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Neuropati Diabetes

dr. Gea Pandhita S, M.Kes, SpS


SMF Saraf RS Antam Medika

Neuropati Diabetes
Neuropati = kerusakan saraf tepi
(saraf perifer).
Neuropati komplikasi yg sering
terjadi pada DM tipe 1 dan DM tipe 2
Polineuropati tipe Neuropati DM
yang paling sering terjadi

Komplikasi Kronis DM
1. Macrovascular:
A. Coronary heart disease
B. Peripheral arterial disease
C. Cerebrovascular disease

2. Microvascular:
A. Eye disease: Retinopathy, Maculopathy.
B. Neuropathy: sensory, motor, autonomic
C. Nephropathy.

Komplikasi Kronis DM
3. Other:
A. GIT (Gastroparesis)
B. Genitourinary (Uropathy, Sexual
dysfunction)
C. Dermatologic
D. Infection
E. Cataract & Glaucoma
F. Periodontal disease
G. Hearing loss

Pathophysiology
Macrovascular:
Atherosclerosis occur earlier in life, more
extensive & more sever.

Microvascular:
thickening of the capillary basement
membrane, increased vascular
permeability.

Neuropati Diabetes
Sekitar 30% dari pasien DM.
Terkait dengan:
lama menderita DM, dan
derajat pengendalian gula darah.

Dapat melibatkan saraf motorik,


sensorik, dan saraf otonom, atau
kombinasi.

Klasifikasi Neuropati DM
A. Somatic
1. Polyneuropathy
Symmetrical, mainly sensory and distal
Asymmetrical, mainly motor and proximal
(including amyotrophy)
2. Mononeuropathy (including mononeuritis
multiplex)

Klasifikasi Neuropati DM
B. Visceral (autonomic)
1.
2.
3.
4.
5.
6.

Cardiovascular
Gastrointestinal
Genitourinary
Sudomotor
Vasomotor
Pupillary

Gambaran Klinis Neuropati DM


Symmetrical sensory polyneuropathy:
Gambaran klinis yang sering dirasakan:
Berkurangnya persepsi sensasi getar pada
anggota gerak bagian ujung
Gangguan modalitas sensasi yg lain (raba,
tekan, nyeri) pada area glove-and-stocking
Penurunan refleks fisiologis angota gerak

Gambaran Klinis Neuropati DM


Symmetrical sensory polyneuropathy:
Kesemutan pada kaki,
Nyeri pada tungkai (memberat pada malam
hari, & terutama pada bagian depan kaki)
Sensasi rasa terbakar pada telapak kaki
Hiper-estesia, dan gaya berjalan yang tidak
normal
Kelemahan otot dan mudah capek (kasus
lanjut)
Perubahan postur jari kaki akibat pembentukan
callus

Uji Diagnostik
Gejala

muscle weakness,
muscle cramps,
prickling,
numbness or pain,
vomiting, diarrhea,
poor bladder control, and
sexual dysfunction

Pemeriksaan kaki menyeluruh


Skin sensation and skin integrity
Quantitative Sensory Testing (QST)
X-ray

Nerve conduction studies


Electromyographic examination (EMG)
Ultrasound

Komplikasi Neuropati DM

Ulkus
Charcot arthropathy
Dislocation and stress fractures
Amputation
Faktor risiko:
Peripheral neuropathy with loss of protective
sensation
Altered biomechanics (with neuropathy)
Evidence of increased pressure (callus)
Peripheral vascular disease
History of ulcers or amputation
Severe nail pathology

Penatalaksanaan Neuropati
DM
Prioritas pertama dalam mengobati neuropati diabetes adalah
untuk menstabilkan kadar gula darah.
Oleh karena itu, penderita diabetes harus rutin memeriksakan diri ke
klinik atau rumah sakit.

Berhati-hati terhadap kaki penderita diabetes.


melindungi kaki dari cedera dengan memakai sepatu yang baik dan
nyaman sepanjang waktu.
Lakukan perawatan kaki rutin di klinik atau rumah sakit, terutama jika
telah terjadi ganguan mati rasa di kaki.

Pengobatan neuropati diabetes ditujukan untuk memperlambat


perkembangan penyakit dan membantu mengurangi rasa sakit.
Diagnosis dan pengobatan dini sangat penting.

People with diabetes should


check both of their feet every
day.
It is important to check your
feet all over, including in
between your toes.
If you can't see the bottom of
your foot, use a mirror or ask
another person to check for
you.
Let your doctor or nurse know
if you find any:
Kemerahan telapak kaki
Kulit pecah-pecah
Bengkak
Swelling
Melepuh

Perawatan Kaki Diabetes


Menggunakan lotion untuk mencegah kaki
kering dan pecah-pecah
Memotong kuku dengan baik secara teratur
Menggunakan kaus kaki dan sepatu yang
sesuai dan nyaman
Segera periksa ke klinik atau rumah sakit
apabila ada masalah pada kaki

Langkah-langkah mencegah
perburukan Neuropati DM:
Kontrol DM kadar gula darah harus selalu
dalam batas normal.
Kontrol Tekanan Darah.
Olah raga teratur.
Berhenti merokok.
No Alcohol.
Pola makan sehat.
Menjaga berat badan tetap normal.
Kontrol rutin ke klinik atau rumah sakit.

Treatment of Symmetric Polyneuropathy

Glucose control
Pain control
Tricyclic antidepressants
Topical creams
Anticonvulsants

Foot care

Prevention of Diabetes

Healthy
Eating
Lifestyle
modification
Regular
Exercise

RS ANTAM MEDIKA - JAKARTA

TERIMA KASIH

Asymmetricalmotordiabeticneuropathy(diabeticamyotrophy)
Severe&progressiveweakness&wastingoftheproximal
musclesofthelimbs(Mainlylower)
Severepain(anterioraspectoftheleg),hyperaesthesia&
paraesthesiae.
Lossofweight('neuropathiccachexia').
Thepatientmaylookextremelyill&beunabletogetoutofbed.
Theremaybeabsenttendonreflexes,extensorplantarresponses,
&theCSFproteinisoftenraised.
Somedeficitsbecomepermanent.
Managementismainlysupportive.

Mononeuropathy
Motororsensory
Peripheralorcranialnerve
Unlikethegradualprogressionofdistal
symmetricalandautonomicneuropathies,
mononeuropathiesaresevereandofrapidonset
buttheyeventuallyrecover.
Mostcommonlyaffectedarethe3rdand6th
cranialnerves(diplopia),thefemoralandsciatic
nerves,mediannerve(carpaltunnelsyndrome),
ulnarnerve,Lateralpoplitealnerve(footdrop).

Autonomicneuropathy
Clinicalfeatures

1.CVS:Posturalhypotension,restingtachycardia,fixedheartrate.
2.GIT:Dysphagia,abdominalfullness,nausea&vomiting,unstable
glycaemia,duetodelayedgastricemptying('gastroparesis'),nocturnal
diarrhoeafaecalincontinence,&Constipation.
3.Genitourinary:Difficultyinmicturition,urinaryincontinence,
recurrentinfection,erectiledysfunction&retrogradeejaculation,
4.Sudomotor:Gustatorysweating,nocturnalsweatswithout
hypoglycaemia,anhidrosis;fissuresinthefeet
5.Vasomotor:Feetfeelcold,dependentoedema,&bullousformation
6.Pupillary:Decreasedpupilsize,delayedorabsentreflexestolight.
Thedevelopmentofautonomicneuropathyislessclearlyrelatedtopoor
metaboliccontrolthansomaticneuropathy,andimprovedcontrolrarely
resultsinameliorationofsymptoms.

Management
Painandparaesthesiaefromperipheralsomatic
neuropathies

1.Strictglycaemiccontrol

2.Anticonvulsants(gabapentin,pregabalin,carbamazepine,phenytoin)

3.Antidepressants(amitriptyline,imipramine,duloxetine)

4.Opiates(tramadol,oxycodone)

Management
Posturalhypotension:Supportstockings,Fludrocortisone,
adrenoceptoragonist,NSAIDs

Gastroparesis:Dopamineantagonists(metoclopramide,domperidone),
Erythromycin.

Diarrhoea:Loperamide,Broadspectrumantibiotics
Constipation:laxatives(senna)
Erectiledysfunction(impotence):Phosphodiesterasetype5
inhibitors(sildenafil,vardenafil,tadalafil)oral,vacume,implantation,
psychosexualtherapy.

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