Professional Documents
Culture Documents
Diabetes Mellitus
Hermina Novida
Hyperglycemic Crisis
Diabetic Ketoacidosis (DKA)
Hyperosmolar hyperglycemic state (HHS)
Ketoacidosis Lactate (KAL)
Hypoglycemia In Diabetes Mellitus
The ADA Workgroup recommended that people with
insulin secretagogue or insulin treated diabetes
become concerned about the possibility of developing
hypoglycemia at a self-monitored (or device estimated)
plasma glucose concentration of ≤ 70 mg/dL (≤ 3.9
mmol/L).
50
Patients affected per year (%)
40
30
20
10
0
Sulphonylurea- Insulin- “Standard” insulin Intensively
treated type 2 treated type 2 therapy in type 1 Treated in type 1
diabetes diabetes diabetes diabetes (DCCT)
Factors that Precipitate or Predispose to Hypoglycaemia :
Excessive insulin level
Excessive Error by patient, doctor or pharmacist
dosage
HYPOGLYCEMIA
HYPOGLYCEMIA
• Autonomic
• Neuroglycopenic
Common Symptoms of Acute Hypoglycaemia
in Diabetes Mellitus
+
+
ACTH
+
Established
Capillary blood sample
diagnosis
Oral glucose
(15-20 gram)
Evaluation
Intramuscular glucagon
0.5 – 1 mg Repeat
after 10 ‘
Maintainance
180 – 200 mg%
10% Dextrose Intravenous glucose
20 – 30 ml 50%
dextrose
Practical Guidelines of the Treatment of Hypoglycemia with
Formula 3-2-1-1 for Pts with DM to Avoid “Honey Moon” Phenomena
(Clinical Experiences : Tjokroprawiro 1996-2014)
• Laboratory findings
• Differential diagnosis
History and Physical examination
Perkeni 2015
HHS (HONK) – ESSENTIALS OF DIAGNOSIS
(ADA-2009, Kitabchi et al 2009, Tjokroprawiro 2009-2013)
• IV fluid (NS)
• Insulin (Continuous IV drip/im)
• K+
• Bicarbonate (pH < 7)
……..General management issues !!!!
0.45% NaCl (250 – 500 ml/h) depending 0.9% NaCl (250 – 500 ml/h)
on hydration state depending on hydration state
Insulin has several effects, but the following are the most important when treating
DKA :
• Suppression of ketogenesis
• Reduction of blood glucose
• Correction of electrolyte disturbance
J.Goguen, J. Gilbert / Can J Diabetes 42 (2018) S109–S114
Terapi insulin pada krisis hiperglikemia
Langkah pertama: melakukan resusitasi cairan untuk memperbaiki
deplesi cairan tubuh, bila kadar kalium <3.3 mEq/L, harus diberikan
pemberian kalium terlebih dahulu sebelum pemberian infus insulin
secara kontinyu diberikan
Pada umumnya infus insulin intravena diberikan dengan dosis 5-7 U/jam
(yang mampu menurunkan gluosa darah sebesar 50-70 mg/dL/jam)
Bila penurunan gluosa darah <60 mg/dL/jam perlu diperhatikan
kemungkinan adanya rehidrasi yang kurang atau asidosis yang
memburuk
Bila kadar glukosa darah telah mencapi <250 mg/dL dosis insulin
dikurang menjadi 50% dari dosis sebelumnya. Infus insulin tetap
diberikan sampai ketosis teratasi dan pasien sudah dapat makan/minum
Perkeni 2015
TERAPI KETOASIDOSIS DIABETIK (KAD) - REVISI 2010 68
(Clinical Experiences and Illustrated : Tjokroprawiro 1991-2014)
FORMULA : 2,4,18,24–Time ; FORMULA : 2,80,30,20–Fluid *) F4 : 25 meq K+, dlm 100 ml RL, drip 5 jam
2 4 18 24 TIME
Koreksi HIPOKALEMIA gunakan FORMULA sbb : FORMULA KAD : 2 80 30 20 FLUID
HIPO K: F1, F2, F3, F4 (251005) *)
Hati hati pada pasien CKD dan GAGAL JANTUNG IDRIV AMAN pada kasus HIPOKALEMIA
Monitoring
• Capillary blood glucose - hourly
• Urine output
• Mental status
Resolution of DKA is defined as :