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preliminary
Diabetes mellitus is a metabolic disorder that is genetically and clinically including heterogeneous
with manifestations in the form of loss of carbohydrate tolerance, if it has developed fully clinically,
diabetes mellitus is characterized by fasting and postprandial hyperglycemia, atherosclerosis and
microangiopathic vascular disease. 1.7 Type 2 Diabetes Mellitus is a hyperglycemic disease due to
cell insensitivity to insulin. Insulin levels may decrease slightly or be in the normal range. Because
insulin is still produced by beta pancreatic cells, type II diabetes mellitus is considered as non-insulin
dependent diabetes mellitus.6,9 Type 2 Diabetes Mellitus is a metabolic disorder characterized by an
increase in blood sugar due to decreased insulin secretion by pancreatic beta cells and / or impaired
insulin function (insulin resistance) .3
in women higher than men. Women are more at risk of developing diabetes because physically
women have a greater chance of increasing their body mass index. Results
is 95% of the world population suffering from diabetes mellitus and only 5%
Pathogenesis
relative and absolute insulin. Insulin efficiency can occur through 3 pathways, namely:
Pathophysology
1. Insulin resistance
Type 2 diabetes mellitus is not caused by a lack of insulin secretion, but because insulin target cells
fail or are unable to respond to insulin normally. This condition is commonly referred to as "insulin
resistance" .1,8 Insulin resistance occurs mostly as a result of obesity and lack of physical activity and
aging. In patients with type 2 diabetes mellitus, too much hepatic glucose production can occur but
there is no autoimmune destruction of Langerhans B cells such as type 2 diabetes mellitus.
Deficiency of insulin function in patients with type 2 diabetes mellitus is only relative and not
absolute. 4.5
In the early stages of developing type 2 diabetes mellitus, B cells showed a disruption in first-phase
insulin secretion, meaning that insulin secretion failed to compensate for insulin resistance. If not
handled properly, in the next development there will be damage to pancreatic B cells. Damage to
pancreatic B cells will occur progressively often will cause insulin deficiency, so that eventually
patients need exogenous insulin. In patients with type 2 diabetes mellitus, these two factors are
generally found, namely insulin resistance and insulin deficiency.
Risk factor
The increase in the number of DM patients, most of whom are type 2 diabetes mellitus, is related to
several factors, namely irreversible risk factors, altered risk factors and other factors. According to
American DiabetesAssociation (ADA) that DM is associated with irreversible risk factors including
family history of DM (first degree relative), age ≥45 years, ethnicity, history of giving birth to a baby
with a birth weight> 4000 grams or history of having gestational diabetes and history of birth with
low weight. Other factors associated with diabetes risk are those with polycystic ovarysindrome
(PCOS), metabolic syndrome patients who have a disturbed glucose tolerance (TGT) or impaired
fasting blood glucose (GDPT) before, have a history of cardiovascular diseases such as stroke, CHD,
or peripheral renal Diseases (PAD ), alcohol consumption, stress factors, smoking habits, gender,
consumption of coffee and caffeine.
1.Obesity (obesity) There is a significant correlation between obesity and blood glucose levels, in
the degree of obesity with BMI> 23 can cause an increase in blood glucose levels to 200mg%. 1,2
Clinical symptoms
Symptoms of diabetes mellitus can be distinguished into acute and chronic acute symptoms of
diabetes mellitus, namely: Polyphagia (lots of eating) polydipsia (lots of drinking), Polyuria (a lot
of urination / frequent urination at night), increased appetite your weight drops rapidly (5-10 kg
within 2-4 weeks), easily tired. The chronic symptoms of diabetes mellitus are: Tingling, skin
feels hot or like punctured needles, numbness in the skin, cramps, fatigue, easy drowsiness,
blurred vision, easily shaky and easily loose teeth, decreased sexual ability even in men,
impotence can occur, pregnant women often experience miscarriages or fetal deaths in the
womb or with babies born more than 4kg.
Diagnosis Complaints and typical symptoms plus the results of blood glucose testing when> 200
mg / dl, fasting blood glucose> 126 mg / dl is sufficient to establish a diagnosis of DM. For the
diagnosis of DM and other glucose tolerance disorders blood glucose was examined 2 hours
after glucose load. At least 2 times abnormal blood glucose level is needed to confirm the
diagnosis of other days of DM or abnormal Oral Glucose Tolerance Test (OGTT). Confirmation is
not necessary in the typical circumstances of hyperglycemia with acute metabolic
decompensation, such as ketoacidosis, rapid weight loss. There is a difference between a DM
diagnostic test and a screening check. Diagnostic tests are performed on those who show
symptoms of DM, while screening aims to identify those who are asymptomatic, but have a risk
of DM (age> 45 years, overweight, hypertension, DM family history, history of recurrent
abortion, giving birth to babies> 4000 gr , HDL cholesterol <= 35 mg / dl, or triglycerides ≥ 250
mg / dl). Diagnostic tests are performed on those who are positive for screening tests. 11
Screening can be done through examination of blood glucose levels or fasting blood glucose
levels, then can be followed by a standard oral glucose tolerance test (OGTT)
Management of diabetes mellitus
The principle of managing diabetes mellitus in general is five in accordance with the DM
Consensus Management in Indonesia in 2006 is to improve the quality of life of DM patients.
The objectives of DM management are: 2 Short term: loss of complaints and signs of DM,
maintaining a sense of comfort and achieving the target of controlling blood glucose. Long term:
prevented and hampered progression of microangiopathic complications, macroangiopathy and
neuropathy. The ultimate goal of management is a decrease in DM morbidity and mortality. To
achieve this goal, it is necessary to control blood glucose, blood pressure, body weight and lipid
profile, through patient management holistically by teaching self-care and behavior change.
1. Diet The principle of regulating the eating of people with diabetes is almost the same as the
recommended diet for the general public, namely a balanced diet and according to the
individual caloric and nutritional needs. In people with diabetes, it is important to emphasize
the importance of regular eating in terms of meal schedules, type and amount of food,
especially in those who use blood glucose-lowering drugs or insulin. The recommended
standard is food with a balanced composition in terms of carbohydrates 60-70%, fat 20-25% and
protein 10-15%. To determine nutritional status, calculated by BMI (Body Mass Index). The Body
Mass Index (BMI) or Body Mass Index (BMI) is a simple tool or way to monitor the nutritional
status of adults, especially those related to underweight and overweight. To find out the value
of this IMT, it can be calculated by the following formula: Weight Weight (Kg) BMI = ----------------
---------------- ---------------- Height (m) X height of Body (m) 2. Exercise (physical exercise / sport)
2. Exercise is recommended regularly (3-4 times a week) for approximately 30 minutes, which is
in accordance with Continuous, Rhythmical, Interval, Progressive, Endurance (CRIPE). Training
according to the patient's ability. An example is mild walking for 30 minutes. Avoid habits of life
that are lacking in motion or lazy.
3. Health Education Health education is very important in management. Primary prevention
health education must be given to high-risk community groups. Secondary health education is
given to groups of DM patients. While health education for tertiary prevention is given to
patients who have chronic diabetes complications.
4. Medication: oral hypoglycemic, insulin If the patient has made arrangements for eating and
physical exercise but has not managed to control blood sugar levels then consider the use of
hypoglycemic drugs
REFERENCE: DIABETES MELITUS TIPE 2 Restyana Noor Fatimah Medical Faculty, Lampung
University. J MAJORITY .Volume 4 Nomor 5. Februari; 2015