Neuropati diabetes

Dr Endra Gunawan,SpPD.
RS Utama Husada

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Kaki Diabetes –
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Kaki dengan resiko tinggi

Neuropati perifer
Penyakit arteri perifer

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Statistik
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• separuh pasien amputasi di karenakan

diabetes
• Resiko meningkat 40kali pada pasien
diabetes
• masalah kaki mencapai 40% pada
negara berkembang

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

statistik
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• 85% of amputasi dimulai dg ulkus

• 49-85% kasus amputasi bisa dicegah

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Neuropati perifer –
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motor sensoris

• Bentuk yang paling umum dari

neuropati
• Mengenai pada 50% pasien
diabetes setelah 15 tahun
• Bilateral
• Gejala yang sama kaki kiri dan
kanan

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Faktor resiko nuropati diabetes

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• Kontrol glikemik yg jelek

• Lamanya menderita
diabetes
• usia
• Berat badan
• Peminum alkohol

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Neuropati diabetes
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• Gejala
– Rasa terbakar
– Rasa tertusuk
– Nyeri

• Tanpa gejala

Slides current until 2008

Diabetic neuropathy
Curriculum Module III-7C
Slide 8 of 37

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Mati rasa pada neuropati diabetik

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Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

kerusakan saraf sensorik

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Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Kerusakan saraf motorik

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Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Callus lokal
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Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Kerusakan saraf autonomik Slide 13 of 37

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
Slide 14 of 37

Lepaskan sepatu…
Slides current until 2008
 Diabetic neuropathy
Curriculum Module III-7C

Neuropati diabetes skrening test

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• Test sensasi
– Biothesiometer
– Tuning fork
– 10 gm monofilament

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
Slide 16 of 37

Resiko tinggi

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 Diabetic neuropathy
Curriculum Module III-7C
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Penyakit vaskular perifer

• Penyebab: penurunan perfusi

karena kerusakan pembuluh
darah

• lokasi:distal
Tibial dan peroneal arteri

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Penyakit vaskular perifer pada

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diabetes

• 15-40 kali menyebabkan

amputasi

• usia 70 tahun punya resiko 70

kali resiko amputasi

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Karakteristik penyakit vaskular

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pada diabetes

• Sering didapatkan
• Bisa pada usia muda
• Tidak ada perbedaan jenis
kelamin
• perokok
• progresif

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Penyakir vaskular perifer

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• gejala
– Intermittent claudication
– Nyeri saat istirahat

•Tanpa gejala
– Inaktifitas
– Neuropati

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Gejala
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• Nadi menghilang
• Kaki dingin
• Kulit dan kuku jelek
• Hilangnya bulu kaki

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
Slide 22 of 37

Tanda dan gejala

• Ada 4 tingkat
1. Tanpa gejala
2. Intermittent claudication
3. Nyeri saat istirahat terutama tidur
4. Ulcus atau gangrene

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
Slide 23 of 37

Penilaian vaskular

Raba nadi kaki

– Dorsalis pedis
– Tibialis posterior

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Evaluasi non invasif

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• Usg dopler
– Ankle Brachial Index (ABI)
<0.9 abnormal
0.9 to 1.0 normal
>1.3 non-compressible

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Peripheral vascular disease

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Tatalaksana

• Berhenti merokok

• Tetap berjalan

• operasi

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
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tatalaksana

• ACUTE :
 Menyembuhkan luka
 Menghindari amputasi

• CHRONIC :
Mencegah kekambuhan
 Diabetic neuropathy
Curriculum Module III-7C
Slide 27 of 37

Kstegori resiko
Category Risk profile Check-up frequency

0 No sensory neuropathy Once a year

1 Sensory neuropathy Every 6 months

Sensory neuropathy
2 /peripheral vascular Every 3 months
disease/foot deformities
3 Previous ulcer Every 1-3 months

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C

Penyebab amputasi
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diabetesNeuropati atau
vaskular
Trauma

Ulcer

Gagal sembuh

Infeksi

Amputasi Pecararo
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 Diabetic neuropathy
Curriculum Module III-7C
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Amputasi terjadi tiap 30 detik pada

diabetes

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 Diabetic neuropathy
Curriculum Module III-7C
Slide 30 of 37

Kapan kita rujuk ke internist?

 Diabetic neuropathy
Curriculum Module III-7C
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Terimakasih

Slides current until 2008

 Diabetic neuropathy
Curriculum Module III-7C
Neuropathy Slide 32 of 37

Objective : No wound

Intervention and plan of treatment

* General foot care

* Appropriate foot wear

 Diabetic neuropathy
Curriculum Module III-7C

Neuropathy + Deformity
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OBJECTIVE : WOUND FREE

Intervention and plan of treatment

* Foot care
* Preventive surgery

*Protective foot wear

 Diabetic neuropathy
Curriculum Module III-7C
Slide 34 of 37

Neuropathy + History of
wound/amputation

Objective:Treat wound early, no recurrent wound & no amputation

Intervention and plan of treatment

* Foot care

*Treat the wound by off loading Tech.

*Surgery (for complicated wound)


 Diabetic neuropathy
Neuropathy + Bone Curriculum Module III-7C
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Disorganization

Objective : Wound free & No Amputation

Intervention and plan of treatment

* Intensive foot care

* Rehabilitation :
 a. Conservative treatment
 b. Reconstructive Surgery
* Protective footwear
 Diabetic neuropathy
DIABETIC FOOT CARE AND EDUCATION Curriculum Module III-7C
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• CHECK YOUR FEET

EVERY DAY

• DO YOUR SEE RED SPOTS ?

• DO YOU HAVE BLISTERS OR

CALLUSES ?

DIFFERENTIATION
OF THE FOOT
HEALTHY FOOT
• Nerves let you feel pain,
vibration, pressure, heat, and
cold
• Blood Vessels Carry nutrients
and oxygen to your feet to
nourish them and help them heal
from injuries.
• Bones give your foot shape and
help distribute the pressure from
your body's weight.
• Joints are the connections
between your bones. They help
absorb pressure and allow your
foot to move. Your arch is a
group of joints that provides
stability for you entire foot
Diabetic neuropathy
Curriculum Module III-7C
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DIABETIC FOOT
• Damaged Nerves  difficult to
feel pain, pressure, heat and
cold.
• Blocked Blood Vessels bring
fewer nutrients and oxygen to
feet  sores may not be able to
heal.
• Weakened Bones may slowly
shift, causing foot to become
deformed and changing the way
distributes pressure.
• Collapsed Joints, especially a
collapsed arch, can no longer
absorb pressure or provide
stability. The surrounding skin
 Diabetic neuropathy
DIABETIC FOOT CARE AND EDUCATION Curriculum Module III-7C
Slide 38 of 37

• CHECK YOUR FEET

EVERY DAY

• DO YOUR SEE RED SPOTS ?

• DO YOU HAVE BLISTERS OR

CALLUSES ?
 Diabetic neuropathy
CARE AND EDUCATION
Curriculum Module III-7C
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IRRITATIONS, SKIN BLISTER

LESIONS

CUTS BETWEEN YOUR TOES

 Diabetic neuropathy
Curriculum Module III-7C
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 DO YOU FEEL TINGLING?

 ARE YOUR FEET COLD?
 ARE YOUR FEET NAILS INGROWN?
 HAS YOUR ARCH DECREASED?
 Diabetic neuropathy

CARE AND EDUCATION

Curriculum Module III-7C
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• KEEP SKIN SUPPLE & MOISTURISED

 Diabetic neuropathy

CARE AND EDUCATION

Curriculum Module III-7C
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• DO NOT WALK BARE FOOT

 Diabetic neuropathy
EXAMINE YOUR FEET DAILY Curriculum Module III-7C
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• DRY YOUR FEET PROPERLY

 Diabetic neuropathy
Curriculum Module III-7C
Slide 44 of 37

WARNING SIGNS AND

SYMPTOMS OF DIABETIC FOOT
PROBLEMS