6 Group

English In Nursing VI
Stikes Suaka Insan Banjarmasin
Definition
Diabetes mellitus is a heterogeneous group of
disorders characterized by an increase in blood
glucose levels or hyperglycemia . ( Brunner and
Suddarth , 2002)
Clasification
Type I diabetes : insulin-dependent diabetes mellitus (
IDDM ) ;
Type II diabetes : insulin-dependent diabetes mellitus
( NIDDM ) ;
Another type of DM .

Etiology
Type I diabetes :
Genetic factors
People with diabetes type I diabetes is not inheriting itself : but
inherit a predisposition or a genetic predisposition toward the DM
type I. Genetic predisposition is found in individuals who have HLA
antigen type .
immunological factors
The existence of an autoimmune response in which antibodies
directed abnormal response to normal tissue reacts to the body by
way of the network is considered as if it was 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 .

Etiology
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 :
1. Age ( insulin resistance tends to increase at the age of
30 years ) ;
2. Obesity ;
3. family history ;
4. Lifestyle .

Etiologi
Uncontrolled diabetes during pregnancy will be
accompanied by:
fetal macrosomia
Difficult labor & birth
sectio Caesaria
Stillbirth (stillbirth)
baby hypoglycemia
Pathophysiology
Insulin in Type I diabetes do not exist, because in this
type arises due to an autoimmune reaction to an
inflammation on beta cell insulitis . This led to the
emergence of antibodies against beta cells called ICA (
Islet Cell Antibody ) . Antigen reaction ( beta cells )
with antibodies ( ICA ) it creates causes the
destruction of beta cells . Insulitis can be caused by a
variety of viruses such as cocksakie virus , rubella ,
CMV , herpes and lain0lain . That it only attacked on
insulitis beta cells , alpha and delta cells usually
remain intact .

Pathophysiology
On type II diabetes normal amount of insulin , may be
more but the number of insulin receptors on the surface of
cells that lack . The insulin receptor is like a door lock to
enter the cell . At the state had less number of key holes up
despite his key ( insulin ) a lot , but because of a lock (
receptor ) is less , then the glucose enter cells will be small,
so that the cell will lack the fuel ( glucose ) and glucose in
the blood vessels increases . The state is the same as in
diabetes mellitus type I. The difference is that in addition
to type II diabetes high glucose levels , insulin levels are too
high or normal . This condition is called insulin resistance .
At DM type II beta cell number was reduced to 50-60 % of
normal .

Clinical manifestations
Polyuria ( urinating more )
Polydipsia ( drinking a lot )
Poliphagi ( eat a lot )
Weight loss , fatigue , irritability fatigue , lack of
energy .
blurry eyes

Complication
acute
Hypoglycemia
Ketoacidosis
Diabetic
Chronicle
makroangiopati , the major blood vessels , vascular
peripheral blood vessels , the brain blood vessels .
microangiopathic the small blood vessels of diabetic
retinopathy , diabetic nephropathy .
Diabetic neuropathy

Management
The main objective management of clients with
Diabetes Mellitus is to regulate blood glucose and
prevent complications acut and chronic. If the client
successfully address the diabetes he suffered, he will be
spared from hyperglikemia or hypoglycemia.
Treatment of diabetes depends on the accuracy of the
interaction of three factors: physical activity, dietary
and pharmacological intervention with insulin
preparations and oral hyperglikemik. Initial and
ongoing health education is important in helping
clients cope with these conditions.
Pharmacological
For the treatment of diabetic patients can be given
OAD like :
1. OHO ( oral hypoglycemic drugs )
a. Group sulfonylurea : chlorpropamide , tolbutamide ,
glibenclamide , glikazid , Glipizide.
b. Group biguanid :Metformin, Diabex,Glukophage,Acarbose

2. Insulin
Case
A client of Mr R is 54 years old admitted to hospital with complaints of
fatigue felt since 5 days ago, accompanied by pain throughout the body.
Past medical history, the client has been suffering from diabetes for 3
years, clients like to eat sweet things.
physical examination
Health status of clients seen being sick
BB: 49 Kg, TB: 163 cm
Awareness: Komposmentis
Blood Sugar : 250 mg/dl
Vital signs
BP: 130/80 mmHg
P: 88 x / min
T: 36, 6 0 C
RR: 24 x / min

Nursing Management
purpose
Identifying patterns of exhaustion every day.
Identify the signs and symptoms of increased disease
activity affecting activity tolerance.
Disclose increase energy levels.
Demonstrate improved ability to participate in desired
activities.




Interventions
Review of activities that can lead to fatigue.
Monitor pulse, breathing frequency, and blood
pressure before and seudah activity.
Provide alternative activities with adequate rest
periods / unmolested.
Increase the participation of clients in performing
activities of daily living as needed.




Thank you