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Definisi

Suatu kelompok penyakit metabolik


Hiperglikemia
Karena kelainan sekresi insulin, kerja
insulin atau keduanya
Klasifikasi
I. Type I diabetes, insulin-dependent diabetes mellitus (IDDM) or "juvenile-onset diabetes"
II. Type II diabetes, non-insulin-dependent diabetes (NIDDM) or "adult-onset diabetes"
III. Other specific types
A. Genetic defects of beta-cell function (e.g., maturity-onset diabetes of the young [MODY]
types 1-3 and point mutations in mitochondrial DNA)
B. Genetic defects in insulin action
C. Disease of the exocrine pancreas (e.g., pancreatitis, trauma, pancreatectomy, neoplasia,
cystic fibrosis, hemochromatosis, fibrocalculous pancreatopathy)
D. Endocrinopathies (e.g., acromegaly, Cushing's syndrome, hyperthyroidism,
pheochromocytoma, glucagonoma, somatostinoma, aldosteronoma)
E. Drug or chemical induced (e.g., glucocorticosteroids, thiazides, diazoxide, pentamidine,
vacor, thyroid hormone, phenytoin, beta-agonists, oral contraceptives)
F. Infections (e.g., congenital rubella, cytomegalovirus)
G. Uncommon forms of immune-mediated diabetes (e.g., "stiff-man" syndrome, anti-insulin
receptor antibodies)
H. Other genetic syndromes (e.g., Down, Klinefelter's, Turner's syndrome, Huntington's
disease, myotonic dystrophy, lipodystrophy, ataxia-telangiectasia)
IV. Gestational diabetes mellitus
Patogenesis
DM tipe II
 Dipengaruhi genetik dan faktor lingkungan
 Pe↑ resistensi seluler thd insulin dan disusul
disfungsi sel β pankreas
1. Keterlambatan sekresi insulin fase-1 (fase
cepat)
2. Jumlah reseptor di perifer kurang
3. Kualitas reseptor jelek
4. Kelainan pasca reseptor shg proses
glikolisis intraseluler terganggu
Faktor Risiko
 Usia > 45 tahun
 Obesitas
 Jarang beraktivitas fisik
 Orang tua DM
 Riwayat melahirkan bayi > 4000gram
atau riwayat DM gestasional
 Hipertensi
 HDL < 35 mg/dL dan atau trigliserida >
250 mg/dL
 Riwayat TGT atau GDPT
 Riwayat peny kardiovaskular
G
E
J
A
L
A
Diagnosis
Diagnosis

1. Gejala klasik DM + GDS > 200mg/dl


2. Gejala klasik DM + GDP > 126 mg/dl
3. Kadar glukosa darah 2 jam pada TTGO > 200mg/dl
Komplikasi

Akut :
 Hipoglikemi
 Koma Lakto-Asidosis
 Ketoasidosis Diabetik–Koma Diabetik
 Koma Hiperosmoler Non-Ketotik
Kronis :
 Mikroangiopati (nefropati DM, retinopati DM)
 Makroangiopati (PJK, diabetic feet, stroke)
 Mikro-makroangiopati (neuropati, mudah
infeksi)
 Lain-lain (artropati, kardiomiopati)
Penatalaksanaan
1. Edukasi
2. Terapi gizi medis
3. Exercise
4. Intervensi farmakologis
- obat hipoglikemik oral
- insulin
- kombinasi
 Memicu produksi insulin
1. Sulfonilurea: glimepirid, glibenklamid
2. Glinid : Repaglinid, nateglinid
 Meningkatkan sensitifitas terhadap insulin
1. Biguanid : metformin, buformin
2. Tiazolidinedion : pioglitazon, rosiglitazon
 Penghambat enzim alfa glukosidase
1. Akarbose
 Rapid-acting : Humulin R, Novolin R
 Short-acting : glulisine, lispro, dan aspart
 Intermediate-acting: NPH, Humulin N, dan
Novolin N
 Long-acting : etemir (Levemir) dan glargine
(Lantus)
 Ultralong-acting: degludec (Tresiba)