DISCUSSION

Definition
Diabetes Mellitus is a metabolic disease characterized by high blood sugar
(hyperglycemia) caused by impaired insulin secretion and insulin resistance or both.

In type II diabetes mellitus, the pancreas can still make insulin, but the quality
of insulin produced is poor and can not function properly as the key to entering glucose
into cells. As a result glucose in the blood increases, and can also occur because of body
tissue cell in muscle patient are insensitive or already insulin resistant.

(Haida Nurlaila, 2013. Hubungan Empat Pilar Pengendalian DM Tipe 2 dengan Rerata Kadar Gula Darah. Universitas Airlangga)
 Risk Factor
 Family history of diabetes (i.e parents or sibling with type 2 diabetes)
 Obesity (BMI ≥25 kg/m2) or ethnically relevant definition for overweight )
 Physical inactivity
 Race/ethnicity (e.g African American, Latino, Native American, Asian American,
Pacific Islander)
 Previously identified with IFG, IGT, or an Hemoglobin A10
 History of GDM or delivery of baby > 4 kg
 Hypertension
 HDL cholesterol level < 35 mg/dl and/or triglyceride level > 250 mg/dl
 Polycystic ovary syndrome or acanthosis nigricans
 History of cardiovascular disease
Pathophysiology

Type 2 Diabetes Mellitus

Pathophysiology
CLINICAL MANIFESTATION
 Typical symptoms of diabetes mellitus : polidipsi,
poliuri, polifagi and weight loss
 Non typical symptoms of diabetes mellitus : fatigue,
tingling, wounds is hard to heal, itchy, eyes blur,
erectile disfunction (male) and pruritus in vulva
(female).
 How to Diagnose
Diagnostic criteria :
1. Classical symptoms of DM + Glucose during plasma >200
mg/dL (11.1 mmol /L)
2. Or, Classical symptoms of DM + Fasting plasma glucose
>126 mg/dL (7.0 mmol / L)
3. Glucose Plasma 2 hours on TTGO >200 mg / dL (11.1
mmol/L)
4. A1c ≥ 6.5% (ADA, 2010)

(Siti Setiasi, dkk. 2014. Buku Ajar Ilmu Penyakit Dalam Edisi VI. Jakarta : Interna Publishing)
 How to Diagnose

PERKENI. Konsensus pengelolaan dan pencegahan diabetes mellitus tipe 2 di Indonesia. 2011. Jakarta: PB Perkeni;2011.
Therapy
Non Pharmacology
 1. Education

 2. Medical Nutrition Therapy

 3. Exercise
 Therapy
Pharmachology
TYPE MECHANISM SIDE EFFECT
Biguanide Increase insulin sensitivity, inhibits production of Lactic acidosis
liver glucose
Glitazone Increase insulin sensitivity, inhibits release of Weigh gain, edema
insulin resistance mediator
Sulfonylurea Stimulates pancreatic beta cell to release Hypoglycemia
insulin
Glinide Stimulates pancreatic beta cell to release Hypoglycemia
insulin
Alpha Inhibits carbohydrate absorption in the Meteorismus, flatulence,
glucosidase intestine tract diarrhea
inhibitor
Setiati S, Sudoyo AW, Alwi I, Simadibrata M, Setiyohadi B, Syam FA. Buku Ajar Ilmu Penyakit Dalam. Edisi 6. Jakarta: Interna, 2014.
Therapy
 Indikasi dan Kontraindikasi Penggunaan Insulin
Penggunaan insulin pada pasien diabetes melitus diindikasikan pada pasien dengan penurunan
berat badan yang cepat, menderita ketoasidosis, asidosis laktat, dan koma hiperosmolar,
pasien diabetes melitus yang mengalami stress berat seperti infeksi sistemik, operasi berat,
diabetes melitus gestasional yang tidak terkendali, serta diabetes melitus yang tidak berhasil
dengan pengobatan OHO dosis maksimal. Pada pasien hipoglikemi dan hipersensitif pada
insulin dikontraindikasikan pada penggunaan insulin.

Sinoputro D et al. 2016. Penggunaan insulin untuk diabetes mellitus dari generasi ke generasi
 Therapy
Total daily Insulin
0.5 x BB

Total Prandial Insulin (TPI) Total Basal Insulin (TBI)

60% TDI 40% TDI

Morning Dose Day Dose Evening Dose Night Dose

1/3 x TPI 1/3 x TPI 1/3 x TPI (10.00)
100% TBI

Petunjuk Praktis Terapi Insulin pada Pasien Diabetes Mellitus (PB PAPDI)
 Goal Therapy
Good Borderline Evaluation
Glucose
fasting 80-100 100-125 >126
2 hour post-prandial 80-144 145-179 >180
A1c <6.5 6.5-8 >8

Setiati S, Sudoyo AW, Alwi I, Simadibrata M, Setiyohadi B, Syam FA. Buku Ajar Ilmu Penyakit Dalam. Edisi 6. Jakarta: Interna, 2014.
 Type 2 Diabetes is Associated With
Stroke
Serious Complications 2- to 4-fold increase in
cardiovascular mortality and
stroke
15

Diabetic
Retinopathy
Leading cause Cardiovascular
of blindness Disease
in adults
8/10 individuals with
diabetes die from CV events
Diabetic
Nephropathy
Leading cause of Diabetic
end-stage renal disease Neuropathy
Leading cause of
non-traumatic lower
extremity amputations
UK Prospective Diabetes Study Group. Diab Res 1990; 13: 1–11.
Fong DS, et al. Diab Care 2003; 26 (Suppl. 1): S99–S102.
Molitch ME, et al. Diab Care 2003; 26 (Suppl. 1): S94–S98.
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