Konsultasi DM

[3/18, 13:20] Pasien ( A )๐Ÿ‘๐Ÿผ:

[3/18, 13:20] A๐Ÿ‘๐Ÿผ:

Selamet siang dokter aku mau periksa ini
[3/18, 13:20]

Dokterku: Ya silahkan ceritanya
[3/18, 13:23] A๐Ÿ‘๐Ÿผ:

Pada kesempatan iniย aku mau konsultasi kesehatan tentang penyakit saya yang sudah lama dok

[3/18, 13:26] Dokterku: Oh dalam catatan medik klinik bpk menderita penyakit diabetes , betul?
[3/18, 13:27] A๐Ÿ‘๐Ÿผ: Ya aku sudah mengalami sakit DM sudah lama , aku setiap bulan kontrol di klinik ini untuk pemeriksaan darah gula darah , kholesterol dan as urat
[3/18, 13:28] Dokterku: Sekarang bpk periksa lagi darah nya supaya aku mengetahui perkembangan kemajuannya
[3/18, 13:32] A๐Ÿ‘๐Ÿผ: Ini dok hasilnya
Gula darah puasa 200 mg/dl
Kholesterol 200 mg/dl
Asam urat 5 mg/dl ….
Bagaimana dok
[3/18, 13:40] Dokterku: Oh perkembangannya untuk kadar gula darah belum ada kemajuan , bapak tetap meminum obat anti diabetes telan yang biasa saya resepkan
Bapak harus tetap melakukan olah raga pagi hari setiap hari selama 1/2 jam untuk kebugaran
Bpk menjaga makan , makan yang jangan berlebihan kadar gulanya , nasi sekali lalu menu makan berikut tidak nasi , boleh kentang atau ketela .
Minum tidak usah dengan gula tebu , sedikit sajaย ย  , gula pengganti jangan diminum … hati hati efeknya
Sayur sayuran tetap dimakan untuk menurunkan kadar gula bisa pare, bisa kacang polong.
Buah buahan tetap dimakan tiap hari pilih alpokat, apel bagus untuk turunkan gula darah.
[3/18, 13:42] A๐Ÿ‘๐Ÿผ: Terimakasih dokter atas nasihat nya , saya ingin keterangan lebih lengkap dok tentang Diabetes , bisa di teks ke WA saya ?
[3/18, 13:43] Dokterku: Ini pengelolaan Diabetes yang sudah di bukukan … Selamat mempelajari
[3/18, 13:4]

Dokterku:

Diabetes tipe 1

About

Autoimmune islet cell destruction leads to need for exogenous InsulinUsual endogenous Insulin production is 16-24 u per dayInsulin allows glucose and potassium to enter into cells

Aetiology

Autoimmune islet cell destruction and associations with HLA D3 and HLA D4Type 1 diabetes is a cell mediated autoimmune disease against pancreatic beta cellsMost evidence suggests a T cell mediated disorderC-peptide can be assayed as a marker of endogenous insulin secretionRaised Glutamic acid decarboxylase (GAD) is seen in Type 1 DiabetesAnother possible autoantigen is insulinoma-associated protein 2 (IA-2)GAD is useful in identifying late presenting Type 1s -“LADA” latent autoimmune diabetes of adult

Clinical

Polyuria, Polydipsia and weight lossOral or Genital balanitis/vulvitisDiabetic ketoacidosisKetone breath, Kussmaul’s respirationConfusion

Later complications

Hyperglycaemia often picked up on urinalysis or blood testLater Eye problemsStroke, Myocardial infarction/IHD, Peripheral vascular diseaseImpotence, Foot ulcers, ObesityNephropathy

International definitions

Normal Fasting sugar < 6.1 mmol [110 mg/dl] and 2 hr 7.0 mmol [126 mg/dl]Impaired Glucose tolerance OGTT 2 hr Glucose > 7.8-11 mmol/l [140-199 mg/dl]Diabetes : Random > 11.1 mmol/l [200 mg/dl] + symptoms (if not repeat another day)

Investigations

Islet cell antibodies (ICA) 80%Glutamic acid decarboxylase antibodies(GAD) 90%Insulin autoantibodies (IAA)FBC, U&E to look for renal diseaseLipids – screen for and treat dyslipdemiasECG – evidence of IHD or LVHCXR to assess heart sizeRetinal photography to document eye disease

Management

  • all need InsulinSee separate topic on Diabetic ketoacidosisWeight loss, dietary advice, risk factor assessment, smoking cessation, exerciseInsulin is given in several different methods all trying to mimic the normal physiological insulin responseNormal requirements are 16-24 units per dayThere is often a honey moon period after a few weeks in which insulin requirements drop

Regimens

Insulin is given subcutaneously usually in varying sites to avoid local complicationsMixed Intermediate/soluble insulin given bdBasal/Bolus where 50-60% of the insulin is given as a long acting basal dose and then a dose of soluble short acting is given with meals.For those who fail these methods with a HbA1C above 7.5 then an insulin pump may help

For educational use only. Check all unfamiliar drugs in the BNF/Desktop reference or Drug data sheet. Information is constantly changing. May contain errors or omissions. All doses refer to Adults. All liability is with the prescriber.
[3/18, 13:48] Dokter ku:

Diabetes tipe 2

About

Autoimmune islet cell destruction leads to need for exogenous InsulinUsual endogenous Insulin production is 16-24 u per dayInsulin allows glucose and potassium to enter into cells

Aetiology

Autoimmune islet cell destruction and associations with HLA D3 and HLA D4Type 1 diabetes is a cell mediated autoimmune disease against pancreatic beta cellsMost evidence suggests a T cell mediated disorderC-peptide can be assayed as a marker of endogenous insulin secretionRaised Glutamic acid decarboxylase (GAD) is seen in Type 1 DiabetesAnother possible autoantigen is insulinoma-associated protein 2 (IA-2)GAD is useful in identifying late presenting Type 1s -“LADA” latent autoimmune diabetes of adult

Clinical

Polyuria, Polydipsia and weight lossOral or Genital balanitis/vulvitisDiabetic ketoacidosisKetone breath, Kussmaul’s respirationConfusion

Later complications

Hyperglycaemia often picked up on urinalysis or blood testLater Eye problemsStroke, Myocardial infarction/IHD, Peripheral vascular diseaseImpotence, Foot ulcers, ObesityNephropathy

International definitions

Normal Fasting sugar < 6.1 mmol [110 mg/dl] and 2 hr 7.0 mmol [126 mg/dl]Impaired Glucose tolerance OGTT 2 hr Glucose > 7.8-11 mmol/l [140-199 mg/dl]Diabetes : Random > 11.1 mmol/l [200 mg/dl] + symptoms (if not repeat another day)

Investigations

Islet cell antibodies (ICA) 80%Glutamic acid decarboxylase antibodies(GAD) 90%Insulin autoantibodies (IAA)FBC, U&E to look for renal diseaseLipids – screen for and treat dyslipdemiasECG – evidence of IHD or LVHCXR to assess heart sizeRetinal photography to document eye disease

Management

  • all need InsulinSee separate topic on Diabetic ketoacidosisWeight loss, dietary advice, risk factor assessment, smoking cessation, exerciseInsulin is given in several different methods all trying to mimic the normal physiological insulin responseNormal requirements are 16-24 units per dayThere is often a honey moon period after a few weeks in which insulin requirements drop

Regimens

Insulin is given subcutaneously usually in varying sites to avoid local complicationsMixed Intermediate/soluble insulin given bdBasal/Bolus where 50-60% of the insulin is given as a long acting basal dose and then a dose of soluble short acting is given with meals.For those who fail these methods with a HbA1C above 7.5 then an insulin pump may help

For educational use only. Check all unfamiliar drugs in the BNF/Desktop reference or Drug data sheet. Information is constantly changing. May contain errors or omissions. All doses refer to Adults. All liability is with the prescriber.

( aemxx )

Iklan

One thought on “Konsultasi DM

Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:

Logo WordPress.com

You are commenting using your WordPress.com account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s