DIABETES MELITUS

Pencegahan Kecacatan

1.Brain stroke

2.Vascular Disease

3. Cardio Vascular

Cardiovascular disease is a serious complication of diabetes mellitus. In the last 2

decades, great strides have been made in reducing microvascular complications in
patients with diabetes through improving glycemic control. Decreasing rates of
cardiovascular events have proved to be more difficult than simply intensifying the
management of hyperglycemia. A tremendous effort has been made to deepen
understanding of cardiovascular disease in diabetes and to formulate the best treatment
approach. This review summarizes the current state of knowledge and discusses areas of
uncertainty in the care of patients with diabetes who are at risk for cardiovascular disease.

4.Neuropathy

5.Pancreat

6.Retinopathy

The multsystem complicatons of diabetes such as retnopathy, neuropathy,nephropathy and

cardiovascular diseases are considered important, impinging on public health. Diabetc
retnopathy is one of the leading causes of blindness worldwide; individuals with this conditon
run a 25 tme higher risk of losing the sight than do normal individuals. .

pustaka

IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-
0861.Volume 16, Issue 2 Ver. III (February. 2017), PP 39-41 www.iosrjournals.org

Nephropathy

Diabetes is a serious chronic disease that needs attenton. Approximately 15% of all people with
diabetes will be affected by a foot ulcer during their lifetme.

Diabetc foot ulcers (DFUs) often co-exist with vascular insufficiency and are the major cause of
gangrene and amputaton in people with diabetes. Risk of developing diabetc foot ulcers is
greatly increased by reduced sensaton and blood perfusion.

Diabetc foot ulcers represent a huge risk to the patent’s quality of life, escalatng
wound/infecton management and costs, and account for a large proporton of all natonal
healthcare budgets

People with diabetes must inspect their feet regularly, or have a family member or care provider
do it on their behalf. Daily inspecton is the foundaton of diabetc foot ulcer preventon. All
wounds and sores should be taken seriously early on.

Regular, gentle cleansing with soapy water, followed by the applicaton of topical moisturizers,
helps to keep the skin healthy and better able to resist breakdown and injury.

Shoes should be checked to ensure that they fit properly and offer adequate support. Consider
athletc/sports shoes and thick, padded socks. Diabetc socks (unrestrictve on circulaton) are
also available. In the case of foot deformites or special support needs, custom shoes should be
considered.

Minor foot injuries and infectons, such as cuts, scrapes, blisters and tnea pedis (athlete’s foot),
can be unintentonally worsened by home treatments that impede healing. Patents should be
reminded to avoid hot soaks, heatng pads and harsh topical agents such as hydrogen peroxide,
iodine and astringents. Minor wounds should be gently cleansed and treated with topical
antseptcs. In additon, a physician should inspect any minor wounds that do not heal quickly.

By reinforcing preventve advice and inspectng the patent’s feet at routne follow-ups, the
physician can help the patent develop and maintain good foot-care practces.

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Coloplast Corp. Minneapolis, MN 55411 1.800.533.0464

Romanelli et al. Exudate management made easy. Wounds Internatonal 2012;1(2).

MANAGEMENT OF DIABETES:

The main modes of treatment of diabetes:

1. Diet and diet counseling.

2. Drugs

3. Exercise

4. Educaton (dietary guidelines).

 DIET: Dietary introductons for a diabetc must be simple because he/she has to follow a diet for
the rest of his/her life. There is considerable variaton in the chemical compositon of food and in
modes of cooking. The menu must include foods that the patent likes, that are affordable and
easily available.

PRINCIPLE OF DIET:

Calories: The total intake of calories is more important for a diabetc than the exact proportons
of proteins, fats and carbohydrates in the diet. A diabetc should be kept on a well-balanced diet
providing just enough calories to maintain ideal body weight. In a diabetc of normal weight
enough calories should be given to maintain weight. In an underweight, calories should be given
to increase the weight to normal and maintain it. In an obese, calories should be given to
decrease the weight to normal and maintain it.

Carbohydrates: Ingested food goes into the metabolic pool where all nutrients (except those
required for growth and repair) are converted to carbohydrates and fats. Thus, even on a diet of
meat and fish with a negligible amount of carbohydrates. Carbohydrates are deposited as
―Glycogen‖ in the muscle and liver by the acton of insulin. In diabetes, due to deficiency of
insulin, this metabolism is disturbed. Carbohydrates restricton impairs insulin sensitvity and
reversed by high carbohydrate diet. Hence, carbohydrates is maintained to about 55-60% of total
calories. Most carbohydrates should be in the form of polysaccharides such as bread, cereals,
beans, etc; Whole apple is better than apple juice because of its high fibre content and low
glycemic index.

GLYCEMIC INDEX: High glycemic index forms of carbohydrates are foods that produce high
concentraton of blood glucose and increased insulin demand and that therefore, could possibly
contribute to higher risk of type – Π diabetes. The ability of a food item to raise the blood sugar
is measured in terms of glycemic index.

DIETARY FIBRE: Dietary fibre and complex carbohydrates benefits for diabetes. Such diet lowers:
v Insulin requirements v Increase peripheral tssue insulin sensitvity v Decrease serum
cholesterol and triglyceride values v Aid in weight control / weight loss v Lower blood
pressure.

PROTEINS: A diet high in protein is good for the health of diabetes, because i. Supplies the
essental aminoacids needed for tssue repair. ii. Doesn’t rise blood sugar during absorpton as
much as carbohydrates. iii. Doesn’t supply as many calories as fat. iv. Also promotes satety and
helps both types of diabetc patents to adhere to the carbohydrate allowance. Hence, 20% of
proteins are supplied from the total calories. 1g of protein/kg body weight is adequate, more
1.25 or 1.5g/kg body weight may be given if necessary.
FATS: Fats should be provided about 20% - 25% of calories. They cannot be oxidized as readily as
carbohydrates. The normal end products of oxidaton of fats are Co2 and H2O. Ketone bodies are
intermediate products of normal fat metabolism. They are produced in the liver and utlized by
the tssues to provide energy. The accumulaton of these products results in diabetc coma. The
ensuring exercise breakdown of fats results in accumulaton of ketone bodies which are then
excreted in the urine daily metabolism of 100g carbohydrates prevents accumulaton of ketone
bodies.

VITAMINS: Vitamin supplementaton may be helpful to overcome oxidatve stress and deficiency.
Diet rich in all vitamins partcularly in vitamin – C and E antoxidant in fruits and vegetables.
Carbohydrates are not completely metabolized when there is a deficiency of vitamin – B. It is
postulated that products are partal carbohydrates metabolism, like ―Pyruvic acid‖ accumulate
in such situatons and damage the nerves, resultng in ―PERIPHERAL NEUROPATHY‖. The
diabetc requires supplements of vitamin – B. It is also advisable to supple vitamin – A, as the
liver.

MINERALS: Supplementaton may be helpful to overcome oxidatve stress and deficiency.

Minerals especially magnesium and zinc are encouraged. Normal casual intake should be
suggested for diabetes and Na may have a role in the development of ―insulin resistance‖ apart
from its role in maintaining blood pressure. Moderate dietary Na restricton is beneficial
―chromium supplementaton decreases‖. The requirement for insulin or oral hypoglycaemic
agents in patent with type – Π diabetes.

pustaka

INTERNATIONAL JOURNAL OF SCIENTIFIC & TECHNOLOGY RESEARCH VOLUME 4, ISSUE 08,

AUGUST 2015