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Hipoglikemia i DR. Dr. Andi Makbul Aman, SpPD, K-EMD, FINASIM HIPOGLIKEMIA DALAM PRAKTIK SEHARI-HARI ii HIPOGLIKEMIA DALAM PRAKTIK SEHARI-HARI Penulis : Andi Makbul Aman Mansyur ISBN : 978-602-61363-4-3 Diterbitkan Oleh : Departemen Ilmu Penyakit Dalam Fakultas Kedokteran Universitas Hasanuddin 2018 Hak Cipta Dilindungi Undang-Undang : Dilarang memperbanyak, mencetak dan menerbitkan sebagian atau seluruh isi buku ini dengan cara dan bentuk apapun tanpa seizin penulis dan penerbit iii Pengantar dari Penulis Hipoglikemia merupakan kondisi klinis yang ditandai oleh penurunan kadar glukosa darah melewati ambang batas yang bisa ditoleransi oleh tubuh. Hipoglikemia sering dijumpai dalam praktek sehari-hari, baik pada pasien rawat jalan maupun pasien rawat inap di rumah sakit. Bila tidak terdeteksi dan tidak mendapat terapi dengan cepat akan menimbulkan konsekwensi dan komplikasi yang serius. Kualitas hidup pasien hipoglikemia terutama yang berulang akan menurun, menyebabkan kerusakan otak ringan hingga permanen bahkan dapat menjadi pemicu terjadinya penyakit jantung koroner dan kematian secara mendadak. Tujuan penulisan buku ini adalah untuk memberikan informasi lengkap tentang definisi, prevalensi, jenis dan klasifikasi serta dampak dari hipoglikemia, baik untuk pasien diabetes melitus maupun untuk pasien non-diabetes. Dipaparkan pula tentang tatacara diagnosis dan terapi dari hipoglikemia. Penulis menyampaikan terima kasih kepada semua pihak yang telah membantu mulai saat merancang hingga tahap penulisan buku ini selesai. Ucapan terima kasih terutama penulis haturkan kepada Bapak Prof. Dr. dr. Ahmad Rudijanto, SpPD, K-EMD, FINASIM selaku ketua umum PB. PERKENI periode tahun 2012-2015 dan 2015-2018 atas dukungan serta kesediannya untuk memberikan kata sambutan pada buku ini. Demikian pula kepada Bapak Prof. Dr.dr. H. Syakib Bakri, SpPD, K-GH, FINASIM yang senantiasa memberikan gagasan, semangat, bantuan literatur serta saran dan koreksi sehingga buku ini berhasil diterbitkan. iv Buku ini masih jauh dari kesempurnaan, namun diharapkan akan menjadi salah satu bahan referensi dan acuan bagi para mahasiswa fakultas kedokteran, peneliti, dokter umum dan dokter spesialis serta praktisi kesehatan lainnya sehingga turut berkonstribusi dalam upaya meningkatkan kualitas pelayanan kesehatan masyarakat. Makassar, Februari 2018 Penulis, A. Makbul Aman Mansyur v KATA SAMBUTAN Ketua Umum Pengurus Besar Perkumpulan Endokrinologi Indonesia (PB.PERKENI) Periode 2012-2015 dan 2015-2018 Hipoglikemia merupakan suatu kondisi klinik yang dapat bersifat emergensi dan memerlukan penanganan yang cepat dan tepat sehingga dampak dari hipoglikemia itu dapat diminimalisir. Hipoglikemia yang tidak tertangani dengan baik akan menimbulkan dampak yang tidak diinginkan seperti: penurunan kualitas hidup, gangguan fungsi kognitif, penurunan kesadaran, bahakan dapat menjadi pemicu penyakit kardiovaskuler yang dapat menjadi penyebab kematian. Hipoglikemia sering ditemukan dalam praktek sehari-hari, terutama dialami oleh pasien diabetes mellitus (DM) yang mendapat terapi obat anti diabetes, khusunya insulin atau obat oral yang meningkatkan pelepasan insulin dari sel- beta (sulfonylurea atau glinid). Kekhawatiran terhadap risiko hipoglikemia merupakan hambatan utama bagi para klinisi dan pasien dalam upaya pencapaian target glikemik yang diinginkan pada pasien DM. Hipoglikemia juga dapat dialami oleh pasien non-diabetes, terutama pada beberapa kelainan endokrin dan juga pada kondisi klinis tertentu. Hipoglikemia bahkan dapat dialami oleh individu dengan kondisi kesehatannya normal. Dalam buku ini dijelaskan dengan cukup lengkap tentang kondisi hipoglikemia, mulai dari homeostasis glukosa darah yang normal, prevalensi, jenis, penyebab, patogenesis, komplikasi serta pentalaksanaannya. vi Atas nama PB. PERKENI perkenankan saya mengucapkan selamat dan terima kasih kepada semua pihak yang telah berhasil menyusun buku tersebut. Semoga buku ini dapat menjadi bahan referensi bagi pembacanya dan bermanfaat untuk peningkatan kualitas pelayanan kesehatan, khususnya dalam bidang endokrin dan metabolisme. Jakarta, 10 Februari 2018 PB PERKENI Prof. Dr. dr. Achmad Rudijanto SpPD-KEMD Ketua Umum vii DAFTAR ISI HALAMAN JUDUL ....................................................................... i PENGANTAR PENULIS .............................................................. iii KATA SAMBUTAN KETUA PB. PERKENI ................................... v DAFTAR ISI ................................................................................. vii DAFTAR TABEL .......................................................................... xi DAFTAR GAMBAR ...................................................................... xiii BAB I Pendahuluan BAB II Homeostasis Glukosa Darah A Pankreas sebagai regulator utama metaboliksme glukosa...... 3 B Intraksi pancreas dengan berbagai organ lain dalam pengaturan kadar glukosa darah ............................................. 9 C Respon tubuh bila terjadi hipoglikemia ................................... 13 Daftar Pustaka ............................................................................. 16 BAB III Definisi, Etiopatogensis, Kriteria Diagnostik dan Klasifikasi Hipoglikemia .............................................................................. A Definisi.................................................................................... 20 B Gejala dan keluhan hipoglikemia ........................................... 22 C Akibat hipoglikemia ................................................................ 24 viii D Mekanisme pertahanan tubuh terhadap hipoglikemia ............. 27 E Perubahan hemodinamik pada hipoglikemia ........................... 29 F Klasifikasi hipoglikemia ........................................................... 31 Daftar Pustaka ............................................................................. 35 BAB IV Hipoglikemia pada Pasien Diabetes Melitus A Hipoglikemia pada pasien DM tipe 1 ....................................... 44 B Hipoglikemia pada pasien DM tipe 2 ....................................... 48 C Terapi hipoglikemia pada pasien diabetes melitus .................. 54 D Variasi hipoglikemia pada pasien diabetes melitus ................ 57 Daftar Pustaka ............................................................................. 70 BAB V Hipoglikemia pada Pasien Non-Diabetes A Hipoglikemia reaktif ............................................................... 80 B Hipoglikemia puasa ............................................................... 81 C Penyakit dan kelainan yang berkaitan dengan kejadian hipoglikemia pada pasien non-diabetes ................................. 82 D Diagnosis hipoglikemia pada pasien non-diabetes ................. 99 Daftar Pustaka ............................................................................. 101 ix BAB VI Hipoglikemia Imbas Obat A Hipoglikemia imbas obat anti diabetes ................................... 107 B Hipoglikemia imbas obat non-diabetes .................................. 118 Daftar Pustaka ............................................................................. 132 BAB VII Hipoglikemia pada Pasien yang dirawat di Rumah Sakit A Hipoglikemia pada pasien non-diabetes yang dirawat dirumah sakit.......................................................................... 140 B Hipoglikemia pada pasien diabetes yang dirawat dirumah sakit ....................................................................................... 143 C Pencegahan hipoglikemia pada pasien yang dirawat dirumah sakit ...................................................................................... 147 D Target glikemik pada pasien yang dirawat inap di rumah sakit 148 E Hipoglikemia pada pasien yang dirawat di ruang perawatan umum ..................................................................................... 149 F Terapi hipoglikemia pada pasien yang dirawat inap di ruang perawatan umum ................................................................... 151 G Hipoglikemia pada pasien yang dirawat di ruang perawatan Intensif ................................................................................... 154 H Target glikemik pada pasien yang dirawat diruang perawatan Intensif ................................................................................... 155 Daftar Pustaka ............................................................................. 157 x BAB VIII Hipoglikemia dan Penyakit Kardiovaskuler A Dampak Kardiovaskuler pada Hipoglikemia ........................... 170 Daftar Pustaka ............................................................................. 177 xi DAFTAR TABEL Tabel 2.1. Hormon yang berperan pada mekanisme counter of regulatory respons (CRR) ................................... 15 Tabel 3.1 Penyebab hipoglikemia .......................................... 21 Tabel 3.2. The Wipple’s triad ................................................... 22 Tabel 3.3 Gejala dan tanda hipoglikemia pada orang dewasa 24 Tabel 3.4 Perubahan hemodinamik dan aliran darah regional pada hipoglikemia .................................................. 30 Tabel 3.5 Klasifikasi hipoglikemia berdasarkan manifestasi klinik, kadar glukosa darah dan kemampuan untuk menolong diri sendiri .............................................. 33 Tabel 4.1 Penyebab terjadinya hipoglikemia pada pasien diabetes melitus ..................................................... 41 Tabel 4.2 Klasifikasi hipoglikemia pada pasien diabetes melitus menurut ADA workgroup 2013 ..................
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