METABOLISME

KARBOHIDRAT & DM
Dr.toni

Carbohydrate Digestion

Insulin Secretion

DM
Multitude of mechanisms
Insulin
Regulation
Secretion
Uptake or breakdown
Beta cells
damage

Action of Insulin on the Cell

Metabolism

*Action of Insulin on
Carbohydrate, Protein
and Fat Metabolism

Carbohydrate

Facilitates the transport of glucose into muscle

and adipose cells
Facilitates the conversion of glucose to
glycogen for storage in the liver and muscle.
Decreases the breakdown and release of
glucose from glycogen by the liver

 Protein
Stimulates protein synthesis
Inhibits protein breakdown;
diminishes gluconeogenesis

 Fat
Stimulates lipogenesis- the
transport of triglycerides to
adipose tissue
Inhibits lipolysis prevents
excessive production of ketones
or ketoacidosis

Definisi:>>>>>>

DM: Suatu kelompok

penyakit metabolik yg ditandai
adanya hiperglikemia yg
disebabkan krn kx. Sekresi
insulin, gg kerja insulin atau
keduanya.

Prediabetes: Impaired glucose

tolerance and impaired fasting
glucose
Prediabetes is a term used to distinguish people who are at
increased risk of developing diabetes. People with
prediabetes have impaired fasting glucose (IFG) or impaired
glucose tolerance (IGT). Some people may have both IFG and
IGT.
IFG is a condition in which the fasting blood sugar level is
elevated (100 to 125 milligrams per decilitre or mg/dL) after
an overnight fast but is not high enough to be classified as
diabetes.
IGT is a condition in which the blood sugar level is elevated
(140 to 199 mg/dL after a 2-hour oral glucose tolerance test),
but is not high enough to be classified as diabetes.

Types of Diabetes
Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Gestational Diabetes
Other types:
LADA
MODY (maturityonset diabetes of
youth)
Secondary Diabetes
Mellitus

*Type I Diabetes
Low or absent endogenous insulin
Dependent on exogenous insulin for life
Onset generally < 30 years
5-10% of cases of diabetes
Onset sudden
Symptoms: 3 Ps: polyuria, polydypsia, polyphagia

*Type I Diabetes Cell

*Type II Diabetes

Insulin levels may be normal, elevated or depressed

Characterized by insulin resistance,

diminished tissue sensitivity to insulin,
and impaired beta cell function (delayed or inadequate
insulin release)

Often occurs >40 years

Risk factors: family history, sedentary lifestyle, obesity
and aging
Controlled by weight loss, oral hypoglycemic agents and
or insulin

Type II Diabetes

*Kriteria Dx DM menurut WHO 1999

1. Adanya keluhan/ tanda klinis khas

DM, cukup diperiksa kadar glukosa
plasma sewaktu dinyatakan DM bila:
> 200mg/ dl atau
2. kadar glukosa plasma puasa > 126
mg/dl
3. kadar glukosa plasma > 200mg/dl
pd 2jam sesudah beban glukosa 75 g
pada TTGO

KELOMPOK RESIKO TINGGI DM:

Semua orang dewasa berumur > 45

tahun.
Riwayat keluarga DM terutama ortu dan
saudara kandung.
Obesitas yaitu > 20% BB ideal atau IMT>
27kg/m
Sebelumnya pernah TGT atau GPPT
DM gestasional sblmya atau pernah
melahirkan bayi > 4kg.
dislipidemia

Secondary causes of Diabetes mellitus include:

Acromegaly,
Cushing syndrome,
Thyrotoxicosis,
Pheochromocytoma
Chronic pancreatitis,
Cancer
Drug induced hyperglycemia:
Atypical Antipsychotics - Alter receptor binding characteristics, leading to
increased insulin resistance.
Beta-blockers - Inhibit insulin secretion.
Calcium Channel Blockers - Inhibits secretion of insulin by interfering with
cytosolic calcium release.
Corticosteroids - Cause peripheral insulin resistance and gluconeogensis.
Fluoroquinolones - Inhibits insulin secretion by blocking ATP sensitive potassium
channels.
Naicin - They cause increased insulin resistance due to increased free fatty
acid mobilization.
Phenothiazines - Inhibit insulin secretion.
Protease Inhibitors - Inhibit the conversion of proinsulin to insulin.
Thiazide Diuretics - Inhibit insulin secretion due to hypokalemia. They also
cause increased insulin resistance due to increased free fatty acid

LADA
Latent Autoimmune Diabetes in Adults
(LADA) is a form of autoimmune (
type1 diabetes) which is diagnosed
in individuals who are older than the
usual age of onset of type 1 diabetes.
Alternate terms that have been used
for "LADA" include Late-onset
Autoimmune Diabetes of Adulthood,
"Slow Onset Type 1" diabetes, and
sometimes also "Type 1.5
Often, patients with LADA are
mistakenly thought to have
type2 diabetes, based on their age
at the time of diagnosis.

LADA (cont.)

Gestational diabetes
A form of glucose intolerance that is diagnosed in some
women during pregnancy.
Gestational diabetes occurs more frequently among African
Americans, Hispanic/Latino Americans, and American
Indians. It is also more common among obese women and
women with a family history of diabetes.
During pregnancy, gestational diabetes requires treatment to
normalize maternal blood glucose levels to avoid
complications in the infant.
After pregnancy, 5% to 10% of women with gestational
diabetes are found to have type 2 diabetes.
Women who have had gestational diabetes have a 20% to 50%
chance of developing diabetes in the next 5-10 years.

*Kriteria Dx. DM

gestasional menurut
ADA:
Puasa: > 105 mg/dl
1jam : > 190mg/dl
2jam: > 165 mg/dl
3 jam: > 145 mg/dl

beban glukosa 100 gram

*Kriteria Dx DM

gestasional
menurut WHO:

2 jam: > 140 md/dl beban glukosa 75 gram

*Gejala klinik DM:

Poliuri
Polifagia
Polidipsi
Kesemutan
Impotensi
Kelemahan tubuh
Mata kabur

*Komplikasi DM:
Gagal ginjal ringan berat
Mata kabur katarak & kerusakan retina
Gangguan saraf tepi
Gangguan saraf pusat
Gangguan pada jantung PJK
Gangguan pada hati perlemakan hati &

sirosis hati
Hipertensi & atherosklerosis
Impotensi
Paru-paru mudah terkena TB

Management of Diabetes Mellitus

Nutrition
Blood glucose
Medications
Physical activity/exercise
Behavior modification