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    Diabetes melitus padausia lanjut

    Alfi Syahar Yakub

    1Alfi Syahar Yakub, SKp.,M.Kes

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    Diabetes melitus

    Prevalensi semakin meningkat

    Dampakusia lanjut +DM tipe 2

    Indonesia

    ledakan DM tipe 2, nomor 4

    2Alfi 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 bodys own immune system.

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    Blindness

    Renal failure

    DisabilityAmputations

    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

    9Alfi 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

    10Alfi Syahar Yakub, SKp.,M.Kes

    http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/YouTube%20%20%20%20%20%20%20%20-%20What%20is%20Type%201%20Diabetes_.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Type%202%20Diabetes%20Overview%20.wmvhttp://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4http://localhost/var/www/apps/YOUTUBE/Youtube%20DM/Diabetes,%20Type%201,%20Type%202,%20Glucose,%20Insulin.mp4
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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

    11Alfi 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

    12Alfi 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

    13Alfi Syahar Yakub, SKp.,M.Kes

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    Managing Diabetes

    Dont be

    Glucosecentric

    We must treat the entire metabolicsystem

    14Alfi 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

    15Alfi 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.