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Himawan Sanusi
• Diabetes mellitus
• Thyroid
Type 2 DM : a silent killer
Engelgau MM et al. The evolving diabetes burden in the US. Ann Intern Med.2004;140:945
Diabetes in elderly
Prevalence
The prevalence of diabetes mellitus
increases with age
The National Health and Nutrition
Examination Survey (NHANES) of 1999–
2000 suggested that 38.6% of people over
the age of 65 have diabetes
The prevalence is higher in some minority
racial and ethnic groups, including African
Americans, Hispanics, and Native Americans
Prevalence of DM in
elderly
USA : estimated at 7 million / 20% of
all people 65 y.o. and older
Decline slightly in those older than 75
compared with those 65 – 74 y.o.
Decreases further in those older than
85
Why elderly people
Type 2 DM
Diabetes Mellitus in elderly
Drugs Decreased
physical activity
• Asymptomatic : usually
• 3 P (polyphagic, polyuria, polydipsic)
• Weight loss, blurred vision
• Diabetic complication : UTI, skin infect,
etc.
When to perform D/ test ??
1. Symptoms of diabetes (3 P)
Casual plasma glucose concentration >200
mg/dl
or
2. Fasting plasma glucose > 126 mg/dl
FPG, no caloric intake for at least 8 hours
or
3. 2-h post-OGTT > 200 mg/dl
75 gram glucose dissolved in water
DIAGNOSIS OF
DIABETES MELLITUS
Elderly subjects are more glucose
intolerance, the diagnosis in the
elderly should be FPG and OGTT
Clinical Features
• Symptom free
• Prevent short term complications (HONC)
• Prevent long term complications
• Quality of life = Lifestyle focus
Insulin
Meglitinides
Thiazolidinediones
Increase insulin secretion
Increase glucose uptake
from pancreatic b-cells
in skeletal muscle and
decrease lipolysis in
adipose tissue
Insulin secretagogue
Sulfonylureas
Increase insulin
secretion from Biguanide (metformin)
pancreatic b-cells Decreases hepatic
production and
increases glucose uptake
a-Glucosidase inhibitors
Delay intestinal
DPP – 4 inhibitor carbohydrate absorption
c) Biguanide : metformin
Cr serum > 1.5 mg/dl, CHF, PPOK
e) Thiazolidinedione : pioglitazone/rosiglitazone
Water retention
Acute Complications
Hypoglycemia
Diabetic ketoacidosis
Hyperosmolar nonketotic coma
Chronic Complication
Macro - Microvascular
Insulin
Intravenous insulin in small doses (10–15
units) should be given initially, followed by a
drip infusion of 1–5 units/h
Potassium deficits should be corrected
Treating of precipitating event
More than one-third of patients can be
discharged without insulin treatment
Insulin Resistance
Insulin Glucose
receptor X
PPARg +RXR
X Synthesis GLUT 4
mRNA
PPRE transcription
promoter Coding reg
Modified from Howard L. Foyt et al. Thiazolidinediones. Diabetes Mellitus: a Fundamental and Clinical Text, 2nd Ed.
Pioglitazone reduced Insulin resistance
Insulin Glucose
Insulin
receptor
PPARg +RXR
Synthesis GLUT 4
mRNA
Pio
PPRE transcription
promoter Coding reg
Modified from Howard L. Foyt et al. Thiazolidinediones. Diabetes Mellitus: a Fundamental and Clinical Text, 2nd Ed.