CINIA KASMARA

MITHA LESTARI
Defition for Diabetes Mellitus

 Diabetes mellitus is a disorder in which the level of blood glucose is

persistently raised above the normal range. Diabetes mellitus is a
syndrome with disordered metabolism and inappropriate hyperglycemia
due to either a deficiency of insulin secretion or to a combination of
insulin resistance and inadequate insulin secretion to compensate.
Diabetes mellitus occurs in two primary forms:

1. type 1, characterized by absolute insufficiency, and the more prevalent

2. type 2, characterized by insulin resistance with varying degrees of
insulin secretory defects.
 Graphic of diabetics in Indonesia

Source : Riskesdas,2010,kemenkes
 Causes for Diabetes Mellitus
The cause of both type 1 and type
2 diabetes remains unknown,
although genetic factors may play
a role. Diabetes mellitus results
from insulin deficiency or
resistance. Insulin transports
glucose into the cell for use as
energy and storage as glycogen.
 Risk Factors For
Diabetes Mellitus Include

 Obesity.
 Physiologic or emotional stress, which can cause prolonged
elevation of stress hormone levels.
 pregnancy, which causes weight gain and increases levels of
estrogen and placental hormones, which antagonize insulin
 metabolic syndrome, which is considered a precursor to the
development of type 2 diabetes mellitus
 some medications that can antagonize the effects of insulin,
including thiazide diuretics, adrenal corticosteroids, and
hormonal contraceptives
Classification of Diabetes Mellitus

 There are several different types of diabetes mellitus; they may differ
in cause, clinical course, and treatment. The major classifications of
diabetes are:
 · Type 1 diabetes (insulin dependent diabetes mellitus) is caused
by B-cell destruction, usually leading to absolute insulin deficiency
 Immune mediated
 Idiopathic
 · Type 2 diabetes (previously referred to as non insulin dependent
diabetes mellitus) ranges from those with predominant insulin
resistance associated with relative insulin deficiency, to those with a
predominantly insulin secretory defect with insulin resistance
PATHOPHYSIOLOGY OF DIABETES

 When a person eats a meal, insulin secretion increases

and moves glucose from the blood into muscle, liver,
and fat cells. In those cells, insulin:
 Transports and metabolizes glucose for energy
 Stimulates storage of glucose in the liver and muscle (in
the form of glycogen)
 Signals the liver to stop the release of glucose
CLINICAL MANIFESTATIONS

 Clinical manifestations of all types of

diabetes include the “three Ps”:
polyuria, polydipsia, and polyphagia.
Polyuria (increased urination) and
polydipsia (increased thirst) occur as a
result of the excess loss of fluid
associated with osmotic diuresis.
 DIABETES MANAGEMENT

The main goal of diabetes

treatment is to normalize insulin
activity and blood glucose levels
to reduce the development of
vascular and neuropathic
complications.
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1. Drugs for Treating Hyperglycemia

The drugs for treating type 2 diabetes fall into several
categories:
 1) Drugs that primarily stimulate insulin secretion by
binding to the sulfonylurea receptor.
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 2) Drugs that alter insulin action: Metformin works in

the liver. The thiazolidinediones appear to have their
main effect on skeletal muscle and adipose tissue.
 3) Drugs that principally affect absorption of glucose:
The glucosidase inhibitors acarbose and miglitol are
such currently available drugs.
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Insulin
Insulin is indicated for type 1 diabetes
as well as for type 2 diabetic patients
with insulinopenia whose
hyperglycemia does not respond to
diet therapy either alone or combined
with other hypoglycemic drugs.
 There are five components of diabetes
management:
• Nutritional management
• Exercise
• Monitoring
• Pharmacologic therapy
• Education