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Diabetes mellitus

a condition characterized by hyperglycemia
resulting from the body's inability to use
blood glucose for energy. In type 1 diabetes,
the pancreas no longer makes insulin and
therefore blood glucose cannot enter the cells
to be used for energy. In type 2 diabetes,
either the pancreas does not make enough
insulin or the body is unable to use insulin

Type 1 diabetes
a condition characterized by high blood
glucose levels caused by a total lack of
insulin. Occurs when the body's immune
system attacks the insulin-producing beta
cells in the pancreas and destroys them.
The pancreas then produces little or no
insulin. Type 1 diabetes develops most
often in young people but can appear in

Type 2 diabetes:
a condition characterized by high blood
glucose levels caused by either a lack of
insulin or the body's inability to use
insulin efficiently. Type 2 diabetes
develops most often in middle-aged and
older adults but can appear in young

Major Risk Factors for Type 2 DM
Family history of diabetes (parents or siblings with
Obesity (≥120% over desired body weight
or BMI ≥27 kg per m2)
Race/ethnicity (e.g., black, Hispanic, native American,
Asian American, Pacific Islander)
Age ≥45 years
Previously identified IFG or IGT
Hypertension (≥140/90 mm Hg)
HDL cholesterol level ≤35 mg/dL (0.90 mmol/L)
and/or a trigyceride level ≥250 mg/dL (2.83 mmol/L)
History of gestational diabetes mellitus or delivery of
babies over 4,032 g

in some cases. but increases the risk that the mother will develop diabetes later. GDM is managed with meal planning. and. insulin. activity. .Gestational diabetes mellitus (GDM) a type of diabetes mellitus that develops only during pregnancy and usually disappears upon delivery.


berarti risiko rendah TDK . berarti risiko sedang Jawaban YA tidak ada. atau amat besar Jawaban YA dua/lebih berarti risiko tinggi Jawaban YA hanya satu.Uji risiko diabetes kehamilan YA 1 Berasal dari etnis risiko tinggi 2 Obesitas 3 Riwayat keluarga DM 4 Usia di atas 25 tahun 5 Pernah DM kehamilan 6 Pernah melahirkan bayi mati.

People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke.Pre-diabetes a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. Other names for pre-diabetes are impaired glucose tolerance and impaired fasting glucose. .

physician offices.Diabetes educator a health care professional who teaches people who have diabetes how to manage their diabetes. Some diabetes educators are certified diabetes educators (CDEs). . Diabetes educators are found in hospitals. home health care. and other settings. managed care organizations.

The study showed that people who lost 5 to 7 percent of their body weight through a low-fat. .Diabetes Prevention Program (DPP): a study by the National Institute of Diabetes and Digestive and Kidney Diseases conducted from 1998 to 2001 in people at high risk for type 2 diabetes. Participants who received treatment with the oral diabetes drug metformin reduced their risk of getting type 2 diabetes by 31 percent. low-calorie diet and moderate exercise (usually walking for 30 minutes 5 days a week) reduced their risk of getting type 2 diabetes by 58 percent. All study participants had impaired glucose tolerance. also called pre-diabetes. and were overweight.

Oral hypoglycemic agents medicines taken by mouth by people with type 2 diabetes to keep blood glucose levels as close to normal as possible. meglitinides. Classes of oral hypoglycemic agents are alpha-glucosidase inhibitors. sulfonylureas. biguanides. . and thiazolidinediones. D-phenylalanine derivatives.

(Brand name: Precose. The result is a slower and lower rise in blood glucose throughout the day.Acarbose an oral medicine used to treat type 2 diabetes. It blocks the enzymes that digest starches in food. especially right after meals. Belongs to the class of medicines called alphaglucosidase inhibitors.) .

(Generic names: acarbose and miglitol. especially right after meals.) . The result is a slower and lower rise in blood glucose throughout the day.Alpha-glucosidase inhibitor: a class of oral medicine for type 2 diabetes that blocks enzymes that digest starches in food.

Also called hemoglobin A1C or glycosylated hemoglobin. Hemoglobin is the part of a red blood cell that carries oxygen to the cells and sometimes joins with the glucose in the bloodstream. which is proportional to the amount of glucose in the blood. .A1C: a test that measures a person's average blood glucose level over the past 2 to 3 months. the test shows the amount of glucose that sticks to the red blood cell.

The meter (or monitor) soon displays the blood glucose level as a number on the meter's digital display. portable machine used by people with diabetes to check their blood glucose levels.Blood glucose meter a small. . one places a drop of blood on a test strip in the machine. After pricking the skin with a lancet.

A blood glucose meter (or blood glucose test strips that change color when touched by a blood sample) is needed for frequent blood glucose monitoring.Blood glucose monitoring checking blood glucose level on a regular basis in order to manage diabetes. .

A test of Cpeptide levels shows how much insulin the body is making." a substance the pancreas releases into the bloodstream in equal amounts to insulin.C-peptide (see-peptide): "Connecting peptide. .

stomach pain. fruity breath odor. along with a severe lack of insulin. Untreated DKA can lead to coma and death. result in the breakdown of body fat for energy and an accumulation of ketones in the blood and urine. .Diabetic ketoacidosis (DKA) an emergency condition in which extremely high blood glucose levels. Signs of DKA are nausea and vomiting. and rapid breathing.

Fasting blood glucose test a check of a person's blood glucose level after the person has not eaten for 8 to 12 hours (usually overnight). . This test is used to diagnose pre-diabetes and diabetes. It is also used to monitor people with diabetes.

Human leukocyte antigens (HLA) proteins located on the surface of the cell that help the immune system identify the cell either as one belonging to the body or as one from outside the body. Some patterns of these proteins may mean increased risk of developing type 1 diabetes. .

. Fasting hyperglycemia is blood glucose above a desirable level after a person has fasted for at least 8 hours. Postprandial hyperglycemia is blood glucose above a desirable level 1 to 2 hours after a person has eaten.Hyperglycemia excessive blood glucose.

dizziness or light-headedness. usually less than 70 mg/dL. shakiness. nervousness. It may also be treated with an injection of glucagon if the person is unconscious or unable to swallow. Also called an insulin reaction.Hypoglycemia a condition that occurs when one's blood glucose is lower than normal. and confusion. Hypoglycemia is treated by consuming a carbohydrate-rich food such as a glucose tablet or juice. perspiration. If left untreated. sleepiness. Signs include hunger. hypoglycemia may lead to unconsciousness. .

taken after an 8. IFG. is a level of 110 mg/dL to 125 mg/dL. shows a level of glucose higher than normal but not high enough for a diagnosis of diabetes. also called pre-diabetes. . Most people with prediabetes are at increased risk for developing type 2 diabetes.Impaired fasting glucose (IFG) a condition in which a blood glucose 12-hour fast.

." "subclinical. also called prediabetes. is a level of 140 mg/dL to 199 mg/dL 2 hours after the start of an oral glucose tolerance test. Other names for IGT that are no longer used are "borderline. Most people with pre-diabetes are at increased risk for developing type 2 diabetes." "chemical. IGT." or "latent" diabetes.Impaired glucose tolerance (IGT) a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes.

Insulin resistance the body's inability to respond to and use the insulin it produces. and high levels of fat in the blood. Insulin resistance may be linked to obesity. . hypertension.

kromium. karotenoid. terutama lemak omega 3 Diet tinggi karbohidrat Makanan berindeks glisemik tinggi Tepung dan gula terolah Terlalu banyak/terlalu rendah garam Kekurangan elemen kelumit (kalsium. vanadium. seng.Kemungkinan gaya hidup pemicu resistensi insulin Diet tinggi lemak Diet sangat rendah lemak Diet rendah protein Kekurangan asam lemak essensial. magnesium. dan vitamin A) Asupan sayur rendah Kurang bergerak (sedentary)Stress tinggi Penggunaan bahan yang mengan-dung nikotin .

beta oksidasi menurun TNFά meningkat Disfungsi hemostatik. kadar fibrinogen tinggi. kecenderungan agregasi trombosit Tekanan darah meningkat Stres oksidatif meningkat . ternasuk peningkatanan trombosis.Keadaan metabolik yang tertali dengan resistensi insulin Resistensi leptin Dislipidemia Kadar lipoprotein meningkat Homosistein meningkat Trigliserida tinggi Sistem transport glukosa otot lurik terganggu (GLUT-4) Hiperkortikolism DHEA menurun Kadar GH rendah Lipogenesis meningkat.

.Ketone a chemical produced when there is a shortage of insulin in the blood and the body breaks down body fat for energy. High levels of ketones can lead to diabetic ketoacidosis and coma. Sometimes referred to as ketone bodies.

. vomiting. and stomach pain.Ketosis a ketone buildup in the body that may lead to diabetic ketoacidosis. Signs of ketosis are nausea.

.Rapid-acting insulin a type of insulin that starts to lower blood glucose within 5 to 10 minutes after injection and has its strongest effect 30 minutes to 3 hours after injection. See aspart insulin and lispro insulin. depending on the type used.

On average. It has its strongest effect 2 to 5 hours after injection but keeps working 5 to 8 hours after injection. Also called R insulin.Regular insulin short-acting insulin. regular insulin starts to lower blood glucose within 30 minutes after injection. .

nurses. and others. and more. handling episodes of illness and of low and high blood glucose. blood glucose monitoring. pharmacists. the ongoing process of managing diabetes. planned physical activity. managing diabetes when traveling. .Self-management in diabetes. Includes meal planning. The person with diabetes designs his or her own self-management treatment plan in consultation with a variety of health care professionals such as doctors. dietitians. taking diabetes medicines.

See regular insulin.Short-acting insulin a type of insulin that starts to lower blood glucose within 30 minutes after injection and has its strongest effect 2 to 5 hours after injection. .

Somogyi effect (rebound hyperglycemia) when the blood glucose level swings high following hypoglycemia. The Somogyi effect may follow an untreated hypoglycemic episode during the night and is caused by the release of stress hormones. .

dan gunakan energi untuk kurangi BB. jadwal tak harus ketat. normal. Kegunaan diit Kontrol gula darah (makan/jajan harus diatur di seputar pemberi-an insulin agar tak hipoglisemia. .Perbedaan antara IDDM dan NIDDM (IDDM) DM tipe 1 (NIDDM) DM tipe 2 Onset Anak/dewasa muda (<25 th) Biasanya setelah usia pertengahan Proporsi <10% dari total penderita DM >90% dari total penderita Diabetes Melitus Riwayat keluarga Tidak lazim Amat lazim Gejala Akut/sub-akut Lambat Ketoasis Sering sekali Jarang. kecuali diberi-kan pula insulin Buat tubuh lebih sensitif terhadap insulinnya sen-diri. kecuali sakit/stres Antibodi ICA. GAD Sangat sering positif Biasanya negatif Obesitas waktu onset Non-obese Biasanya obes sebelum onset Kaitan dengan HLA tipe tertentu Ada Tidak ada Kaitan dengan penyakit autoimum Kadang ada Tidak ada C-peptida darah/urin Sangat rendah Rendah. namun target sel tak sensitive. Guna latihan fisik Rangsang sirkulasi dan bantu tubuh gunakan insulin Turunkan BB. atau tinggi Kegunaan insulin Penyelamat nyawa Kadang diperlukan untuk control gula darah Penyebab Pankreas tak mampu buat insulin Produksi insulin masih ada.

3 juta • 2025: 300 juta (WHO.Prevalensi • 1999: 80 juta (Zimmet 1990) • 1994: 104 juta (Zimmet 1994) • 2010: 239. 1999) . IDF.

April 1999) .5 juta • 2025: 12.Prevalensi (Indonesia) • 1995: 4.4 juta (International Diabetes Monitor.

Diagnosis DM berdasarkan kadar gula darah DM- DM? DM Kadar glukosa darah sewaktu Plasma vena <110 110-199 ≥200 Darah kapiler <90 90-199 ≥200 Kadar glukosa darah puasa Plasma vena <110 110-125 ≥126 Darah kapiler <90 90-109 ≥110 Smber: Pengelolaan DM tipe 2 di Indonesia. PERKENI 2002 .

Pemeriksaan penyaring kelompok risiko DM Usia >45 tahun BB > 110% BBI [BMI > 23] Hipertensi ≥ 140/90 mm Hg Riwayat keluarga DM Riwayat abortus berulang. atau BBL > 4000 gram Kolesterol HDL ≤ 35 mg/dl dan/atau trigliserida ≥ 250 mg/dl Sumber: Konsensus pengelolaan DM tipe 2 Indonesia 2002. melahirkan bayi cacat. PERKENI. 2002 .

IGT=impaired glucose tolerance. Asian) * History of gestational diabetes mellitus or delivering a baby weighing more than 4.Recommendations Persons for Diabetes Screening of Asymptomatic Timing of first test and repeat tests Test at age 45. repeat more frequently than every three years if patient has one or more of the following risk factors: * Obesity: >=20% of desirable body weight or BMI >=27 kg per m2 * First-degree relative with diabetes mellitus * Member of high-risk ethnic group (black. HDL=high-density lipoprotein.032 g (9 lb) * Hypertensive (>=140/90 mm Hg) * HDL cholestrol level <=35 mg per dL (0.83 mmol per L) * History of IGT or IFG on prior testing (BMI=body mass index. Native American. IFG=impaired fasting glucose) . Hispanic. repeat every three years for patients 45 years of age or older Test before age 45.90 mmol per L) and/or triglyceride level >=250 mg per dL (2.

PERKENI. 2002) . karena mekanismenya belum dapat ditentukan dengan pasti (dikutip dari Konsensus pengelolaan DMtipe 2 di Indonesia 2002. umumnya menjurus ke defisiensi insulin absolut autoimun idiopatik Tipe 2 Bervariasi mulai yang terutama dominan resistensi insulin disertai defisiensi insulin relatif sampaiyang terutama defek sekresi insulin disertai resistensi insulin Tipe lain Defek genetik fungsi sel ß Defek genetik kerja insulin Penyakit eksokrin pankreas Endokrinopati Karena obat atau zat kimia Infeksi Sebab immunologi yang jarang Sindrom genetik lain yang berkaitan dengan DM DM gestasional Catatan: DM pada sirosis hati belum bisa dikelompokkan ke dalam klasifikasi di atas.Klasifikasi Etiologis Diabetes Melitus Jenis Etiologi Tipe 1[1] Destruksi sel ß.

Penanganan • Pendidikan • Pengobatan gizi medis • Olahraga • Obat penurun gula darah .

Pengobatan gizi medis • • • • Status metabolik optimal Cegah/obati penyulit kronis Perbaiki derajat kesehatan Tata gizi perorangan .

300 195 55 35 III 1. Diit VI. III diperuntukan bagi penderita obesitas. atau DM dengan penyulit .500 390 90 65 Dikutip dari Bagian Gizi RSCM/Persagi. II.100 160 50 30 II 1.700 260 65 45 V 1.900 300 70 50 VI 2. VII. remaja.300 350 85 65 VIII 2. VIII untuk penderita kurus. 1993 Diit I. Diit IV.Macam diit DM dan komposisi zat gizinya Macam Kalori Karbohidrat Protein Lemak I 1.100 325 80 55 VII 2. V untuk penderita berberat badan normal.500 225 60 40 IV 1.

Khromium As. Golden seal. Mineral Manganese. Serat (guar gum). Kalium. C. amino L-taurine. Evening primirose oil (GLA). dan E.Vitamin Bkompleks. Lecithin. dan dandelion root . dan Co-Q10 Herbal Alfalfa. dan L-carnitine Suplemen Yeast (ragi). Bawang putih. B6.

3. OHO dimulai dari dosis kecil.Obat Anti Diabetik Oral (ADO) Sulfonilurea Dosis harian Lama kerja Frek/ hari 100-250 100-500 24-36 1 Glibenklamid 2.2. (dikutip dari Konsensus pengelolaan DM tipe 2 di Indonesia 2002.4 0.5. dan dapat ditingkatkan hingga dosis maksimal. susuai dengan respons kadar glukosa darah.5-6 24 1 Repaglinid 0. Sulfonil urea ditelan 15-30 menit sebelum makan. dan ditingkatkan secara bertahap. 2 Nateglinid 120 Pioglitazon 15-30 Generik Mg/tab Klorpropamid Glinid Tiazolidindion Penghambat Glukosidase α Acarbose Biguanid Metformin 50-100 500-850 Pemberian Sebelum Makan Tak bergan-tung jadwal makan 15-30 24 100-300 250-3000 6-8 1 3 Bersama suap pertama 1-3 Bersama/sesudah makan Cat. PERKENI.5-5 2.5-15 12-24 1-2 Glipizid 5-10 5-20 10-16 1-2 Gliklazid 80 80-240 10-20 1-2 Glikuidon 30 30-120 - - Glimepirid 1. 2002) an . 1.

• • • • • delaying or skipping a meal eating too little food at a meal getting more exercise than usual taking too much diabetes medicine drinking alcohol .

Hypoglycaemia • • • • • dizzy or light-headed hungry nervous and shaky sleepy or confused sweaty .

) of any fruit juice 1 cup (8 oz.) of regular soda 5 or 6 pieces of hard candy glucose gel or tablets (take the amount noted on the package to add up to 15 grams of carbohydrate) .) of milk 1 or 2 teaspoons of sugar or honey 1/2 cup (4 oz.• • • • • • 1/2 cup (4 oz.