Académique Documents
Professionnel Documents
Culture Documents
Hemi Sinorita
SubBag Endokrinologi Bagian/SMF Penyakit Dalam FK UGM/RS Dr Sardjito Yogyakarta
Komplikasi Diabetes
hipoglikemi
Komplikasi akut
hiperglikemi
mikroangiopathy
Komplikasi kronis
makroangiopathy
Microangiopathy
Macroangiopathy
Diabetic Retinopathy
Leading cause of blindness in adults1,2
Stroke
2- to 4-fold increase in cardiovascular mortality and stroke5
Diabetic Nephropathy
Leading cause of end-stage renal disease3,4
Cardiovascular Disease
8/10 individuals with diabetes die from CV events6
Diabetic Neuropathy
Prospective Diabetes Study Group. Diabetes Res 1990; 13:111. 2Fong DS, et al. Diabetes Care 2003; 26 (Suppl. 1):S99S102. 3The Hypertension in Diabetes Study Group. J Hypertens 1993; 11:309317. 4Molitch ME, et al. Diabetes Care 2003; 26 (Suppl. 1):S94S98. 5Kannel WB, et al. Am Heart J 1990; 120:672676. 6Gray RP & Yudkin JS. Cardiovascular disease in diabetes mellitus. In Textbook of Diabetes 2nd Edition, 1997. Blackwell Sciences. 7Kings Fund. Counting the cost. The real impact of non-insulin dependent diabetes. London: British Diabetic Association, 1996. 8Mayfield JA, et al. Diabetes Care 2003; 26 (Suppl. 1):S78S79.
1UK
Retinopathy
Its recommended to perform a routine-retinal check up each year Diabetic retinopathy haemorhage ablasio blindness Methods:
Early referral
Nephropathy
Start : microalbuminuria macroalbuminuria - renal filtration rate renal failure Early detection of microalbuminuria is required, referring experienced physician If GFR<30 consult to the nephrologists
HbA1c
Blood pressure <130/80 mmHg LDL cholesterol <100 mg/dL HDL cholesterol >50 mg/dL F >40mg/dL M Triglycerides <150 mg/dL STOP smoking! 30 minutes daily exercise Diet advise
<6.0%? < 7%
1. Meraba denyut pembuluh darah pada punggung kaki 2. Pemeriksaan dengan alat doppler
Retinopathy with photo coagulation Nephropathy with dialysis: hemodialysis or peritonial CHD with stent installment Peripheral vascular disease with metabolic and infection control, foot rest Neuropathy symptomatis
Metabolic Ketoacidosis (Ketoasidosis metabolik) Hyperglycemic Hyperosmoler State (Kondisi hiperglikemik hiperosmoler)
Asam laktat
KRITERIA DIAGNOSIS
1 jam I
jam II
NaCl 0,45%
dextran L
icu, CVP
HYPOGLYCEMIA
Hypoglycemia : blood glucose < 50 mg/dl Clinically, it is defined by Whipple triad : 1.Low plasma glucose level 2.Symptoms consistent with hypoglycemia 3.Resolution of symptoms with correction of plasma glucose
Symptoms
Adrenergic symptoms (catecholamine mediated) : diaphoresis palpitations pallor tachycardia apprehension anxiety sensation of hunger headache weakness restlessness Neuroglycopenic symptoms : reduced intellectual capacity confusion convulsion
Management of hypoglycemia:
Mild hypoglycemia: Oral glucose 15-20 g : 10-15 min then check blood glucose. If glucose level does not increase 18 mg/dl, give oral glucose again Severe hypoglycemia: Solution 50 ml of dextrose 50% given intravenously, check blood glucose in 20 min. If it is still hypoglycemia administrate once again Glucagon 1.0 mg s.c/i.m/i.v. Adverse effects include nausea, vomiting and headache. Contraindicated to sulfonylureas-induced hypoglycemia. Ineffective in patient who is anorectic, or with protracted hypoglycemia
terima kasih
< 60 = Hypoglycemia (need dextrose Tx) 60-70 0 0 0 0 70-109 0,2 0,5 1 1,5 110-119 0,5 1 2 3 120-149 1 1,5 3 5 150-179 1,5 2 4 7 180-209 2 3 5 9 210-239 2 4 6 12 240-269 3 5 8 16 270-299 3 6 10 20 300-329 4 7 12 24 330-359 4 8 14 28 >360 6 12 16 28