CHAPTER I

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
systema 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 isquite 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 ransition 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
peoplediabtes 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.
2.
3.
4.
5.
6.
7.
8.
9.

What is the Diabetes Mellitus ?

What is the type of Diabetes Mellitus ?
How Understanding the pathophysiology of the disease and Diabetes Mellitus ?
What is Sign and Symptoms of Diabetes Mellitus ?
How to diagnose the disease diabetes mellitus ?
What is risk factors of Diabetes Mellitus ?
What is the complication of Diabetes Mellitus ?
How the treatment of diabetes mellitus ?
What is the prevention of Diabetes Mellitus ?

1.3 Destination

1.
2.
3.
4.

To determine Understanding the pathophysiology of the disease and Diabetes Mellitus

To determine the classification of Diabetes Mellitus
To find out how to diagnose the disease Diabetes Mellitus
To find out how to cure diabetes mellitus

CHAPTER II
DISCUSSION

2.1 Definition of Diabetes Mellitus

Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic

diseases in which there are high blood sugar levels over a prolonged period. Symptoms of high
blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated,
diabetes can cause many complications. Acute complications include diabetic ketoacidosis and
nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease,
stroke, chronic kidney failure, foot ulcers, and damage to the eyes.

2.2 Types Of Diabetes Mellitus

1. Type 1 diabetes (T1D): The body stops producing insulin or produces too little insulin to
regulate blood glucose level.

Type 1 diabetes involves about 10% of all people with diabetes in the United States.

Type 1 diabetes is typically diagnosed during childhood or adolescence. It used to be

referred to as juvenile-onset diabetes or insulin-dependent diabetes mellitus.

Type 1 diabetes can occur in an older individual due to destruction of the pancreas by
alcohol, disease, or removal by surgery. It also results from progressive failure of the
pancreatic beta cells, the only cell type that produces significant amounts of insulin.

People with type 1 diabetes require insulin treatment daily to sustain life.

2. Type 2 diabetes (T2D): Although the pancreas still secretes insulin, the body of someone
with type 2 diabetes is partially or completely unable to use this insulin. This is
sometimes referred to as insulin resistance. The pancreas tries to overcome this resistance
by secreting more and more insulin. People with insulin resistance develop type 2
diabetes when they fail to secrete enough insulin to cope with their higher demands.

At least 90% of adult individuals with diabetes have type 2 diabetes.

Type 2 diabetes is typically diagnosed in adulthood, usually after age 45 years. It used to
be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These
names are no longer used because type 2 diabetes does occur in younger people, and
some people with type 2 diabetes require insulin therapy.

Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral
medications. However, more than half of all people with type 2 diabetes require insulin to
control their blood sugar levels at some point in the course of their illness.

3. Gestational diabetes (GDM) is a form of diabetes that occurs during the second half of
pregnancy.

Although gestational diabetes typically resolves after delivery of the baby, a woman who
develop gestational diabetes is more likely than other women to develop type 2 diabetes
later in life.

Women with gestational diabetes are more likely to have large babies.
Metabolic syndrome (also referred to as syndrome X) is a set of abnormalities in which

insulin-resistant diabetes (type 2 diabetes) is almost always present along with hypertension
(high blood pressure), high fat levels in the blood (increased serum lipids, predominant elevation
of LDL cholesterol, decreased HDL cholesterol, and elevated triglycerides), central obesity, and
abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular
disease is associated with metabolic syndrome.
Prediabetes is a common condition related to diabetes. In people with prediabetes, the
blood sugar level is higher than normal but not yet high enough to be considered diagnostic of
diabetes.

Prediabetes increases a person's risk of developing type 2 diabetes, heart disease, or

stroke.

Prediabetes can typically be reversed (without insulin or medication) with lifestyle

changes such as losing a modest amount of weight and increasing physical activity levels.
Weight loss can prevent, or at least delay, the onset of type 2 diabetes.

An international expert committee of the American Diabetes Association redefined the

criteria for prediabetes, lowering the blood sugar level cut-off point for prediabetes.
Approximately 20% more adults are now believed to have this condition and may
develop diabetes within 10 years if they do make lifestyle changes such as exercising
more and maintaining a healthy weight.

2.3 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 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 insulindependent diabetes. Diabetes 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 asillness 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

Diabetes may be diagnosed on the basis of one abnormal plasma glucose (random 11.1
mmol/L or fasting 7 mmol/L) in the presence of diabetic symptoms such as thirst, increased
urination, recurrent infections, weight loss, drowsiness and coma.
In asymptomatic people with an abnormal random plasma glucose, two fasting venous
plasma glucose samples in the abnormal range (7 mmol/L) are recommended for
diagnosis.Two-hour venous plasma glucose concentration 11.1 mmol/L two hours after 75 g
anhydrous glucose in an oral glucose tolerance test (OGTT).
The World Health Organization (WHO) now recommends that glycated haemoglobin
(HbA1c) can be used as a diagnostic test for diabetes. An HbA1c of 48 mmol/mol (6.5%) is
recommended as the cut-off point for diagnosing diabetes. A value less than 48 mmol/mol does
not exclude diabetes diagnosed using glucose tests. [7] See also the separate article on Glycated
Haemoglobin.

2.6 Risk Factors For Type 2 Diabetes

Obesity, especially central (truncal) obesity.

Lack of physical activity.

Ethnicity: people of South Asian, African, African-Caribbean, Polynesian, MiddleEastern and American-Indian descent are at greater risk of type 2 diabetes, compared with
the white population.

History of gestational diabetes.

Impaired glucose tolerance.

Impaired fasting glucose.

Drug therapy - eg, combined use of a thiazide diuretic with a beta-blocker.

Low-fibre, high-glycaemic index diet.

Metabolic syndrome.

Polycystic ovarian syndrome.

Family history (2.4-fold increased risk for type 2 diabetes).

Adults who had low birth weight for gestational age.

2.7 Complications Diabetes Mellitus

Refer to the separate articles under 'Acute' and 'Chronic' headings in this section.
Acute

See Diabetic Ketoacidosis and Hyperosmolar Hyperglycaemic State.

See Emergency Management of Hypoglycaemia.

Chronic

Cardiovascular disease: see ischaemic heart disease (Stable Angina, Acute Coronary
Syndrome), Cerebrovascular Events and Peripheral Arterial Disease.

See Diabetic Nephropathy.

See Diabetic Retinopathy and Diabetic Eye Problems.

See Diabetic Neuropathy, Autonomic Neuropathy and Neuropathic Pain and its
Management.

See Diabetic Foot, Leg Ulcers and Painful Foot.

Frequent, recurrent and persistent infections.

2.8 Diabetes Mellitus Treatment

The goal of diabetes management is to keep blood glucose levels as close to normal as
safely possible. Since diabetes may greatly increase risk for heart disease and peripheral artery
disease, measures to control blood pressure and cholesterol levels are an essential part of
diabetes treatment as well.
People with diabetes must take responsibility for their day-to-day care. This includes
monitoring blood glucose levels, dietary management, maintaining physical activity, keeping
weight and stress under control, monitoring oral medications and, if required, insulin use via
injections or pump. To help patients achieve this, UCSF's Diabetes Teaching Center offers selfmanagement educational programs that emphasize individualized diabetes care. The program
enables patients to make more consistent and appropriate adjustments in their therapy and
lifestyle.
Dietary Management and Physical Activity

Modifying eating habits and increasing physical activity are typically the first steps
toward reducing blood sugar levels. At UCSF Medical Center, all patients work with their doctor
and certified dietician to develop a dietary plan. Our Teaching Center conducts workshops that
provide patients with information on food nutrient content, healthy cooking and exercise.
Insulin Therapy
People with type 1 diabetes require multiple insulin injections each day to maintain safe
insulin levels. Insulin is often required to treat type 2 diabetes too. Using an insulin pump is an
alternative to injections. The pump is about the size of a pager and is usually worn on your belt.
Insulin is delivered through a small tube (catheter) that is placed under the skin (usually in the
abdomen).
There are four major types of insulin:

Rapid-acting

Short-acting

Intermediate-acting

Long-acting
Your doctor will determine your dose and how often you need to take insulin. There is no

standard insulin dose as it depends on factors such as your body weight, when you eat, how often
you exercise and how much insulin your body produces.
Oral Medications
Sometimes blood sugar levels remain high in people with type 2 diabetes even though
they eat in a healthy manner and exercise. When this happens, medications taken in pill form
may be prescribed. The medications work in several different ways. These include improve the
effectiveness of the body's natural insulin, reduce blood sugar production, increase insulin
production and inhibit blood sugar absorption. Oral diabetes medications are sometimes taken in
combination with insulin.

2.9 Prevention Of Diabetes Mellitus

Tip 1: Get more physical activity
There are many benefits to regular physical activity. Exercise can help you:

Lose weight

Lower your blood sugar

Boost your sensitivity to insulin which helps keep your blood sugar within a normal
range

Research shows that both aerobic exercise and resistance training can help control diabetes, but
the greater benefit comes from a fitness program that includes both.

Tip 2: Get plenty of fiber

It's rough, it's tough and it may help you:

Reduce your risk of diabetes by improving your blood sugar control

Lower your risk of heart disease

Promote weight loss by helping you feel full

Foods high in fiber include fruits, vegetables, beans, whole grains, nuts and seeds.

Tip 3: Go for whole grains

Although it's not clear why, whole grains may reduce your risk of diabetes and help
maintain blood sugar levels. Try to make at least half your grains whole grains. Many foods
made from whole grains come ready to eat, including various breads, pasta products and many
cereals. Look for the word "whole" on the package and among the first few items in the
ingredient list.

Tip 4: Lose extra weight

If you're overweight, diabetes prevention may hinge on weight loss. Every pound you
lose can improve your health, and you may be surprised by how much. Participants in one large
study who lost a modest amount of weight around 7 percent of initial body weight and
exercised regularly reduced the risk of developing diabetes by almost 60 percent.

Tip 5: Skip fad diets and just make healthier choices

Low-carb diets, the glycemic index diet or other fad diets may help you lose weight at
first, but their effectiveness at preventing diabetes isn't known nor are their long-term effects.
And by excluding or strictly limiting a particular food group, you may be giving up essential
nutrients. Instead, think variety and portion control as part of an overall healthy-eating plan.

When to see your doctor

If you're older than age 45 and your weight is normal, ask your doctor if diabetes testing
is appropriate for you. The American Diabetes Association recommends blood glucose screening
if:

You're age 45 or older and overweight

You're younger than age 45 and overweight with one or more additional risk factors for
type 2 diabetes such as a sedentary lifestyle or a family history of diabetes
Share your concerns about diabetes prevention with your doctor. He or she will applaud

your efforts to keep diabetes at bay, and perhaps offer additional suggestions based on your
medical history or other factors.

CHAPTER III
CLOSING

3.1 Conclusion
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 .

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Type of Diabetes Mellitus are :

1. Diabetes Mellitus Type 1 : insulin-dependent diabetes mellitus ( Insulin Dependent
Diabetes Mellitus / IDDM )
2. Type 2 diabetes mellitus : insulin-dependent diabetes mellitus ( Non - Insulin Dependent
Diabetes Mellitus / NIDDM )
3. Gestasional Diabetes Mellitus
Treatment of Diabetes Mellitus are :
1. physical exercise
2. medition
3. counseling

3.2 Suggest
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

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Febriyatri , Diena.2009
Improvement in Diabetes Mellitus Cases Installation Outpatient Disease in Hospital Doctor
Mohammad HoesinPalembang .BinaHusadasticks . 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-sulfonilureapada-diabetes-mellitus/
Holy Raplia ,Serni . 2011
Relationship Determinants of Diabetes Mellitus Patients with Genesis Outpatient Hospital
Palembang in Bari in 2011 . Sticks BinaHusada . Palembang

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