Wells, 9th ed, Pharmacotherapy

Diabetes mellitus (DM) is a group of

metabolic disorders characterized by
hyperglycemia and abnormalities in
carbohydrate, fat, and protein
metabolism.
 Type 1 Type 2
Diabetes Diabetes
Characterized by
impaired insulin
Loss of insulin secretion and
secretion results resistance to insulin
from autoimmune action. Glucose
destruction of the utilization by tissues is
beta-cells in the impaired
pancreas

Stimulates pancreas
to produce more
insulin in an attempt
to overcome insulin
Alldredge, 10th, Applied
resistance
Therapeutics

• (5%–10% of cases) usually develops
in childhood or early adulthood and
results from autoimmune-mediated
destruction of pancreatic β-cells,
resulting in
absolute deficiency of insulin. The
autoimmune process is mediated
by macrophages
and T lymphocytes with
autoantibodies to β-cell antigens
(eg, islet cell antibody,
insulin antibodies).
Uncommon
• (1%–2% of cases) include
endocrine disorders (eg,
acromegaly, Cushing
syndrome), gestational
diabetes mellitus (GDM),
diseases of
the exocrine pancreas (eg,
pancreatitis), and medications
(eg, glucocorticoids,
pentamidine,
niacin, α-interferon)
Wells, 9th ed, Pharmacotherapy
• (90% of cases) is characterized by a
combination of some degree of
insulin resistance and relative insulin
deficiency. Insulin resistance is manifested
by
increased lipolysis and free fatty acid
production, increased hepatic glucose
production,
and decreased skeletal muscle uptake of
glucose.
Type 1 Type 2
DM DM
causes of Microvascular
diabetes
• complications include retinopathy, neuropathy, and
nephropathy.
Macrovascular complications include coronary heart
disease, stroke, and peripheral
vascular disease.
Alldredge, 10th, Applied
Therapeutics
 Wells, 9th ed, Pharmacotherapy

TYPE 1 TYPE 2
The most common initial symptoms are Patients are often asymptomatic and may be
polyuria, polydipsia, polyphagia, weight loss, diagnosed secondary to unrelated blood
and lethargy accompanied by hyperglycemia testing

Lethargy, polyuria, nocturia, and polydipsia

Individuals are often thin and are prone to
can be present. Significant weight loss is
develop diabetic ketoacidosis if insulin is
less common; more often, patients are
withheld or under conditions of severe stress
overweight or obese.

Between 20% and 40% of patients present with

diabetic ketoacidosis after several
days of polyuria, polydipsia, polyphagia, and
weight loss.
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Dorceley, Novel Biomarkers
Stein, 4th ed, Boh’s Pharmacy
 Stein, 4th ed, Boh’s Pharmacy

utilisasi
glukosa
 Stein, 4th ed, Boh’s Pharmacy

merefleksikan perubahan kontrol glikemik

Alldredge, 10th, Applied
Therapeutics
 Stein, 4th ed, Boh’s Pharmacy

protein terglikolisis,
tidak reliabel
kontrol esensial
Stein, 4th ed, Boh’s Pharmacy
 Stein, 4th ed, Boh’s Pharmacy

insulinoma (tumor produksi insulin)

),
supresi produksi oleh insulin eksogen, supresi produksi dengan
tes supresi somatostatin
Alldredge, 10th, Applied
Therapeutics
 Wells, 9th ed, Pharmacotherapy

1. A1C of 6.5% or more

2. Fasting (no caloric intake for at least 8 hours) plasma glucose of 126 mg/dL
(7.0 mmol/L) or more
3. Two-hour plasma glucose of 200 mg/dL (11.1 mmol/L) or more during an
oral glucose tolerance test (OGTT) using a glucose load containing the
equivalent of 75 g anhydrous glucose dissolved in water
4. Random plasma glucose concentration of 200 mg/dL (11.1 mmol/L) or more
with classic symptoms of hyperglycemia or hyperglycemic crisis In the
absence of unequivocal hyperglycemia, criteria 1 through 3 should be
confirmed by repeat testing.
5. Normal fasting plasma glucose (FPG) is less than 100 mg/dL (5.6 mmol/L).
6. Impaired fasting glucose (IFG) is FPG 100 to 125 mg/dL (5.6–6.9 mmol/L).
7. Impaired glucose tolerance (IGT) is diagnosed when the 2-hour postload
sample of OGTT is 140 to 199 mg per dL (7.8–11.0 mmol/L).
8. Pregnant women should undergo risk assessment for GDM at first prenatal
visit and have glucose testing if at high risk (eg, positive family history, per
sonal history of GDM, marked obesity, or member of a high-risk ethnic
group).
Effects of Hypothyrodism
Effects of Hyperthyroidism
Grave’s Disease
Hashimoto
Thyroiditis
Diagnosing
The
Hyperthyroidism
https://www.healthline.com/health/tsh-normal-range-by-age#men
TPA (Thyroid Peroxidase Antibodies) dan
TgAb (Thyroglobulin autoantibodies)
TPA (Thyroid Peroxidase Antibodies) dan
TgAb (Thyroglobulin autoantibodies)
TRAb (Thyroid Receptor Stimulating Antibodies)
dan TSI (Thyroid-stimulating immunoglobulin)
TMAb (Thyroid Antimicrosomal Antibody)
• Cho et al. (2014). Biomarkers of thyroid function and autoimmunity for
predicting high-risk groups of thyroid cancer: a nested case–control
study. BMC Cancer, 14:873.
• Arneson, Wendy & Brickell,Jean. (2007). Clinical chemistry : a laboratory
perspective. Philadelphia : F.A Davis Company
• Santos et al. (2015). Hashimoto’s thyroiditis in adolescents. US
Endocrinology, 11:2, 85-87
• Koda-Kimble, Mary Anne & Alldredge, Brian K. (2013). Applied
therapeutics (10th ed.). Philadelphia : Lippincott Williams & Wilkins.
• Wilson, D. D. (2008). McGraw-hill manual of laboratory and diagnostic
tests (1st ed.). US: McGraw-Hill Professional.
• Dorceley, Brenda. et al. (2017). Diabetes , Metabolic Syndrome and
Obesity: Target and Therapy. Novel Biomarkers for Prediabetes,
Diabetes, and Associated Complications. Dovepress.
• Stein, S. M., (2015). Boh’s Pharmacy Practice Manual: A Guide to
the Clinical Experience 4th Edition. Wolters Kluwer Health :
Lippincott Williams & Wilkins.
• Trevor, A. J., et al. (2013). Pharmacology: Examination & Board
Review 10th Edition. Mc Graww Hill Education: Appleton & Lange.
• Wells, B. G., et al. (2015). Pharmacotherapy Handbook 9th Edition.
Mc Graww Hill Education: Appleton & Lange
• http://www.bio.davidson.edu/Courses/Immunology/Students/Sprin
g2003/Breedlove/GravesDisease.html
• https://www.healthline.com/health/tsh-normal-range-by-
age#men
• https://reference.medscape.com
THANK YOU 