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 NI LUH PUTU WARDANI (12700052)

 NI WAYAN EKA ARIMAS (12700212)
All cells in the human body needs sugar
to work normally. Sugar can enter the body's
cells with the help of the hormone insulin. If
the amount of insulin in the body is not
enough, or when the body's cells do not
respond to insulin (insulin resistance), there
will be a buildup of sugar in the blood. This
is what happens in patients with diabetes
 Diabetes mellitus type 1, diabetes mellitus
that is caused by insufficient production of
insulin by the pancreas.
 Diabetes mellitus type 2, which is caused by
insulin resistance, so the use of insulin by the
body becomes ineffective.
 Gestational diabetes, hyperglycemia was first
discovered during pregnancy.
 Type 1 diabetes is believed to be an autoimmune disease in
which the body's own immune system specifically attack
and destroy insulin-producing cells found in the pancreas.
 Type 2 diabetes is thought to be caused by a combination
of genetic and environmental factors. Many patients with
type 2 diabetes have a family member who also suffers from
type 2 diabetes or other health problems associated with
diabetes, such as high blood cholesterol, high blood pressure
(hypertension) or obesity.
 Gestational diabetes is caused by the hormonal changes
that occur during pregnancy. Elevated levels of several
hormones produced by the placenta makes the body's cells
become less responsive to insulin (insulin resistance).
Because the placenta continues to grow during pregnancy,
hormone production is also increasing and aggravate insulin
resistance has occurred.
At first, patients often do not realize that he was
suffering from diabetes mellitus, even many years later.
However, it should be suspected if a person has a
complaint DM DM classical form:
 polyuria (many of urination)
 polydipsia (thirst so so much to drink)
 polyphagia (eat a lot because feeling hungry constantly)
 weight loss can not be explained why
If the above complaint experienced by someone,
may be examined to confirm the diagnosis of DM in
the form of additional complaints:
 weakness, tiredness, tingling, itching
 blurred vision
 poor wound healing
 erectile dysfunction in male patients
 itching in genital female patients
Acute Complications
Circumstances include the acute complications of DM is diabetic
ketoacidosis (KAD) and hyperosmolar hyperglycemic status (SHH). In
this two-state blood glucose levels are very high (the KAD 300-600 mg /
dL, the SHH 600-1200 mg / dL), and patients are usually unconscious.
Due to a high death rate, the patient should be immediately taken to the
hospital for proper treatment.
The state of hypoglycemia are also included in the acute
complications of diabetes, in which blood glucose levels decreased to <60
mg / dL. DM patients are unconscious to think having a state of
hypoglycemia. Things that can cause hypoglycemia as patients taking too
much (most often sulfonylureas) or inject too much insulin, or the patient
does not eat after taking the drug or injecting insulin.
Symptoms of hypoglycemia include profuse sweating,
palpitations, trembling, hunger, dizziness, anxiety, and if severe, may lose
consciousness to coma. If the patient is conscious, can soon be given a
sweet drink containing glucose.If the patient's condition does not improve
or unconscious patient should be immediately taken to hospital for
treatment and subsequent monitoring.
Chronic complications
Diabetes mellitus uncontrolled for long periods will
cause damage to blood vessels and nerves. The blood vessels
can be damaged divided into two types, namely large and
small blood vessels.
Included in the large blood vessels, among others:
 The blood vessels of the heart, which if broken will lead to
coronary heart disease and sudden cardiac arrest
 Peripheral blood vessels, especially in the legs, which if
damaged will cause ischemic injury to the leg
 Cerebral blood vessels, which if damaged could cause a
Damage to small blood vessels (microangiopathic) such
as the retinal blood vessels and can lead to blindness. Also, it
can cause damage to kidney blood vessels which will lead to
diabetic nephropathy. For more details, read the article to
kidney failure.
Prevention of type 2 diabetes mellitus is mainly aimed at people
who are at risk of developing type 2 diabetes. The goal is to slow the
onset of type 2 diabetes, maintain the function of insulin-producing cells
in the pancreas, and prevent or delay the emergence of disorders of the
heart and blood vessels. Risk factors for type 2 diabetes can be divided
into factors that can be modified and the factors that can not be modified.
Prevention efforts by reducing modifiable risk
 Risk factorsthat can not be modified for example, race and ethnicity,
history of family members suffering from diabetes mellitus
 Modifiable risk factors for example being overweight, physical
inactivity, hypertension (> 140/90 mmHg), impaired blood lipid profile
(HDL <35 mg / dL or triglycerides> 250 mg / dL, and an unhealthy
diet high in sugar and low in fiber
 Prevention of type 2 diabetes in people at risk in principle is to make
lifestyle changes that include exercise, weight loss, and dietary
Destination management of patients with diabetes mellitus type 2
is a lower blood glucose levels to normal or near normal, so as to
prevent the occurrence of complications in these patients. In patients
with type 2 diabetes, management begins with lifestyle change which is
doing a healthy diet and increasing physical activity in order to reach
your ideal weight.

Diabetes mellitus is not curable, but can still be controlled.

In diabetic patients, diet is an important aspect to control the

elevated levels of blood glucose.
Weight loss and exercise is very important because it will
increase the body's sensitivity to insulin, thus helping to control blood
glucose levels increase. Aerobic exercise such as walking, cycling,
jogging, and swimming are encouraged performed regularly for 30
minutes, 3-4 times a week.
Sports, no doubt, bring positive effects to the health of patients
with diabetes mellitus. Exercise is one of the recommended ways to
control blood sugar levels and prevent long-term diabetes complications
such as nerve damage and heart disease. However, you should still be
mindful of the risk of blood sugar drop too low, or often referred to as
Symptoms of hypoglycemia include:
 weakness and fatigue
 confused
 hungry
 tremble
 cold sweats
 headache
 fainting or seizures (in severe cases)
Activities can be divided into several sessions, each session
of 10-15 minutes. Recommended activities are activities that
increase breathing and heart rate and cause little sweat, such
as walking, gardening, swimming, or cleaning the house. Perform
an increase in the intensity and duration of exercise gradually.

Do not do physical activity is too heavy or too long. If you do, your
body will produce hormones adrenaline and other hormones that will
fight insulin function. That way, your blood sugar will increase.
 Before starting the exercise, patients with diabetes should consult with
their doctor to ensure that the activities are chosen fairly safe practice and
in accordance with the physical circumstances,
 Practice with someone who knows that you are a diabetic and knows
what he should do if you are suddenly experiencing hypoglycemic.
 Bring snacks during exercise, such as a box of raisins or candy, to be used
if you are experiencing hypoglycemic.
 If not accompanied, use bracelets or attribute that indicates that you are
 Use shoes and comfortable cotton socks
 After the exercise, perform the checks on your feet to look for any
redness, blisters, sores or blisters.
 Drink plenty of water before, during and after exercise to prevent
 Do not ignore your pain. Immediately stop exercising if you suddenly
feel the pain.
 Choose activities that you enjoy doing so that you can live happily
activity regularly.
Sport is an important activity that should be done every one to stay
healthy. For patients with diabetes mellitus, well controlled or not
controlled, the benefits of exercise even more. The types of exercise is
good for diabetic patients include:
 Aerobic

Aerobic exercise makes the heart and bones strong,

reduce stress and improve blood flow. Examples of aerobic exercise that
can be done iswalking briskly, dancing or aerobics class. If you have a
problem with the nerve foot or knee, you should reduce the load on the
foot by choosing swimming, cycling or rowing.
 Lifting weights (weight lifting)
Weight training can help improve bone strength and muscle while
burning fat and maintaining bone density.
 Stretching (stretching)
Stretching or stretching to prevent muscle cramps, stiffness and
muscle injuries. Several types of flexibility exercises such as yoga
and tai chi involves meditation and breathing techniques to reduce

 Other activities?
 Choosing up the stairs of the escalator or elevator ride

 Parking the car in a place away from the mall entrance

 Brisk walking or cycling when there is an opportunity

 Playing with the kids

 Pet dog a walk

One complication that often occurs in patients with diabetes
mellitus is a matter of feet. Problems in the feet of people with
DM is caused by two things, namely:

 Poor blood flow. This happens because the blood vessel damage
caused by high blood sugar levels for a long time. Impaired blood
flow causes the foot is not getting enough nutrition, so skin
becomes weak legs, easy cuts and difficult to recover in the event
of injury.
 Nerve damage. It also occurs due to high blood sugar levels for a
long time. Nerve damage causing a patient's sensitivity to pain
DM is reduced, so that the patient is unconscious when her feet