resistensi insulin pasca operatif

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RESISTENSI INSULIN PASCA OPERATIF

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penataksanaan resistensi insulin pasca operatif

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Page 1: Resistensi Insulin Pasca Operatif

RESISTENSI INSULIN PASCA OPERATIF

Page 2: Resistensi Insulin Pasca Operatif

DEFINISI• Resistensi Insulin dilemahkan respon insulin kegagalan kontrol gula darah

• Resistensi insulin pasca operatif transien

STRESS HIPERGLIKEMIA GDP > 126 mg/dL atau GDS >200 mg/dL (tanpa riwayat DM) Hiperglikemia + HbA1C < 7%

(dengan riwayat DM)Management of Hyperglycemia in Critical Illness : Review of Targets and Strategies. MJAFI 2011;67:53-7.

Page 3: Resistensi Insulin Pasca Operatif

KOMPLIKASI

Stress hyperglycaemia. Lancet 2009;373:1798-807

Page 4: Resistensi Insulin Pasca Operatif

PATOFISIOLOGI

Insulin resistance: An adaptive mechanism becomes maladaptive in the current environment — An evolutionary perspective. METABOLISM CLINICAL AND EXPERIMENTAL 2013;62:622-33

Page 5: Resistensi Insulin Pasca Operatif

PUASA PRE OPERATIF

ASA :6 jam makanan padat2 jam clear liquid

- ~ tidak memiliki kalori- Puasa pre operatif 16-

18 jam hal tak terduga

FUEL METABOLISM IN STARVATION. Annu Rev Nutr 2006;26:1-22

Page 6: Resistensi Insulin Pasca Operatif

PUASA PRE OPERATIF

Short-term starvation and mitochondrial dysfunction – A possible mechanism leading to postoperative insulin resistance. Clinical Nutrition 28 (2009) 497–509 2009;28:497-509

Page 7: Resistensi Insulin Pasca Operatif

TINDAKAN PEMBEDAHAN

Nutrition and Metabolic Control. In: Miller RD, ed. Miller's Anesthesia. Seventh ed. United States of America; 2009

Page 8: Resistensi Insulin Pasca Operatif

TERAPI GIZIESPEN dan ERAS Minuman karbohidrat (12,6 g karbohidrat/100 mL) atau maltodextrin 12,5% (50 g karbohidrat) yang diberikan sebanyak 800 mL pada malam sebelum operasi dan 400 mL pada saat 2-3 jam sebelum operasi

MENURUNKAN RESPON FASE AKUT

MENURUNKAN RESISTENSI INSULIN

Page 9: Resistensi Insulin Pasca Operatif

TERAPI GIZI

Pemberian minuman karbohidrat pre operatif :Merangsang sekresi ghrelinMenghambat pelepasan hormon kortisolMeningkatkan IGF-IMenekan ekspresi PDK4Meningkatkan pensinyalan insulin pada jalur

P13

Page 10: Resistensi Insulin Pasca Operatif

TERIMA KASIH