Diabetes

melitus
Definition
Diabetes is a group of metabolic diseases
characterized by hyperglycemia resulting
from defects in insulin secretion, insulin
action, or both

Diabetes Care January 2013 vol. 36 no. Supplement 1 S67-S74

Epidemiologi
 Incidence of diabetes is alarmingly
increasing all over the globe.
 Prevalence of childhood diabetes
range between 3-50/100,000
worldwide; .
 Dana Dabelea (2014):
 Type 1 DM in 2001 = 1,48/1000
2009 = 1,93/1000
 Type 2 DM in 2001 = 0,34/1000
2009 = 0,46/1000
Dana Dabelea. Prevalence of Type 1 and Type 2 Diabetes
Among Children and Adolescents from 2001 to 2009. JAMA.2014
WHO CLASSIFICATION 2000
Is based on etiology not on type of
treatment or age of the patient.
 Type 1 Diabetes
(idiopathic or autoimmune b-cell
destruction)
 Type 2 Diabetes
(insulin resistance)
 Other specific types
 Classification
• B cell Pancreas destruction
DM tipe 1 • Absolute insulin deficiency

• Kombinasi resistensi insulin dan inadekuat

DM Tipe 2 sekresi insulin

• Pancreas Exocrin desease, Pancreas Fibrous

DM tipe lain Cystic, drugs

DM Gestasional Diabetes yang mucul saat kehamilan

Common symptoms of diabetes:
 Polidipsi
 Poliuri
 Polifagi
 Blurry vision
 Cuts/bruises that are slow to heal
 Weight loss - even though you are eating
more (type 1)
 Pain or numbness in the hands/feet
Diagnostic Criteria
 Fastingplasma glucose (FPG) ≥ 126 mg/dl
(7.0 mmol/l); OR
 Symptoms (such as polyuria, polydipsia,
unexplained weight loss) AND
a random plasma glucose > 200 mg/dl
(11.1 mmol/l); OR
 Random plasma glucose > 200 mg/dl (1.1
mmol/l) 2 hours after a 75g glucose load
 TYPE 1 DIABETES: ETIOLOGY

Type 1 diabetes mellitus mostly caused by

autoimmune disease.
 Islet cell autoantibodies
 Glutamic acid decarboksilase
 AUTOIMMUNITY
 Circulating antibodies against b-cells and
insulin.
 Immunofluorescent antibodies &
lymphocyte infiltration around pancreatic
islet cells.
 Evidence of immune system activation.
Circulating immune complexes with high
IgA & low interferon levels.
 Association with other autoimmune
diseases.
Screening for T1
The reason to screen and intervene early in T1D:

 Common, serious in terms of morbidity and

mortality
 Latency period without symptoms
 Screening test with sensitivity and specificity
 Intervention early is more effective, preserves
C-peptide
HONEYMOON PERIOD
 Due to b-cell reserve optimal function &
initiation of insulin therapy.
 Leads to normal blood glucose level
without exogenous insulin.
 Observed in 50-60% of newly diagnosed
patients & it can last up to one year but it
always ends.
 Can confuse patients & parents if not
educated about it early.
COMPLICATIONS OF
DIABETES
 Acute:
 DKA
 Hypoglycemia
 Late-onset:
 Retinopathy
 Neuropathy
 Nephropathy
 Ischemic heart disease & stroke
TREATMENT GOALS

 Prevent death & alleviate symptoms

 Achieve biochemical control
 Maintain growth & development
 Prevent acute complications
 Prevent or delay late-onset
complications
TREATMENT ELEMENTS
 Education
 Insulintherapy
 Diet and meal planning
 Monitoring
 HbA1c every 2-months
 Home regular BG monitoring
 Home urine ketones tests when indicated
FUNCTION OF INSULIN
 Insulin being an anabolic hormone
stimulates protein & fatty acids
synthesis.
 Insulin decreases blood sugar
1. By inhibiting hepatic glycogenolysis
and gluconeogenesis.
2. By stimulating glucose uptake,
utilization & storage by the liver,
muscles & adipose tissue.
TYPES OF INSULIN
 Shortacting (neutral, soluble,
regular)
 Peak 2-3 hours & duration up to 8 hours
 Intermediate acting
 Isophane (peak 6-8 h & duration 16-24 h)
 Biphasic (peak 4-6 h & duration 12-20 h)
 Semilente (peak 5-7 h & duration 12-18
h)
 Long acting (lente, ultralente & PZI)
 Peak 8-14 h & duration 20-36 h
 EXERCISE
 Decreases insulin requirement in
diabetic subjects by increasing both
sensitivity of muscle cells to insulin &
glucose utilization.
 It can precipitate hypoglycemia in the
unprepared diabetic patient.
 It may worsen pre-existing diabetic
retinopathy.
 MONITORING
 Compliance (check records)
 Home Reguler Blood Glucose tests
 HbA1 every 2 months
 Insulin & meal plan
 Growth & development
 Well being & life style
 School & hobbies