An introduction to Diabetes Mellitus

Ns. Ahmad Hasyim W, M.Kep, MNg

LOGO
 Ahmad Hasyim Wibisono
Malang 1 Juli 1986
085646333305 / ahasyimw@gmail.com
Pendidikan
 Sarjana keperawatan Universitas Brawijaya Malang (2009)
 Magister keperawatan Universitas Indonesia (2013)
 Master of nursing in diabetes management and education,
Flinders University Australia (2015)
Pelatihan
 Certified wound care clinician (2012)
 Certified stoma therapist (2012)
Pekerjaan
 Dosen program studi ilmu keperawatan FK UB
Profil  Ketua komite keperawatan RS UB (2016-2017)
 Penanggung jawab pedis care center (rumah perawatan
luka, stoma dan edukasi diabetes)
 Trainer nasional program sertifikasi perawatan luka
Organisasi
 Waka Bid Riset Infokom DPD PPNI Kota Malang
 Active member of
ADEA - Australian Diabetes Educators Association
WCET - World Council of Enterosthomal Therapist
InWCCA – Indonesia Wound Care Clinician Association
Contents

Sign and Diabetes

Introduction
symptoms management

Roles of the
Definition Pathophysiology
nurse

Etiology Classification
Introduction: spectrum of blood glucose homeostasis
Introduction: a quick statistics

Diabetes prevalence in
Indonesia is estimated to be
6,5%  ± 17 M people
 Definition
Diabetes mellitus is a chronic disease caused by inherited and/or acquired
deficiency in production of insulin by the pancreas, or by the ineffectiveness of
the insulin produced. Such a deficiency results in increased concentrations of
glucose in the blood
Regulation of Plasma Glucose Level
How Insulin Decrease Plasma Glucose Level?
Etiology

β – cell destruction
 Overuse
 Autoimmune disorder
 Congenital pancreas defect
Resistance to insulin
Insulin structure abnormality
 Classification
 Type 1 DM
 Beta cell destruction, usually leading to absolute insulin deficiency  Immune-mediated,
Idiopathic
 Formerly known as Insulin Dependent DM (IDDM)
 Type 2 DM
 It is a combined insulin resistance and relative deficiency in insulin secretion
 Formerly known as Noninsulin Dependent DM (NIDDM)
 Gestational Diabetes Mellitus (GDM):
 Gestational Diabetes Mellitus (GDM) developing during some cases of pregnancy but
usually disappears after pregnancy.
 Diabetes mellitus associated with other conditions or syndromes
 Genetic defects of beta cell development or function
 Genetic defects in insulin action
 Chronic Pancreatic infection
Pathophysiology of T1DM
Affects approximately 5% to 10% of people with the DM; has acute onset,
usually before 30 years of age
Characterized by destruction of the pancreatic beta cells  absolute insulin
deficit
 Glycosuria  excessive loss of fluids and electrolytes (osmotic diuresis) 
hypovolemia
 Uncontrolled Glycogenolysis and gluconeogenesis  ↑ hyperglycemia
 Massive fat breakdown  ↑ ↑ ketone bodies  DKA
Pathophysiology of T2DM

 Affects approximately 90% to 95% of people with DM; has slow and gradual onset, usually
after 30 years of age and obese
 Characterized by insulin resistance and impaired insulin secretion relative insulin deficit
 DKA is not commonly happens
 Glycosuria  excessive loss of fluids and electrolytes (osmotic diuresis) 
hyperglycemic hyperosmolar nonketotic syndrome  hypovolemia
 On very late stage: Poorly controlled Glycogenolysis and gluconeogenesis  ↑
hyperglycemia, hyperlipidemia
 More than 80% of patients progressing to type 2 diabetes are insulin resistant
Pathophysiology of GDM
Is any degree of glucose intolerance with its onset during pregnancy
Secretion of placental hormones, which causes insulin resistance
Those at risk include marked obesity, a personal history of GDM, glycosuria, or a
strong family history of diabetes
Occurs in 14% of pregnant women and increases their risk for hypertensive
disorders during pregnancy, abnormally large babies
After delivery, blood glucose levels usually return to normal. However, many
women who have had GDM develop type 2 diabetes later in life.
Should be counseled to maintain her ideal body weight and to exercise regularly
to reduce her risk for type 2 diabetes
Sign and symptoms
Classic signs of hyperglycemia: polydipsia, polyuria, polyphagia
Other signs:
 Fatigue and weakness, sudden vision changes, tingling or numbness in
hands or feet, dry skin, skin lesions or wounds are slow to heal, and recurrent
infections
 Progressive weight loss
Signs of acute complications: AMS, pre shock/shock symptoms, headache,
lightheadedness
Diagnosis criteria for Diabetes

Classic sign of diabetes plus casual plasma glucose concentration equal to or

greater than 200 mg/dL
OR
Fasting plasma glucose greater than or equal to 126 mg/dl
OR
Two-hour postload glucose equal to or greater than 200 mg/dl through an oral
glucose tolerance test (OGTT)
OR
HbA1c ≥ 6.5%
Complications
Acute
 DKA
Diabetes increases the risk for
 HHS cardiovascular diseases and cerebro
 Hypoglycemia vascular accidents
 Hyperglycemia
Chronic
 Retinopathy
 Nephropathy
 Angiopathy (micro & macro)
 Neuropathy
 HEALTH BEHAVIOR Other predisposing factors

Positive Negative

Holistic health Diabetes

Psychological adjustment
NEW HEALTH BEHAVIOR Success
Diabetes management
Failure

Drugs
Physical exercise
EDUCATION
Managing diabetes Diet modification
Self monitoring
 Lifestyle adjustments

Theory

FACT
Diabetes education
“The ultimate goal of education is not knowledge, but ACTION”

 Diabetes management: to maintain quality of life, keep the person

free from diabetes symptoms, and prevent complications by
controlling blood glucose, blood lipids and blood pressure with as few
hypoglycaemic episodes as possible
 Patients empowerment paradigm:
 Patientsshould be able to self-manage diabetes adequately with
the support of health professionals
Diabetes education

Lifestyle education is mainly nurse’s responsibility

 Medical doctors: medicines management
 Dietitian: advanced dietary consultation (DAA, 2009)

The art of diabetes education:

 Behaviour change based on personal awareness (ADEA, 2009)
 Stress free lifestyle modification  fun and enjoyable
 Blood glucose lowering agents

 Oral agents:
 Biguanides: metformin
 Sulfonylurea
 Acarbose
 dipeptidyl peptidase 4 (DPP 4)
inhibitor
 Injectables
 Insulin
 Glucagon like peptide receptor
agonist (GLP-RA)
Physical exercise for diabetes
 Moderate intensity aerobic training which aims for increase heart rate
 Intensity recommendation: 50-70% of maximal heart rate of a person
 Example: walking, cycling, swimming
 Safe Blood glucose range recommendation 100-250 mg/dl
 30-45 mins a day, 3-5 times a week, 150 mins per week in total
Basic diabetes diet

 Carbohydrate: 45-65% total calorie intake

 Protein: 10–20%
 Fat: 20-25%
 Na: <2300 mg daily
 High fiber
Nursing diagnosis

Risk-prone health behavior Overweight

Ineffective health management Risk for unstable blood glucose level
Readiness for enhanced health management Activity intolerance
Imbalanced nutrition: less than body requirements Impaired skin integrity
Obesity Impaired tissue integrity
Independent learning
 Insulin therapy
 Dietary menu management in type 2 diabetes
 Self monitoring guideline
THANK YOU 