Beruflich Dokumente
Kultur Dokumente
Nama Lengkap
: Dr.dr Dharma Lindarto. SpPD, KEMD
Tempat & Tanggal Lahir : D. Merangir, 22 Desember 1955.
Jabatan
: Kepala Divisi Endokrin-Metabolik Deprt IPD FKUSU/RSUP H Adam Malik
Medan
Alamat rumah
: Jln Gaperta No. 188 Medan 20124. Tel: 061- 8468380 HP: 0811631514
Alamat Kantor
: Div. Endok- Metab Dep I Peny Dalam FK USU/RSUP. H Adam Malik, Medan
)
Pendidikan
Dokter Umum
Konsultan Endokrin
S3 /Doktor
Pendidikan Tambahan
1.The Course on the Management of Diabetes Mellitus in the Primary Health Services. Jakarta
August, 2000
2. Involved in Department of Endorinology & Metabolism. Royal Adelaide Hospital Internal Medicine
Services.
2001. Adelaide. Australia.
3. Course In Advances Endocrinology. Endocrine & Metabolic Society Of Singapore. 2005
4. Training Course in The Pathophisiology of Osteoporosis And Bone Disease. At Shangrila Las Rasa
Sentosa
Resort, Singapore. 2005.
5. Practical Diabetology Course, Skodsborg Health Centre, Denmark, 2006
Organisasi Profesi
1. Pengurus IDI Cabang Kota Medan
2. Pengurus PAPDI Cabang Medan.
3. Sekretaris Perkeni Cabang Medan.
4. Ketua Persadia Cabang Medan.
5. Anggota Perosi Wil Sumut
Dharma Lindarto
Div. Endokrin-Metabolik Departemen Ilmu Penyakit
Dalam FK USU / RSUP H Adam Malik Medan
Questions
Lifestyle
modification is effective in
preventing/delaying type 2 diabetes and should be
offered to all individuals at high risk of developing
type 2 diabetes (Grade A)
Evidence Statements
Lifestyle modification including increasing physical
activity, improving diet, and weight loss are effective in
preventing/delaying the onset of type 2 diabetes in high
risk individuals
Weight loss, physical activity and dietary modification
contribute to reducing the risk of developing type 2
diabetes
Evidence Statements
Lifestyle interventions in people with IGT reduce
progression to type 2 diabetes beyond the intervention
period
Pharmacological interventions (including metformin,
acarbose, rosiglitazone and orlistat) are effective in
preventing/delaying the onset of type 2 diabetes in high
risk individuals
KSU
Prevention Diabetes
Primer
Secunder
Tertier
IGT
Genetic
Preclinical
predisposition state
Primary
prevention
NIDDM
Complications
Disability
Death
Clinical
disease
Complications
Disability
Death
Secondary
prevention
Tertiary
prevention
IGT
Genetic
Preclinical
predisposition state
Primary
prevention
NIDDM
Complications
Disability
Death
Clinical
disease
Complications
Disability
Death
Secondary
prevention
Tertiary
prevention
Normal
IGT
Genetic
Preclinical
predisposition state
NIDDM
Complications
Disability
Death
Clinical
disease
Complications
Disability
Death
KSU
2/4
KSU
3/4
Aerobic Exercise
glucose
Glut 4
Muscle
contracts
Increase in
insulin and
exercise
mediated
receptors
increase
muscle uptake
of glucose
ATP
Glycogen stores
Anaerobic exercise
Muscle cell
fatigue
Blood glucose rises
due to neuroendocrine
responses
Muscle
contracts
Creatine
phosphate
Lactic
acid
Creatine
kinase
ATP
ATP
Glycogen
glycolysis
Activity
Brisk walking
Running (7.5 min per km)
Running (5 min per km)
Swimming
Rope skipping (70/min)
Rope skipping (80/min)
Badminton
Tennis
Squash
Basketball
McArdle, et., 1991
Calorei
0.07
0.13
0.208
0.162
0.162
0.165
0.097
0.109
0.212
0.138
1000 k. calories/week.
Drygas, et al., 2000; Fletcher, et al., 1996; Lee, et al., 2000
KSU
Fuel Contribution to
Total 02 Uptake (%)
100
Free fatty
acid uptake
Muscle glycogen
50
0
Glycogen
2
Glucose +
FFA Uptake
3
FFA
4 hrs
Glucose
Uptake
4/4
KSU
METs
BMX biking
8.5
Ballet
4.8
Washing dishes
2.3
Sleeping
0.9
Ainsworth et al 2000 Med Sci
Sport & Exerci
20 minutes
60 minutes
Football
120kcal
360kcal
Swimming
(leisure)
90kcal
270kcal
180 kcal
315kcal
Walking
(2.5mph)
135kcal
45kcal
150kcal
155kcal
Jaffa cakes x 4
138kcal
243kcal
3 digestive biscuits
210kcal
0g
6g
Jaffa cakes x 4
4g
9g
3 digestive biscuits
9.6g
Carbohydrate requirements
Will vary with
duration and intensity
of exercise, as well as
age of child
Minimum of 15g per
hour
Avoid consuming
excess calories
Sweden
The Nurses
Health Study
USA
Finnish
Finland
Diabetes
Prevention Study
USA
Experimental Study
China
males 260
(6 yrs)
males & 577
Females (6 yrs)
70,000
GTT
Nurses (8 yrs)
&males 523
Females (4 yrs)
JAMA, 1999
Tuomilehto, et al., N
Engl J Med, 2001
TRIPOD: troglitazone
STOP-NIDDM: acarbose
XENDOS: orlistat
TRIPOD = Troglitazone in Prevention of Diabetes Study; STOP-NIDDM = Study to Prevent NonInsulin-Dependent Diabetes Mellitus; NAVIGATOR = Nateglinide and Valsartan in
Impaired Glucose Tolerance Outcomes Research; DREAM = Diabetes Reduction Approaches with Ramipril and Rosiglitazone; XENDOS = Xenical in the Prevention of Diabetes in
Obese Subjects; ORIGIN = Outcomes Reduction with Initial Glargine Introduction.
Insulin reduction
If
Summary 1
Summary 2
Young people need to be encouraged to do
regular activity
This may not improve diabetes control
Where weight is a concern care should be taken
to match additional food consumption with
energy requirements
Where possible adjust insulin to prevent
hypoglycaemia during exercise if weight is
concern
Effective exercise management requires regular
blood glucose monitoring before, during and
after activity
Summary 3
When young people are deciding to take up
structured training for a sport, it is important
for the diabetes team to consider;
The physiological requirements of training and
competition
The lifestyle of the athlete
The culture of the sport
Anti Doping ????? Therapeutic Use Exemption
(TUE) may be needed (www.100percentme.co.uk)
Tujuan
< 90%
90 110 %
110 120 %
> 120 %
BB idaman
BB idaman
BB idaman
BB idaman
Gemuk
Normal
Kurus
Contoh
Ringan
20-25 kal
30 kal
35 kal
Sedang
30 kal
35
40
Berat
35 kal
40
40-50
Karbohidrat
Anjuran 45-65% total asupan energi
Total KH <130 g/hari tidak dianjurkan
Diutamakan tinggi serat.
Sukrosa 5 % total asupan energi
Distribusi 3X makan /hari
1 g KH = 4 kkal
R/ ORIBEST
Konsensus Pengelolaan & Pencegahan DM tipe 2, 2011
Protein
Anjuran
Protein
Lemak
Anjuran
Serat
Anjuran 25 g/hari
Serat larut air (buah dan sayuran) dapat
menurunkan/memperlambat penyerapan glukosa dan lipid
Serat
Serat baik untuk kesehatan, karena:
- Membuat perut terasa lebih kenyang
Sumber Serat
Pemanis
Terdiri dari pemanis berkalori (gula alkohol dan
fruktosa) dan tidak berkalori (aspartam, sakarin,
sukralose)
Fruktosa tidak dianjurkan > 50 g perhari karena efek
samping pada lemak darah
Natrium
Na: 3000 mg = 6-7 g NaCl (1 sdt. Garam dapur)
Garam dapur dalam jumlah berlebihan berisiko
meningkatkan tekanan darah
Kurangi konsumsi makanan yang diasinkan seperti : ikan
asin, telur asin, corned beef, sarden, sosis, nugget dll
: 25 %
: 30 %
: 30 %
: 10-15 %
49
Jadwal
: 3 x makan utama
2 3 x makanan selingan
2.
Jumlah
3.
Jenis
Simpulan
Terapi
KSU