Blok Endokrin

Profil Lipid dan Karbohidrat

Sulistyo M. Agustini
FK.UMM
2012
 Referesi
• Fischbach FT, Dunning MB,. 2009. A Manual of
Laboratory & Diagnostic Test.342-357; 448-462
• Desai SP, Isa-Pratt S, 2000. Clinician’s Guide to
Laboratory Medicine. 269-282
• Mahley RW. 2008. Metabolism Lipid in Williams
Textbook of Endocrinology, 11th ed. Chap.30-33; 36
• PERKENI, 2011. Konsensus DM tipe 2
• McPherson R, Pincus MR. 2007. Henry’s Clinical
Diagnosis & Management by Laboratory Methods. 21st
Edition. Sauders Elsevier. 185 – 198; 200- 219
 Pendahuluan
• Studi Epidemiologi terbaru Indonesia “ Epidemi
DM 2” perubahan gaya hidup & urbanisasi
• ± 50 % belum terdiagnosis 2/3 terdiagnosis &
menjalani pengobatan baik scr farmakologi/ non
farmakologi
• Komplikasi DM dpt dicegah dg kontrol glikemik yg
optimal di Ind belum tercapai, Hb A1c (8%)
• Dx : klinis dan Laboratorium ( Pemeriksaan kimia
klinik, & Urinalisa)
Regulation of glucose metabolism
Profil, Diabetes Testing, Blood Glucose
• Basic metabolic screen:
• Standard Panel: Cloride, sodium, potassium, Co2, BUN, creatine,
“Glucose”

• Fasting Blood Glocose

• Hemoglobin A1c (Hb A1c)
• Glucose Tolerance Test (GTT); Oral Glucose Tolerance Test
(OGTT)
• Lactose Tolerance; Breath Hydrogen Test
• Related Test That Influence Glucose Metabolism C-Peptide
• Glucagon
• Insulin
 Disorders of Glucose
Function of the Endocrine Pancreas
• Insulin ( Peptide Hormon, 5800 dalton, by β cells
in the is lets of Langerhans Pancreas)
• Glucagon (Proglucagon is synthesized in
pancreatic α cells & L cells of distal small bowel)
• Somastatin (Hypothalamic hormone)

 Disorders of Glucose
• Hypoglycemia
• Hyperglycemia
 Glucose Measurement Methods
Whole blood glucose
Fasting Pls 2 h Pls Glucose
Glucose

Normal <100mg/dL <5,6mmol/L <140 mg/dL <7.8mmol/L

Pre-Diabetes
• Immpaired fasting 100-125 5.6 - 6.9
glucose
• Immpaired 140 -199 7.8 -11.0
glocose tolerance

Diabetes mellitus ≥ 126 ≥ 7.0 ≥ 200 ≥ 11.1

From American Diabetes Association, 2004a. Henry’s 2007

 Diagnosis DM
• Keluhan klinis klasik (Poliuria, Polidipepsia, polifagia
& berat bdn turun tanpa sebab yg jelas)
• Keluhan lain: lemah badan, kesemutan, gatal,
disfungsi ereksi (laki2), pruritus vulva (wanita)

3 Kategori :
1. Klinis klasik + glukosa plasma sesaat : ˃ 200 mg/dl
2. Glukosa plasma puasa: ≥ 126 mg/dl+ klinis
3.Test Toleransi glukosa oral (TTGO) 75 gr: ˃ 200 mg/dl
• Pemeriksaan HbA1c (>6.5%) oleh ADA 2011
• 1. Gejala klasik DM + glukosa plasma sewaktu
200 mg/dL (11,1 mmol/L)
Glukosa plasma sewaktu merupakan hasil
pemeriksaan sesaat pada suatu hari tanpa
memperhatikan waktu makan terakhir
Fig. 2. A flow chart of sequential metabolic and neural events initiated by the consumption
of energy-rich diets leading to leptin insufficiency in the brain and derangements in the
hypothalamic regulation of insulin secretion, glucose metabolism, and energy expenditure
that together promote fat accrual and metabolic disorders including type 2 diabetes.
(Printed with permission from Kalra [6].) BBB, blood–brain barrier.
Komplikasi DM terhadap Organ-2
 Clinical Implications
• Hyperglycemia (glucose drh↑)
1. DM : - fasting glucose > 126 mg/dL
- 2 h Post prandial > 200mg/dL atau oaral GTT

2. Other Condition:
1. Cushing disease (glucocorticoids ↑)
2. Acute emotional (physical stressMI, convulsions)
3. Pancreatitis
4. Glucagonoma
5. Chonic Renal Disease
6. Vit B deficiency
7. Pregnancy
• Hypoglicemia (Blood plasma glucose↓):

1. Pancreatic islet cell carcinoma (insulinomas)

2. Addison’s disease (adrenal insufficiency), Ca of
adrenal gland
3. Hypopituitarism, Hypothyroidism, ACTH
deficiency
4. Liver damage
5. Premature infant
6. Insulin over dose