Management of Diabetes mellitus

Prof. Dr. Surya Dharma, MS, Apt.

Fakultas Farmasi Unand

Problems

• Increased of prevalence

• Cronic complications

ex. Diabetic Foot Problems

• Prevention, primer, secunder tertier

Etiology of Insulin Resistence

Weight gainObexisity

Circulation FFA Lipoatrophyadipokines

Insulin ResistanceThe subnormal biologic response to

a given concentration of insulin

Physicalinactivity Aging Genetica

Etiology of -Cell Dysfunction

Genetics Lipotoxicity Glucose toxicity

-Cell FailureInadequate compentation for insulin

resistance and selective non-responsivoness to glucose

Loss of -cell …… ? Cytokines ? Amyloid

accumulation

The Role of Genes and the Environment

Normal

GENES EnvironmentInsulinresistance

Diabetes genes insulin resistance genes-cel function genesObesity genes

Decreased Insulinsecretion

Type DM

Diet Activity Toxins

Risk Factors for Type 2 Diabetes

Genetic factors-Ethnicity-Family history

GastationalDiabetes polycystic Ovarian syndrome, and party

Type 2Diabetes

Increasing age Central

obesity

Physicalinactivity

Diet

Pathophysiology of DM

Hepatic glucoseProduction (HGP

Peripheral GlucoseUptake

Blood Glucose

Macrovascular Complication of Type 2 Diabetes

• 80% of people with type 2 diabetes thr from CVD

~ Coronary heart disease (CHD)

- eg, angina, heart attack, heart failure

- 2-to 4-fold increased risk

~ Cerebrovascular disease

- eg, stroke, transient ischemic attacks

- 2-to 4-foid increased risk

~ Peripheral vascular disease

- eg. Intermittent claudication, gangrene, amputations

Complek interaction between

• Periperal neuropaty

• Micro angiopathy

• Macro vascular disease

• Poor foot hygiene

Diabetic Foot Problems

Peripheral neuropathy with loss of pain sensation is the commount cause of fort ulceration, closely followed by poor higiene

Management of foot problems

• Education center

• Metabolic control

• Mechamical control

• Wound control

• Microbiological control

Management of Diabetes Mellitus

• Monitoring of Glucosa levels

• Food planning

• Phsical activity

Treatment of hyper glycemid

Treatment of Cardiovascular risk factor

Milestones of Diabetes Management

Nutrition th/

Education

Exercise Anti hypergly-cemic ogents