CHAPTER I

INTRODUCTION

A. Background
Diabetes Mellitus (DM) is one of the health issues that have an impact on productivity and can
degrade Human Resources.
This disease affects not only the individual, but a country's health system. Although there is no
national survey, in line with lifestyle changes including diet Indonesian society estimated sufferers
DM is increasing, especially in the older adult age groups in all socio-economic status.
Currently DM disease prevention efforts have not occupy the main priorities in health care, although
the known negative impacts caused quite large among other chronic complications in chronic heart
disease, hypertension, brain, nervous system, heart, eyes and kidneys.
Diabetes or diabetes is a disease caused by
increase in blood sugar levels (hyperglycemia) due to insulin deficiency either absolute or relative.
Absolut means no insulin at all, while the relative mean significant numbers / is a little high or less
workability. Insulin is a hormone made in the pancreas. There are 2 kinds of type DM:
DM type I, or so-called insulin-dependent diabetes mellitus. DM is caused due to lack of insulin in the
blood that occurs due to
destruction of pancreatic beta cells. Prominent symptom is the occurrence of frequent urination
(especially at night), often hungry and often thirsty, most patients with DM type is normal weight or
underweight. Usually occurs at a young age and require lifelong insulin.
DM type II or called DM that is not dependent on insulin. DM is due to the insulin that is not
able to work well, the levels of
Insulin can be normal, low or even increased, but the function of insulin for glucose metabolism no /
less. As a result of glucose in the blood remains high, causing hyperglycemia, 75% of type II diabetic
patients with obersitas or there are very overweight and usually known diabetes after the age of 30
years.
DM type 3 or so-called gestational diabetes mellitus (English: gestational diabetes, insulin-resistant
type 1 diabetes, double diabetes, type 2 diabetes the which has progressed to require injected insulin,
latent autoimmune diabetes of adults, type 1.5 "diabetes, type 3 diabetes , LADA) or diabetes mellitus
that occurs only during pregnancy and recover after childbirth, with the involvement of interleukin-6
and C-reactive protein in the pathogenesis track. [29] GDM may damage the health of the fetus or the
mother, and about 20-50% of women with GDM survive

B. Problem Formulation
Based on the background in atasdapat formulated the problem as follows.
1.2.1 What is the sense of diabetes mellitus (DM)?
1.2.2 Any type of diabetes mellitus?
1.2.3 What are the signs - signs and symptoms of diabetes mellitus?
1.2.4 What are the causes of diabetes mellitus?
1.2.5 How does the treatment of diabetes mellitus and handlers?
1.2.6 How does Diabetes mellitus with limb?
C.Purpose
Based on the above problem formulation, achieved the goal of
This research is:
1.3.1 To know the definition of diabetes mellitus
1.3.2 To find out what type of diabetes mellitus
1.3.3 To know what are the signs - signs and symptoms of diabetes mellitus
1.2.4 To find out what are the causes of diabetes mellitus?
1.3.5 To determine how the treatment of diabetes mellitus and handlers
1.3.6 To determine the relationship of diabetes mellitus with limb

CHAPTER II
DISCUSSION

A Definition of diabetes mellitus

Diabetes mellitus, DM (Greek: , diabainein, translucent or fountain) (Latin: mellitus,
sweetness), 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, as a result of:
deficiency of insulin secretion, insulin activity, or both
glucose transporter deficiency.
or both.
Various diseases, syndromes and can be triggered by simtoma diabetes mellitus, such as: Alzheimer's
disease, ataxia-telangiectasia, Down syndrome, Huntington's disease, mitochondrial disorders,
miotonis dystrophy, Parkinson's disease, Prader-Willi syndrome, Werner syndrome, Wolfram
syndrome, Leukoaraiosis, dementia , hypothyroidism, hyperthyroidism, hypogonadism, and others.
DM is a metabolic disorder resulting from the failure of the pancreas to secrete insulin (a hormone
that responsibel on glucose utilization) adequately. Due to the common occurrence of hyperglycemia.
DM is a heterogeneous group of disorders characterized by abnormalities in blood glucose levels or
hyperglycemia caused by deficiency of insulin or insulin action due to inadequate (Brunner &
Suddart).
Blood sugar levels vary throughout the day, rising after a meal and returned to normal within 2 hours.
Normal blood sugar levels in the morning after the night before fasting is 70-110 mg / dL of blood.
Blood sugar levels are usually less than 120-140 mg / dL at 2 hours after eating or drinking liquids
that contain sugar and other carbohydrates.
B. Type - Diabetes mellitus type
The World Health Organization (WHO) classifies forms of diabetes mellitus based care and
simtoma:
1. Type 1 diabetes, which includes simtoma ketoacidosis until the destruction of beta cells in the
pancreas caused by or causing autoimmunity, and idiopathic. Diabetes mellitus with unclear
pathogenesis, such as cystic fibrosis or deficiency of mitochondria, are not included in this
classification.
2. Type 2 diabetes, which is caused by a deficiency of insulin secretion, often accompanied by insulin
resistance syndrome
Diabetes mellitus type 1
Diabetes mellitus type 1, diabetes children (English: childhood-onset diabetes, juvenile diabetes,
insulin-dependent diabetes mellitus, IDDM) is diabetes that occurs due to reduced insulin ratio in
blood circulation caused by the loss of insulin-producing beta cells in the islands Langerhans of the
pancreas. IDDM can be suffered by children and adults.
Until now IDDM can not be prevented and can not be cured, even with diet and exercise. Most people
with type 1 diabetes have health and good weight when the disease began suffered. In addition, the
sensitivity and the body's response to insulin is generally normal in patients with this type of diabetes,
especially in the early stages.
The most common cause of loss of beta cells in type 1 diabetes is the autoimmune reaction that
destroys error pancreatic beta cells. Autoimmune reactions can be triggered by an infection in the
body.

Currently, type 1 diabetes can be treated by using insulin, with careful monitoring of blood glucose
levels through blood testing monitors. The basic treatment of type 1 diabetes, even for the earliest
stages, is replacement of insulin. Without insulin, ketosis and diabetic ketoacidosis can lead to coma
and even death can result. Emphasis is also given to the adjustment of lifestyle (diet and exercise).
Apart from the injection in general, is also possible through the insulin pump, which allows for the
provision of inputs insulin 24 hours a day at dose levels that have been determined, it is also possible
dose (a bolus) of insulin needed at mealtime. And it is also possible for the administration of insulin
input through "inhaled powder".
Treatment of type 1 diabetes must continue. Treatment will not affect the normal activities if sufficient
awareness, appropriate care, and discipline in the examination and treatment of run. The average
glucose level for patients with type 1 diabetes should be as close as possible to the normal rate (80120 mg / dl, 4-6 mmol / l. Some physicians suggest up to 140-150 mg / dl (7-7.5 mmol / l) for those
who have problems with the lower number, such as "frequent hypoglycemic events" .Angka above
200 mg / dl (10 mmol / l) are often accompanied by discomfort and urinate too often leading to
dehydration. Figures above 300 mg / dl (15 mmol / l) usually require immediate treatment and can
lead to ketoacidosis. Low levels of blood glucose, called hypoglycemia, can cause loss of
consciousness.
Diabetes mellitus type 2
Diabetes mellitus type 2 (English: adult-onset diabetes, obesity-related diabetes, non-insulindependent diabetes mellitus, NIDDM) is a type of diabetes that occurs is not caused by the ratio of
insulin in the blood circulation, but is a metabolic disorder caused by mutations in many genes,
including those that express cell dysfunction, impaired insulin secretion, insulin resistance of the
cells caused by dysfunction of the hormone resistin GLUT10 with cofactors that causes tissue cells,
especially in the liver becomes less sensitive to insulinserta RBP4 that suppress absorption of glucose
by striated muscle but increase the secretion of blood sugar by the liver. Mutation of these genes often
occur on chromosome 19 which is the densest of chromosomes found in humans.
In NIDDM found that high expression of SGLT1, the ratio of RBP4 and hormone resistin high,
increase metabolic rate glycogenolysis and gluconeogenesis in the liver, a decrease in the rate of
oxidation reaction and increase the rate of esterification reaction in the liver.
In the early stages of the disorder appears is reduced insulin sensitivity, which is characterized by
increased levels of insulin in the blood. Hyperglycemia can be treated with anti-diabetic drugs that
can improve insulin sensitivity or reduce glucose production from the liver, but the more severe the
disease, also decreases insulin secretion, and insulin therapy is sometimes needed. There are several
theories that mention the exact cause and mechanism of this resistance, but central obesity is known
as a predisposing factor for insulin resistance, in relation to the expenditure of adipokines (its a group
of hormones) that damage tolerance glukosaObesitas found in approximately 90% of patients
developed world with a diagnosis of type 2 diabetes. Other factors include incubate and family
history, although in the last decade have increasingly begun to affect teenagers and children.
Type 2 diabetes can occur without any symptoms prior to diagnosis. Type 2 diabetes usually, initially,
treated by changes in physical activity (exercise), diet (generally a reduction in carbohydrate intake),
and through weight reduction. It can restore insulin sensitivity, even when weight loss / load is
humble ,, for example, around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits.
The next step, if necessary ,, treatment with oral [antidiabetic drugs. [As / When / For] the production
of insulin is initially unimpaired treatment, oral (often used in combination) can still be used to
increase the production of insulin (eg, sulfonylureas) and regulate the release / release that are not
appropriate of glucose by the liver (and attenuate insulin retaliation to some degree (eg, metformin),
and substantially attenuate insulin retaliation (eg, thiazolidinediones). If this fails, the science of
insulin hormone treatment will be required to maintain normal or near normal glucose levels. A
orderly way of life on blood glucose checks are recommended in many cases, most notably once and
need when taking medication.

A dipeptidyl peptidase 4 inhibitor sitagliptin called, was recently allowed to be used as the treatment
of diabetes mellitus type 2. As dipeptidyl peptidase 4 inhibitor others, sitagliptin will open up
opportunities for the development of tumor cells as well as cancer.
A very typical phenotype shown by NIDDM in humans is a deficiency in mitochondrial oxidative
metabolism in skeletal muscle. Conversely, tri-iodotironina hormone induces mitochondrial
biogenesis in and increase the synthesis of ATP synthase in complex V, increases the activity of
cytochrome c oxidase in complex IV, decrease reactive oxygen species, reduce oxidative stress, being
the hormone melatonin will increase ATP production in the mitochondria and increase respiratory
chain activity, especially in complex I, III and IV. Together with insulin, the hormone third forming
cycle regulating mitochondrial oxidative phosphorylation in skeletal muscle. On the other hand,
metalotionein which inhibits the activity of GSK-3beta will reduce the risk of heart muscle deficiency
in diabetics.
Simtoma that occur in NIDDM can be reduced dramatically, followed by a reduction in body weight
after gastric bypass surgery. This is known as a result of increased secretion of incretin hormones, but
experts have not been able to determine whether this method can provide a cure for NIDDM with
changes in glucose homeostasis.
In traditional therapy, flavonoid hesperidin and naringin-containing compounds, known to cause
an increase in glucokinase mRNA,
an increase in GLUT4 expression in the liver and tissues
an increase in peroxisome proliferator gamma perceiving
an increase in the ratio of plasma insulin, and leptin protein C
a decrease in liver GLUT2 expression
a decrease in the ratio of plasma fatty acid and triglyceride levels in the liver
a decrease in the ratio of plasma and liver cholesterol levels, such as by pressing the 3-hydroxy-3methylglutaryl-coenzyme reductase, acyl-CoA, cholesterol asiltransferase
a decrease in fatty acid oxidation in the liver and the activity of carnitine palmitoyl, among others,
by reducing the synthesis of glucose-6 phosphatase dehydrogenase and phosphatidic fosfohidrolase
increasing the rate of glycolysis trajectory and / or decrease the rate of gluconeogenesis track
being naringin alone, lowered mRNA transcription karboksikinase phosphoenolpyruvate and glucose6 phosphatase in the liver.
Hesperidin is an organic compound found in many types of citrus fruits, are naringin found in many
types of fruit wines.
C. Signs and symptoms of diabetes mellitus
Early signs can be seen that a person suffering from diabetes or diabetes that can be seen directly from
the effects of an increase in blood sugar levels, which increase blood sugar levels reach a value of
160-180 mg / dL and urine (urine) diabetic containing sugar (glucose ), so that the urine often
dilebung or surrounded by ants.
People with diabetes generally show signs and symptoms below, although not all experienced by
patients:
1. The number of issued more urine (polyuria)
2. Frequent or quickly feeling thirsty / thirst (polydipsia)
3. Excessive hunger or eat a lot (Polyphagia)
4. The increased urinary frequency / urinary continue (glycosuria)
5. Losing weight is not clear why
6. Tingling / numbness in the nerve endings in the hands and feet ditelapak
7. Fast tired and weak all the time
8. Experiencing myopic vision suddenly
9. If the cuts / scratches (skin infection) slow healing
10. Easy to infection, especially in the skin.
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D. Factors that cause diabetes mellitus

Diabetes can be caused by several factors triggers, including:
diet
o Eating excessive and exceeds the caloric content needed by the body can accelerate the onset of
diabetes mellitus. consumption of excessive eating and not balanced with insulin secretion in
sufficient quantity can cause blood sugar levels to rise and will certainly lead to diabetes mellitus.
Obesity (overweight)
o The squab with weight more than 90 kg tended to have a greater chance of developing diabetes
mellitus. Nine out of ten people obese potential for diabetes mellitus.
genetic factors
o Diabetes mellitus can be passed down from parents to children. Genes that cause diabetes mellitus
will be taken by the child if the parents suffer from diabetes mellitus. This gene inheritance to his
grandchildren and even great-grandchildren even though the risk is very small.
Chemicals and pharmaceuticals
o The chemicals can irritate the pancreas that causes inflammation of the pancreas, inflammation of
the pancreas will result in decreased pancreatic function so that no secretion of hormones for the
body's metabolic processes, including insulin. All types of drug residues accumulated in a long time
can irritate the pancreas.
disease and infection of the pancreas
o Infectious microorganisms and viruses in the pancreas can also cause inflammation of the pancreas
which will automatically cause the function of the pancreas down so that no secretion of hormones for
the body's metabolic processes, including insulin. Diseases such as high cholesterol and dyslipidemia
terkema can increase the risk of diabetes mellitus.
lifestyle
o lifestyle also greatly affect the causes of diabetes mellitus. If people are lazy to exercise have a
higher risk of developing diabetes mellitus due to exercise serves to burn excess calories in the body.
Calories that accumulate in the body is the main factor causing diabetes mellitus in addition to
pancreatic dysfunction. The World Health Organization (WHO) says diabetes cases in Asian countries
will rise by 90 percent in the next 20 years. "In 10 years, the number of diabetics in Hanoi, Vietnam,
doubled. The reason? In this city, people prefer riding than cycling, "said Dr. Gauden Galea, WHO
Advisor for Non-Communicable Diseases in the Western Pacific Region. In conclusion, those who are
less physically active have a higher risk of obesity than those who diligently biking, walking, or other
activities.
sweet tea
o The explanation is simple. The high intake of sugar causes blood sugar levels soaring. Yet the risk of
excess calories. A glass of sweet tea contains approximately 250-300 calories (depending on density).
Caloric needs of an average adult woman is 1,900 calories per day (depending on activity). From our
sweet tea was able to 1000-1200 calories. Not to plus three meals of rice and side dishes. Should be
assumed that every day we are excess calories. End: obesity and diabetes.
Fried
Because of the small, one fried not enough for us. And fried is one of the high risk factors trigger
degenerative diseases, such as cardiovascular, diabetes mellitus, and stroke. The main cause of
cardiovascular disease (CVD) is the blockage of the coronary arteries, with one of the main risk factor
was dyslipidemia. Dyslipidemia is a disorder of lipid metabolism characterized by elevated levels of
total cholesterol, LDL (bad cholesterol) and triglycerides, and decreased levels of HDL (good
cholesterol) in the blood. Increasing the proportion of dyslipidemia in the community due to the habit
of eating a variety of foods low in fiber and high in fat, including fried.
Like snacking
o We thought that by limiting the afternoon or evening to avoid obesity and diabetes. Because not full,
stomach filled with a piece or two pieces of biscuits and snacks like potato chips. In fact, biscuits,
potato chips, and other sweet pastries containing high carbohydrate content and without adequate
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food. All the food was classified in foods with a high glycemic index. Meanwhile, sugar and flour
contained in it have a role in raising blood sugar levels.
Lack of sleep.
o If the quality of sleep is not obtained, so disturbed metabolism. Research experts from the
University of Chicago revealed that lack of sleep for 3 days resulted in the body's ability to process
glucose declined drastically. That is, the risk of diabetes increases. Lack of sleep also can stimulate a
hormone in the blood that trigger appetite. Driven hunger, people with sleep disorders triggered by
eating high-calorie foods that make blood sugar levels rise.
Often stress
o Stress as flooding, must be channeled to the major flood. When stress comes, the body will increase
the production of the hormones epinephrine and cortisol blood sugar to rise and there is a reserve of
energy to move. Our bodies are designed so that for a good purpose. However, if high blood sugar
continues triggered by prolonged stress with no way out, is tantamount to suicide slowly.
Smoking Addiction
o An American study involving 4,572 volunteers men and women found that active smokers the risk
of diabetes increased by 22 percent. It added that the increase in risk is not just caused by smoking,
but the combination of unhealthy lifestyles, such as diet and exercise.
Using contraceptive pills
Most of the contraceptive pill is made from a combination of estrogen and progestin or progestin
alone. Combination pills often lead to changes in blood sugar levels. According to Dr. Dyah
Purnamasari S, Sp PD, of the Division of Endocrinology RSCM Metabolic, hormonal contraceptive
pill work opposite to the action of insulin. Because insulin work unopposed, the pancreas is forced to
work harder to produce insulin. If left too long, the pancreas becomes exhausted and not functioning
properly.
avid soda
o From the research conducted by the Nurses' Health Study II on 51 603 women aged 22-44 years,
found that increased consumption of soft drinks make weight and risk of diabetes soared. The
researchers said the increased risk was due to the content of sweetener in soft drinks. In addition,
liquid calories do not make us full, so motivated to drink more.
2.4.1 Pathophysiology
Possibility of type 2 diabetes induction of various hormonal abnormalities, such as the secretion of
hormones of the adrenal gland, pituitary and thyroid are observational studies that are worthy of
leaves at this time. For example, the incidence of IGT and diabetes mellitus often referred linked by
acromegaly and hiperkortisolisme or Cushing's syndrome.
Hormone hypersecretion of GH in acromegaly and Cushing's syndrome often results in insulin
resistance, both in the liver and other organs, with hyperinsulinemia and hyperglycemia simtoma,
which have an impact on cardiovascular disease and result in death.
GH does have an important role in the metabolism of glucose by stimulating glukogenesis and
lipolysis, and increases blood glucose levels and fatty acids. In contrast, insulin-like growth factor 1
(IGF-I) increases sensitivity to insulin, especially in striated muscle. However, in acromegaly, an
increase in the ratio of IGF-I can not lower insulin resistance, therefore excess GH.
Therapy with somatostatin can reduce excess GH in most people, but because it also inhibits the
secretion of insulin from the pancreas, this therapy will lead to complications in glucose tolerance.
While the hormone cortisol hypersecretion in hiperkortisolisme that cause visceral obesity, insulin
resistance, and dyslipidemia, and hyperglycemia leads to the decrease glucose tolerance, insulin
resistance occurrence, stimulation of gluconeogenesis and glycogenolysis. When synergism with
cofactor hypertension, hypercoagulable, may increase cardiovascular risk.
Hormone hypersecretion also occurs in the thyroid gland in the form of tri-iodotironina with
hyperthyroidism that causes an abnormality of glucose tolerance.
In patients with neuroendocrine tumors, changes in glucose tolerance induced by insulin hiposekresi,
as occurs in patients with pancreatic surgery, pheochromocytoma, glucagonoma and somatostatinoma.
Suspected hormone hypersecretion also induce other types of diabetes, namely type 1 cytokines
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Synergy shaped hormone, interferon-gamma and TNF-, was found to carry signals for beta cell
apoptosis, both in vitro and in vivo.

Beta cell apoptosis also occurs due to the mechanism of Fas-FasL, and / or hypersecretion of
cytotoxic molecules, such as granzyme and perforin; besides hyperactivity CD8- and CD4- T cells.
E.Complications
Long-term complications include cardiovascular disease (double the risk), chronic renal failure (the
main cause of dialysis), retinal damage which can lead to blindness, and nerve damage that can lead to
impotence and gangrene with risk of amputation. More serious complications are more common when
poor blood sugar control.
Long-term complications of diabetes
Organ / tissue exposed clincher that occurred Complications
Atherosclerotic plaques formed blood vessels and arteries clog large or medium in the heart, brain,
legs and penis.
Small blood vessel wall is damaged so that vessels can not transfer oxygen normally and leak
Circulation unsightly cause unsightly wound healing and can cause heart disease, stroke, gangrene of
the feet and hands, impotent and infection
Eyes There was damage to the small blood vessels of the retina Impaired vision and eventually
blindness can occur
Kidney Thickening of the renal vasculature
Protein leaking into the urine
Blood does not normally filtered kidney function is bad
Kidney failure
Nerves Nerve damage because glucose is not metabolized normally and because of reduced blood
flow limb weakness that occurs suddenly or gradually
Reduced taste, tingling and pain in the hands and feet
chronic nerve damage
The autonomic nervous system Damage to the nerves that control blood pressure and blood pressure
digestive tract that go up and down
Difficulty swallowing and changes in gastrointestinal function with an attack of diarrhea
Skin Decreased blood flow to the skin and loss of flavor that causes recurrent injury Wound,
infection (diabetic ulcers)
Wound healing unsightly
Impaired blood white blood cell function Susceptible infections, especially urinary tract infections
and skin
Gluka connective tissue not normally metabolized so thickened tissue or contract carpal tunnel
syndrome Dupuytren's contracture
F. The treatment and handling of diabetes mellitus
Patients with type 1 diabetes insulin therapy generally undergo treatment (Lantus / Levemir,
Humalog, Novolog or Apidra) is continuous, but it is to exercise moderation and controlling the diet
(diet).
In patients with type 2 diabetes mellitus, treatment and handling management focused on
lifestyle and physical activity. Controlling blood sugar levels is becoming key to treatment programs,
namely by reducing weight, diet, and exercise. If this does not achieve the expected results, the tablet
drug delivery will be required. Even the administration of insulin injections are necessary if the tablet
does not address the control of blood sugar levels.

G. PREVENTIVE CARE
1. Identification
Patients carrying the following information: the type of DM, complications, regimen
Treatment
2. Vaccination
A good action, especially against pnemokokus and
influenza
3. Do not smoke
4. Detection and Management of hypertension and hyperlipidemia
5. Foot Care
H. relationships with members of the body of diabetes mellitus
Relationships Dental Health and Diabetes Mellitus
Most people have a habit like eating lazy toothbrush. But it's also not all. Especially when the person
knows is true with maintaining dental health can prevent the body from other diseases. One of the
diseases that can be avoided is diabetes mellitus. Because according to a study in the US shows that
patients with chronic tooth decay could be that the person living with type 2 diabetes mellitus.
In severe tooth decay, bacteria can enter the bloodstream and disrupt the immune system. Cells of the
immune system that is broken to release a protein called cytokines. These cytokines cause damage to
cells of the pancreas produces insulin, the hormone that triggers diabetes. If this happens once, even
though the person previously in good health then the person is likely to develop type 2 diabetes.
In addition, the high content of cholesterol from the body needs glucose is the main factor triggering
the risk of diabetes for people who experience tooth decay.

CHAPTER III
CLOSING

Conclusion
There are so many factors that cause a person suffering from diabetes mellitus. As conohnya, Obesity
(overweight), genetic factors, unhealthy lifestyle (rarely exercise), lack of sleep, and many others.

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Putu Adi. 2009. DIABETES MILLITUS. www.wordpress update: 23 February 2014 at: 02:15
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