PaperS

Diabetes Mellitus

PREPARED BY:
NURNILAM SAFITRI
ARDIANTI
SYAFARUDDIN
INTRODUCTION

We say thanks to God forhis blessings so that we can completed a paper with
titleDiabetes mellitus.We also say thanks to the faculty who have provide guidance to us
so that we can finish the preparation of this paper .

The purpose of this paper is fullfilled the task from lecturer and to increase our
knowledge about diabetes mellitus.In this paper we realize that a lot of shortcomings. The
critics and suggestions that are built from a very helpful reader is 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 will reward all our good. Amin yaa Robal Alamin .

MAKASSAR, MARCH 2016

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
INTRODUCTION
Background
Diabetes Mellitus is one of the degenerative diseases which strongly associated with
metabolic diseases, 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
which
impact on productivity and can reduce human resources.
Diabetes mellitus disease not only affects on individual, but the health care system in
a country. Although there is no national survey, in line with changeslifestyle including
diet Indonesian people expected patient. Diabetes mellitus is increasing (decrease),
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, 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. The 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)
 Problem Formulation
1. How to understand the pathophysiology of Diabetes Mellitus?
2. What is the classification of Diabetes Mellitus ?
3. How to diagnose the disease diabetes mellitus ?
4. How to treatment of diabetes mellitus ?
Objectives
1. To determine the pathophysiology of Diabetes Mellitus
2. To determine the classification of Diabetes Mellitus
3. To find out how to diagnose the disease of Diabetes Mellitus
4. To find out how to cure diabetes mellitus

CHAPTER II
DISCUSSION
 Definition of Diabetes Mellitus
Diabetes mellitus , DM (Greek : , diabanein , 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 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)

Pathophysiology
In humans the energy 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 metabolism of
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 .
Pathophysiologyof diabetes mellitustype 1
No insulin production in type 1 of diabetes mellitus , 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 .

Pathophysiology of diabetes mellitus type 2

In type 2 diabetes mellitus may in fact be a normal amount of insulin but 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 :
a. primarily central obesity ( apple shape )
b. A diet high in fat and low in carbohydrates
c. Less exercise
d. Factor descent
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:
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. 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 .

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 .
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 basal production of 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
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.
 Many 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 pregnancy .
In contrast , obesity is not causes by sweet food, 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 .
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

Conclusion
1. Pathophysiology of Diabetes Mellitus are :
a) Patofisologi type 1 diabetes mellitus
No insulin production in type 1 of diabetes mellitus , 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) Type 1 of diabetes mellitus : insulin-dependent diabetes mellitus ( Insulin
Dependent Diabetes Mellitus / IDDM )
b) Type 2 of 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
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.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
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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