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Defition for Diabetes Mellitus

 Diabetes mellitus is a disorder in which the level of blood glucose is

persistently raised above the normal range. Diabetes mellitus is a
syndrome with disordered metabolism and inappropriate hyperglycemia
due to either a deficiency of insulin secretion or to a combination of
insulin resistance and inadequate insulin secretion to compensate.
Diabetes mellitus occurs in two primary forms:

1. type 1, characterized by absolute insufficiency, and the more prevalent

2. type 2, characterized by insulin resistance with varying degrees of
insulin secretory defects.
Graphic of diabetics in Indonesia

Source : Riskesdas,2010,kemenkes
Causes for Diabetes Mellitus
The cause of both type 1 and type
2 diabetes remains unknown,
although genetic factors may play
a role. Diabetes mellitus results
from insulin deficiency or
resistance. Insulin transports
glucose into the cell for use as
energy and storage as glycogen.
Risk Factors For
Diabetes Mellitus Include

 Obesity.
 Physiologic or emotional stress, which can cause prolonged
elevation of stress hormone levels.
 pregnancy, which causes weight gain and increases levels of
estrogen and placental hormones, which antagonize insulin
 metabolic syndrome, which is considered a precursor to the
development of type 2 diabetes mellitus
 some medications that can antagonize the effects of insulin,
including thiazide diuretics, adrenal corticosteroids, and
hormonal contraceptives
Classification of Diabetes Mellitus

 There are several different types of diabetes mellitus; they may differ
in cause, clinical course, and treatment. The major classifications of
diabetes are:
 · Type 1 diabetes (insulin dependent diabetes mellitus) is caused
by B-cell destruction, usually leading to absolute insulin deficiency
 Immune mediated
 Idiopathic
 · Type 2 diabetes (previously referred to as non insulin dependent
diabetes mellitus) ranges from those with predominant insulin
resistance associated with relative insulin deficiency, to those with a
predominantly insulin secretory defect with insulin resistance

 When a person eats a meal, insulin secretion increases

and moves glucose from the blood into muscle, liver,
and fat cells. In those cells, insulin:
 Transports and metabolizes glucose for energy
 Stimulates storage of glucose in the liver and muscle (in
the form of glycogen)
 Signals the liver to stop the release of glucose

 Clinical manifestations of all types of

diabetes include the “three Ps”:
polyuria, polydipsia, and polyphagia.
Polyuria (increased urination) and
polydipsia (increased thirst) occur as a
result of the excess loss of fluid
associated with osmotic diuresis.

The main goal of diabetes

treatment is to normalize insulin
activity and blood glucose levels
to reduce the development of
vascular and neuropathic

1. Drugs for Treating Hyperglycemia

The drugs for treating type 2 diabetes fall into several
 1) Drugs that primarily stimulate insulin secretion by
binding to the sulfonylurea receptor.

 2) Drugs that alter insulin action: Metformin works in

the liver. The thiazolidinediones appear to have their
main effect on skeletal muscle and adipose tissue.
 3) Drugs that principally affect absorption of glucose:
The glucosidase inhibitors acarbose and miglitol are
such currently available drugs.

Insulin is indicated for type 1 diabetes
as well as for type 2 diabetic patients
with insulinopenia whose
hyperglycemia does not respond to
diet therapy either alone or combined
with other hypoglycemic drugs.
There are five components of diabetes
• Nutritional management
• Exercise
• Monitoring
• Pharmacologic therapy
• Education