Pankreas 3: Diabetes Diagnostic

DM diagnosis

Terms: 2 times made in the measurement
Fasting glucose level 126 mg / dl is the best index to the value of 2 hour glucose 200 mg / dl = diabetic complications first appear retinopati the diabetic
When in including a high risk category and the results certainly have not done so TTGO DM (oral glucose tolerance test) each year, namely;
1. three days before the test, eating and regular sports
2. fasting 10 - 12 minutes
3. check sugar fasting
4. drink 75 grams of glucose + 250 ml of water and drink within 5 minutes
5. do check GD X 4 ½ hours each
results:
- Well, if the GD 70 - 110 mg / dl
- If value:
<200>dl after 2 hours, including the normal Confirmation TTGO not be done if there are special circumstances such as hyperglycemia DM, acidosis, BB came down fast, etc. DM implementation There are 3 ways:

1. Diet Planning
Namely the search for daily calorie needs in a way:
A. - Use the formula:

BB ideal = [TB cm - 100] - 10%

Reduction of 10% do not apply to the men <160 poor =" <90%" normal =" 90-110%" more =""> 110-120%
Fat => 120%

BB ideal X 30 (men) or 25 (women) = needs basaltic

Daily Needs Needs = Basal + type of work
Light = 10%
Medium = 20%
Weight = 40-100%
Lean patients, pregnant, breastfeeding, grow flowers = 20-30%

B. - Search for integrity without looking at the type of daily activities (dg find RDW% (Relative Body Weight))

BB kg
RDW = ------------------- X 100%
TB -100 cm

Lean = BB X 40-60 kal / day
Normal X 30 = BB
Tallowy X 20 = BB
X = Obest BB 10-15

Example;
Patients 50 kg DM BB, TB 150 cm, how much needs kal / day?

50 kg
RDW = ------------------- X 100% = 100% (normal category)
150 cm -100

So calorie needs per day X 30 = BB
50 X 30 = 1500 kal / day
The proposed menu of food choices;
KH = 60-70%
Protein = 10-15%
Fat = 20-25%

2. Physical Exercise
Exercise method with X CRIPE 3-4 every week
Continuous ongoing = no stop
= Rhythmical contraction and relaxation of regular
Interval = fast and slow lapse of regular cross -
= Progressive training of the light to heavy
Endurance time = survive in a certain time

3. Use of Drugs
a. Group Sulfonilurea
BB is used for normal, often causing hypoglycemia
I work:
- Stimulation of insulin release stored
- Lower threshold sekresi insulin
- Improve insulin sekresi
drug sample;
* Clorpropamid & glibenclamid
- Insufficiency risk of renal and not recommended on the parents
* Tolbutamid & glikuidon
- Both for parents and people with kidney dysfunction and hepar
b. Group Biguanid
used for people with fat and not BB meyebabkan hipoglikemia
I work:
- Improve insulin sensitivity in hepar and perifer
- Decrease in intestinal glucose absorbs
- Reduce the glucose level at the time hiperglikenia
drug sample; metformin

c. Inhibitor α Glukosidase
how it works with preventing α glukosidase down so that the absorption of glucose
example drugs; acarbose

d. Insulin Sensitizing Agent
how to work with insulin to increase sentitifitas
sample drugs; thoazolidinediones


e. Insulin
indication of insulin:
1. DM weight of the BB is going down fast
2. ketoasidosis, acidosis lactate, comma hiperosmolar
3. DM with heavy infection and surgery
4. DM pregnancies that occurred in the uncontrollable
5. not susceptible to the OHO or contraindicate
drug sample;
short work actrapid =
work is being = monotrad, NPH, insulatrad
long work = PZI
mix = mixtrad


Diabetes Complications

a. Comma HYPOGLYCEMIA
coma is due to glucose in the blood is too low.
This is caused by:
1. people with DM in the early stages.
2. DM treatment on:
a. the use of insulin
b. sulfonilurea users (not for biguanid)
c. that the mother of baby DM
3. non-DM patients with history gastrektomi, tumor, Addison disease, liver disease, and others.
There are 2 phases in hipoglikemia
1. aware phase (phase I)
Lack of glucose in the brain activation caused nerve autonomy hypothalamus that result in enzyme release epinephrine giving effect:
- sweat, trembling
- Headache, palpitasi (due to brain glucose down)
2. phase is not aware (phase II)
The least degree of glucose in the blood supply the brain cause metabolic disturbances that result in disrupted function of the brain interference occurs. Characteristics-characteristics:
- The strange behavior
- Sensory of the more obtuse
- Coma

Note:
Somogyi effect: a result of insulin at the time hyperglycemia that are not measurable, so that the hormone increased opposition and improve the regulatory measure glucose in the range hyperglycemia.
Prevention: the provision of glucose is carried out gradually revealed.

Diagnosis hyperglycemia commas:
Enforcement of this diagnosis is based on the Trias WHIPPLE:
1. hypoglycemia with symptoms of the Ssp
2. glucose level <50 dl
3. symptoms disappear with the glucose handling:
1. ABC, rest, then measure GDS
2. if aware of: water solution of sugar
3. if not aware give mucosa cheek with honey / sugar / syrup
4. if you are not aware: infus D40%, 50 ml bolus every 30 minutes to realize, and every day watching GDS
5. if still not aware of the GDS is above normal: manitol 2 mg / kg every 6 hours BB dexametason or 10 mg / kg bolus + BB 2 mg every 6 hours (because of edema suspected cerebri)
6. avoid the high glucose level, because it will aggravate edema. Glucose should level 90-180 mg / dl
7. if the patient has a history with the urea sulfonil of 1-2 mg of glukagon im not will susceptible

b.HYPERGLIKEMIA - The principle of KAD and KHHNK same - Both due to the effect defisiensi insulin:
1. Hiperglikemia
2. Dehydration (due to loss due to diuresis osmotik ion Na, K, P, Mg), ion interference.
3. Hipovolemia, hiperosmolar
4. Lipolisis, asidosis
5. Nitrogen balance is negative because the protein used glukoneogenesis