In commemoration of the National Elderly Day in 2022, Diponegoro National Hospital (RSND) held an Online Seminar entitled “Holistic and Comprehensive Understanding on Diabetes Mellitus in the Elderly” last week.

In his speech, Dr. dr. Sutopo Patria Jati, M.M., M.Kes, as the President Director of the RSND said that this activity was a sharing momentum and commitment to be able to provide the latest information on the development of health issues including management and treatment, which is expected to be one of the activities that can be held regularly by the RSND and the Faculty of Medicine Undip. This will be an important part of the realization of a teaching hospital which is expected to be more responsive in sharing knowledge or expertise.

In the first session of this seminar, there were 4 speakers namely dr. Sigid Kirana Lintang B., Sp.FM (K), dr. Yosep Purwoko, M.Kes, Sp.PD (K-Ger), dr. Etisa Adi Murbawani, M.Si, Sp.GK (K), Intan Rahmania Eka Dini, M.Sc., Apt. The moderator of this seminar was dr. Budi Laksono.

In his material, dr. Sigid conveyed about the virtues of doctors, namely noble profession, prioritizing the interests of patients, putting aside personal interests, and trying the best for patients.

“Doctors are human beings who are full of limitations, the doctor’s job is not to prevent humans from dying or treatment failure. There are many aspects outside the medical field that greatly affect the results of treatment. An understanding of the Ordinary and Extraordinary principles can prevent doctors from feeling guilty when they fail to treat patients,” he said.

dr. Yosep Purwoko, M.Kes, Sp.PD (K-Ger) discussed Diabetes Mellitus (DM) which is a group of metabolic diseases with hyperglycemia characteristics that occur due to abnormalities or insulin secretion, insulin action or both. The goals of DM management are to prevent acute metabolic decompensation, reduce morbidity and mortality due to complications, achieve a better quality of life, and avoid administering drugs aggressively and non-procedurally.

“The classic complaints of DM include polyuria, polydipsia, polyphagia and unexplained weight loss. Other complaints are weakness, tingling, itching, blurred eyes, erectile dysfunction in men, and pruritus vulva in women. The main steps in managing DM in the geriatric population include education and individual treatment, prevention and treatment of cardiovascular risks, controlling glycemic stress, as well as screening and treatment for the emergence of geriatric syndromes that often occur in the elderly who suffer from DM, for example depression, cognitive impairment, urinary incontinence, falls, pain, and polypharmacy,” said dr. Yosep.

While dr. Etisa explained that eating arrangements in DM patients are customized according to habits and adjusted as their daily eating patterns. Giving the small frequent feeding diet is very appropriate to be applied to the elderly with DM to control blood sugar levels, as well as adjusting the need for a combination of diet and physical activity settings to control blood sugar levels in DM patients.

“With increasing ages, organ function declines in the elderly, one of which is gastrointestinal function. The presence of uncontrolled DM also accelerates the decline in these functions, the elderly will be increasingly disturbed by their food intake. Nutritional factors are one of the things that can be changed to control blood sugar levels, prevent complications as well as decrease in physical and mental function due to DM,” she said.

Intan Rahmania Eka Dini, M.Sc., Apt said that in counseling, it is necessary to explain whether the patient understands and believes in the diagnosis and treatment, pays attention to his health, knows what will happen if the disease is not treated, is sure that the medicine used will work, knows how to use the medicine, know when and what happens at onset, assumes the healing value is greater than the cost of treatment, believes that health workers are helpful, and are ready to take medication.

Speakers in the second session were dr. Widodo Sarjana AS, MKM., Sp.KJ., dr. Arinta Puspita Wati Sp.S(K), dr. Hari Peni Julianti, M.Kes., Sp.KFR (K), FISPH, FISCM. The second session was moderated by dr. Dwi Ngestiningsih, Sp.PD (K-Ger), M.Kes, FINASIM.

dr. Widodo explained about the symptoms of depression, including sadness; loss of interest in activities and hobbies you used to enjoy; fatigue and decreased energy; pessimistic or hopeless; helpless or feeling guilty; irritability and feeling restless; difficulty concentrating, remembering details and making decisions; insomnia, waking up early in the morning or even sleeping too much; having ideas of attempting suicide; feeling painful; headache; abdominal pain continuously and do not improve even with treatment.

“Symptoms of depression in the elderly are often not recognized because they appear as physical complaints. Depressed elderly also often complain of forgetting so that they are considered as dementia, as the sad feeling lasts for at least two weeks. While the challenges of diabetes and depression are comorbid diabetes, depression is a challenging clinical issue but still under-appreciated. Symptoms of depression affecting up to a third of people with diabetes. It does not only impair quality of life but also add to the difficulties experienced in diabetes self-management. So health professionals are obliged to identify depression in people with diabetes, they have to go under treatment effectively.”

The second speaker of this session, dr. Arinta Puspita Wati, Sp.S (K) discussed Diabetic Neuropathy, a neurological disorder due to complications of diabetes mellitus. This nerve damage can include both the somatic and autonomic nerves. One form of symptoms can be in the form of chronic pain complaints characterized by tingling, burning, stabbing, shooting, slashing and even electrocution. Treatment of diabetic neuropathy needs to be done properly and carefully, especially in elderly patients. In addition to drugs, preventive measures need to be taken to prevent further complications.

dr. Hari Peni Julianti, M.Kes., Sp.KFR (K), FISPH, FISCM in her material on Rehabilitation in Elderly DM patients revealed the importance of regular physical exercise to improve insulin sensitivity, control blood glucose, maintain/lose weight, increase HDL-cholesterol levels, and maintain fitness.

Uncontrolled blood sugar levels experienced by people with diabetes can cause damage to blood vessels and nerves in the legs. This condition causes long wound healing. To prevent injuries, patients must carefully care for and maintain foot health. The use of special shoes for diabetics can be helpful.

“Custom made shoes can be adapted to the contours of every diabetic. Soft inline material, little connection area, adjustable toe box can be open toe box or closed toe box, soft midsole, thick outsole with rocker bar profile, medial lateral side which also determines the width of the shoe should be according to the width of the patient’s foot. The shoes are also equipped with fasteners. Use the right size socks without tight bands in the ankle or calf area and wear it upside down. The patient should have more than one pair,” explained dr. Peni.

“Functional ability is the ability or skill to carry out daily activities, hobbies, work, intellectual actualization, social interaction, family roles, and society. The WHO classification for type II DM disorders based on the ICF is distinguished in body functions, body structures, activity, participation, impairments, activity limitations, participation restrictions, and environmental factors,” she concluded. (Lin – Public Relations)