Diabetes Mellitus Tipe 2

dan Penatalaksanaannya

SESUDAH MAKAN KADAR GULA DARAH NAIK .

PANKREAS MENGHASILKAN INSULIN

GULA DIMASUKKAN KEDALAM SEL-SEL

GULA DARAH TURUN KEMBALI

Supaya gula tidak terus naik

Terjadi reaksi biologik Energi

Oral Glucose Tolerance Test (OGTT)

0

50

100

150

200

250

300

0 0,5 1 1,5 2 2,5 3 3,5 4

Jam

Glu

kosa

(m

g/d

l)

INSULIN KURANG JUMLAHNYA

ATAU

INSULIN KERJANYA pada sel KURANG

ATAU

JUMLAH & KERJANYA KURANG sempurna

MASUKNYA GULA KEDALAM SEL KURANG

GULA DARAH TIDAK TURUN

TETAP TINGGI

KLASIFIKASI TIPE DIABETES MELITUS

Tipe 1 Destruksi sel beta, umumnya menjurus ke defisiensi insulin absolut• Autoimun• Idiopatik

TIPE 2> 90%

• RESISTENSI INSULIN DISERTAI

• DEFISIENSI INSULIN RELATIF

Tipe lain • Defek genetik fungsi sel beta• Penyakit eksokrin pankreas

dan lain-lain

Diabetes melitusgestasional

GULA DARAH TINGGI (HIPERGLIKEM)

MERACUN

KOMPLIKASI

-------------------------------------------------

HIPERGLIKEMI + “PENDAMPINGNYA ”

KOMPLIKASI PEMBULUH DARAH DAN JANTUNG

(KARDIOVASKULER)

> 60% DIABETISI MENINGGAL KARENA KOMPLIKASI TERSEBUT

PENDAMPING HIPERGLIKEMI YANG= FAKTOR RISIKO PENYAKIT KARDIOVASKULER

HIPERTENSI

DISLIPIDEMIA

KEGEMUKANKEBIASAAN MEROKOK

UMUR

GENDER

Eyes (retinopathy, glaucoma,

cataracts)

Brain and Cerebral Circulation(stroke, TIA)

Heart and Coronary Circulation(angina, MI, CHF)Kidneys

(nephropathy, ESRD)

Peripheral Nervous System

(peripheral neuropathy) Peripheral Vascular Tree(peripheral vascular disease, gangrene, amputation)

Tissue Damage in Many Organ Systems Leads Tissue Damage in Many Organ Systems Leads to Serious Long-term Complications in T2DMto Serious Long-term Complications in T2DM

Tissue Damage in Many Organ Systems Leads Tissue Damage in Many Organ Systems Leads to Serious Long-term Complications in T2DMto Serious Long-term Complications in T2DM

CHF=congestive heart failure; ESRD=end-stage renal disease; MI=myocardial infarction; TIA=transient ischemic attack; T2DM=type 2 diabetes mellitusAdapted from International Diabetes Federation. Complications. Available at: http://www.eatlas.idf.org/complications. Accessed April 14, 2006.

Abdominal obesity increases the risk of developing type 2 diabetes

<71 71–75.9 76–81 81.1–86 86.1–91 91.1–96.3 >96.3

24

20

16

12

8

4

0

Rel

ativ

e ri

sk

Waist circumference (cm)

Carey et al 1997

GEJALA DIABETES

• KLASIK

Poliuria Polidipsi Polifagi BB Tenaga

• GEJALA KOMPLIKASI

KUALITAS

HIDUP

PATOFISIOLOGI

DIABETES MELLITUS TIPE 2

Type 2 Diabetes Mellitus

Represents the final stage of a

chronic and progressive

syndrome representing a

hetrogenous disorder of insulin

resistance and decreased -cell

function caused by both genetic

and acquired abnormalities

Insulin Resistance

• Insulin resistance is characterized by the impaired ability of insulin to stimulate glucose disposal in peripheral tissues and suppress hepatic glucose production

• Based on abnormalities in the insulin receptors or post-receptor reaction e.g. impaired GLUT-4 translocation

American Diabetes Association. (2002). Gestational diabetes mellitus. (Position statement). Diabetes Care, 25: S94-96.

Insulin receptors – glucose transporter

Sri Hartini KS Kariadi,2007

INSULIN RESISTANCE

• Genetic•Environment •Obesity

↑ TNF-α ↓ Adiponectin

FPG ↑

IFG

↑ FFA↑ TG↓ HDL

GeneticFetal Malnutrition

Pancreas

Hyperglycaemia

Hyperinsulinaemia

ED ED CVD CVD

Decompensation I

Decompensation II

METABOLIC

SYNDROME - cell compensation

Liver Muscle

Hypertension

Hyperinsulinemia

Hyperinsulinemia

Dyslipidemia in Type 2 Diabetes

Dyslipidemia in Type 2 Diabetes

• High triglyceride level

• Low HDL-cholesterol

• Preponderance of small dense LDL

• High triglyceride level

• Low HDL-cholesterol

• Preponderance of small dense LDL

KRITERIA DIAGNOSIS

_________________________________________ • DIABETES MELLITUS

Kadar glukosa darah sewaktu + gejala klasik, 200 mg/dl atau

Kadar glukosa darah puasa 126 mg/dl atau

Kadar glukosa 200 mg/dl pada 2 jam sesudah beban glukosa 75 gram pada TTGO **

__________________________________________________2. TOLERANSI GLUKOSA TERGANGGU (TGT=IGT)

Kadar glukosa 140- < 200 mg/dl pada 2 jam sesudah beban glukosa 75 gram pada TTGO ( Test Toleransi Glukosa Oral)

________________________________________________________

3. GLUKOSA PUASA TERGANGGU (GPT= IFG)

Kadar glukosa 100 – 126 mg/dl waktu puasa (8-10 jam)

KOMPLIKASI MENAHUNKOMPLIKASI MENAHUN

Penebalan dinding pembuluh darahPenebalan dinding pembuluh darah

Penyempitan pembuluh darahPenyempitan pembuluh darah

Pembuluh darahkecil

Pembuluh darahkecil

RetinaRetina SarafSaraf GinjalGinjal

KebutaanKebutaan • Kesemutan• Disfungsi ereksi

• Kesemutan• Disfungsi ereksi

Cuci darahCuci darah

Pembuluh darahbesar

(Aterosklerosis)

Pembuluh darahbesar

(Aterosklerosis)

JantungJantung OtakOtak TungkaiTungkai

Seranganjantung

Seranganjantung

“Stroke”“Stroke” BorokBorok

OLAH RAGAOLAH RAGA

1.Pemakaian energi + pengaturan makan

1.Pemakaian energi + pengaturan makan

2.Kepekaan terhadap insulin 2.Kepekaan terhadap insulin

• Gula darah • Pola lipid membaik• Tekanan darah

• Gula darah • Pola lipid membaik• Tekanan darah

3.Peredaran darah lebih baik3.Peredaran darah lebih baik

Tidak berat - teraturTidak berat - teratur

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