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8/18/2019 Overview DM Tipe 1
1/19
11/16/09
1
!"# %&'()
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Pelatihan DM tipe 1 dan KAD, IDAI
Pendahuluan
•
75-82."9 #592:&)". (92#2 ;2'2 2-2.
• +/&-".
•
8/18/2019 Overview DM Tipe 1
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Klasifikasi DM
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Klasifikasi
• [email protected] 012"3$ 4'..,5""67 –
@"2:595> 9";5 A O>5:20"2- :5>2/ 2(9&"#(-Q –
@"2:595> 9";5 F –
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Autoimun sel beta
Kegagalan primer sel beta
Insulin resistance
(PCOS,AN)
#$%&'#(#
MODY
DM tipe 1
8/18/2019 Overview DM Tipe 1
3/19
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Perbedaan DM tipe 1 dan 2
DM tipe 1
DM tipe 2
Etiologi & patofisiologi
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– XST '5-02- Y 2(9&2-H:&'"
– ZST '5-02- [ 2(9&2-H:&'"
NIH-funded Diabetes Prevention Trial-Type 1
8/18/2019 Overview DM Tipe 1
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Perjalanan Alamiah DMT-1
%
WAKTU
M a s s a s e l !
Predisposisi
Genetik
Insulitis –
Kerusakan sel ! pancreas
Diabetes
Pra Diabetes
Pemicu –
Lingkungan
Gejala
Klinis
Reaksi autoimun seluler
Reaksi autoimun humoral
FPIR hilang
OGTT (+)
20
40
60
80
“Honeymoon”
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8/18/2019 Overview DM Tipe 1
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Diagnosis Laboratorium
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•
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8/18/2019 Overview DM Tipe 1
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Tujuan tatalaksana
• +&-9/&) #592:&)". &;H#2)E
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Tatalaksana DM tipe 1
– !"#$%&"
– d(9/">"
– 01"39,#"#
– ,'(.2>" ;2>"5- '2- .5)(2/02
– ;##"##."($ N H'(,$'3,(J J)=9".,9 9'($3')
8/18/2019 Overview DM Tipe 1
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L->()"-
• 72'2 @% H;5 A 95/62'"
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– +(2)"92> ?"'(; #5-(/(-E
Fungsi insulin
8/18/2019 Overview DM Tipe 1
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Hormon pankreas: Insulin dan Glukagon mengatur metabolisme gula tubuh
Tidak puasa: dominasi insulin Puasa: dominasi glukagon
Oksidasi glukosa #
Sintesis glikogen #
Sintesis lemak #
Sintesis protein #
Glikogenolisis #
Glukoneogenesis #
Ketogenesis #
(A) Kadar insulin darah
meningkat sebagai respons dari peningkatan
kadar glukosa darah
setelah makan
(B) Kembali ke kadar basal dalam waktu 2-3 jam.
Horm Metab Res 1994;26:591–8.
Pola fisiologis sekresi insulin
dan glukosa dalam darah :
8/18/2019 Overview DM Tipe 1
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Insulin
• L->()"- SEU J A * ` .0`?2/"I >NE
•
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L->()"-
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8/18/2019 Overview DM Tipe 1
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Insulin dan lama kerjanya
L->()"-
;/5;2/2H&-
OC'3$P%9&(J
8($"3."+,%$"P%9&(J
7/5#"e5' "->()"- AS`fS
7/5#"e5' "->()"- FS`ZS
7/5#"e5' "->()"- YS`XS
7/5#"e5' "->()"- [S`WS
7/5#"e5' "->()"- US`US
T%2,+P%9&(J "->()"- 2-2)&0(5
Onset of
Action
(h or min)
0.5–1 h
0.5–1 h
0.5–1 h
0.5–1 h 0.5–1 h
0.5–1 h
10-20 min
1.5–2 h
Peak
Action
(h)
1 – 3
4 – 12
5 – 10
5 – 10 5 – 9
1 – 3
1 – 3
1 – 3
Maximal
Duration
(h)
6 – 8
18–24
18–24
18–24 18–24
18–24
18–24
3 – 5
450"#5- L->()"-
Efek samping pemberian insulin
•
BB naik.
• Lipodistrofi.
•
Hipoglikemia.
8/18/2019 Overview DM Tipe 1
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Tatalaksana DM tipe 1
– L->()"-
– ($)*&
– 01"39,#"#
– ,'(.2>" ;2>"5- '2- .5)(2/02
– ;##"##."($ N H'(,$'3,(J J)=9".,9 9'($3')
Nutrisi
• +2)&/" 95/'"/" '2/"B – USCUUT +b – AUCFST ;/&95"- – YST )5#2.E
• +5:(9(?2- .2)&/"B – ASSS g O*>"2 O92?(-Q e ASSQ .2)E – \5/'2>2/.2- \\ "'52)
• @":20" #5-62'"B – FST >2/2;2-E – AST >-2N. ;20"E – FUT #2.2- >"2-0E – AST >-2N. >"2-0E – FUT #2.2- #2)2#E – AST >-2N. %2)2#E
• +&->()92>" '5-02- -(9/">"&-">E
8/18/2019 Overview DM Tipe 1
12/19
11/16/09
12
Tatalaksana DM tipe 1
– L->()"-
– d(9/">"
– !"#$%&'#'
– ,'(.2>" ;2>"5- '2- .5)(2/02
– ;##"##."($ N H'(,$'3,(J J)=9".,9 9'($3')
Exercises
• \&)5? h4 2;2 >262B – !"'2. 2'2 .)".2>"E
– +&-9/&) 0)".5#". :2
