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COMPLICATIONOF
DIABETES MELLITUSKLINIK DIABETES TERPADU
RS ISLAM KLATEN
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When you have diabetes, youre:
Twenty times more likely to develop
KIDNEY disease Four times more likely to have a STROKE
Four times more likely become BLIND
Two to four times more likely to have a
HEART attack
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Researchers continue to make greatprogress what triggers complication DM
& how to manage or prevent them
Blood sugar close to normal reducerisks of complication
Controlled blood sugar not to late tostart (As soon as begin managing blood
sugar level slow the progression ofcomplication & reduce chances ofdeveloping still more healthn problems
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COMPLICATIONS of DM
ACUTE
1.Diabetic ketoacidosis (DKA)
2.Hyperglycemic hyperosmolar state (HHS)
3.Hypoglycemia 4. Lactic acidosis
CHRONIC
1.Microangiopathy (retinopathy, nephropathy,neuropathy, Cardiomyopathy, Diabetic foot, etc)
2.Macroangiopathy (Heart attack/IMA, Stroke,
PAD)
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Acute complications
Medical emergencies, complications are
these spark medical emergencies
requiring immediate attention.
This include low blood sugar, high blood
sugar and excessive blood acids.
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PATOFISIOLOGI KAD & HHS
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laktic acid
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DKA
Occurs when muscle cells become sostarved for energy that body takesemergency measures & breaks down fat toxic acids as ketones
Most common type 1 DM insufficientinsulin to adjust raise of blood sugar
Cause by extreme stress or illness
Infection body produce adrenalinworks against insulin
Forget to take insulin
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Sign & symptom of DKA
Deep, rapid breathing
Sweet, fruity smell on breath
Loss of appetite
Nausea
Vomiting
Fever
Stomach pain
Weight loss
Fatigue
Weakness
Confusion Drowsiness
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Clinical presentation
Lost more than 5% body weight
More than 35 breaths a minute
Cant control blood sugar Become confused
Nausea and vomiting
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What should you do?
Check ketones if feeling especiallystressed or blood sugar persistently above240mg/dL
High ketones in blood ketones excretedin urine.
High ketones in urine must treatment &
stay in hospital DKA can lead into coma and posibly
death.
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Treatment
Replenishing lost fluids through i.v. line
Insulin combined with glucose, injected
into iv stop making ketones
Gradually blood sugar level back to
normal, if quickly can produce swelling in
the Brain
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HHS
Blood sugar reaches such a high level that bloodbecome thick and syrupy (level >600 mg/dL)
Cells cant absorb much blood sugar, the sugar
passed from blood to urine draws tremenous
amounts of fluid from body and producesdehydration
Common in type 2 DM, especially who dont
monitor blood sugar and who dont know have DM Trigger factors: high-dose steroid, diuretics,
infection, illness, stress or drinking excessive
alcohol
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HHS, sign & symptom
Excesive thirst
Increased urination
Weakness
Leg cramps
Confusion
Rapid pulse
Convulsions
Coma
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What should you do?
Check blood sugar level (> 600mg/dL)
Emergency treatment can correct the
problem within hours
Give intravenous fluids to restore water to
the tissue
Short acting insulin to help cells canabsorb glucose
Without prompt treatment can be fatal
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Hypoglycemia Blood sugar level
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Sign & symptom of Hypoglycemia
Later symptomp (BG < 40mg/dL)
Slurred speech
Drunkenlike behavior
Drowsiness
Confusion
Emergency symptoms (BG
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Hypoglycemia unawareness
Some people had DM for several yearsdont experience early symptoms of hypoglycemia, such as shakiness or
nervousness because chemicalchanges from long standing DM may maskthe symptoms or keep them for occuring
This condition may not realize blood sugaris low until later symptoms, such asconfusion or slurred speech, set in.
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What should you do?
As soon realize blood sugar is low, eat ordrink somethingraise BG level quickly.Example:
Hard candy, equal to about five live savingA regular (not diet) soft drink
Half a cup of fruit juice
Glucose tablets, nonprescription sugarpills made especially for treating low bloodsugar
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What should you do?
If after 15 minutes continue to experiencesymptoms, repeat the treatment. If theystill, contact the doctor.
If lose consiousness or for some otherreason are unable to swallow, thetreatmen of choice is an injection D 40%or glucagon injection (fast acting hormonecontra insulin to stimulate the releasesugar into the blood)
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Alhamdullillah
Thank you for
your attention
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CHRONICCOMPLICATION
OfDIABETESMELLITUS
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Chronic complications
Development of other diseases
Long-term DM complications are those
that develop gradually and that may
become disabling or live-threatening. They
include nerve, kidney, eye, heart and
blood vessel disease
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MICROVASCULAR
RETINOPATHY
NEPHROPATHY
CARDIOMYOPATHYNEUROPATHY
AUTONOMIC CARDIAC
GASTRIC
UROGENITAL
CHRONIC COMPLICATIONS
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CHRONIC COMPLICATION
MACROVASCULAR
CHD RISK 2 4 x
DEATH
60 %
CEREBROVASCULAR
STROKE : 4 x
PERIPHERAL VD
40 50 % NON-TRAUMATICAMPUTATION
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Nonproliferatif
Mild & most common
Blood vessel in retina become weak &swell or bulges or fatty deposits
Doesnt affect in the vision unless
Responsible for sharpest visionProliferatif
Tiny blood vessel are damage, bleed or
close off New & fragile of blood vessel in retina may
bleed
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If bleeding is heavy or occurs in the certain
it can obscure your vision
New blood vessel (neo vascularisation)also can form scar tissue can push & pull
on your retina and distour vision
Special treatment by an optalmologist wthLaser or Vitrectomy
Important to cath the disease early so that
it can be treated
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Sign & symptom
Spiders cobweb or tiny specks floating in an eye
A gray shadow in the filed vision
Blurred vision
Blurred word while reading
A dark or empty spot in the center vision
Dark streaks or red film that block vision
Eye pain
Flahes or light or rings around objects
Srait line that appear distorted
Vision loss
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How is it Treated? (retinopathy)
Reguler eye examinations to identity problemearly
Laser procedure to seal weak blood vessel
In most cases only one eye is treated at a time may several treatments pain
Bleedin in the middle eye need surgicalprocedure to remove the blood an replace with
clear fluid Detached (ablatio) retina by scar tissue requires
surgery to position the retina in place
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Nephropathy
Inside kidney are million tiny blood vessel filter waste from the blood disposed tourine
DM can damage this delicate filteringsystem, before developed any symptom
More 3/10 type 1 DM nephropathy
1/10 type 2 DM nephropathy Type DM younger, longer have DM higher
risk of kidney damage
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Sign & symptom
Swelling of ankles, feet and hands
Shortness of breath
High blood pressure
Confusion or difficulty concentrating
Poor appetite
Nausea and vomiting
Dry, itchy skin
Fatigue
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How is treated? (nephropathy)
Treatment depends on how advance thedisease is. Keeping BG level normal can preventyour condition from getting worse, possiblyimprove.
ACE inhibitors may help hypertension & heart
problem ARB can improve kidney function and decrease
microalbuminuria
Low pretein diet seems to reduce workload of
kidney (consult doctors & dietician) Severe damage with (ESRD) transplant,
Hemodialyse or CAPD (continous ambulatoryperitoneal dialyse)
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Neuropathy
Have an intricate network of nerves runs
throughout the body, connecting brain to
muscles, skin and other organs.
Brain senses pain, control the muscles,
and perform automatic task such as
breathing and digestion
Neuropathy affect 6/10 type 2 DM
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Sign & symptom
Many kind of nerve damage
Weakened muscles & an unsteady walk
Autonomic nerves can increase heart rate
& perspiration level In men can interfere to ability erection
In sensory nerves damage unable
detect sensation such as pain, warmth,coolness and texture
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Sign & symptom
Commonly damage often in the legs, less in thearm
Tingling feeling, numbness, pain or combination
these sensation
Burning pain comes and goes
Discomfort as a crawling sensation
Begin in tips of toe or finger or both and
gradualy spread upward Damage nerve in toe, if untreated can lose of all
sensation high risk for injury without realizing
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Sign & symptom
Foot care very important
If lost feeling in the feet and not to check
them each day, may not realize have a cut
or open wound until serious infection
The main cause of amputations in DM
60.000 amputation each year in DM
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How is it treated? (neuropathy)
Good BG control will reduce your symptoms
To relieve pain: pain reliever or antidepressantor
antiseizure medication
Capsaicin cream (hot pepper extract) Other therapy: accupuncture, biofeedback and
relaxation techniques
Type 2 DM patients
dont burn themself whenbathing or electric blanket or heating pad. Guard
against frost bite in cold temperature
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Heart and blood vessel
DM dramatically increased your risk of developing
one of many cardiovascular problems, including: Chest pain (angina)
Heart attack
Stroke
Narrowing of the arteries (legs and brain poorblood circulation) peripheral vascular disease
High blood pressure
DM can damage mayor arteries (supply heart &brain) easier for fatty deposits (plaques) increase pressure in arteries & reduce bloodcirculation
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Sign & symptom
Symptoms heart disease vary. Early stage produce nosymptom. Later may include:
Shortnss of breath
Pain of the chest, jaw or arm
Fatigue or weakness Swelling (edema)
Lightaheadness
Rapid or irreguler heart beat (palpitation)
Excessive perspirationPeople with DM are particular risk for silent (asymptomatic) heart attacks without typical symtomps (painless)
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How it is treated?
Many forms of heart disease are treatedwith medicationto prevent symptom fromworsening
If accumulation of plaques in the arteriesmay procedure angioplasty to openarteries sometimes bypass arteriessurgery
To prevent including healthy diet, moreexercise, stopping smoking, losing weight(if over weight)
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Risk of infection
High BG impaired function the immunecells to fight off germ & bacteriainfection
Location: mouth, gums, lungs, skin, feet,bladder and genital
High BG damage nerve otherwisealert infection
damage nerves to control bladder
sensation
fail alert bladder is full
overstreched lose muscle tone abilityyo empty completely bacteria may grow infection
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Sign and symptom
Many vary depending location of infection
Low grade fever
Gum : red and bleeding
Bladder: frequent urination, urgency and
burning sensation
Vagina: itching &/or discharge in vagina Foot: redness & pus are warning an
infection
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How it is treated?
Antibiotic to kill bacteria
A foot injury: procedure to clean the
injured area and remove infected tissue
Reduce risk of gum disease by brushing
and flossing the teeth regularly
Reduce risk of bladder infection by going
the bathroom regularly and making sure to
empty the bladder
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MEDICATION of IMPOTENCE
I. Sildenafil (Viagra, Androz, Edegra,Silagra) isnt effectivefor everyone
1hour before activity effective 4 hours
II. Alprostadil (synthetic of prostaglandin E-1)
not a pill self intraurethral (a grain rice)or self injection therapy (5-20 minutes before and 1 hour
erection)
III. Vacuum device
IV. Penile implanta. semirigid, benabled rod (permanent erection)
b. inflantable (with pump in scrotum produce an erectiononly when you want)
V. Counseling (if psychologycal factors)
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Preventing complication Tight BG control normal or near-normal
Diabetes Control and Complication Trial(DCCT): Tight BG control reduce 50% risk ofmany complication
United Kingdom Prospective Diabetes Study
(UKPDS):Keep BG normal: 1/4 fewer complications (eyes,kidneys and nerves) and reduce risk of heartdisease
Kumamoto study: the intensive insulin therapyhave delay in the start and progression of eye,kidney and nerve complication
SELF CARE
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SELF CARE:
Reducing risk of complication
Have a yearly physical examination
Get a yearly eye examination
See the dentist regularly
Keep up to date vaccination (flu, pneumonia) Care the feet
Dont smoke
Take a daily aspirin
Monitor blood pressure
Manage stress
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