DM

dr M Arman Nasution SpPD
Understand Diabetes and Take Control
DIABETE
S
Diabetes = pancuran
Melitus =
madu atau gula
G U LA D AR AH
S
S
S
S
300
S
S
S
S
S
S
400
S
S
S
S
A l ir a n D a r a h
S
S
G LU KO SA
200
S
S
S
S
S
S
S
S
S
S
S
S
S
100
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
S
SEL
S
S
S
Se l
H a ti
Sel
O to t
Sel
Lem ak
SS EE LL
Penyakit menahun
yang ditandai
dengan kadar
glukosa darah
melebihi nilai
normal
(hiperglikemia)
akibat kekurangan
hormon insulin
atau kerja hormon
insulin terganggu
Regulation of Plasma Glucose

Level
How Insuline Decrease Plasma

Glucose Level?
The Stats Diabetes is one of this nations

most prevalent, debilitating, deadly and
costly diseases 20.8 Million people which is
equivalent to 7.0% of the population have
diabetes (2005)
(up from 18.2 million in 2003)
A Disease in which the body does not produce or

properly use insulin. Insulin is a hormone that is
needed to convert sugar, starches and other food into
energy needed for daily life.
The cause of diabetes still remains a mystery,
however both genetics and environmental factors
such as obesity and lack of exercise appear to play
roles.
Cost of diabetes in America in 2002 was

at least $132 billion !!
10.9 million men and 9.7 women aged 20 years or

older have diabetes and nearly 1/3 of them do not
know it
14.6 million people are diagnosed and 6.2 million
people are undiagnosed 1.5 million new cases of
diabetes were diagnosed in people aged 20 years
or older
People with diabetes often have typical complaints (symptoms):
Thirst and frequent drinking
More frequent urination, particularly at night
Unexplained weight loss
Fatigue
Blurred vision
Frequent infections : skin, genital
Type 2 diabetes is often without symptoms

in its early stages. Thats the reason there
are 40% of people with Type 2 diabetes
are unaware of their disease. When there
are symptoms, they may occur gradually.
If present, they usually are:
feeling tired and weak

passing large volumes of urine,
especially during the night
having frequent infections
having blurred eyesight
Weight-loss
Excessive hunger and thirst
Organ penting yang berperan dalam metabolisme

karbohidrat, lemak dan protein
Terdiri dari 2 bagian :
1. Bagian Eksokrin
yang mengeluarkan enzimenzim pencernaan.
Contoh : Amilase, Lipase, dll.
2. Bagian Endokrin
yang mengeluarkan hormonhormon
Contoh : Insulin, glukagon
Hormon yang dikeluarkan oleh sel pankreas

yang berperan dalam metabolisme karbohidrat
Fungsi insulin : menormalkan
kadar glukosa dalam tubuh
melalui proses :
Glikogenesis (hati dan otot)
Up take glukosa oleh jaringan
perifer dan oksidasi glukosa
Hormon yang dikeluarkan oleh sel pankreas

yang berperan pada metabolisme karbohidrat
Fungsi glukagon adalah meningkatkan kadar glukosa
dalam tubuh bila tubuh kekurangan glukosa melalui
proses :
Glikogenolisis (glikogen menjadi glukosa dlm hati)
Gluconeogenesis (pembentukan glukosa dari senyawa
organik lain yang bukan karbohidrat)
Up take glukosa oleh jaringan perifer diturunkan
Kita mewaspadai kondisi

diabetes ini karena setiap 24
jam terjadi hal berikut ini :
3600 kasus baru diabetes
terdiagnosa
580 individu meninggal karena
komplikasi diabetes
225 individu mengalami
amputasi terkait diabetes
120 individu mengalami gagal
ginjal tahap akhir
55 individu diabetik
mengalami kebutaan
-Type 1
-Type 2
-Diabetes gestational
-other spesific type
Type 1 Diabetes Mellitus

Type 2 Diabetes Mellitus
Gestational Diabetes
Other types:
LADA (
MODY (maturity-onset diabetes of
youth)
Secondary Diabetes Mellitus
DM Tipe 1
Disebabkan destruksi sel islet pankreatik/sel ,

sehingga terjadi defisiensi insulin absolut. Ada 2 tipe
utama : autoimun ( 90%, terjadi destruksi sel oleh
antibodi terhadap sel ) dan idiopathic (apabila tidak
ada autoimunitas)
Disebabkan karena resistensi insulin dan

gangguan sekresi insulin oleh sel beta
DM Tipe 2
DM
Gestasional
diabetes yang terjadi pada saat kehamilan
Diabetes
Diabetes
Tipe
Tipe Lain
Lain
Diabetes tipe lain : disebabkan oleh kerusakan

sel beta secara genetik (maturity onset diabetes
of the young/MODY), gangguan kerja insulin
secara genetik (rabson-mendenhall syndrome),
penyakit-penyakit eksokrin (pankreatitis, cystic
fibrosis), endokrinopati (cushings syndrome,
hipertiroidisme, aldosteronoma), penggunaan
obat (glukokortikoid, pentamidine), infeksi
(rubella congenital, stiff man syndrome),
sindrom genetik lain yang terkait dengan
diabetes (downs syndrome, prader-willi
syndrome)
There are 2 main types of diabetes:
Type 1 (15%): Due to total lack of insulin insulin

is required for life
treatment
Type 2 (85%): Plenty of insulin which does not work very well
in the body. Insulin treatment may be
required at some stage but is
not required in all patients
Was previously called insulin-dependent diabetes

mellitus (IDDM) or juvenile-onset diabetes.
Type 1 diabetes develops when the bodys
immune system destroys pancreatic beta cells,
the only cells in the body that make the hormone
insulin that regulates blood glucose.
This form of diabetes usually strikes children and
young adults, although disease onset can occur
at any age.
Type 1 diabetes may account for 5% to 10% of all
diagnosed cases of diabetes.
Risk factors for type 1 diabetes may include
autoimmune, genetic, and environmental factors.
31
1. Etiology of Type 1 Diabetes
2. Etiology of Type 2 Diabetes
33
34
a
Merupakan jenis DM yang paling

banyak dijumpai (90 - 95% kasus)
Pada tahap dini sering tidak bergejala
dan tidak terdiagnosis hingga
bertahun-tahun
Was previously called non-insulin-dependent diabetes

mellitus (NIDDM) or adult-onset diabetes.
Type 2 diabetes may account for about 90% to 95% of
all diagnosed cases of diabetes.
It usually begins as insulin resistance, a disorder in
which the cells do not use insulin properly. As the need
for insulin rises, the pancreas gradually loses its ability
to produce insulin.
Type 2 diabetes is associated with older age, obesity,
family history of diabetes, history of gestational
diabetes, impaired glucose metabolism, physical
inactivity, and race/ethnicity.
African Americans, Hispanic/Latino Americans,
American Indians, and some Asian Americans and
Native Hawaiians or Other Pacific Islanders are at
particularly high risk for type 2 diabetes.
Type 2 diabetes is increasingly being diagnosed in
children and adolescents.
Type 2 DM
Family History
Obesity
Habitual physical inactivity
Previously identified impaired glucose
tolerance
(IGT) or impaired fasting glucose (IFG)
Hypertension
Hyperlipidemia
37
38
Type 1
Young age
Normal BMI, not obese
No immediate family
history
Short duration of
symptoms (weeks)
Can present with
diabetic coma
(diabetic ketoacidosis)
Insulin required
Type 2
Middle aged, elderly
Usually
overweight/obese
Family history usual
Symptoms may be
present for
months/years
Do not present with
diabetic coma
Insulin not necessarily
required
Previous diabetes in
pregnancy
These differences are not absolute

Discovered in 1921 by
Banting and Best
Consist of A & B chains
linked by 2 disulfide
bonds
A =(plus
21amino
acids B = 30 amino
acids
additional
disulfide
in A)
Patient J.L., December 15,

1922
February 15, 1923
Diet/
exercise
Oral
Oral
monotherapy combination
Oral
+/- insulin
Diet and exercise my control condition for some time

Variety of tablets available when diet exercise no longer work
Tablets can be used in combination with each other or with insulin
Insulin can also be used alone
Insulin
Latent Autoimmune Diabetes in Adults (LADA)

is a form of autoimmune (type1 diabetes)
which is diagnosed in individuals who are older
than the usual age of onset of type 1 diabetes.
Alternate terms that have been used for
"LADA" include Late-onset Autoimmune
Diabetes of Adulthood, "Slow Onset Type 1"
diabetes, and sometimes also "Type 1.5
Often, patients with LADA are mistakenly
thought to have type2 diabetes, based on
their age at the time of diagnosis.
MODY Maturity Onset Diabetes of the Young

MODY is a monogenic form of diabetes with an autosomal
dominant mode of inheritance:
Mutations in any one of several transcription factors or in the

enzyme glucokinase lead to insufficient insulin release from
pancreatic -cells, causing MODY.
Different subtypes of MODY are identified based on the mutated
gene.
Originally, diagnosis of MODY was based on presence of

non-ketotic hyperglycemia in adolescents or young adults
in conjunction with a family history of diabetes.
However, genetic testing has shown that MODY can occur
at any age and that a family history of diabetes is not
always obvious.
A form of glucose intolerance that is diagnosed in

some women during pregnancy.
Gestational diabetes occurs more frequently
among African Americans, Hispanic/Latino
Americans, and American Indians. It is also more
common among obese women and women with a
family history of diabetes.
During pregnancy, gestational diabetes requires
treatment to normalize maternal blood glucose
levels to avoid complications in the infant.
After pregnancy, 5% to 10% of women with
gestational diabetes are found to have type 2
diabetes.
Women who have had gestational diabetes have
a 20% to 50% chance of developing diabetes in
the next 5-10 years.
Diabetes that first

presents during
pregnancy
Occurs in 2-10% of
pregnancies
30-60% chance of
developing T2DM
Other specific types of diabetes

result from specific genetic
conditions (such as maturity-onset
diabetes of youth), surgery, drugs,
malnutrition, infections, and other
illnesses.
Such types of diabetes may account
for 1% to 5% of all diagnosed cases
of diabetes.
Secondary causes of Diabetes mellitus include:
Acromegaly,
Cushing syndrome,
Thyrotoxicosis,
Pheochromocytoma
Chronic pancreatitis,
Cancer
Drug induced hyperglycemia:
Atypical Antipsychotics - Alter receptor binding characteristics, leading to

increased insulin resistance.
Beta-blockers - Inhibit insulin secretion.
Calcium Channel Blockers - Inhibits secretion of insulin by interfering with
cytosolic calcium release.
Corticosteroids - Cause peripheral insulin resistance and gluconeogensis.
Fluoroquinolones - Inhibits insulin secretion by blocking ATP sensitive
potassium channels.
Naicin - They cause increased insulin resistance due to increased free fatty
acid mobilization.
Phenothiazines - Inhibit insulin secretion.
Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia. They also
cause increased insulin resistance due to increased free fatty acid
mobilization.
Pemeriksaan penyaring ditujukan pada mereka yang memiliki

risiko DM tetapi tidak menunjukkan gejala DM.
Berikut beberapa faktor risiko DM :

Usia > 45 thn, bila normal diulang kembali dengan interval
3 tahun
Kegemukan (BMI 23 kg/m2)
Hipertensi (TD > 140 / 90 mm Hg)
Riwayat keluarga DM
Riwayat melahirkan bayi dengan BB > 4 kg atau riwayat
DM pada kehamilan ( DM gestasional)
Kurang aktivitas fisik
Riwayat TGT atau GDPT atau penyakit kardiovaskular
Penderita PJK, Hipertiroidisme
Kadar Lipid abnormal (HDL < 35 mg/dl,Trigliserida 250
mg/dl)
Komplikasi DM sudah dimulai sejak dini

sebelum
diagnosis ditegakkan !!!
50% ketika didiagnosis telah menyandang
satu komplikasi kronik
21% : mengalami retinopati
18% : gambaran EKG yang abnormal
14% : gangguan aliran darah ke tungkai
TGT dan GPT menunjukkan adanya mekanisme

patofisiologi yang berbeda
Meskipun TGT maupun GPT didasari ada oleh
resistensi insulin, tetapi keduanya menunjukkan
perbedaan tempat di mana resistensi insulin
terjadi
Penderita GPT : resistensi insulin terutama
terjadi pada jaringan hati, sedangkan sensitifitas
insulin pada jaringan otot masih normal
Penderita TGT : sensitifitas insulin di jaringan
hati tetap normal atau sedikit menurun,
sedangkan pada jaringan otot telah terjadi
resistensi insulin
Diagnosis DM ditegakkan atas dasar

pemeriksaan konsentrasi glukosa darah.
Diagnosis tidak dapat ditegakkan atas dasar
adanya glukosuria.
Guna penentuan diagnosis DM, pemeriksaan
glukosa darah yang dianjurkan adalah
pemeriksaan glukosa secara enzimatik dgn
bahan darah plasma vena.
Kecurigaan adanya DM perlu dipikirkan
apabila terdapat keluhan klasik (poliuri,
polidipsi, polifagia
-Makrovascular
-Microvascular
Microvasuclar:
damage to eyes,
kidneys, nerves
(retinopathy,
nephropathy,
neuropathy)
Macrovascular: 2X
risk for heart attack
and stroke, peripheral
vascular disease
The longterm effects of diabetes mellitus

include progressive development of the
specific complications of retinopathy with
potential blindness, nephropathy that may
lead to renal failure, and/or neuropathy with
risk of foot ulcers, amputation, Charcot
joints, and features of autonomic
dysfunction, including sexual dysfunction.
People with diabetes are at increased risk of
cardiovascular, peripheral vascular and
cerebrovascular disease.
Short term:
Symptoms of diabetes
Dehydration
Diabetic Coma
Infections
Ketoacidosis
hypoglikemia
Long term:
Kidney
Eye
Heart
Circulation
Amputation
Complications of Diabetes in the US Heart

disease and stroke account for 65% of
deaths in people with diabetes Adults with
diabetes have heart disease death rates
about 2 to 4 times higher than adults
without diabetes Risk for stroke is also 2 to
4 times higher with diabetes
Hipoglikemia (kadar gula darah terlalu

rendah) dapat terjadi bila pasien diabetes minum
obat tablet atau suntik insulin terlalu banyak, atau
makan makanan terlalu sedikit, atau olahraga
terlalu berat, maka kadar gula darahnya akan
turun terlalu rendah.
Gejalanya adalah badan merasa lemas, lapar,
pusing, gemetar, berkeringat, dan detak jantung
yang cepat. Bahkan dapat menyebabkan pingsan
bila kadar gula darahnya menjadi sangat rendah.
Akibat gula darah yang terlalu tinggi dapat pingsan

karena mengalami ketoasidosis. Keadaan ini sangat
berbahaya karena dapat menyebabkan kematian
Koma ketoasidosis diabetic : komplikasi serius,
merupakan keadaan darurat pada diabetes ; harus
segera diatasi karena dapat menyebabkan kematian.
Keadaan ini timbul karena : Kadar gula darah
terlalu tinggi dan kurangnya hormon insulin, sehingga
tubuh menggunakan lemak sebagai sumber energi
yang menghasilkan benda KETON di darah dan urin
Gejala Ketoasidosis :
Kadar gula darah tinggi (> 240 mg/dl)
Terdapat keton di urin
Nafas berbau aseton
Makin banyak kencing sehingga timbul kekurangan
cairan tubuh
Mual, muntah dan sakit perut
Sesak nafas (nafas cepat dan dalam)
Badan lemas, akhirnya pingsan
Pencetus timbulnya ketoasidosis :

Infeksi, stress atau trauma
Penghentian insulin
Dosis insulin yang kurang
1. Bagi yang tidak DM
Teruskan gaya hidup sehat

Skrining berkala
(Diet, olah raga, hindari stress)
2. Bagi yang berisiko tinggi DM

atau PRE-DIABETES
Konsultasi dokter untuk
menentukan program
pencegahan DM yang
sesuai
Periksa laboratorium untuk

menentukan risiko komplikasi &
mencari faktor risiko lain yang
dapat memicu perkembangan DM
(American Diabetes Association)
Menurunkan berat badan 5%

Mengatur diet
- asupan lemak < 30% kalori
- asupan lemak jenuh < 10%
kalori
- serat > 15 g/1000 kkal
Olahraga (> 150
menit/minggu)
Certain people are more at risk of diabetes:
Those who are overweight/obese
People with a family history of diabetes
Women who had diabetes during pregnancy or have had a baby

weighing more than 4 kg
Physically inactive people
Certain ethnic groups (african, american indian,
asian)
People who have high blood pressure or high
cholesterol
Age more than 45 years
Risk of Type 2 Diabetes can be reduced:
Losing weight
Taking regular exercise : walking for 30 mins per day
Eating healthier food:

Less fat (burgers, fries, crisps, sweet foods)
More fibre (fruit and vegetables, wholegrain
alternatives for rice, bread)
Cutting down on alcohol consumption
Ultimate aim is to reduce the longterm complications

3. Bila diduga/didiagnosis DM
2. Segera konsultasi
dokter :
Memastikan diagnosis DM
Evaluasi awal
Menentukan pengelolaan
yang tepat
1. Jangan panik !!
Mengendalikan Kadar Glukosa

Darah
1. Perubahan Gaya Hidup
Diet
Olah raga
Menjaga berat
badan normal
Nutrition
Blood glucose
Medications
Physical activity/exercise
Behavior modification
Mengendalikan Kadar Glukosa Darah
2. Minum obat
sesuai petunjuk
dokter
3. Periksa ke dokter
secara berkala
4. Periksa
laboratorium
secara berkala
Glycemic Control:
A1c
Fasting
(preprandial)
Plasma Glucose
7%
70-130 mg/dL
Postprandial or
HS
Plasma Glucose
<180 mg/dL
80
Self-monitoring of blood glucose

Extremely useful for outpatient monitoring specially for
patients who need tight control for their glycemic state.
A portable battery operated device that measures the
color intensity produced from adding a drop of blood to
a glucose oxidase paper strip.
e.g. One Touch, Accu-Chek, DEX, Prestige and
Precision.
The major components of the

treatment of diabetes are:
Diet is a basic part of management in

every case. Treatment cannot be
effective unless adequate attention is
given to ensuring appropriate nutrition.
Dietary treatment should aim at:
ensuring weight control

providing nutritional requirements
allowing good glycaemic control with blood
glucose levels as close to normal as possible
correcting any associated blood lipid
abnormalities
Carbohydrate
60-70% calories from carbohydrates and
monounsaturated fats
Protein
10-20% total calories
Fat
<10% calories from saturated fat
10% calories from PUFA
<300 mg cholesterol
Fiber
20-35 grams/day
Alcohol
Type I limit to 2 drinks/day, with meals
Type II substitute for fat calories
Physical activity promotes weight reduction and

improves insulin sensitivity, thus lowering blood
glucose levels.
Together with dietary treatment, a programme
of regular physical activity and exercise should
be considered for each person. Such a
programme must be tailored to the individuals
health status and fitness.
People should, however, be educated about the
potential risk of hypoglycaemia and how to
avoid it.
There are currently four classes of oral

anti-diabetic agents:
i. Biguanides
ii. Insulin Secretagogues Sulphonylureas
iii. Insulin Secretagogues Nonsulphonylureas
iv. -glucosidase inhibitors
v. Thiazolidinediones (TZDs)
Short-term use:
Acute illness, surgery, stress and emergencies

Pregnancy
Breast-feeding
Insulin may be used as initial therapy in type 2 diabetes
in marked hyperglycaemia
Severe metabolic decompensation (diabetic ketoacidosis,
hyperosmolar nonketotic coma, lactic acidosis, severe
hypertriglyceridaemia)
Long-term use:
If targets have not been reached after optimal dose of

combination therapy or BIDS, consider change to multidose insulin therapy. When initiating this,insulin
secretagogues should be stopped and insulin sensitisers
e.g. Metformin or TZDs, can be continued.
Pharmacological effect:
Anabolic
-
Anticatabolic
Glucose uptake - Inhibits gluconeogenesis

Glycogen synthesis
- Inhibits glycogenolysis
Lipogenesis
- Inhibits lipolysis
Protein synthesis
- Inhibits proteolysis
- Triglyceride uptake
- Inhibits fatty acid oxidation
89
Strength
- The number of units/ml

e.g. U-100 , U-20, U-10
Source
- Pork: Differs by one a.a.

- Beef-Pork
- Human (recombinant DNA technology)
90
Regular insulins:
Human insulin: Humulin (from E.coli),

Novalin (from yeast)
NPH - neutral protamine Hagedorn (NPH),
protamine mixed.
Lente insulin / Ultralente insullinzinc added
Insulin Analogs:
Fatty Acid Acylated insulins
Insulin Lispro (Humalog) (1996)
Insulin Aspart (NovoLog) (2000)
Insulin Glargine (Lantus) (2002)
Insulin Detemir (Levemir) (Jun.,2005)
Insulin Glulisine (Apidra) (Jan., 2006)
Adverse effects
- Hypoglycemia
- Treatment:
- Patients should be aware of symptoms of
hypoglycemia
- Oral administration of 10-15 gm glucose
- IV dextrose in patients with lost consciousness
- 1 gm glucagon IM if IV access is not available
- Skin rash at injection site

- Treatment: Use more purified insulin preparation
- Lipodystrophies (increase in fat mass) at injection site
- Treatment: rotate the site of injection
96
97
Insulin Pump
Blood test that measures the amount of

glucose that has been incorporated into the
hemoglobin protein of the red blood cell (RBC).
Reflects the lifespan of a RBC, so test will
reveal the effectiveness of diabetes therapy
for the preceding 8-12 weeks.
HbA1c levels remain more stable than sugar
levels.
Not affected by short-term fluctuations in
sugar
Normal is 4-6%
Evaluated periodically (1-2 per year if well
controlled, more frequently if not)
Relative Risk (%)
20
Retinopathy
Nephropathy
Neuropathy
Microalbuminuria
15
13
Aim for AIc of < 7%
11
9
7
5
3
1
6
A1c (%)
10
11
12
DCCT, Diabetes Control and Complications Trial.

1. Adapted from Skyler JS. Endocrinol Metab Clin North Am. 1996;25:243254.
2. DCCT. N Eng J Med. 1993;329:977-986.
3. DCCT. Diabetes. 1995;44:968-983.
Overweight and obesity are diagnosed

by measuring weight and height (Body
Mass Index (BMI)):
BMI =
Weight in Kg
Height in metres2
Normal = 20-25
Overweight = 25-30
Obese = more than 30
Everyone should know their BMI!

Patients should be educated to practice selfcare. This allows the patient to assume
responsibility and control of his / her own
diabetes management. Self-care should
include:
Blood glucose monitoring

Body weight monitoring
Foot-care
Personal hygiene
Healthy lifestyle/diet or physical activity
Identify targets for control
Stopping smoking
Komplikasi akut dapat berakibat fatal

Komplikasi kronik mengakibatkan cacat
dan menyulitkan
Karena
itu,
Factors other than blood sugar increase

likelihood of complications and should be
managed
Complications can be delayed/prevented by:
Controlling blood sugars: sticking to diet/exercise

programme, taking medication as prescribed
Controlling blood pressure: diet, salt restriction,
Controlling cholesterol levels: diet, statin tablets
Stopping smoking
Taking aspirin?
medication
ASS wr WB

DM

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

DM

Hochgeladen von

Copyright:

Verfügbare Formate

dr M Arman Nasution SpPD

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Regulation of Plasma Glucose

Understand Diabetes and Take Control

How Insuline Decrease Plasma

Understand Diabetes and Take Control

Understand Diabetes and Take Control

The Stats Diabetes is one of this nations

A Disease in which the body does not produce or

Understand Diabetes and Take Control

Cost of diabetes in America in 2002 was

Understand Diabetes and Take Control

10.9 million men and 9.7 women aged 20 years or

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Understand Diabetes and Take Control

People with diabetes often have typical complaints (symptoms):

Thirst and frequent drinking

More frequent urination, particularly at night

Unexplained weight loss

Frequent infections : skin, genital

Understand Diabetes and Take Control

Type 2 diabetes is often without symptoms

feeling tired and weak

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Organ penting yang berperan dalam metabolisme

Hormon yang dikeluarkan oleh sel pankreas

Understand Diabetes and Take Control

Hormon yang dikeluarkan oleh sel pankreas

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Kita mewaspadai kondisi

Understand Diabetes and Take Control

Type 1 Diabetes Mellitus

Understand Diabetes and Take Control

Disebabkan destruksi sel islet pankreatik/sel ,

Disebabkan karena resistensi insulin dan

diabetes yang terjadi pada saat kehamilan

Understand Diabetes and Take Control

Diabetes tipe lain : disebabkan oleh kerusakan

There are 2 main types of diabetes:

Type 1 (15%): Due to total lack of insulin insulin

Understand Diabetes and Take Control

Understand Diabetes and Take Control

Was previously called insulin-dependent diabetes

Understand Diabetes and Take Control

1. Etiology of Type 1 Diabetes

Understand Diabetes and Take Control

Understand Diabetes and Take Control

2. Etiology of Type 2 Diabetes

Understand Diabetes and Take Control

Merupakan jenis DM yang paling

Understand Diabetes and Take Control

Was previously called non-insulin-dependent diabetes

Understand Diabetes and Take Control

These differences are not absolute

Understand Diabetes and Take Control