01. diabetes mellitus part 1 - prof.askandar

7/21/2019 01. Diabetes Mellitus Part 1 - Prof.askandar

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GARIS BESAR KULIAH UNTUK MAHASISWA SEMESTER-6

DIABETES MELLITUS-I

FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA, SURABAYA

1

2012

16-927-B

Prof. Dr. dr. As!"d!r T#oro$r!%&ro S$.PD, K-EMD, FINASIM

SURABAYA DIABETES AND NUTRITION 'ENTRE - Dr. SOETOMO TEA'HING HOSPITALFA'ULTY OF MEDI'INE AIRLANGGA UNIVERSITY, SURABAYA

Division of Endocrinology and M!a"olis# $ D%!& of In!rnal Mdicin

SU'ABA(A) 0* MA'+, 2012

.lia/ DM-I SLIDE 1 $ 0

dr& Sri M.r!ii S%&3D) -EMD) 4I5ASIM


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SEA'A,

1**0 !/ SM Penyakit atau "SI5D'MA DIABETES", mulai dikenal

di Mesir 1550 SM (The !ytian Payrus #ers$

200 !/ SM A'ETAEUS8r: 3/ysician; % DIABETES atauSI3,5 < 4L=-T,'U, < 'U5-T,'U,, berarti

men!alir terus& Seha#is minum #anyak, diikuti ken'in!

#anyak& M)T*S % MAD* atau MAN)S&

DIABETES MELLITUS < E5+I5 MA5IS&

2

,IST'( (Tattersall +00$ % Plyuri' states resem#lin! DIABETESMELLITUS ha.e #een des'ri#ed /r .er 500 years& The name

DIABETES 'mes /rm the r: ord /r a S(3,52 the s3eet

taste / DIABETI+ U'I5E 3as re'!ni4ed at the #e!innin! / the

millenium, #ut the ade'ti.e MELLITUS (hneyed$ 3as nly added #y

o/n 'ollo in the late 16th 'entury&

Cntinued


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T/& 1921 FREDERIK G. BANTING(Ahli 7edah$ dan +,A'LES ,& BEST(Asisten Student$ dari Univr!isy of Toron!o-+anada

#ekera sama den!an AMES B& +LLI3(Ahli 7ikimia$

dan &&' MA+LED(Ahli )lmu >aal$ menemukan I5SULI5&

Mulai di!unakan di 11 JANUARI1?++, keada ria umur

1@ tahun (nama % LE5A'D T,M3S5$& The name

I5SULI5 3as 'ined #y MA+LED

T/& 19* - 19**

4'A5E dan 4U+,S (1?5@$ mulai men!!unakan ,

(


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DM T(3E 2 8Ta!!rsall 200>;

I5SULI5 'ESISTA5+E and @-+ELL 4AILU'E, the /undamental

de/e'ts / tye + dia#etes (T2D$, ha.e #een in.esti!ated #y many

resear'hers& The ins.lin cla#% methd de.ised #y 'al%/

D4rono 3as the /irst a''urate te'hniue /r measurin! insulin

a'tin& Maturity-


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D!! DM D& RS P"d&d&!" Dr. Sooo (Hos$&!/ D!!+(0162 3 4500+

UMLAH DM TERDAFTAR DI POLI ENDOKRINOLOGI RSU Dr. SOETOMOSura#aya 1?=@ F +010 (Selama @= Tahun$

Dari 133Pasien terdaftar pada tahun 1964menjadi 35717pd th !1!"46 tahun#

menin$%at 6&' (ipat) den$an pertambahan pasien baru rerata *11!D+ pertahun

6

, 133 p'

, 1!61

, 153&1, 16567

, 914

, !9

, 64!6, 7&4

, 5654

, &

, 1!7&

, 11475

, 16!&

, 13&1&

, 19!39

, !366

, 17667 , 9394

, 31457

, 33636

, 356!6

, 377!4, 39&75, 915!

, 4149

, 4364, 45536

01150110

0176

01780177

0171

0162

01850189

0175

01720179

0119

01160118

0114

011:0112

0117

01114555

4550

4554455:

4552

45594556

4558

4557

4551

MANUAL

ELE'TRONI'

, 33157

, 3&64505 , 35717


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G0&0 10&0 +0&0 0&0 @0&0 50&0 =0&0 0&0 60&0

'o;/!&;

10&0+,D*&7'LINI'AL NEPHROPATHY

&2S!ro:>&?+ll.li!is - angrn

>&0Sy#%!o#a!ic all S!on

Basd on 5+7) 200> >2C

7


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(M'Carty H Iimmet 1??@, Pr.ided % Tkrra3ir 1?6?-+01+$

DIFFEREN'ES IN RATES (@+ OF T4DM IN MAOR ETHNI' GROUPS

L=EST 'E3'TED 'ATES(;isani'$ Central MeJi' 5&=

(Mi'rnesian$ Bural Kiri#ati @&

(Plynesian$ Bural Eestern Sama @&0

(urean$ Pland &5

(Asian )ndian$ Bural )ndia +&(Melanesian$ Bural >ii 1&?

(


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lo"al Dia"!s S!a!is!icslo"al Dia"!s S!a!is!ics(D&!s A/!s IDF 455:, Pro T#oro$r!%&ro 4552(D&!s A/!s IDF 455:, Pro T#oro$r!%&ro 4552-4504-4504++

2@ Prea(en8e f D+) Nether(ands) !!3

45@ Prea(en8e f D+) UA0) !!3

:5@ Prea(en8e f D+) Nauru) !!3

1!4)&!! Number f hi(dren :ith .ID+) ;utheast Asia) !!3

43!)!!! Number f hi(dren :ith .ID+) r(d:ide) !!3

012,555,555 N;r of Po$/ %& DM, 455::::,555,555 Prd&=d ";r of Po$/ %& DM, 4549

:02,555,555 N;r of Po$/ %& IGT, 455: No D!! for IFG

284,555,555 Prd&=d N;r of Po$/ %& IGT, 4549THE ROLES OFTHE ROLES OF

METFORMINMETFORMIN

47@ Pro$or&o" of DM !r&;!/ o %& !&", So;!s As&! M!/s, 455:75@ Pro$or&o" of DM !r&;!/ o %& !&", Wsr" E;ro$ M!/s, 455:

9


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IDF R&o"s !"d G/o!/ Pro#=&o"s of N;r of Po$/ %& D&!s (45-81 !rs+ > 4500 !"d 45:5

ID4) Dia"!s A!las *!/Edi!ion-2011) 3rovidd 2012

10

T/ 21!/=orld Dia"!s +ongrss D."ai) *-? Dc#"r 2011

4500 45:5 IN'REASEREGION MILLIONS MILLIONS @

Afri8a 14+idd(e 0ast and Nth Afri8a 3


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NCASS(M

))8e(( destru8tin) usua((G (eadin$ t abs(ute insu(in defi8ien8G#

II TYPE 4 DIABETES

III OTHER SPE'IFI' TYPES OF DIABETES due t ther 8auses) e

A& )mmune Mediated

7& )diathi'

"Resu(ts frm a pr$ressin Insu(in ;e8retrG Defe8t n the ba8%$rund f

Insu(in Resistan8e#

MRDM (S;r!!! 0176+)


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'RITERIA for DIAGNOSIS of DIABETES> 3E'E5I 2011) ADA 2012

(Summari4ed % Tkrra3ir(Summari4ed % Tkrra3ir +011-+011-+01+01++$$

/bA18 6


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'r&r&! for Ts&" for D&!s &" As$o!&= Ad;/ I"d&


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PELAKSANAAN TES TOLERANSI GLUKOSA ORAL (TTGO+(Pr"&-4556, ADA-4558, T#oro$r!%&ro 4556-4504+

1 hari se#elumnya makan kar#hidrat 'uku

> Puasa semalam 10-1+ am (minimal 6 am$

Dieriksa :luksa Darah Puasa

* Di#erikan !luksa 5 !ram, dilarutkan dalam air +50 ml,diminum dalam 3aktu 5 menit&

6 7eruasa kem#ali samai en!am#ilan darah untuk + am

sesudah minum larutan !luksa terse#ut selesai

7 Dieriksa :luksa Darah + (dua$ am sesudah #e#an :luksa

17

Ke!iatan 9asmani seerti yan! #iasa dilakukan2

? Selama ermeriksaan, asien yan! dieriksa teta

istirahat dan tidak merkk2 #leh minum air utih


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Lang:a/-lang:a/ Diagnos!i: DM dan angg.an Tolransi l.:osa

85SE5SUS 3E'E5I 2011;

DP H (u%sa Darah Puasa

D; H (u%sa Darah ;e:a%tu

DP. H I H (u%sa Darah Puasa .er$an$$u

.. H .(eransi (u%sa .er$an$$u

K*;AN KAS)K (-$K*;AN KAS)K D)A7TS ($

ELU,A5 LI5I DIABETES

D I A B E T E S M E L L I T U S TT D3T 5'MAL

> 0a(uasi ;tatus ii

> 0a(uasi PenGu(it D+

> 0a(uasi Peren8anaan +a%an

;esuai Bebutuhan

> Nasihat Umum

> Peren8anaan +a%an

> atihan Jasmani

> ?erat Idaman

> ?e(um Per(u 2bat Penurun (u%sa

:DP

:DSatau

:DP

:DSatau

Q 1+=

Q +00

1+=

+00

:DP

:DSatau

Q 1+=

Q +00

1+=

+00

*lan! :DS atau :DP

Q 1+=

Q +00

100-1+5

1@0-1??

TT

D 2 a#

200 10-199 J 10

100

1@0

1?


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PRA'TI'AL TOOL FOR INSULIN RESISTAN'E AND -'ELL FUN'TION(M!%s !/ 0179, F!/; !/ 4554, S;!r&d > T#oro$r!%&ro 4559-4504+

HOMA-R !"d HOMA-BUsefu( in Dai(G Pra8ti8e

>0

4 FOLLOW-UP OF TREATMENT

RATIONALE TREATMENT

HOMA-B

-'// F;"=&o"> (N> 853095@+

! ' astin$ Insu(in "Um(#P "mm((# E 3


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PREVALEN'E OF IR IN SELE'TED METABOLI' DISORDERS8Bonora 199?) S.##arid and Ill.s!ra!d To:ro%rairo 2006-2012;

,(3E'TE5SI5

I4 G IT2

URI' A'ID 7

L= ,DL-+ 6

> T/ M!S

,(3E'-+,L ?

0sP!s !"d IR &" L&


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0. DM TI3E-1 8DMT1; FROM -'ELL DESTRU'TION TOABSOLUTE INSULIN DEFI'IEN'Y

PROGREESSIVE INSULIN SE'RETORY DEFE'T (CAIRC+ ON THE BA'KGROUND OF I.R.4. 3AT4ISILI DM TI3E-2 8DMT2;

SEKRESI INSULIN > 0 FIRST PHASE (A'UTE+ CAIRC > 5-9 "&

4 SE'OND PHASE

GABUNGAN IR ? IMPAIRED CAIRC T4DM

IR > INSULIN RESISTAN'E

CAIRC > A'UTE INSULIN RESPONSE (FIRST PHASE+

21


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MA'AM DM DI PRAKTEK SEHARI-HARI8'ang:.#an To:ro%rairo 199>-2012;

??R K&!=) I+. K19

D'>Du$aan ,D+Umur se%itar 14>4! th

Resisten insu(inResisten %etsis

D'>Definitif ,D'>Du$aan ditambah

PA?A test K6!=>peptide !peptidenai% !!=

Diet > DependentD+

atau 2/2Dependent

.anpa Insu(in1! hr< tida%

timbu( BAD>peptide

Puasa 1Definitif ,D'>Du$aan ditambah

>peptide 2, K ! 4.6 3 42.1 U/ + Tr!";" KITS"!


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1 DIABETES MELLITUS

2 'ETI53ATI DIABETI ,A'US 3SITI4

> 3'TEI5U'IA yang %osi!if !an%a %ny"a" lain) a!a.

sla#a 2 :ali %#ri:saan dngan in!rval 2 #ingg.

aa#ila enye#a# lain (misalnya in/eksi$ sudah teratasi&

8ri!ria 5D 19?9; % DM, Betinati Dia#etik, ra!inin Dara/

2&* #gKdl) 3ro!in.ria 1 8sa!.; :aliemeriksaan tana adanya

enye#a# rteinuria lain&

DIAGNOSIS DAN KLASIFIKASI NEFROPATI DIABETIK(Kr&r&! S;r!!! 0179 d!" 0171+

A!a.

TIGA PERSYARATAN DIAGNOSIS NEFROPATI-DIABETIK (ND+ >

2>


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+N. , +edi8a( Nutritin .herapG r Diet< .reatment , B4, B:, B".Gpes f +N.#) OAD"Ora( A$ents fr Diabeti8#) INS"Insu(in#

? M ?3>Diets "Pre>/D Phase# , ith ;pe8ifi8 mpsitin p(us : B*

M Na*

) Prtein !!Phase# , : B*M Na*) Prtein 1>1 R"d! Pro&" d!" B!!s& KTT+

Nfro$!& D&!& S. : J 2 (Sr; Kr!&"&" 4.9 d/ > R"d! Pro&" d!" P!"!" KTT+

8To:ro%rairo 200) (ogian!oro ! al 200; TT acang) Ta/.) T#%

2


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STAGES OF 'HRONI' KIDNEY DISEASESTAGES OF 'HRONI' KIDNEY DISEASE> 'KD> 'KD(N!&o"!/ K&d" Fo;"d!&o"-LB 15-+?

MD'D Modifica!ion of Di! in 'nal Disas + +oc:crof! a.l!

2*

+ K&d" D!! Df&"d !s A"or!/&&s &" P!o/o&=, Ur&", B/ood, or I!&" Tss+


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THE FORMULA OF 'O'KROFT3 GAULT > GFR (s&!d GFR+S+ < SE'UM +'EATI5I5E GFR 'REATININE 'LEARAN'ES

GFR ( +

(L&".+

oH

"14!>AGE# C BODY WEIGHT"B$#

PLASMA 'REATININE"m$d(# ' 7

H"14!>AGE# C BODY WEIGHT"B$#

PLASMA 'REATININE"m$d(# ' 7

GFR ( +(L&".+

?o ' !


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THE MDRD FORMULA (MODIFI'ATION OF DIET IN RENAL DISEASE+

S+ < SE'UM +'EATI5I5E GFR 'REATININE 'LEARAN'ES

076 (S'+30.092 (AGE+35.45: (5.824+ (0.404 IF BLA'KASIA+

4' 8MD'D; for 4EMALE

076 (S'+30.092 (AGE+35.45: (0.404 IF BLA'KASIA+

4' 8MD'D; for MALE

27


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DEFINITION OF ABNORMALITIES IN ALBUMIN E'RETION

8ADA 2006) 3rovidd To:ro%rairo 2006 $ 2012;

N2R+AN2R+A K 3!K 3! K !K ! K 3!K 3!

+AR2 A?U+INURIA+AR2 A?U+INURIA

INIA A?U+INURIAINIA A?U+INURIA3!!3!! !!!! 3!!3!!

ANY TWO OF THREE SPE'IMENS 'OLLE'TED WITHIN A :-6 MONTH PERIOD

3! > 993! > 99 ! > 199+IR2 A?U+INURIA

Eig/! +a.ssof

Elva!d AE'

0 E=r=&s %&&" 42 , 4 M!rd H$r/=&!, : M!rd H$r"s&o",

2 I"f=&o", 9 F


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> AT);AN >)S)K% L PB)MB(1&0 F + am ss.da/ #a:an$L SK*NDB"Pa$i dan ;re s/; !"d

H; SUDA, DIE'AA5 LE, 3USAT DIABETES DA5 5UT'ISI

'SUD D'& SETM $ 4 U5AI' 3ADA T, 19?9 DA5 1991

PENTALOGI-TERAPI DIABETES MELLITUS8As:andar To:ro%rairo 19?>-2012;

1 PN**;AN(tentan! D)A7TS M)T*S$

2 P2A +ABANH P+"DI0. A.AU .0RAPI NU.RI;I +0DI; H .N+#

* 'ANGKOK PANKREASP;s! D&!s d!"

N;r&s&(0171, 0110+

;e( ?eta , pada .i%usF#

.ta( , pada Anjin$F#

BAT ,I3LIEMI 'AL 8,; , < AD

I5SULI5

BAT A5TI DIABETES 8AD;

29


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5UT'ITI5 I5 DIABETES MELLITUS+linical E%rincs To:ro%rairo 197?-2012

DIABETI' DIETS

MEDI'AL NUTRITION THERAPY

"+N.# P.E.N. P-P.E.N.

PAR ENTERAL NUTRITION ( CSONDEC +

01

) 0

) 03

) 04

) 05

) 06

,!&

,14

INSULIN

00

0:

09

,11

,17

NO INSULIN

04

02

06

ORAL NUTRITIONSinc 197? ENTERAL NUTRITIONSinc 199*

PAR ENTERAL NUTRITION P.E.N.

Sinc 199>

PB)P;BA PPAB PNTBA N*TB)T)


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THE 6-E (E-0 UP TO E-6+ REGIMEN OF ENTERAL NUTRITION FOR DIABETI'S

8TUBE 4EEDI5 S5DE;(Clini'al Jerien'es % Tkrra3ir 1??5-+01+$

/spita( rmu(a , 01)03)05 Pharm< rmu(a , 0) 04) 06, ;ites f +UA

ENTERAL- 0

8E-1;

06&00 am

ENTERAL- 2

8E-;

05&00 m

ENTERAL- 9

8E-*;

06&00 m

ENTERAL- :

8E->;

0+&00 m

ENTERAL- 4

8E-2;

11&00 am

ENTERAL- 6

8E-6;

11&00 m

1 = Timesday + Started at 06&00 am -;ur )nter.al

TIMING OF INSULIN INE'TION > :5 MIN. BEFORE OR PRE'ISELY o" E0 ,E: ,E9

ENAM3LE DIA5E'ALO8D; ' ,S3ITAL 4'MULA

1

DIA5E'ALO

I5SULI5

6

MU4A or D

2

MU4A or D

MU4A or D

>

DIA5E'ALO

I5SULI5

*

DIA5E'ALO

I5SULI5

>1


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T/ Di!-B 197? 8'visd T5M-2002; T/ Mo!/r - Di!

Pros$=&

;

;

;

;

0 D&-B+ > T Mor-D& "197

Diet>? astin$ "197

3 Diet>?1 "6!= bh) != P) != # "19&!#

4 Diet>?1 astin$ "19&!#

5 Diet>?FF >ND"DBD#>;ta$e "19

6 Diet>?3FF >ND"DBD#>;t 3 M 4 "19&3#

7 Diet>?eFF >R0UAR /D "19&3#

& Diet>+ "+a(nutrisi# "19&9#

9 Diet>+ astin$ "19&9#

1! Diet>FFF >fr an$rene "1999#

1 Diet> "!!!#

13 Diet>/ "/epar# "!!1#

14 Diet B>.1 "!!4#

15 Diet B>. "!!4#16 Diet B>.3 "!!4#

17 Diet B> "!!4#

1& Diet ?1>.1 "!!4#

19 Diet ?1>. "!!4#

! Diet ?1>.3 "!!4#1 Diet ?1> "!!4#

rPre D+

r

D+

11 D&-KV > for 'VD "1999#

>2


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(Tkrra3ir(Tkrra3ir, ;ari Eitarti, )ndra3ati, >rieda et al, ;ari Eitarti, )ndra3ati, >rieda et al , 1???, 1???-+00-+00$$

SPE'IFI'ATIONS > : of 40 DIABETI' DIETSSPE'IFI'ATIONS > : of 40 DIABETI' DIETS(TNMs+(TNMs+! Dr. SOETOMO HOSPITAL! Dr. SOETOMO HOSPITAL

DIET- G!"r" or H$!r

Diet-7 lus 5 Se'i/i'atins

D&-KV > Sro, 'AD, POAD

.hese are ab(e t (:er/m8Gsteine ee(

('o/. :55 d!+

1 Ar!inin Cntent 2 >i#er +5-5 !day

> >late

Oit 7=

* Oit 71+

D&-B (@ '!/+ > 67@ ', 45@ F, 04@ P

.hese are ab(e t (:er/m8Gsteine ee(

('o/. :55 d!+

1 Ar!inin Cntent 2 >i#er +5-5 !day

> >late

Oit 7=

* Oit 71+

D&-B0 (@ '!/+> 65@ 'HO, 45@ F, 45@ P

ARININ , Atherprte8tie ia Nitri8 2'ide "N2#

/2+2;.0IN0 , 2'idatie ;tress ) AD+A

AsGmmetri8 Di +ethG( Ar$inine

"AD+A#

>>


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DIET-B 8197?;H T/ Mo!/r Di!

K 67@ !/, L 45@ !/, Pro&" 04@ !/, Ko/sro/ :55 !r&,

SAFA 9@, PUFA 9@, MUFA 05@, R!s&o PS ? 0.5, Sr! 49-:9 !r&

I5DIASI

1 D)A7T)S) AN: T)DAK TA;AN APAB

> DM 7); DAB) 10 TA;*N

2 D)S)P)DM)A

";a(ah satu atau (ebih , . ) /D ) B(< .t< ) D #

L ;asil Disertasi S> (Askandar Tkrra3ir 1?6$

>


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(C;< lus M*>ALL$

LLL$

00 m!day

R

-10G

10G

Mentined A#.e

15-+0G

"Su!ar >ree"

00 m!day

1&0

5G

5G10G

1+G

C;A

P*>A

M*>A

PB)7B

=6G

Star'h

+0G

+5 - 5 !day +0-5 !day

0G

=0-0G

THERAPEUTI' DIETS FOR DIABETI'S AND OR DYSLIPIDEMI'S

Cnnr (1?6+$ % Sin!le Diet (C7; =5G, +0G, P 15G, Chl& 100 m!day$

F# Disertatin>197& ".he ? as .he +ther>Diet#

FF# .he Per8enta$e must be Indiidua(ied

FFF# A88eptab(e Dai(G Inta%e

"0stab(ished bG DA#

>*

(ADA, +00+, +00$

RE'OMMENDATION

(T#oro$r!%&ro 0187, R 4554+

T,E B-DIETH;MA'RONUTRIENT

>)7B


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3EDMA5 DIET-B2) DIET-B>) dan DIET-Bonsns.s Dia"!ologi) 5frologi) ii

'SUD Dr& So!o#o - 4 Unair S.ra"aya8S.ra"aya 6 A%ril 2002;

FASE PRA-HEMODIALISA > D&-B4, B:+

0 PRA>/D U+U+ Diet>?Bandun$an Prtein , !/D B/U;U; Diet>?3Prteinuria 3 $hari) atau

Bandun$an Prtein , !


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3E'BA5DI5A5 L5A5 ,85SE5SUS 3E'E5I 2011;

>7

'!r! r#! ;!! Ef s!$&";!!

Rd;s&A0'

K;";"!" Kr;&!"

;u(fni(urea +enin$%at%an se%resiinsu(in

?? nai%)hip$(i%emia

1)!>)!= ;an$at efe%tif +enin$%at%an berat badan)hip$(i%emia "$(iben%(amid dan%(rprpamid#

(inid +enin$%at%an se%resiinsu(in

?? nai%)hip$(i%emia

!)5>1)5= ;an$at efe%tif +enin$%at%an berat badan) pemberian3'hari) har$anGa maha( dan/ip$(i%emia

+etfrmin +ene%an prdu%si$(u%sa hati Mmenambah sensitifitas

terhadap insu(in

Dispepsia) diare)asidsis (a%tat

1)!>)!= .ida% ada %aitanden$an berat badan

0fe% sampin$ $astrintestina()%ntraindi%asi pada insufisiensi rena(

Pen$hambat$(u%sidasea(fa

+en$hambat absrpsi$(u%sa

(atu(ens) tinja(embe%

!!)&= .ida% ada %aitanden$an berat badan

;erin$ menimbu(%an efe%$astrintestina() 3'hari dan maha(

.ia(idindin +enambah sensiti fi tasterhadap insu(in

0dema !)5>1)4= +emperbai%i prfi(ipid "pi$(itan#) berptensimenurun%an infar% mi%ard"pi$(itan#

Retensi 8airan) /) fra%tur)berptensi menimbu(%an infar%mi%ard) dan maha(

DPP>4 inhibitr +enin$%at%an se%resiinsu(in) men$hambatse%resi $(u%a$n

;ebah) muntah !)5>!)&= .ida% ada %aitan den$an beratbadan

Pen$$unaan jan$%a panjan$ tida%disaran%an) maha(

In%retinana($mimeti%

+enin$%at%an se%resiinsu(in) men$hambatse%resi $(u%a$n

;ebah) muntah !)5>1)!= Penurunan berat badan Inje%si 'hari) pen$$unaan jan$%apanjan$ tida% disaran%an) dan maha(

Insu(in +ene%an prdu%si$(u%sa hati) stimu(asipemanfaatan $(u%sa

/ip$(i%emi) ??nai%

1)5>3)5= Dsis tida% terbatas)memperbai%i prfi( (ipid dasan$at efe%tif

Inje%si 1>4 %a(ihari) harus dimnitr)menin$%at%an berat badan)hip$(i%emia dan ana($nGa maha(

Beteran$an ,


38/40

ASK-SDNC

OBAT HIPOGLIKEMIK ORAL > KONSENSUS PERKENI 4500 F Prdu% risina(FF

FFF Badar p(asma efe%tif terpe(ihara se(ama 4 jam

?e(um beredar di Indnesia>?

olongan nri: 5a#a Dagang MgK!a" Dosis /arian La#a :ra8a#;

4r:K/ari =a:!.

:li#en'lamid DanilL +,5-5 +,5-15 1+-+@ 1-+

:lii4idMinidia# 5-10 5-+0 10-1= 1-+

:lu'trl- 5-10 5-+0 1+-1=LL 1

:likla4id Diami'rn 60 60-+0 10-+0 1-+Diami'rn-MB 0-=0 0-1+0 +@ 1Se#elum

:likuidn :lurenm 0 0-1+0 =-6 +-

makan

:limeirid

AmarylL 1-+--@ 0,5-= +@ 1

:lu.as 1-+--@ 1-= +@ 1

Amadia# 1-+--@ 1-= +@ 1

MetriJ 1-+--@ 1-= +@ 1

linidBea!linid DeJanrm 1 1,5-= -

Nate!linid StarliJ 1+0 =0 -

Tiaolidindion Tidak #er!antun!Pi!lita4n

A'tsL 15-0 15-@5 +@ 1

ad3al makanDe'ulin 15-0 15-@5 +@ 1

3ng/a#"a!A'ar#se

:lu'#ay 50-100 100-00 7ersama suaan

l.:osidas ertama'lid 50-100 100-00

:lumin 500 500-000 =-6 +-

Big.anidMet/rmin

:lu'ha!e 500-650 +50-000 =-6 1-

7ersamasesudah

makanMet/rmin B:lu'ha!e-BL 500-50

:lumin-B 500 500-+000 +@ 1

"a! o#"inasi

T!a%

Met/rmin :lu'.an'e

+501,+5 Ttal :li#en'lamid

maksimal +0 m!hr

1+-+@ 1-+

7ersamasesudah

:li#enklamid 500+,5

makan

5005:limeirid Amaryl-Met

>DC

1+50 +500 - +Met/rmin +500 @1000

PiniJ 15-0 15-@5 16-+@ 1

3ng/a#"a! D33-I Sita!litin 9anu.ia +5, 50, 100 +5-100 +@ 1

SaJa!litin 9


39/40

ASK-SDNC-

MEKANISME KERA, EFEK SAMPING UTAMA, DAN A0'(KONSENSUS PERKENI 4500, Pro T#oro$r!%&ro 4500-4504+

'ARA KERA UTAMA EFEK SAMPING UTAMA PENURUNAN A0'

Insu(in +ene%an prdu%si $(u%sa hati) /ip$(i%emia) 1O

Diare) dispepsia) 1

Pen$hambat +en$hambat absrpsi $(u%sa (atu(ens) !9

0


40/40

RSUD Dr. SOETOMO

PUSAT DIABETES J NUTRISI SURABAYA (PDNS+ >0176-4504 0

PDNS L-8

(0455 4+

'SUD Dr& SETM) 19>? $ 2012 Bd +a%aci!y 1**0

3D5S + S! f ? E ! M " *2

01. diabetes mellitus part 1 - prof.askandar

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