Studi kasus serial ini bertujuan untuk menganalisis tatalaksana nutrisi yang adekuat pada pasien diabetes melitus (DM) dalam mencegah, memperlambat dan memperbaiki komplikasi kronis dengan memberikan tatalaksana nutrisi sesuai kondisi klinis, laboratoris dan status gizi pasien. Hiperglikemia kronis terkait dengan kerusakan jangka panjang, disfungsi, dan gagal organ, khususnya mata, ginjal, syaraf, jantung dan pembuluh darah. Tatalaksana kadar gula darah yang baik dapat menurunkan risiko, menunda onset, dan menurunkan tingkat keparahan dari komplikasi kronis. Komplikasi kronis dari DM terbagi dalam dua kategori, yaitu komplikasi makrovaskular dan mikrovaskular. Ke-empat kasus yang dipaparkan merupakan pasien DM berusia 37-64 tahun yang menderita DM dengan komplikasi makrovaskular dan mikrovaskular. Pemberian kalori pada pasien-pasien kasus serial ini dihitung dengan menggunakan rumus Harris Benedict. Protein diberikan sesuai ada tidaknya nefropati dan tingkat nefropati. Pemberian lemak 25% dari total kalori dengan komposisi sekitar SAFA 7%, PUFA 8% dan MUFA 10%. Kombinasi tatalaksana nutrisi sesuai kebutuhan bersamaan dengan pemberian insulin atau obat antidiabetes mampu mengontrol kadar gula darah mendekati normal. Pemberian protein sesuai dengan kemampuan fungsi ginjal mampu mengontrol kadar ureum dan kreatinin dengan status gizi pasien tetap terjaga. Kesimpulannya : Penatalaksanaan nutrisi pada pasien DM harus bersifat individual, untuk mempertahankan status kesehatan dan memperlambat, bahkan menghindari timbulnya komplikasi DM. Tatalaksana nutrisi harus di-evaluasi secara berkala sesuai dengan kondisi klinis pasien.
This case serial study is aim to know the effect of adequate nutrition therapy on diabetic mellitus patient in preventing, slowing and overcome chronic complication. Nutrition therapy was according to their clinical condition, laboratory and nutrition status. Chronic hyperglycemia is related to long term organ damage, organ dis-function and failure. This is especially affect the eye, kidney, nerve, heart and vascular. Glucose control near to normal range will be able to decrease the risk, onset and morbidity of chronic complication. Diabetic chronic complication is divided into two categories, macrovascular and micro-vascular. The four diabetic mellitus patients in this case series were 37 to 64 years old with macro-vascular and micro-vascular complication. Calories for these patients were calculated using Harris Benedict equation. Protein was given according to kidney function and if there is nephropathy, then protein was given according to the level of nephropathy. Lipid were provided 25% from total calories, with a composition around 7% of SAFA, 8% PUFA and 10% MUFA. A combination of nutrition therapy and insulin or oral anti-diabetic drugs is able to maintain glucose control near to normal range. Protein provision according to kidney function was able to control urea and creatinine level along with maintaining nutrition status. Conclusion : Nutrition therapy in diabetic patient must be prescribe individually, according to anamnesis, physical examination, laboratory finding and other supporting examination. Nutrition therapy is targeted to maintain health status, to slowdown, and hopefully to prevent diabetic complication. Nutrition therapy must be evaluated periodically according to patient clinical status. |
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