1. Management of Diabetes mellitus Prof. Dr. Surya Dharma, MS, Apt. Fakultas Farmasi Unand

2. Problems Increased of prevalence Cronic complications ex. Diabetic Foot Problems Prevention, primer, secunder tertier

3. Etiology of Insulin Resistence Weight gain Obexisity Circulation FFA Lipoatrophy adipokines Insulin Resistance The subnormal biologic response to a given concentration of insulin Physical inactivity Aging Genetica

4. Etiology of  -Cell Dysfunction Genetics Lipotoxicity Glucose toxicity  -Cell Failure Inadequate compentation for insulin resistance and selective non-responsivoness to glucose Loss of  -cell …… ? Cytokines ? Amyloid accumulation

5. The Role of Genes and the Environment Normal GENES Environment Insulin resistance Diabetes genes insulin resistance genes  -cel function genes Obesity genes Decreased Insulin secretion Type DM Diet Activity Toxins

6. Risk Factors for Type 2 Diabetes Genetic factors -Ethnicity -Family history Gastational Diabetes polycystic Ovarian syndrome, and party Type 2 Diabetes Increasing age Central obesity Physical inactivity Diet

7. Pathophysiology of DM Hepatic glucose Production (HGP Peripheral Glucose Uptake Blood Glucose

8. Macrovascular Complication of Type 2 Diabetes 80% of people with type 2 diabetes thr from CVD ~ Coronary heart disease (CHD) - eg, angina, heart attack, heart failure - 2-to 4-fold increased risk ~ Cerebrovascular disease - eg, stroke, transient ischemic attacks - 2-to 4-foid increased risk ~ Peripheral vascular disease - eg. Intermittent claudication, gangrene, amputations

9. Complek interaction between Periperal neuropaty Micro angiopathy Macro vascular disease Poor foot hygiene Diabetic Foot Problems

11. Peripheral neuropathy with loss of pain sensation is the commount cause of fort ulceration, closely followed by poor higiene

13. Management of foot problems Education center Metabolic control Mechamical control Wound control Microbiological control

14. Management of Diabetes Mellitus Monitoring of Glucosa levels Food planning Phsical activity Treatment of hyper glycemid Treatment of Cardiovascular risk factor

15. Milestones of Diabetes Management Nutrition th/ Education Exercise Anti hypergly- cemic ogents