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ENGLISH ASSIGNMENT PAPER

“DIABETES MELLITUS”

Lecturer :

Created By :
1. Silvia Oktofiana Moi Wale (24185568A)
2. Ayu Anggresti (24185575A)
3. Hikmah Dwi R. (24185576A)
4. Wulan Amalia W. (24185585A)
5. Finka Nuranisa S. (24185604A)
6. Heny Puspita N. (24185605A)
7. Resy Budi R. (24185619A)

BACHELOR OF PHARMACY
FACULTY OF PHARMACY
UNIVERSITY OF SETIA BUDI SURAKARTA
2019
PREFACE
Thanks God we prayed to Allah SWT who haves given grace and His gift to us, so we
managed to finish the paper on time Alhamdulillah titled “Diabetes Mellitus”.
This paper contains information about diabetes mellitus, complications,
phatophysiology, how to cope and ways treatment. Expected that this paper can gives us all
the information about this hereditary disease.
We realize that this paper is far from perfect, therefore criticism and suggestions from
all stakeholders that are built for the perfections we always hoped this paper.
Finally, we say thank you to all those who have participated in the prepararation of this paper
from beginning to end. May Allah always be pleased with all our efforts, Amen.

Surakarta, 24 Nopember 2019

Author
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 system a 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 is quite
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 transition 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 people diabtes 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. How Understanding the pathophysiology of the disease and Diabetes Mellitus ?
2. A classification of Diabetes Mellitus ?
3. How to diagnose the disease diabetes mellitus ?
4. How the treatment of diabetes mellitus ?

1.3 Objectives
1. To determine Understanding the pathophysiology of the disease and Diabetes
Mellitus
2. To determine the classification of Diabetes Mellitus
3. To find out how to diagnose the disease Diabetes Mellitus
4. To find out how to cure Diabetes Mellitus

CHAPTER II
DISCUSSION
2.1 Definition of Diabetes Mellitus
Diabetes mellitus , DM (Greek : διαβαίνειν , diabaínein , translucent or shower
water ) (Latin : mellitus , sweet taste ) , 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 . According to the American Diabetes Asosiation ( ADA ) of 2003, diabetes
was merupkan a group of metabolic diseases with hyperglikemia characteristics that
occur due to abnormalities in insulin secretion , insulin action or both . Meanwhile,
according to the 1980 WHO mellistus diabetes is something that can not be poured in
a clear and concise answer but in general it can be said as a collection of anatomical
and chemical problems that are the result of a number of factors which come by
absolute or relative insulin deficiency and impaired insulin function . Diabetes
mellitus is a group of disorders characterized by elevated levels of blood glucose (
hyperglikemia ) there may be a decrease in the body's ability to respond to insulin and
or a decrease or absence of the formation by the pancreas ( Burnner and suddarrth ,
2003)
2.2 Phatophysiology
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 metabolism plays an
important role that incorporate glucose into the cells that are used as fuel ( Faculty of
Medicine , Department of Health , WHO , 2004) Insulin is released by the beta cells
can be described as a child was the key that can unlock the door entry of glucose into
the cells , and then in the cells was in metabolismekan glucose into energy . If there is
no insulin , the glucose can enter the cells with glucose result will still be inside the
blood vessels , which means the levels in the blood rises . In these circumstances the
body becomes weak because there is no source of energy in the cell . This is what
happens in diabetes mellitus type 1.

2.2.1 Phatophysiology of Diabetes Mellitus type 1


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 .
This led to the emergence of antibodies against beta cells called ICA ( Islet
Cell Antibody ) . Antigen ( beta cells ) caused by antibodies cause destruction
of beta cells .

2.2.2 Phatophysiology 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 .
The cause of insulin resistance in type 2 diabetes mellitus was not so clear ,
but the following factors play a role stout :
 Primarily central obesity ( apple shape )
 A diet high in fat and low in carbohydrates
 Less exercise
 Factor descent

2.3 Classification of Diabetes Mellitus


There are several different types of diabetes mellitus . The disease is
distinguished by the cause , clinical course and treatment .
Classification of Diabetes Mellitus main ones are:
a. Diabetes Mellitus Type 1
Insulin-dependent diabetes mellitus ( Insulin Dependent Diabetes Mellitus
/ IDDM ) Less than 5-10 % of patients with insulin -dependent diabetes . In this
type of diabetes , the 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 .
b. Diabetes Mellitus type 2
Insulin-dependent diabetes mellitus ( Non - Insulin Dependent Diabetes
Mellitus / NIDDM ) Less than 90-95 % of people with type 2 diabetes , which is
insulin-dependent diabetes .
Diabtes 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 as illness or
surgery

2.4 Signs and Symptoms of Diabetes Mellitus


The typcal symptoms
1. Symptoms typical
 Polyuria (frequent urinationespecially at night)
 Polyphagia (lots of fast food or hungry)
 Polydipsia (excessive thrist)

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


Diagnosis of Diabetes Mellitus According Utami P , ( 2003) Diabetes mellitus
can be diagnosed through laboratory tests with a blood test . Diabetes mellitus
diagnosis criteria are taken from the World Health Organization 's decision ( WHO) is
based on blood sugar or glucose . Diagnosis of diabetes millitus be in charge by
measuring blood glucose levels when fasting and 1-2 hours after drinking 75 grams of
glucose solution ( oral tolerance test ) . Blood glucose levels when fasting state
showed pruduksi basal insulin or the body's basic nature . Several parameters can be
used to diagnose diabetes mellitus is as follows :
1. A is said to suffer from diabetes mellitus , if blood sugar levels as ≥ 200 mg / dl . (
when blood sugar is the blood glucose level at a time can change throughout the
day with the amount of carbohydrate eaten .
2. Someone said to suffer from diabetes if blood glucose levels when fasting > 126
mg / dl or 2 hours after drinking 75 grams of glucose solution showed a blood
glucose level > 200 mg / dl . ( Fasting = no food or caloric input since the last 10
hours ) .
3. Someone said to be normal or without diabetes mellitus if blood glucose levels
when fasting is < 110 mg / dl , blood glucose levels 1 hour
Recommendations to WHO criteria for the diagnosis of diabetes mellitus and
hypoglycemia intermediate :
1. Type examination normal value diabetes
 Fasting Glucose
 Glucose 2 hours pp
> = 7.0 mmol / 1 ( 126mg/dl ) , or
> = 11.1 mmol ( 200mg/dl )
2. Impaired glucose tolerance (IGT)
 Fasting Glucose
 Glucose 2 hours pp
< = 7.0 mmol / 1 ( 126 ) mg / dl , and
> = 7.8 mmol / 1 and < 11.1 mmol ( 140 mg / dl and 2000 mg / dl )
3. Impaired fasting glucose (IFG)
 Fasting Glucose
 Glucose 2 hours pp
6.1 - 6.9 mmol / 1 ( 110-125 mg / dl ) , and
< 7.8 mmol / 1 ( 140 mg / dl )

2.6 Factor Originator


Factors seed is a major cause of disease onset diabetes in addition to other
causes such as infection , pregnancy and drugs . But despite demikain , in people with
diabetes seeds , not yet guarantee the onset of diabetes disease . The seeds may still
not appear significantly until the end.
Beberpa factors that can fertilize , and is often a precipitating factor of
diabetes mellitus are :
a. Lack of movement / lazy
b. Food excessive
c. Pregnancy
d. Lack of insulin production
e. Disease hormone that works opposite to insulin
In brief, the factors that increase the risk of diabetes is :
1. Genetic disorders
Diabetes can be decreased according to the genealogy family history of
diabetes , because of a gene disorder that results in the body can not produce
insulin properly . But the risk of developing diabetes is also dependent on factors
overweight , stress , and less mobile.
2. Age
Generally humans experience physiological changes drastically declined
rapidly after the age of 40 years . Diabetes often appear after a person enters the
vulnerable age , especially after age 45 years in those with severe badanya excess ,
so that his body no longer sensitive to insulin.
3. Stress Lifestyle
Chronic stress tends to make a person look for sweet foods and high fat to
increase brain serotonin levels . Serotonin has a calming effect while to relieve
stress . But the sugar and fat that is harmful to those who are at risk get diabetes.
4. The wrong diet
Malnourished or overweight increases the risk of both diabetic .
Malnutrition ( mal nutrition ) can damage the pancreas , whereas obesity (
excessive fat ) resulted in impaired insulin action ( insulin retention ).
Poor nutrition can occur during pregnancy , childhood , and in adulthood
due to excessively strict diet . While pda janinmungkin malnutrition occurs
because mothers smoke or consume alcohol during hamilnya.
In contrast , obesity is not because the food is sweet or rich in fat , but
more due to the amount of consumption is too much , sehongga blood sugar
reserves stored in the body sangant excessive . Approximately 80 % of type II
diabetics are those classified as obese.

2.7 Treatment of Diabetes Mellitus


Broadly speaking, the treatment is done by :
1. Physical exercise
Physical exercise in the form of exercise cause a decrease in blood sugar
levels caused by the elevation of peripheral glucose utilization areas . But when
high blood sugar levels > 18 mmol / 320mg % and if there is ketosis , should
exercise will lead to a more severe state of diabetes , sugar and ketonemia will be
rising due to the increase in hepatic gluconeogenesis and ketosis . Recommended
regular physical exercise ( 3-4 times a week ) for about 30 minutes , that are
appropriate Cripe ( Continuous , rhythmical , Interval , Progressive , Endurance ,
Training ) . As far as possible reach the 75-85 % target zone denyaut pulse
maximum ( 220 - age ) , adapted to the capacity and condition of comorbidities .
For example, moderate exercise is a regular walk at least 30 minutes of moderate
exercise is walking briskly for 20 minutes and jogging for example oalhraga
weight.
2. Medications
Oral antidiabetic drugs were divided into 2 groups, namely :
Class of sulfonylureas.
Sulfonylurea class of works by stimulating the beta cells of the pancreas to secrete
insulin.
1) Blocking the binding of insulin
2) Enhance tissue sensitivity to insulin
3) Supresses glucagon

a. Sulfonylureas class I
 Chlorpropamide (Diabenese)
 Indications : NIDDM
 Contra – Indications :
- juveil diabetes
- NIDDM heavy or unstable
- Ketoacidosis
- Surgery
- Severe infection
- Trauma
- Liver disorders
- Kidney or thyroid
- Pregnant
 Dosage froms and dosage : 100 mg tablets ; 250 mg tablets and
middle-aged patients 250 mg / day , the older age of 100-125 mg / day
. Rules used 3 times daily with meals.
 Side effects :
- Cholestatic jaundice
- Such as disulfiram reaction
- Nausea
- Vomiting
- Diarrhea
- Anorexia
 Special risk : in patients with impaired renal function and lactating
women.

b. Sulfonylureas class II
 Glipizide ( Aldiab)
 Indications : NIDDM

 Conta – Indications :
- Diabetes ketoacidosis with or without coma
- Juvenile diabetes
- Kidney disorders
- Liver weight
 Dosage froms and dosage : 5 mg tabs and an initial dose of 15-30 mg
1x / day before breakfast , plus a dose of 2.5-5 mg depending on blood
sugar levels.
 Side effects :
- GI disorders
- Hypoglycemic
- Allergic skin reactions erythema
- Maculopapular eruptions ,
- Urticaria
- Pruritus
- Eczema
- Porphyria
- Photosensitivity
- Reactions such as disulfiram
- Hematologic reactions : agranulositois , leukopenia ,
thrombocytopenia , anemia plastesik , hemolytic anemia ,
pansetopenia , dizziness , drowsiness , headache . Increased AST ,
LDH , alkaline phosphatese , BUN and creatinine
 Special risk : patients with liver , kidney and pregnant women.
 Glimepiride (Amadiab)
 Indications : diabetes mellitus type 2 (NIDDM)
 Conta – Indications :
- Type 1 diabetes
- Diabetic ketoacidosis
- Diabetic coma prekoma or
- Hypersensitivity to glimepiride
- Pregnancy
- Lactation
 Dosage froms and dosage : KAPL 1 mg ; 2 mg ; 3 mg ; 4 mg . Dose of
1 mg 1 x / day dose was increased for 1-2 weeks
 Side effects :
- Hypoglycaemic
- While visual disorders
- GI disorders
- Liver damage
- Thrombopenia
- Leukopenia
 Special risk : hypersensitivity and liver function disorders
 Glibenclamide (Prodiabet)
 Indications : NIDDM
 Conta – Indications :
- IDDM
- Ketoacidosis
- Severe infections
- Stress
- Trauma
- Kidney disorders
- Liver or thyroid weight
- Acute porifia
 Dosage froms and dosage : : 5 mg tablets . Initial dose of 2.5 mg / day ,
2.5 mg improved
 Side effects :
- Cholestatic jaundice
- Allergic dermatologic and hematologic reactions
- GI disorders
- Headache
- Dizziness
- Paresthesias
 Special risk : old age and hypoglycemia
An indication of this group are :
1. Ideal when weight around
2. Insulin requirements if less than 40 U / day
3. When no severe acute stress such as infection or surgery

The side effects of sulfonylureas class :


1. Nausea , vomiting, headache , vertigo and fever
2. Sense skin dermatitis , pruritis
3. Abnormalities , hermatologik : lekopeni , trombosittopeni and enemia
3. Extension
Extension to the management plan is essential for maximum clearance can
result . Diabetes education is the education and training in the knowledge and
skills to diabetic patients which aims to support behavior change to improve
patient understanding of his illness , which is necessary to achieve optimum good
health , good health and optimal adjustment , and psychological state of
adjustment and a better quality of life . Education is an integral part of the nursing
care of patients with diabetes .
The purpose of the extension is diabetes mellitus :
a. Increasing knowledge
b. Changing attitudes
c. Changing behavior and improve compliance
d. Changing the quality of life

CHAPTER III
CLOSING
1.1 Conclusion
1. Pathopysiology of Diabetes Mellitus are :
a. Pathopysiology of Diabetes Mellitus type 1
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. Pathopysiology 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.
2. Classification of Diabetes Mellitus are :
a. Diabetes Mellitus type 1 : insulin-dependent diabetes mellitus ( Insulin
Dependent Diabetes Mellitus / IDDM ).
b. Diabetes Mellitus type 2 : insulin-dependent diabetes mellitus ( Non -
Insulin Dependent Diabetes Mellitus / NIDDM )
3. Diagnosis of Diabetes Mellitus are :
According Utami P , ( 2003) Diabetes mellitus can be diagnosed
through laboratory tests with a blood test . Diabetes mellitus diagnosis criteria
are taken from the World Health Organization 's decision ( WHO) is based on
blood sugar or glucose.
4. Treatment of Diabetes Mellitus are :
a. Physical exercise
b. Drug
c. Conseling
1.2 Advice
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. For
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.

REFERENCES

Febriyati, Diena. 2009. Improvement in Diabetes Mellitus Causes Installation Outpatient


Disease in Hospital Doctor Mohammad Hoesin Palembang. Bina Husada sticks.
Palembang
Holy Raplia, Semi. 2011. Relationship Determinants of Diabetes Mellitus Patient with
Genesis Outpatient Hospital Palembang. Bina Husada sticks. Palembang.

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