Metabolic disorders 

DIABETES MELLITUS
Learning Objective :

I. Metabolisme
karbohidrat
II. Jenis- jenis gangguan
metabolisme
karbohidrat
III. Diabetes Melitus
I. Metabolism of Carbohydrate
Processes on the metabolism of
carbohydrate :
Glicolysis
Glicogenelysis
Glucogenolysis
HMP shunt (hexose Mono Phosphate Shunt)
gluconeogenesis
All of process produce Energy
II. TYPES OF CARBOHYDRATE METABOLISM
DISORDERS

1) DIABETES MELLITUS

2) FRUCTOSE INTOLERANCE DERIVATIVES

In these disorders, body loss the enzyme
that to digest fructose, a sugar (sucrose)

3) GALACTOSEMIA
Galactosemia (high blood galactose
levels) caused by deficiency of an
enzyme needed to metabolize galactose
 III. Diabetes Mellitus
Diabetes mellitus is a multisystem
disease with the features hyperglycemia
caused by defects in insulin
secretion,working insulin, or both.

DM is something that can not be stated in a

clear and briefly answer, but in general it
can be said as a set of anatomical and
chemical problems caused a number of
factors which acquired an absolute or
relative insulin deficiency and disorders
insulin function
(WHO)
 EPIDEMIOLOGY

In Indonesia, based on Health

Research Association in 2007,
• from 24 417 respondents
aged> 15 years,
• 10.2% had impaired glucose ETIOLOGY
tolerance (blood glucose 140-
200 mg / dl after fasting for 14
hours and given a 75 g oral  Type 1 diabetes is partly
glucose).
• As many as 1.5% had a
inherited and then triggered
diagnosis of diabetes mellitus by certain infections
and
• 4.2% had undiagnosed  Type 2 diabetes is mainly
diabetes mellitus due to lifestyle factors and
genetics.
 CLASSIFICATION
DIABETES MELLITUS
a. type 1
- autoimmune
- idiopathic
b. type 2
c. Gestational diabetes mellitus / gestational (GDM)
d. Other specific types :
1) Genetic defects of beta cell function: MODY
2) Genetic defects of insulin: insulin resistance syndrome, severe
3) Endocrinophaty: Cushing's syndrome, acromegaly
4) Exocrine pancreatic disease
5) Drug or chemically induce
6) Infection
 CLINICAL FEATURES

Classical complaints: Other complaints:

a) Decrease in body a) Peripheral nerve
weight (BW) and a disorders /
weak sense numbnes
b) Many urination b) visual disturbances
(Polyuria) c) Itching / boils
c) Lots of drinking d) erectile disorder
(polydipsia) e) whitish
d) Many eating
(polyphagia)
Clinical Features of Type 1 & 2 DM
features Tipe I Tipe II
age of onset Usually < 20 y.o Usually > 30 y.o

body mass Low to normal obesity

Plasm Insulin Low or nothing Normal or high for the

first

Plasma glucagon High can be decrease High, can’t be decrease

Plasma Glucose increase increase

Insulin Sensitivity Normal decrease

Therapy Insulin Decrease of body

weight
thiazolidinedion,
metformin,
sulfonylurea, insulin.
phatophysiology
 Anamnese:
found:
Diabetes Mellitus is specific complaint:
• Polyuria
• Polidipsi
• polifagia
• Weight loss is unexplained

Other complaints such as

• Weak
• Tingling
• Erectile dysfunction in men
• Pruritus vulvae in women
• Eyes blurred
PHYSICAL EXAMINATION
found some defects following
1) Hand: turner carpal syndrome, trigger finger / thumbs,
limited joint motion, sensory abnormality
2) Skin: pigmentation, vitiligo
3) blood pressure
4) Axilla: acantinosis nigricans
5) Neck: enlarged lymph glands
6) Head: xanthelasma, signs of bell's palsy, ptosis
7) Eyes: check the sharpness of the eye, cataract
8) Insulin injection site
9) Abdomen: hepatomegaly
10) Lower extremity: neuropathic foot ulcers, hair loss, etc
 Examination support

Screening can be done by examination of

blood glucose during, fasting blood glucose
levels, followed by standard oral glucose
tolerance test.
  Clinical diagnosis of
DM will generally be
considered if there
are complaints of
DIAGNOSis specific DM
 Examination of blood
glucose as> 200 mg
/ dl is sufficient to
establish the
diagnosis of DM
 COMPLICATIONS

A. Macrovascular Complications
3 types of macrovascular complications commonly
develop in people with diabetes is coronary heart
disease (coronary heart disease = CAD),
cerebrovascular disease and peripheral vascular
disease (PVD = peripheral vascular disease).

B. Microvascular Complications
Microvascular complications mainly occur in people
with type 1 diabetes.1 microvascular complications,
including retinopathy, nephropathy, and neuropathy.
management
 PROMOTIVE

EXTENSION FOR PRIMARY PREVENTION

EXTENSION FOR SECONDARY PREVENTION

EXTENSION FOR TERTIARY PREVENTION

 PREVENTIVE
1) PRIMARY PREVENTIONprevent the
occurrence of DM
2) SECONDARY PREVENTION  DM
Disabled Detect and Early administration
of the initial
3) TERTIARY PREVENTION Prevent
Further Disability Occurrence
 DIABETES MANAGEMENT
GOALS

Keep the plasma glucose levels Prevent or minimize the the

within the normal range possibility of complications of
diabetes

DIABETES MANAGEMENT pillar

meal planning

education

exercise iNTERVENTION
pharmacological

Oral Insulin
Hypoglicemic
drugs therapy
 NON-PHARMACOLOGICAL THERAPY
IN DIABETES MELLITUS
MEDICAL NUTRITION THERAPY
Some of the proven benefits from medical
nutrition therapy include:
1) Lose weight
2) Lowered systolic and diastolic blood
pressure
3) Lowering blood glucose levels
4) Improve the lipid profile
5) Increase the insulin receptor sensitivity
6) Improve the blood coagulation system
 Prognosis

The prognosis in people with type 2

diabetes varies.It depends on how well an
individual modifies the risk of
complications.
 PATIENT STATUS
•

I. Personal
• Name :-
• Age : 55 Years
• Gender : Female

• II. History Disease

Main complaints: Often weak despite eating a lot of
Additional complaints: - Polyuria
- Polyfagia
- Polydipsia
•
III. HISTORY OF DISEASE: -
IV. PHYSICAL EXAMINATION VI. DIAGNOSIS:
anthropometry:
• BW: 90 kg
DIABETES
• BH: 156 cm MELLITUS
vital Sign
BP: 130/80 mmHg

V. Examination support
adrandom GBR: 198 mg / dl
Based on the signs and symptoms such as fatigue,
despite being found much to eat, polyuria, polyfagi,
blood glucose andrandom polidipsi and 198 mg / dl.
Possible of disease is women aged 55 years leads to
Diabetes Mellitus.
However, to ensure the necessary checks fast blood
glucose, blood glucose post-prandial, and if
required can also be done HbA1c checks.
If after inspection glucose blood sugar levels are
found to increase the management carried out in
accordance with the processing alogritme type 2
diabetes.