referat dm pd anak
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REFERAT
DIABETES MELLITUSPADA ANAK
Oleh:Nourma Yustia Sari, S.Ked
KEPANITERAAN KLINIK ILMU PENYAKIT ANAK
FAKULTAS KEOKTERAN
UNI!ERSITAS MU"AMMAIYA" SURAKARTA#$%&
Pem'im'i():
dr. Alo*sius Se+tiaro, S+.A
dr. Elie- Roha(a, S+. A, M.Kes
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A. Latar Belakang Masalah
Diabetes MellitusKum+ula( dari )a())ua( meta'olisme *a()
dita(dai oleh ti())i(*a adar )luosa
darah *a() a'(ormal.
"i+er)liemia teradi ai'at resiste(si sel
tu'uh terhada+ ati/itas i(suli(,
de-isie(si i(suli(, atau edua(*a.
M +ada a(a meli'ata( 'e'era+a -ator:
)e(eti da( erusaa( sel 'eta +a(reas.
BAB I
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B. Tujuan Penulisan Referat
Me(elasa( +e(*ait ia'etes Mellitus +ada A(a da(me(am'ah hasa(ah eilmua( +ada 'ida() ilmu +e(*aita(a.
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C. Manfaat Penulisan Referat
Teoritis
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BAB II
A. Anatomi Pankreas
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B. Fisiologi Insulin
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C. Fisiologi Glukagon
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D. Diabetes Mellitus
. •ia'etes mellitus +e(*ait meta'oli dima(a+e(derita dia'etes tida 'isa mem+rodusi i(suli(
dalam umlah *a() 0uu+ atau tu'uh tida mam+u
me())u(aa( i(suli( se0ara e-eti- sehi())a teradi
ele'iha( )ula di dalam darah.
!.•M ti+e % teradi 1%2 th•Sa(di(a/ia 3$:%$.$$$ +o+ulasi•4e+a() %:%$$.$$$ +o+ulasi•USA %5:%$$.$$$ +ol+ulasi.
•Ameri0a( ia'etes Asso0iatio( 6AA7 seitar %$,#
uta ora() di Ameria me(derita M da( *a() tida
terdia)(osis seitar 5,8 uta.
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". PAT#FI$I#L#GI
a. Diabetes Mellitus Ti%e
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PAT#FI$I#L#GI
b. Diabetes Mellitus Ti%e !
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5. GEJALA KLINIS
Khas M :
Poliuria
Polidi+sia
Poli-a)i Pe(uru(a( 'erat 'ada(
Tida has M : Kesemuta(
9atal
Mata a'ur
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6. DIAGNOSIS DM PADA ANAK A(am(esis
Pemerisaa( -isi
Pemerisaa( +e(u(a()
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Pemeriksaan
&. P'M'RI($AA) P')*)+A)G
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KRITERIA DIAGNOSTIK DMPemerisaa! Gula Dara" I!ter#reasi
9ula darah seatu 69S7 ; #$$ m)<dL
9ula darah +uasa 69P7 %#& ; m)<dL
9ula darah # am PP 6sesudah
di'eria( )luosa =5 )ram7
; #$$ m)<dL
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$. KOMPLIKASIKomplikasi akut:
Diabetes ketoasidosis
Hiperglikemik hiperosmolar state
Komplikasi kronis:
Vaskular: mikrovaskular (retinopati, nefropati, neuropati),
makrovaskular (penyakit jantung koroner, penyakit vaskular
perifer, penyakit vaskular erebrospinal)
!on vaskular
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Chronic
Complications of
Diabts Mllit!s
Micro"asc!lar
Eye disease
Retinopathy
(nonproliferative/proliferative)
Macular edema
Neuropathy
Sensory and motor (mono- and
polyneuropathy)
Autonomic
Nephropathy
Macro"asc!lar
Coronary heart disease
Peripheral arterial disease
Cererovascular disease
!ther
"astrointestinal (#astroparesis$
diarrhea)
"enitourinary (uropathy/se%ual
dysfunction)
&ermatolo#ic
'nfectious
Cataracts
"laucoma
Periodontal disease
earin# loss
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%. TERAPI DM PADA ANAK M ti+e %
iet
Olahra)a
Ma(aeme( stress
Pe()aasa( adar )luosa da( eto( dalam darah
I(suli( osis i(suli( 'er)a(tu() +ada umlah eto(
dalam darah da( status +" +asie( a(a. >ila +" 1 =,3
da( umlah eto( dalam darah 'erada +ada le/el
si)(i-ia(. Pem'eria( % atau # i(esi i(tramus0ularatau su'uta( i(suli( lis+ro 6humalo), ?"@7 atau
i(suli( as+art 6No/olo) ?NL@7 ter+isah dalam % am
de()a( dosis %# U(it<K)>> da+at dilaua(.
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LANJ&TAN Saat eto( tida tedetesi dalam darah maa
i(suli( aa( le'ih ati- da( +em'eria( i(suli(
su'uta( da+at dilaua( de()a( dosis 6$,#5$,5$7
U(it<K)<#84am, 'ila terda+at eto( dalam darah
maa +rodusi i(suli( aa( 'erura() sehi())amem'utuha( $,5% u(it<K)<#8 am.
Pasie( a(a M ti+e % 'iasa(*a me(da+ata(
tera+i 0am+ura( a(tara i(suli( de()a( o(set
0e+at da( o(set lam'at, tera+i om'i(asi i(iu(tu me()o(trol )ula darah asu+a( sehari hari
terutama setelah maa( da( u(tu me()o(trol
adar )ula darah terait de()a( +rodusi )luosa
he+ar.
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T,%e of Insulin Begins -orking Main 'ffet All Gone
$hort/ating
"egular # h $%& h '% h
Humalog or
!ovoog
*+%* min -+%.+ min & h
Interme0iate/
ating
!/H $%& h '%. h *$%* h
Long/ating
antus *%$ h $%$- h $&%$' h
Premi1e0
!/H0"egular # h Variablea
*$%*. h
!/H010$ b
*0& h *%. h *$%* h
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LANJ&TANM Ti+e #
Tera+i *a() dilaua( 'er)a(tu() +ada ti()at e+araha(
+e(*ait.
>ila +ada +emerisaa( "'A%0 masih (ormal 6&,#B7 da( eto(
tida me()alami e(aia( *a() ti())i, maa tera+i(*a
+eru'aha( )a*a hidu+, +ola o(sumsi da( asu+a( alori
di'are()i de()a( olahra)a teratur 6setida(*a 3$ me(it +er
hari7.
>ila teradi e(aia( +ada saat +e(ilaia( "'A%0 6&,#B CB7
maa da+at di'eria( met-ormi( se'a)ai a)e( hi+er)liemia
oral de()a( dosis aal #5$m)5$$m) +er hari da( 'ila sudah
dida+ata( +e(*esuaia( sistem +e(0er(aa( da+at ditam'ah
me(adi % )ram +erhari. Namu( 'ila teradi +erem'a()a(+e(*ait me(adi le'ih +arah dita(dai de()a( +e(i()ata(
umlah eto( uri( se0ara moderat atau 'ila adar Al+ha
"idrosi'utirat darah ;%mmol<L, maa tera+i se+erti +ada
dia'etes mellitus ti+e % da+at di'eria(.
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2deal 3luose evels after $ or 4ore Hours of 5asting6a
Age 2,ears3 Gluose Le4el
& .+%$++ mg0d (&6'%** mmol0)
%** 1+%*.+ mg0d (-6%*+ mmol0)
*$ 1+%*+ mg0d (-6%.6- mmol0)
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'(. PROGNOSISM ti+e %
Me(urut umur +e(derita %$ tahu( le'ih +e(de
di'a(di()a( de()a( ora() *a() 'ua( +e(derita.
Pada a(a *a() me(derita emu()i(a( aa( me()alami
+e()ham'ata( +ertum'uha( sehi())a aa( me(adile'ih +e(de di'a(di()a( de()a( ora() (ormal.
Seda()a( +erem'a() sesual dari a(a +e(derita u)a
aa( terham'at sehi())a +e(0a+aia( umur +u'ertas
aa( le'ih tua dari a(a *a() (ormal.
Pro)(osis aa( me(adi 'uru 'ila +e(*ait tidadidetesi se0ara 0e+at, hal i(i u)a aa( me()ai'ata(
om+liasi aut mau+u( ro(is *a() 0uu+ 'erat
sehi())a da+at me()a(0am ia +e(derita.
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M ti+e #
Pro)(osis aa( sa()at 'ai a+a'ila +er'aia(
status dia'etes dilaua( se0ara te+at da(
0e+at. Pe(ti()(*a +e(*ait didetesi le'ih 0e+at
a)ar da+at dilaua( +e(atalasa(aa(
mau+u( +eru'aha( +ola hidu+ se'elum
mem'eria( om+liasi *a() 'er'aha*a. Peru'aha( +ola hidu+, +ola o(sumsi serta
+e()aasa( etat +e(ti() dalam me(a)a
a)ar +ro)(osis tida me(adi 'uru.
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ia'etes Mellitus meru+aa( +e(*ait terait de()a( sistem
e(dori(olo)i da( +a(reas.
I(suli( meme)a() +era(a( +oo dalam meta'olisme )luosa.
ia'etes Mellitus adalah +e(*ait de()a( 'a(*a )eala *a() me(*ertai
da( memilii -ator dalam da( -ator luar se'a)ai +e(0etus(*a.
Ada # etiolo)i utama dari dia'etes mellitus *a() me(adi dasar lasi-iasi+e(*ait(*a.
M ti+e % *a() di0etusa( oleh tida 0uu+(*a umlah i(suli( sam+ai
tida ter'e(tu(*a i(suli( oleh +a(reas 6Sel >eta Pulau La()erha(s7
dise'a'a( oleh +roses autoimu(itas *a() me()ha(0ura( sel 'eta +ulau
la()erha(s +a(reas.
M ti+e % me(*era() a(a de()a( umur 1 %2 tahu( de()a( rataa( umur+e(derita 8 %$ tahu(.
M ti+e % me(*e'a'a( eter)a(tu()a( a'osolut i(suli( eso)e(i u(tu
me()atur adar )ula darah, da( me(a)a status dia'etes tida
'erem'a() me(adi +e(*ait de()a( 'a(*a om+liasi.
BAB III
A. ('$IMP*LA)
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M ti+e # adalah +e(*ait ro(is *a() 'erhu'u()a( de()a( resiste(si
i(suli( dalam otot atau etidamam+ua( i(suli( me(tra(s+otasia(
)luosa edalam sel sehi())a memi0u teradi(*a +em'e(tua( )ula dihati
*a() me()ai'ata( teradi(*a eadaa( hi+er)liemia.
Pe(*ait i(i 'iasa(*a dialami oleh ora()tua (amu( +ada a(a +e(*ait i(i
da+at u)a teradi.
Pasie( a(a 'iasa(*a me()alami o'esitas da( elelaha( ro(is.
Kom+liasi *a() teradi da+at me(*amai +asie( de()a( M ti+e % a+a'ila
status hi+er)liemia tida didetesi se0ara di(i.
Tera+i *a() dilaua( 'ertuua( me(uru(a( adar )ula darah me(adi
(ormal da( me(0e)ah tim'ul(*a om+liasi *a() 'erat.
Tera+i u(tu me()o(trol hi+er)liemia dilaua( de()a( +em'eria( o'ato'ata( a(tihi+er)liemia se+erti )li'e(lamide da( met-ormi(, 'iasa(*a
tida di+erlua( +em'eria( i(suli( eso)e( (amu( da+at u)a di'eria(
a+a'ila teradi om+liasi aut se+erti dia'etes etoasidosis.
Tera+i u)a me(0au+ +e()atura( +ola o(sumsi 6asu+a( alori7 da( +ola
olahra)a de()a( tuua( me(uru(a( (ila o'esitas 6I(des Massa Tu'uh7.
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ia'etes mellitus meru+aa( um+ula( dari )a())ua(
meta'olisme *a() dita(dai oleh ti())i(*a adar )luosa
darah *a() a'(ormal.
Me()ura()i maa(a(<mi(uma( ma(is are(a da+at
memi0u teradi(*a e(aia( )ula darah. A+a'ila a(a de()a( o'esitas disra(a( u(tu me(uru(a(
'erat 'ada( are(a da+at me(uru(a( risio teradi(*a
dia'etes mellitus.
B. $ARA)
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DAFTAR P&STAKA Moli(aPatri0ia E : Lange Endocrine Physiology : 2nd edition, The M0)ra"ill 0om+a(ies La()e
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9a(o() F illiam : Lange review of Medical Physiology: 22nd edition, The M0)ra"ill 0om+a(iesLa()e Medi0al Series, D"TML e>oo, #$$5.
9ard(er, 9.a/id, Sho'a0, olores : Greenspan’s basic And Clinical Endocrinology, The M0)ra
"ill Dom+a(ies La()e Medi0al Series, D"TML e>oo., #$$=.
LeRoith ere, : iabetes Mellit!s A f!nda"ental And Clinical #e$t % rd edition , Li++i(0ots
illiam a(d ili(s, D"TML e>oo , #$$8.
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"a*, . illiam et al : Chapter %) iabetes Mellit!s , C!rrent iagnosis And #reat"ent )* th
edition, M09ra"ill Dom+a(ies La()e Medi0al Series, D"TML e>oo, #$$=.
Klie)ma(, M.Ro'ert, : &ection ++, Endocrinology, iabetes Mellit!s,'elson’s Pediatric &ecret-th
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arrell, a/id A4 et al :.$ford #e$tboo( of Medicine, /th Edition. D"TML e>oo, OG-ordU(i/ersit* Press.#$$3.
Lo()o, L. Lo()o et al : 0arrison’s, Principal .f nternal Medicine )*th edition, M09ra"ill
Dom+a(ies, Medi0al Series,D"TML e>oo s, #$%#.
Pro/a(, re : .$ford 0andboo( .f Clinical And Laboratory nvestigation 2nd edition, C0#ML e1
oo(, OG-ord U(i/ersit* +ress, #$$5.
>oo(,N.A, Dummi(),A. , 4oh( , 9 : avidson’s Principal And Practice .f Medicine 23 th edition,
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Simo(, Dha(tal, E/errit, "aHel, Ke(dri0, To(* : .$ford 0andboo( .f General Practice 2nd edition
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BAB I5