Diagnosa Lab. pd Metabolisme- KHO dan DM Prof.Iman Sukiman Sp.PK (KH)

Met. KHOPemeriksaan UrinGlukosa darahHbA1c / Hb A1 totalFructosaminInsulinC-peptideBadan ketonAnalisa gas darah dll

PEMERIKSAAN URIN1.Pemeriksaan Reduksi a.tes Benedict b. tes Fehling 2. GOD paper a. Clinistix - red b. Tes-tape - yellow c.Diastix - brown

Pemeriksaan UrinUrinalisa a. protein ; albumin mikroalbuminuria < 60 mg/dl b. keton bodies c. pH urin dll

Interpretasi Pemeriksaan urineTes- tes Reduksi selain glukosa . Semua zat mempunyai gugus reduksi false positiveGlukosuria bila kadar glukosa darah > Tm ginjal Mikroalbumin , < 60 mg% sulit ok urine ditampung 24 jam, sekarang alb/creatin index ( n : < 3 a/c index)

GLUKOSURIA140901261651/212TMKGDWAKTU3

Glukosa darahOxydation reduction methodsEnzymmatik methodsPlasma, serum, whole blood ( conv.1.15Capiller, vena, arteri

Pemeriksaan glukosa darah1. oxidation-reduction methods a. Alkaline cupric reduction - Folin Wu- Benedict - Shaffer Hartmann- Samogyi - Nelson Somogyi b. Alkaline ferric reduction -Hagedoem-Jensen

Pemeriksaan glukosa darah2.Enzymatic methods a. Glucose Oxidase Colorimetric Kenetic b.Hexokinase

Normal Impaired DM

GDP< 110 mg%110-125 mg% > 125 mg %2h GD< 145 mg%140-200 mg%>200mgAd-rendumSymptom poSitive > 200 mg/ dl

Interpretasi pem.glukosa darahHyperglicemia bila GDP > 125 mg/dlNormoglicemia 90 110mg/dlHypoglicemia < 60mg/dl GDP WHO sebelum 1997 DM > 140 mg/dParis Prospective Study, American Collect for Endocrinology GD 2 H PP > 140mg/dl

Hb A1 C atau Hb A1 totalTerkontrol /tak terkontrolHbA1c HbA1 total HbA1a, HbA1b, HbA1c< 8% < 9%HbA1c seumur eritrosit rigid/ tidak fleksibel ggn mikrosirkulasi

FructosamineTerikat pada proteinMasa paruh 3 bulan monitor jangka menengah 1-3 mingguPemeriksaan sulit

InsulinDibtk di sel beta pulau Langerhan pancreasPreproinsulin proinsulin insulin dan c-peptida sel target otot, hati, otak, syaraf, sel adiposa metode pemeriksaan RIA, Elisa, EIA

C-peptida1 mol. C-peptide = 1 mol.insulin masa paruh lebih lamaDilakukan utk mengetahui def. InsulinTidak terpengaruh dengan insulin exogen

Badan keton dan Analisa Gas DarahMet. katabolisme lemak dominanPada urinPada darah ( Dune - Shipney )AGD ( Analisa Gas Darah ) Acidosis metabolik .Pernapasan Kussmaull

DMDM tipe IGenetikSejak anakSering keto asidosisInsulin rendah 0C.peptida rendah->0DM tipe 2Predisposisi> 30 tahunHyperinsulinismRespon obat hypoglicemik oral

DM type 2Epidemiologi meningkat pd popul. pacific. developing countries, afrika dan spanish america, pend aborigin, asia2010 2025 150 250 juta

GenetikSex, Umur dan etnikBehavior dan lifestyleMet.determination , intermediate risk category of type DM

GenetikMonogenik / poligenikAss. Insulin resisten Mutasi gen insulin receptor Type A insulin resisten, Leprechaunism, Rabson-Mendelhall sind. Liproatrophy DM Mutasi PPAR y genAss. Defek insulin sekresi Mutasi gen insulin/proinsulin, Mutasi gen mitochondria, Maturity Onset Diab.of the Young ( MODY ) MODY 1 ( HNF-4a), 2 (Glucokinase, 3 (HNF-1a), 4( IPF-1), 5 (HNF-1 b) , 6 ( NeuroD1/ beta2 )

Model sel beta pankreasNucleus glukosa tranp HNF-4a GlukosaHNF- 1a iIPF-1 i GlukokinaseHNF-1b , NeuroD1 G6PD Mitochondria i glykolisis Krebs cycle ATP ATPintracellularCa store

Ins granule

Insulin sekresi Ca++

DemografiSex wanita > laki lakiUmur >, DM > etnik/ ras

Behavior dan lifestyleObesitasAktivitas FisikDiet StressWesternisasi, urbanisasi, modernisasi

Met determinasi dan intermediate kategori DMImpaired Glucose ToleranceInsulin resistenKehamilan related varitas, gestasi,intra uterin malnutrition, overnutrition

Managemen DM type 2ProblemScreening dan diagnosaGuideline Intervensi lifestyleFarmakopiPencegahanprognosa

DM tipe 1DM type IA (Immune mediated )Anti-islet autoantibody ( RIA )Risk factors DM, obesitas, HLA Cpeptide, HbA1c, DM Type IB ( with severe insulin deficiency)

HLA class 2, HLA class 1Monogenic form of type IA AIRE ( AutoimmumPolyendocrine Synd.) Scurvy gene, X linked polyendocrinopathy,immume dysfuction and diarrhoeIdiopathic type IA

KomplikasiAkut Kronik coma neuropathy hiperglikemia retinopathy hipoglikemia nepropathy dehidrasi ganggren ketoacidosis

TERIMA KASIH

Gangguan Metabolisme LemakIman Sukiman

Meth LemakProfil Lemak Total Cholesterol Trigliserida HDL LDL

Total CholesterolMakin tua kadar chol makin tinggiBad chol dan good cholTotal chol meningkat ~ MCI, Stroke dan peny. periferal-vaskular

Rekomendasi hati-hati resiko < 200 mg% 200 220 > 220

TrigliseridaNormo hati-hati resiko< 200mg% 200- 300 mg% > 300 Hypertriglyceridemia ~ LDL small particle >Meningkat pada Chylomicron dan VLDL

HDLSecara ultra centrifuge HDL- 1 HDL - 2 HDL - 3Good chol.Normo hati-hati risikoLk > 55 < 45 < 35 mg/dlPr > 45 < 35

LDLRumus Friedewarl Tg < 400mg%Enzymatik

Normo hatihati resiko< 150 150 190 > 190 mg%LDL receptor

Ultra centifuge / elektroporesisChylomicronVLDL, I - VLDLHDL 1, 2 dan 3LDL : dense particle LDL low particle LDL

Lain-lainTotal lipidphospholipidApoprotein BApoprotein AApoprotein ELipoprotein a

Hiperlipidemia Familiar

TypePredom > lipoproteinPredom. >lipid contoh I IIa IIb III IV VChylomicronLDLVLDL/LDLBeta VLDLVLDLChylo./ VLDLTrigliseridaCholesterolTRI./CholTri/CholTriTri/ chol LPL def.Fa hyp-cholFa com hypTipe3 hypFa hyp triApo CII def