INTRODUCTION

1.1 Background

Diabetes Mellitus is one among the degenerative diseases are strongly associated with

metabolic diseases and are likely to increase , so the impact of the shift in the consumption

pattern of behavioral nutrition . ( Singgih B , et al . 2003)

Diabetes Mellitus ( DM ) is one of the health problems

impact on productivity and can reduce Human Resources .

This disease not only affects the individual , but the health care system

a country . Although there is no national survey , in line with changes

lifestyle including diet Indonesian people expected patient

Diabetes mellitus is increasing , especially in the age group up to the entire adult

socioeconomic status . Currently Diabetes mellitus disease prevention efforts have not

occupy the main priorities in health care , although known to the resulting negative impact is

quite large among other chronic complications in chronic heart disease , hypertension , brain ,

nervous system , heart , eyes and kidneys .

The success of health development efforts can be measured with reduced morbidity , general

and infant mortality , and increased life expectancy ( life expectancy ) , but the demographic

transition due to the success of efforts to reduce the mortality rate can cause epidemiological

transition , so the pattern is shifted from acute infectious disease degenerative disease

chronic.

According to WHO figures popular with diseases as diabetes is quite fantastic , which ranks

fourth in the world. According to WHO data , the world is now inhabited by 171 million

people diabtes mellitus ( 2000) and will be doubled to 366 million in 2030 . Than 50 % were

aware of the virus, only 30% of the routine treatment . Trend of increasing prevalence will

bring change increasingly prominent position of diabetes mellitus , which is characterized by

a change or increase in substantial improvement grouped 10 (leading diseases) . Besides

diabetes mellitus members increasingly greater contribution to mortality ( ten diseases

leading cause of death ) . ( Bustan , 2007)

1.2 Problem Formulation

1 . How Understanding the pathophysiology of the disease and Diabetes Mellitus ?

2 . A classification of Diabetes Mellitus ?

3 . How to diagnose the disease diabetes mellitus ?

4 . How the treatment of diabetes mellitus ?

13 . Objectives

1 . To determine Understanding the pathophysiology of the disease and Diabetes Mellitus

2 . To determine the classification of Diabetes Mellitus

3 . To find out how to diagnose the disease Diabetes Mellitus

4 . To find out how to cure diabetes mellitus

CHAPTER II

DISCUSSION

2.1 Definition of Diabetes Mellitus

Diabetes mellitus , DM (Greek : διαβαίνειν , diabaínein , translucent or shower water )

(Latin : mellitus , sweet taste ) , also known in Indonesia by the term sugar urine disease is a

metabolic disorder that is caused by many factors , with simtoma form of chronic

hyperglycemia and impaired metabolism of carbohydrates , fats and proteins .

According to the American Diabetes Asosiation ( ADA ) of 2003, diabetes was merupkan a

group of metabolic diseases with hyperglikemia characteristics that occur due to

abnormalities in insulin secretion , insulin action or both . Meanwhile, according to the 1980

WHO mellistus diabetes is something that can not be poured in a clear and concise answer

but in general it can be said as a collection of anatomical and chemical problems that are the

result of a number of factors which come by absolute or relative insulin deficiency and

impaired insulin function .

Diabetes mellitus is a group of disorders characterized by elevated levels of blood glucose

( hyperglikemia ) there may be a decrease in the body's ability to respond to insulin and or a

decrease or absence of the formation by the pancreas ( Burnner and suddarrth , 2003)

2.2 Pathophysiology

In humans the fuel comes from food that we eat everyday , which consists of carbohydrates

( sugars and starches ) , protein ( amino acids ) and fats ( fatty acids ) . The food processing

starts from the mouth to the stomach and then further into the intestines . In the digestive tract

, which consists of carbohydrate foods are broken down into glucose , proteins are broken

down into amino acids and fats into fatty acids . These three nutrients was circulated

throughout the body to be used by the organs in the body as energy . In order to function as

an energy food substances that must be processed , where the glucose is burned through a

chemical process that produces energy is called metabolism . In the process of insulin

metabolism plays an important role that incorporate glucose into the cells that are used as fuel

( Faculty of Medicine , Department of Health , WHO , 2004)

Insulin is released by the beta cells can be described as a child was the key that can unlock

the door entry of glucose into the cells , and then in the cells was in metabolismekan glucose

into energy . If there is no insulin , the glucose can enter the cells with glucose result will still

be inside the blood vessels , which means the levels in the blood rises . In these

circumstances the body becomes weak because there is no source of energy in the cell . This

is what happens in diabetes mellitus type 1 .

2.2.1 Patofisologi type 1 diabetes mellitus

Insulin in type 1 diabetes mellitus no , this is caused by this type arise due to an autoimmune

reaction that caused inflammation in insulitis beta cells . This led to the emergence of

antibodies against beta cells called ICA ( Islet Cell Antibody ) . Antigen ( beta cells ) caused

by antibodies cause destruction of beta cells .

2.2.2 Pathophysiology of diabetes mellitus type 2

In type 2 diabetes mellitus may in fact be a normal amount of insulin but the more the

number of insulin receptors on the cell surface are less . The insulin receptor is like a keyhole

entrance into the cell .

The cause of insulin resistance in type 2 diabetes mellitus was not so clear , but the following

factors play a role stout :

ü primarily central obesity ( apple shape )

ü A diet high in fat and low in carbohydrates

ü Less exercise

ü Factor descent

2.3 Classification of Diabetes Mellitus

There are several different types of diabetes mellitus . The disease is distinguished by the

cause , clinical course and treatment . Classification of Diabetes Mellitus main ones are:

2.3.1 Diabetes Mellitus Type 1 : insulin-dependent diabetes mellitus ( Insulin Dependent

Diabetes Mellitus / IDDM )

Less than 5-10 % of patients with insulin -dependent diabetes . In this type of diabetes , the

beta cells of the pancreas that normally produce insulin are destroyed by an autoimmune

process . As a result , the injection of insulin needed to control blood sugar levels .

2.3.2 Type 2 diabetes mellitus : insulin-dependent diabetes mellitus ( Non - Insulin

Dependent Diabetes Mellitus / NIDDM )

Less than 90-95 % of people with type 2 diabetes , which is insulin-dependent diabetes .

Diabtes type 2 occurs due to decreased sensitivity to insulin ( insulin retention ) . Most people

with type 2 diabetes , oral medications do not control the situation hyperglikemia . Most

people with type 2 diabetes can control their diabetes with diet , exercise , oral hypoglycemia

medication and may require insulin injections in a period of acute physiological stress such as

illness or surgery .

2.4 Signs and symptoms of diabetes

• The typical symptoms

1 . Symptoms typical

Polyuria ( frequent urination especially at night )

Poliphagia ( lots of fast food or hungry )

polydipsia ( excessive thirst )

2 . Symptoms other

Skin disorders such as itching and sores . Normally , the body that is itchy genital area or

areas of skin folds , such as under the breasts and armpits folding thigh .

cataract or refractive errors due to changes in the lens due to hyperglycemia due

gynecological disorders , such as vaginal discharge that causes the candida fungus and

abnormal menstrual patterns .

Impotence in men

Tingling and numbness ( numbness ) in the fingers and toes that causes neuropathy .

wounds or sores that do not heal, despite injuries arise only because of trivial things , such

as abrasions .

The body feels weak and easily tired

Weight loss without a specific cause .

2.5 Diagnosis of Diabetes Mellitus

According Utami P , ( 2003) Diabetes mellitus can be diagnosed through laboratory tests with

a blood test . Diabetes mellitus diagnosis criteria are taken from the World Health

Organization 's decision ( WHO) is based on blood sugar or glucose . Diagnosis of diabetes

millitus be in charge by measuring blood glucose levels when fasting and 1-2 hours after

drinking 75 grams of glucose solution ( oral tolerance test ) . Blood glucose levels when

fasting state showed pruduksi basal insulin or the body's basic nature . Several parameters can

be used to diagnose diabetes mellitus is as follows :

1 . A is said to suffer from diabetes mellitus , if blood sugar levels as ≥ 200 mg / dl . ( when

blood sugar is the blood glucose level at a time can change throughout the day with the

amount of carbohydrate eaten .

2 . Someone said to suffer from diabetes if blood glucose levels when fasting > 126 mg / dl or

2 hours after drinking 75 grams of glucose solution showed a blood glucose level > 200 mg /

dl . ( Fasting = no food or caloric input since the last 10 hours ) .

3 . Someone said to be normal or without diabetes mellitus if blood glucose levels when

fasting is < 110 mg / dl , blood glucose levels 1 hour

Recommendations to WHO criteria for the diagnosis of diabetes mellitus and hypoglycemia

intermediate :

Type examination normal value

diabetes :

• Fasting Glucose

• Glucose 2 hours pp

> = 7.0 mmol / 1 ( 126mg/dl ) , or

> = 11.1 mmol ( 200mg/dl )

Impaired glucose tolerance ( IGT )

• Fasting Glucose

• Glucose 2 hours pp

< = 7.0 mmol / 1 ( 126 ) mg / dl , and

> = 7.8 mmol / 1 and < 11.1 mmol ( 140 mg / dl and 2000 mg / dl )

Impaired fasting glucose ( IFG )

• Fasting Glucose

• Glucose 2 hours pp

 6.1 - 6.9 mmol / 1 ( 110-125 mg / dl ) , and

           < 7.8 mmol / 1 ( 140 mg / dl )

+ Venous plasma glucose 2 hours after eating 75 grams of glucose

• If 2 hours is not measured pp , diabetes status was not clear , and IGT can not be issued

2.6 Factors Originator

Factors seed is a major cause of disease onset diabetes in addition to other causes such as

infection , pregnancy and drugs . But despite demikain , in people with diabetes seeds , not

yet guarantee the onset of diabetes disease . The seeds may still not appear significantly until

the end.

Beberpa factors that can fertilize , and is often a precipitating factor of diabetes mellitus are :

Lack of movement / lazy

Food excessive

Pregnancy

Lack of insulin production

Disease hormone that works opposite to insulin

In brief, the factors that increase the risk of diabetes is

1 . Genetic disorders

Diabetes can be decreased according to the genealogy family history of diabetes , because of

a gene disorder that results in the body can not produce insulin properly . But the risk of

developing diabetes is also dependent on factors overweight , stress , and less mobile .

2 . Age

Generally humans experience physiological changes drastically declined rapidly after the age

of 40 years . Diabetes often appear after a person enters the vulnerable age , especially after

age 45 years in those with severe badanya excess , so that his body no longer sensitive to

insulin .

3 . Stress Lifestyle

Chronic stress tends to make a person look for sweet foods and high fat to increase brain

serotonin levels . Serotonin has a calming effect while to relieve stress . But the sugar and fat

that is harmful to those who are at risk get diabetes .

4 . The wrong diet

Malnourished or overweight increases the risk of both diabetic . Malnutrition ( mal nutrition )

can damage the pancreas , whereas obesity ( excessive fat ) resulted in impaired insulin action

( insulin retention ) .

Poor nutrition can occur during pregnancy , childhood , and in adulthood due to excessively

strict diet . While pda janinmungkin malnutrition occurs because mothers smoke or consume

alcohol during hamilnya .

In contrast , obesity is not because the food is sweet or rich in fat , but more due to the

amount of consumption is too much , sehongga blood sugar reserves stored in the body

sangant excessive . Approximately 80 % of type II diabetics are those classified as obese .

2.7 Treatment of Diabetes Mellitus

Broadly speaking, the treatment is done by :

1 . Physical exercise

physical exercise in the form of exercise cause a decrease in blood sugar levels caused by the

elevation of peripheral glucose utilization areas . But when high blood sugar levels > 18

mmol / 320mg % and if there is ketosis , should exercise will lead to a more severe state of

diabetes , sugar and ketonemia will be rising due to the increase in hepatic gluconeogenesis

and ketosis . Recommended regular physical exercise ( 3-4 times a week ) for about 30

minutes , that are appropriate Cripe ( Continuous , rhythmical , Interval , Progressive ,

Endurance , Training ) . As far as possible reach the 75-85 % target zone denyaut pulse

maximum ( 220 - age ) , adapted to the capacity and condition of comorbidities . For

example, moderate exercise is a regular walk at least 30 minutes of moderate exercise is

walking briskly for 20 minutes and jogging for example oalhraga weight .

2 . Medications

Oral antidiabetic drugs were divided into 2 groups, namely :

class of sulfonylureas

Sulfonylurea class of works by stimulating the beta cells of the pancreas to secrete insulin

1 . Blocking the binding of insulin

2 . Enhance tissue sensitivity to insulin

3 . Suppresses glucagon

4 . Sulfonylureas group I

• chlorpropamide ( Diabenese )

Indications : NIDDM

Contra - indications : juveil diabetes , NIDDM heavy or unstable . Ketoacidosis , surgery ,

severe infection , trauma , liver disorders , kidney or thyroid . Pregnant .

Dosage forms and dosage : 100 mg tablets ; 250 mg tablets and middle-aged patients 250

mg / day , the older age of 100-125 mg / day . Rules used 3 times daily with meals .

Side effects : cholestatic jaundice , such as disulfiram reaction , nausea , vomiting , diarrhea ,

anorexia .

Special risks : in patients with impaired renal function and lactating women .

Sulfonylurea class II

• Glipizide ( Aldiab )

Indications : NIDDM

Contra - indications : diabetes ketoacidosis with or without coma , juvenile diabetes , kidney

disorders , liver weight .

Dosage forms and dosage : 5 mg tabs and an initial dose of 15-30 mg 1x / day before

breakfast , plus a dose of 2.5-5 mg depending on blood sugar levels .

Side effects : GI disorders , hypoglycemic , allergic skin reactions erythema , maculopapular

eruptions , urticaria , pruritus , eczema , porphyria , photosensitivity . Reactions such as

disulfiram . Hematologic reactions : agranulositois , leukopenia , thrombocytopenia , anemia

plastesik , hemolytic anemia , pansetopenia , dizziness , drowsiness , headache . Increased

AST , LDH , alkaline phosphatese , BUN and creatinine .

Special risks : patients with liver , kidney and pregnant women .

• Glimepiride ( Amadiab )

Indications : diabetes mellitus type II ( NIDDM )

Contra - indications : type 1 diabetes , diabetic ketoacidosis , diabetic coma prekoma or ,

hypersensitivity to glimepiride , pregnancy , lactation .

Dosage forms and dosage : KAPL 1 mg ; 2 mg ; 3 mg ; 4 mg . Dose of 1 mg 1 x / day dose

was increased for 1-2 weeks .

Side effects : hypoglycaemic , while visual disorders , GI disorders , liver damage .

Thrombopenia , leukopenia .

Special risks : hypersensitivity and liver function disorders .

• Glibenclamide ( Prodiabet )

Indications : NIDDM

Contra - indications : IDDM , ketoacidosis , severe infections , stress , trauma , kidney

disorders , liver or thyroid weight , acute porifia .

Dosage forms and dosage : 5 mg tablets . Initial dose of 2.5 mg / day , 2.5 mg improved .

Side effects : cholestatic jaundice , allergic dermatologic and hematologic reactions , GI

disorders , headache , dizziness , paresthesias .

Special risks : old age and hypoglycemia .

An indication of this group are :

1 . Ideal when weight around

2 . Insulin requirements if less than 40 U / day

3 . When no severe acute stress such as infection or surgery

The side effects of sulfonylureas class :

1 . Nausea , vomiting, headache , vertigo and fever

2 . Sense skin dermatitis , pruritis

3 . Abnormalities , hermatologik : lekopeni , trombosittopeni and enemia

3 . Extension

Extension to the management plan is essential for maximum clearance can result . Diabetes

education is the education and training in the knowledge and skills to diabetic patients which

aims to support behavior change to improve patient understanding of his illness , which is

necessary to achieve optimum good health , good health and optimal adjustment , and

psychological state of adjustment and a better quality of life . Education is an integral part of

the nursing care of patients with diabetes .

The purpose of the extension is diabetes mellitus :

Increasing knowledge

Changing attitudes

Changing behavior and improve compliance

Changing the quality of life

 CHAPTER III

CLOSING

3.1 Conclusion

1 . Pathophysiology of Diabetes Mellitus are :

a. Patofisologi type 1 diabetes mellitus

Insulin in type 1 diabetes mellitus no , this is caused by this type arise due to an autoimmune

reaction that caused inflammation in insulitis beta cells .

b . Pathophysiology of diabetes mellitus type 2

In type 2 diabetes mellitus may in fact be a normal amount of insulin but the more the

number of insulin receptors on the cell surface are less . The insulin receptor is like a keyhole

entrance into the cell .

2 . Classification of Diabetes Mellitus are :

a. Diabetes Mellitus Type 1 : insulin-dependent diabetes mellitus ( Insulin Dependent

Diabetes Mellitus / IDDM )

b . Type 2 diabetes mellitus : insulin-dependent diabetes mellitus ( Non - Insulin Dependent

Diabetes Mellitus / NIDDM )

3 . Diagnosis of Diabetes Mellitus are :

According Utami P , ( 2003) Diabetes mellitus can be diagnosed through laboratory tests with

a blood test . Diabetes mellitus diagnosis criteria are taken from the World Health

Organization 's decision ( WHO) is based on blood sugar or glucose .

4 . Treatment of Diabetes Mellitus are :

a. physical exercise

b . drug

c . counseling

3.2 Advice

In keeping with the times then it will lead to diseases such as those caused by behavior and

lifestyle salah.Salah one example is it necessary Melitus.Untuk Diabetes prevention early in

avoiding the disease Diabetes Mellitus with maintaining and improving the public health of

the family starting with how to do a diet and a healthy lifestyle

REFERENCES

Febriyatri , Diena.2009

Improvement in Diabetes Mellitus Cases Installation Outpatient Disease in Hospital Doctor

Mohammad Hoesin Palembang . Bina Husada sticks . Palembang

http://bkp2011.blogspot.com/2011/04/makalah-diabetes-melitus.html

http://merinirmalasari.wordpress.com/2012/04/04/dmcontoh-makalah-diabetes-melitus/

http://yosefw.wordpress.com/2007/12/27/penggunaan-antidiabetik-oral-gol-sulfonilurea-

pada-diabetes-mellitus/

Holy Raplia , Serni . 2011

Relationship Determinants of Diabetes Mellitus Patients with Genesis Outpatient Hospital

Palembang in Bari in 2011 . Sticks Bina Husada . Palembang

INTRODUCTION

Thank God we pray for the presence of GOD Almighty , blessings and karunia_Nya step that

we can complete a paper on diabetes mellitus .

The paper builds on the results we have obtained . And we also thank the faculty who have

provided guidance to us so that we can finish the preparation of this paper .

The purpose of this paper is a task given by the lecturers and to increase our knowledge about

diabetes mellitus .

In this paper we realize that a lot of shortcomings , for the criticism and suggestions that are

built from a very helpful reader necessary for the perfection of the next paper . We also

expect that this paper may be useful for all of us , especially us as a writer and is expected to

GOD Almighty will reward all our good. Amin yaa Robal Alamin .

Raha , Mei 2014

author

TABLE OF CONTENTS

PREFACE............................................................................................................................ i

TABLE OF CONTENTS...................................................................................................... ii

CHAPTER I INTRODUCTION.......................................................................................... 1

1.1 Background...................................................................................................................... 1

1.2 Formulation of Masala.....................................................................................................2

1.3 Objective......................................................................................................................... 2

CHAPTER II DISCUSSION

2.1 Definition of Diabetes Mellitus .............................................. ...................................... 3

2.2 Patofisiologi.................................................................................................................... 3

2.3 Classification of Diabetes Mellitus .............................................. ................................ 4

2.4 Signs and symptoms of diabetes ............................................. ..................................... 5

2.5 Diagnosis of Diabetes Mellitus .............................................. ...................................... 6

2.6 factors Pencetus............................................................................................................. 7

2.7 Treatment of Diabetes Mellitus .............................................. ...................................... 8

CHAPTER III CLOSING

3.1Kesimpulan...................................................................................................................... 11

3.2 Saran............................................................................................................................ 11

Sign up PUSTAKA............................................................................................................ 12

Papers   Diabetes Mellitus

                                                         PREPARED BY:

NAME : YUSTIAR SALASARI NIM : 12/12/1001

                                  

ACADEMY OF NURSING GOVERNMENT OF THE DISTRICT MUNA

2014