glucose within the body.

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Insulin is a hormone secreted by the pancreas in response to increased glucose levels in the 6 blood.

Insulin is a hormone produced by the pancreas that is necessary for cells to be28/01/2014 able to use blood sugar.

In response to high levels of glucose in the blood, the insulin-producing cells in the pancreas secrete the hormone insulin. Type I diabetes occurs when these cells 28/01/2014 are destroyed by the bodys own immune system.

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 nephropathy Stroke Blindness Renal failure Disability Amputations

Alfi Syahar Yakub, SKp.,M.Kes

Patogenesis
Proses ketuaan Faktor risiko independent intoleransi glukosa Patogenesis = DM tipe 2 Faktor keturunan & Faktor genetik Disfungsi sel beta, resistensi insulin, inkretin, lipolisis, neurotransmitter dysfunction, glukagon
DM\Diabetes, Type 1, Type 2, Glucose, Insulin.mp4 DM\Type 2 Diabetes Overview .wmv What is Type 1 Diabetes_.mp4
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Insulin resistance and -cell dysfunction are linked

Insulin resistance

Decreased glucose uptake into muscle and adipose tissue and increased hepatic glucose output

Increased lipolysis

Hyperglycemia

Elevated circulating FFA

Alfi Syahar Yakub, SKp.,M.Kes -cell dysfunction

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Faktor risiko DM usia lanjut

Umur tua Obesitas Aktifitas fisik kurang Obat-obatan Genetik Penyakit lain

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
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Managing Diabetes
Dont be Glucose centric We must treat the entire metabolic system

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

Alfi Syahar Yakub, SKp.,M.Kes

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Interaksi obat dengan sulfonilurea

Meningkatkan hipoglikemia
Aspirin, fibrat, trimetoprim menggantikan sulfonilurea dr ikatan albumin Alkohol, penyekat H2, antikoagulan menghambat met. Sulfonilurea AntaPenyekat beta, simpatolitik antagonis counter regulatory hormon

Memperburuk kontrol glukosa darah

Alfi Syahar Yakub, SKp.,M.Kes

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Interaksi obat dengan sulfonilurea

Memperburuk kontrol glukosa darah
Rifampicin, barbiturat meningkatkan metabolisme Sulfonilurea Beta bloker antagonis sulfonilurea HCT, Beta bloker, kortikosteroid, estrogen, phenitoin menghambat sekresi atau kerja insulin

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

Alfi Syahar Yakub, SKp.,M.Kes

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