understanding and treatment of Diabetes mellitus ( DM ) according to the experts
A. Definition of diabetes mellitus ( DM )
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 disorder caused by many factors metabolisyang , with simtoma form of chronic hyperglycemia and impaired metabolism of carbohydrates, fats and proteins , as a result of :
1 . deficiency of insulin secretion , insulin activity , or both .
2 . glucose transporter deficiency .
3 . or both .
Various diseases , syndromes and can be triggered by diabetesmellitus simtoma , such as: Alzheimer's , ataxia - telangiectasia , sindromDown , penyakitHuntington , mitochondrial disorders , distrofimiotonis , penyakitParkinson , sindromPrader - Willi , sindromWerner , sindromWolfram , leukoaraiosis , dementia , hypothyroidism , hyperthyroidism , hypogonadism , and others.
B. Common symptoms
v simtoma hyperglycemia further induce three other classic symptoms :
- Polyuria - frequent urination .
- Polydipsia - always feel thirsty
- Polifagia - always feeling hungry
- Weight loss , often only in diabetes mellitus type 1
v and after long-term without adequate treatment , can lead to a variety of chronic complications , such as :
- Disorders of the eye with the potential result in blindness ,
- Disorders of the kidney to result in renal failure
- Cardiovascular disorders , accompanied by basement membrane lesions that can be identified by examination using electron microscopy .
- Disorders of the nervous system to autonomic nerve dysfunction , foot ulcers , amputation , Charcot joint and sexual dysfunction .
v and other symptoms such as dehydration , ketoacidosis , ketonuria and hyperosmolar non - ketotic which can result in stupor and coma .
- Rentanterhadap infection .
v The word diabetes mellitus itself refers simtoma called glycosuria , or diabetes , which occurs when the patient does not get treatment immediately .
C. Classification
The World Health Organization ( WHO ) classifies forms of diabetes mellitus based care and simtoma :
1 . Type 1 diabetes , which include simtoma ketoacidosis until the destruction of beta cells in the pancreas that caused or cause autoimmunity , and are idiopathic . Diabetes mellitus with unclear pathogenesis , such as cystic fibrosis or mitochondrial deficiency , not included in this classification .
2 . Type 2 diabetes , which is caused by a deficiency of insulin secretion , often accompanied by insulin resistance syndrome
3 . Gestational diabetes , which includes gestational impaired glucose tolerance , and gestational diabetes mellitus GIGT , GDM .
* And according to clinical stage without consideration of the pathogenesis , made into :
1 . Insulin requiring for survivaldiabetes , as in the case of C - peptide deficiency .
2 . Insulin requiring for controldiabetes . At this stage , endogenous insulin secretion is not sufficient to achieve normoglicemia symptoms , if not accompanied by additional hormones from outside the body .
3 . Not insulin requiring diabetes .
Four classes are similar to the clinical stage classification of IDDM (English : insulin - dependent diabetes mellitus ) , while the fifth and sixth stages are members of the classification of NIDDM (English : non- insulin - dependent diabetes mellitus ) . IDDM and NIDDM is a classification that is listed on the International Nomenclature of Diseases in 1991 and the 10th revision of the International Classification of Diseases in 1992 .
Malnutrion - related classification of diabetes mellitus , MRDM , no longer used because , although malnutrition can affect the expression of several types of diabetes , has so far not found evidence that malnutrition or protein deficiency can lead to diabetes . MRDM subtypes ; Protein - deficient pancreatic diabetes mellitus , PDPDM , PDPD , PDDM , is still regarded as a form of malnutrition that is induced by diabetes mellitus and requires further research . Whereas other subtypes , Fibrocalculous pancreatic diabetes , FCPD , classified as exocrine pancreatic disease in Fibrocalculous pancreatopathy trajectory that induces diabetes mellitus .
Classification of Impaired Glucose Tolerance , IGT , now defined as the stage of defective glucose regulation , as can be observed in all types of aberration hiperglisemis . But no longer considered a diabetic .
Classification of Impaired Fasting Glycaemia , IFG , was introduced as the ratio simtoma fasting blood sugar is higher than the upper limit of the normal range , but still below the ratio defined as the basis of a diagnosis of diabetes .
D. Cause
In general melittus diabetes caused by damage to a small part or most of the beta cells of the islands of Langerhans in the pancreas that produce insulin function , resulting in insulin deficiency .
Besides melittus diabetes can also occur due to interference with the function of insulin in glucose enter into the cells . The disorder may occur due to obesity or other reasons as yet unknown
1 . Diabetes Type I :
- Genetic factors
Diabetics are not inherited type I diabetes itself ; but inherit a genetic predisposition or tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type .
- Immunological Factors
The presence of an autoimmune response in which antibodies directed an abnormal response to normal tissue of the body by way of reacting to such networks are considered as if they were foreign tissue . Ie autoantibodies against islet cells of Langerhans and endogenous insulin .
- Environmental factors
Virus or toxin may trigger certain autoimmune process that causes destruction selbeta .
2 . Diabetes Type II
The exact mechanism that leads to insulin resistance and impaired insulin secretion in Type II diabetes is still unknown . Genetic factors play a role in the development of insulin resistance .
- Risk factors :
a. Age ( insulin resistance tends to increase at the age of 65 years )
b . obesity
c . family historyE. ComplicationsLong-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 cause impotence and gangrene with risk of amputation . More serious complications more common when poor control of blood sugar levels .- Diabetic ketoacidosisIn patients with type I diabetes , symptoms develop suddenly and can develop rapidly into a condition called diabetic ketoacidosis . Sugar levels in the blood is high , but because most of the cells can not use sugar without insulin , then these cells take energy from other sources . Fat cells are broken down and produces ketones , which is a toxic chemical compound that can cause the blood to become acidic ( ketoacidosis ) . Early symptoms of diabetic ketoacidosis is thirst and frequent urination , nausea , vomiting , fatigue and abdominal pain ( especially in children ) . Breathing becomes deep and rapid as the body attempts to repair the blood acidity . Patient breath smells like acetone smell . Without treatment , diabetic ketoacidosis can develop into a coma , sometimes within just a few hours . Even after starting insulin therapy , type I diabetic ketoacidosis may develop if they miss a single injection of insulin or experiencing stress due to infection , accident or serious illness . Patients with type II diabetes may not show symptoms for several years . If more severe insulin deficiency , there arose a symptom of frequent urination and thirst . Rarely ketoacidosis . If blood sugar levels are very high ( up to more than 1,000 mg / dL , usually caused by stress such as infection or drugs ) , then the patient will experience severe dehydration , which can cause mental confusion , dizziness , seizures , and a condition called coma hyperglycemic - hyperosmolar non - ketotic .
G. LEARNING ACTIVITIES EXTENSION
In the extension of learning that is taking place or we will target extension in love as in RS , posiandu , and in places which can be convenient to provide counseling , so that people can receive it well. And preparing stages such extension ; The activity phase consisting of a preliminary phase ( introduction ) , stage presentation , and closing stages .
1 . preliminary stage
Is the preparation stage or early stage before entering the presentation of the material that will be taught . The extension phase Pd briefly describes the materials that will be conveyed . This stage is meant to mentally prepare participants to pay attention and study hard during the presentation phase . The introduction is usually 5-10 minutes , or 5 % of the time extension .
2 . stage presentation ( presentation) .
Which is the main process within counseling , therein included the following parts :
a. Description ( explanation) , both within the BTK verbal and non-verbal such as : the use of graphs , pictures , real objects , models , and or demonstrations motion .
b . Sample ( example ) and non- examples ( non example ) that the practical and concrete from the description that they are abstract concepts .
c . Exercise ( exercise) which is a practice for participants .
d . Most ( 80-90 % ) of the time extension activities used within this stage .
3 . closing phase (test and follow-up ) .
An extension is the final stage , this stage includes three activities , namely :
a. Implementation test results counseling , to be answered or done .
b . Feedback is information that the results of the test .
c . Follow-up reply in the form of clues about what to do next .
d . Concluding phase takes about 10-20 minutes , or 10-15 % of the time extension .
H. METHOD
The method used is the extension .
I. TOOL
The tools are in use such as leaflets and food samples .
J. EVALUATION
Evaluations or tests they will be asked to answer orally or done by participants who appointed . example :
For friends, adek - adek , and here are all the same let us learn ,
1 . Come mother there , what understanding of diabetes mellitus was ? .......
2 . Father there what is the cause of diabetes mellitus that? ........
3 . Sister were there any symptoms of diabetes mellitus that? ...
4 . Let there Adek , what ingredients can not be consumed by people with diabetes mellitus ? .....
5 . Come all , who could lift a hand yes , , , , how the classification of diabetes mellitus that? .
REFERENCES
1 . http://www.ningharmanto.com/2009/09/diabetes-mellitus/
2 . IDF Chooses Blue Circle to Represent UN Resolution Unite for Diabetes Campaign , 17 March 2006
3 . http://id.wikipedia.org/wiki/Diabetes_mellitus
4 . Pathophysiology , Clinical concepts of disease processes , Sylvia A. price lorraine M , Wilson.penerbit medical book ( page ; 1110 )
5 . Pathophysiology clinical application inspection & management , valentine l . brashers , publisher of medical books ( page ; 157 )
A wide variety of diseases and medical care , wahyudi , publisher of the national effort Surabaya . ( Page ; 53 )
7 . Guyton human physiology and disease mechanisms , revised edition , publisher of medical books ( hlaman ; 699 )
Nursing Science ( verpleegkunde zv ) , part 2 , m . bouwhuaizen , alihbahsa : med drs Moelia king siregar EGC publisher of medical books ( hlaman ; 49 )
A. Definition of diabetes mellitus ( DM )
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 disorder caused by many factors metabolisyang , with simtoma form of chronic hyperglycemia and impaired metabolism of carbohydrates, fats and proteins , as a result of :
1 . deficiency of insulin secretion , insulin activity , or both .
2 . glucose transporter deficiency .
3 . or both .
Various diseases , syndromes and can be triggered by diabetesmellitus simtoma , such as: Alzheimer's , ataxia - telangiectasia , sindromDown , penyakitHuntington , mitochondrial disorders , distrofimiotonis , penyakitParkinson , sindromPrader - Willi , sindromWerner , sindromWolfram , leukoaraiosis , dementia , hypothyroidism , hyperthyroidism , hypogonadism , and others.
B. Common symptoms
v simtoma hyperglycemia further induce three other classic symptoms :
- Polyuria - frequent urination .
- Polydipsia - always feel thirsty
- Polifagia - always feeling hungry
- Weight loss , often only in diabetes mellitus type 1
v and after long-term without adequate treatment , can lead to a variety of chronic complications , such as :
- Disorders of the eye with the potential result in blindness ,
- Disorders of the kidney to result in renal failure
- Cardiovascular disorders , accompanied by basement membrane lesions that can be identified by examination using electron microscopy .
- Disorders of the nervous system to autonomic nerve dysfunction , foot ulcers , amputation , Charcot joint and sexual dysfunction .
v and other symptoms such as dehydration , ketoacidosis , ketonuria and hyperosmolar non - ketotic which can result in stupor and coma .
- Rentanterhadap infection .
v The word diabetes mellitus itself refers simtoma called glycosuria , or diabetes , which occurs when the patient does not get treatment immediately .
C. Classification
The World Health Organization ( WHO ) classifies forms of diabetes mellitus based care and simtoma :
1 . Type 1 diabetes , which include simtoma ketoacidosis until the destruction of beta cells in the pancreas that caused or cause autoimmunity , and are idiopathic . Diabetes mellitus with unclear pathogenesis , such as cystic fibrosis or mitochondrial deficiency , not included in this classification .
2 . Type 2 diabetes , which is caused by a deficiency of insulin secretion , often accompanied by insulin resistance syndrome
3 . Gestational diabetes , which includes gestational impaired glucose tolerance , and gestational diabetes mellitus GIGT , GDM .
* And according to clinical stage without consideration of the pathogenesis , made into :
1 . Insulin requiring for survivaldiabetes , as in the case of C - peptide deficiency .
2 . Insulin requiring for controldiabetes . At this stage , endogenous insulin secretion is not sufficient to achieve normoglicemia symptoms , if not accompanied by additional hormones from outside the body .
3 . Not insulin requiring diabetes .
Four classes are similar to the clinical stage classification of IDDM (English : insulin - dependent diabetes mellitus ) , while the fifth and sixth stages are members of the classification of NIDDM (English : non- insulin - dependent diabetes mellitus ) . IDDM and NIDDM is a classification that is listed on the International Nomenclature of Diseases in 1991 and the 10th revision of the International Classification of Diseases in 1992 .
Malnutrion - related classification of diabetes mellitus , MRDM , no longer used because , although malnutrition can affect the expression of several types of diabetes , has so far not found evidence that malnutrition or protein deficiency can lead to diabetes . MRDM subtypes ; Protein - deficient pancreatic diabetes mellitus , PDPDM , PDPD , PDDM , is still regarded as a form of malnutrition that is induced by diabetes mellitus and requires further research . Whereas other subtypes , Fibrocalculous pancreatic diabetes , FCPD , classified as exocrine pancreatic disease in Fibrocalculous pancreatopathy trajectory that induces diabetes mellitus .
Classification of Impaired Glucose Tolerance , IGT , now defined as the stage of defective glucose regulation , as can be observed in all types of aberration hiperglisemis . But no longer considered a diabetic .
Classification of Impaired Fasting Glycaemia , IFG , was introduced as the ratio simtoma fasting blood sugar is higher than the upper limit of the normal range , but still below the ratio defined as the basis of a diagnosis of diabetes .
D. Cause
In general melittus diabetes caused by damage to a small part or most of the beta cells of the islands of Langerhans in the pancreas that produce insulin function , resulting in insulin deficiency .
Besides melittus diabetes can also occur due to interference with the function of insulin in glucose enter into the cells . The disorder may occur due to obesity or other reasons as yet unknown
1 . Diabetes Type I :
- Genetic factors
Diabetics are not inherited type I diabetes itself ; but inherit a genetic predisposition or tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type .
- Immunological Factors
The presence of an autoimmune response in which antibodies directed an abnormal response to normal tissue of the body by way of reacting to such networks are considered as if they were foreign tissue . Ie autoantibodies against islet cells of Langerhans and endogenous insulin .
- Environmental factors
Virus or toxin may trigger certain autoimmune process that causes destruction selbeta .
2 . Diabetes Type II
The exact mechanism that leads to insulin resistance and impaired insulin secretion in Type II diabetes is still unknown . Genetic factors play a role in the development of insulin resistance .
- Risk factors :
a. Age ( insulin resistance tends to increase at the age of 65 years )
b . obesity
c . family historyE. ComplicationsLong-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 cause impotence and gangrene with risk of amputation . More serious complications more common when poor control of blood sugar levels .- Diabetic ketoacidosisIn patients with type I diabetes , symptoms develop suddenly and can develop rapidly into a condition called diabetic ketoacidosis . Sugar levels in the blood is high , but because most of the cells can not use sugar without insulin , then these cells take energy from other sources . Fat cells are broken down and produces ketones , which is a toxic chemical compound that can cause the blood to become acidic ( ketoacidosis ) . Early symptoms of diabetic ketoacidosis is thirst and frequent urination , nausea , vomiting , fatigue and abdominal pain ( especially in children ) . Breathing becomes deep and rapid as the body attempts to repair the blood acidity . Patient breath smells like acetone smell . Without treatment , diabetic ketoacidosis can develop into a coma , sometimes within just a few hours . Even after starting insulin therapy , type I diabetic ketoacidosis may develop if they miss a single injection of insulin or experiencing stress due to infection , accident or serious illness . Patients with type II diabetes may not show symptoms for several years . If more severe insulin deficiency , there arose a symptom of frequent urination and thirst . Rarely ketoacidosis . If blood sugar levels are very high ( up to more than 1,000 mg / dL , usually caused by stress such as infection or drugs ) , then the patient will experience severe dehydration , which can cause mental confusion , dizziness , seizures , and a condition called coma hyperglycemic - hyperosmolar non - ketotic .
G. LEARNING ACTIVITIES EXTENSION
In the extension of learning that is taking place or we will target extension in love as in RS , posiandu , and in places which can be convenient to provide counseling , so that people can receive it well. And preparing stages such extension ; The activity phase consisting of a preliminary phase ( introduction ) , stage presentation , and closing stages .
1 . preliminary stage
Is the preparation stage or early stage before entering the presentation of the material that will be taught . The extension phase Pd briefly describes the materials that will be conveyed . This stage is meant to mentally prepare participants to pay attention and study hard during the presentation phase . The introduction is usually 5-10 minutes , or 5 % of the time extension .
2 . stage presentation ( presentation) .
Which is the main process within counseling , therein included the following parts :
a. Description ( explanation) , both within the BTK verbal and non-verbal such as : the use of graphs , pictures , real objects , models , and or demonstrations motion .
b . Sample ( example ) and non- examples ( non example ) that the practical and concrete from the description that they are abstract concepts .
c . Exercise ( exercise) which is a practice for participants .
d . Most ( 80-90 % ) of the time extension activities used within this stage .
3 . closing phase (test and follow-up ) .
An extension is the final stage , this stage includes three activities , namely :
a. Implementation test results counseling , to be answered or done .
b . Feedback is information that the results of the test .
c . Follow-up reply in the form of clues about what to do next .
d . Concluding phase takes about 10-20 minutes , or 10-15 % of the time extension .
H. METHOD
The method used is the extension .
I. TOOL
The tools are in use such as leaflets and food samples .
J. EVALUATION
Evaluations or tests they will be asked to answer orally or done by participants who appointed . example :
For friends, adek - adek , and here are all the same let us learn ,
1 . Come mother there , what understanding of diabetes mellitus was ? .......
2 . Father there what is the cause of diabetes mellitus that? ........
3 . Sister were there any symptoms of diabetes mellitus that? ...
4 . Let there Adek , what ingredients can not be consumed by people with diabetes mellitus ? .....
5 . Come all , who could lift a hand yes , , , , how the classification of diabetes mellitus that? .
REFERENCES
1 . http://www.ningharmanto.com/2009/09/diabetes-mellitus/
2 . IDF Chooses Blue Circle to Represent UN Resolution Unite for Diabetes Campaign , 17 March 2006
3 . http://id.wikipedia.org/wiki/Diabetes_mellitus
4 . Pathophysiology , Clinical concepts of disease processes , Sylvia A. price lorraine M , Wilson.penerbit medical book ( page ; 1110 )
5 . Pathophysiology clinical application inspection & management , valentine l . brashers , publisher of medical books ( page ; 157 )
A wide variety of diseases and medical care , wahyudi , publisher of the national effort Surabaya . ( Page ; 53 )
7 . Guyton human physiology and disease mechanisms , revised edition , publisher of medical books ( hlaman ; 699 )
Nursing Science ( verpleegkunde zv ) , part 2 , m . bouwhuaizen , alihbahsa : med drs Moelia king siregar EGC publisher of medical books ( hlaman ; 49 )
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