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Diabetes melitus pada usia lanjut Alfi Syahar Yakub 1  Alfi Syahar Y akub, SKp.,M.Kes

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Page 1: DM Pd Usia Lanjut

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Diabetes melitus padausia lanjut

Alfi Syahar Yakub

1 Alfi Syahar Yakub, SKp.,M.Kes

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Diabetes melitus

• Prevalensi semakin meningkat

• Dampak usia lanjut + DM tipe 2  

Indonesia

 ledakan DM tipe 2, nomor 4

2 Alfi Syahar Yakub, SKp.,M.Kes

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28/01/2014 3

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 thebloodstream, the faster the chemical activity; the less hormone, the slower the activity

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The pancreas is located behind the liver and is where the

hormone insulin is produced. Insulin is used by the bodyto store and utilize glucose  . 

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Islets of Langerhans containbeta cells and are locatedwithin the pancreas. Betacells produce insulin whichis needed to metabolize

glucose within the body.

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Insulin is a hormone secreted bythe pancreas in response to

increased glucose levels in theblood.

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Insulin is a hormoneproduced by the pancreasthat is necessary for cells tobe able to use blood sugar .

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In response to high levels of glucose in the blood, theinsulin-producing cells in the pancreas secrete thehormone insulin. Type I diabetes occurs when these cells

are destroyed by the body’s own immune system.

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Blindness

Renal failure

Disability Amputations

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 nephropathyStroke

9 Alfi Syahar Yakub, SKp.,M.Kes

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Patogenesis

•Proses ketuaan  Faktor risiko independentintoleransi glukosa

• Patogenesis = DM tipe 2

Faktor keturunan & Faktor genetikDisfungsi sel beta, resistensi insulin, inkretin,

lipolisis, neurotransmitter dysfunction,

glukagonDM\Diabetes, Type 1, Type 2, Glucose, Insulin.mp4 

DM\Type 2 Diabetes Overview .wmv 

What is Type 1 Diabetes_.mp4 

10 Alfi Syahar Yakub, SKp.,M.Kes

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Increased lipolysisDecreased glucose uptake intomuscle and adipose tissue and

increased hepatic glucose

output

Hyperglycemia

Insulin resistance

-cell dysfunction

Elevated

circulating FFA

Insulin resistance and -celldysfunction are linked

11 Alfi Syahar Yakub, SKp.,M.Kes

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Faktor risiko DM usia lanjut

• Umur tua

• Obesitas

Aktifitas fisik kurang• Obat-obatan

• Genetik

• Penyakit lain

12 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

13 Alfi Syahar Yakub, SKp.,M.Kes

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Managing Diabetes

Don’t be 

Glucose – centric

We must treat the entire metabolicsystem

14 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

15 Alfi Syahar Yakub, SKp.,M.Kes

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Interaksi obat dengansulfonilurea

• Meningkatkan hipoglikemia – Aspirin, fibrat, trimetoprim menggantikan

sulfonilurea dr ikatan albumin

 – Alkohol, penyekat H2, antikoagulanmenghambat met. Sulfonilurea

 – AntaPenyekat beta, simpatolitik antagonis

counter regulatory hormon

• Memperburuk kontrol glukosa darah

16 Alfi Syahar Yakub, SKp.,M.Kes

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Interaksi obat dengansulfonilurea

• Memperburuk kontrol glukosa darah – Rifampicin, barbiturat meningkatkan

metabolisme Sulfonilurea

 – Beta bloker antagonis sulfonilurea

 – HCT, Beta bloker, kortikosteroid, estrogen,

phenitoin menghambat sekresi atau kerja

insulin

17 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

18 Alfi Syahar Yakub, SKp.,M.Kes