Pemicu 1

Blok Endokrinologi
 Diabetes
• Diabetes Melitus
– Type 1
– Type 2
• Diabetes Insipidus
 Type 1 Diabetes Melitus
• Type 1 diabetes is a chronic illness
characterized by the body’s inability to
produce insulin due to the autoimmune
destruction of the beta cells in the pancreas.
• Onset most often occurs in childhood, but the
disease can also develop in adults in their late
30s and early 40s.
 Type 1 Diabetes Melitus
• The classic symptoms of type 1 diabetes are as follows:
– Polyuria
– Polydipsia
– Polyphagia
– Unexplained weight loss
• Other symptoms may include fatigue, nausea, and
blurred vision.
• The onset of symptomatic disease may be sudden.
• It is not unusual for patients with type 1 diabetes to
present with diabetic ketoacidosis (DKA).
 Type 1 Diabetes Melitus
• Diagnostic criteria by the American Diabetes
Association (ADA) include the following:
– A fasting plasma glucose (FPG) level ≥126 mg/dL (7.0
mmol/L), or
– A 2-hour plasma glucose level ≥200 mg/dL (11.1
mmol/L) during a 75-g oral glucose tolerance test
(OGTT), or
– A random plasma glucose ≥200 mg/dL (11.1 mmol/L)
in a patient with classic symptoms of hyperglycemia
or hyperglycemic crisis
 Type 1 Diabetes Melitus
• An international expert committee appointed
by the ADA, the European Association for the
Study of Diabetes, and the International
Diabetes Association recommended the HbA1c
assay for diagnosing type 1 diabetes only
when the condition is suspected but the
classic symptoms are absent.
 Type 1 Diabetes Melitus
• Management
– Glycemic control
– Self-monitoring
– Insulin therapy
– Diet and activity
– exercise
 Type 2 Diabetes Melitus
• Type 2 diabetes mellitus consists of an array of
dysfunctions characterized by hyperglycemia
and resulting from the combination of
resistance to insulin action, inadequate insulin
secretion, and excessive or inappropriate
glucagon secretion.
 Type 2 Diabetes Melitus
• Many patients with type 2 diabetes are
asymptomatic.
• Clinical manifestations include the following:
– Classic symptoms: Polyuria, polydipsia,
polyphagia, and weight loss
– Blurred vision
– Lower-extremity paresthesias
– Yeast infections (eg, balanitis in men)
 Type 2 Diabetes Melitus
• Diagnostic criteria by the American Diabetes
Association (ADA) include the following [1] :
– A fasting plasma glucose (FPG) level of 126 mg/dL
(7.0 mmol/L) or higher, or
– A 2-hour plasma glucose level of 200 mg/dL (11.1
mmol/L) or higher during a 75-g oral glucose
tolerance test (OGTT), or
– A random plasma glucose of 200 mg/dL (11.1
mmol/L) or higher in a patient with classic symptoms
of hyperglycemia or hyperglycemic crisis
 Type 2 Diabetes Melitus
• Indications for diabetes screening in
asymptomatic adults includes the following :
– Sustained blood pressure >135/80 mm Hg
– Overweight and 1 or more other risk factors for
diabetes (eg, first-degree relative with diabetes,
BP >140/90 mm Hg, and HDL < 35 mg/dL and/or
triglyceride level >250 mg/dL)
– ADA recommends screening at age 45 years in the
absence of the above criteria
 Type 2 Diabetes Melitus
• Goals of treatment are as follows:
– Microvascular (ie, eye and kidney disease) risk
reduction through control of glycemia and blood
pressure
– Macrovascular (ie, coronary, cerebrovascular,
peripheral vascular) risk reduction through control
of lipids and hypertension, smoking cessation
– Metabolic and neurologic risk reduction through
control of glycemia
 Type 2 Diabetes Melitus
• Recommendations for the treatment of type 2
diabetes mellitus from the European
Association for the Study of Diabetes (EASD)
and the American Diabetes Association (ADA)
place the patient's condition, desires, abilities,
and tolerances at the center of the decision-
making process
 Type 2 Diabetes Melitus
• The EASD/ADA position statement contains 7 key points:
– Individualized glycemic targets and glucose-lowering therapies
– Diet, exercise, and education as the foundation of the treatment
program
– Use of metformin as the optimal first-line drug unless contraindicated
– After metformin, the use of 1 or 2 additional oral or injectable agents,
with a goal of minimizing adverse effects if possible
– Ultimately, insulin therapy alone or with other agents if needed to
maintain blood glucose control
– Where possible, all treatment decisions should involve the patient,
with a focus on patient preferences, needs, and values
– A major focus on comprehensive cardiovascular risk reduction
 Type 2 Diabetes Melitus
• The 2013 ADA guidelines for SMBG frequency focus on an
individual's specific situation rather than quantifying the
number of tests that should be done.
• The recommendations include the following :
– Patients on intensive insulin regimens
• Perform SMBG at least before meals and snacks, as well as occasionally after
meals; at bedtime; before exercise and before critical tasks (eg, driving);
when hypoglycemia is suspected; and after treating hypoglycemia until
normoglycemia is achieved.
– Patients using less frequent insulin injections or noninsulin therapies
• Use SMBG results to adjust to food intake, activity, or medications to reach
specific treatment goals; clinicians must not only educate these individuals
on how to interpret their SMBG data, but they should also reevaluate the
ongoing need for and frequency of SMBG at each routine visit.
 Type 2 Diabetes Melitus
• Approaches to prevention of diabetic
complications include the following:
– HbA1c every 3-6 months
– Yearly dilated eye examinations
– Annual microalbumin checks
– Foot examinations at each visit
– Blood pressure < 130/80 mm Hg, lower in diabetic
nephropathy
– Statin therapy to reduce low-density lipoprotein
cholesterol
 Diabetes Insipidus
• Diabetes insipidus (DI) is defined as the passage of
large volumes (>3 L/24 hr) of dilute urine (< 300
mOsm/kg).
• It has the following 2 major forms:
– Central (neurogenic, pituitary, or neurohypophyseal) DI,
characterized by decreased secretion of antidiuretic
hormone (ADH; also referred to as arginine vasopressin
[AVP])
– Nephrogenic DI, characterized by decreased ability to
concentrate urine because of resistance to ADH action in
the kidney