1

CHAPTER I INTRODUCTION

A. General background In the current era of globalization is generally still a lot of people's lifestyles who still do not understand about the importance of health. They generally eat all kinds of foods, such as: foods high in fat and cholesterol without balanced with exercise or physical activity to burn fat and the wrong lifestyle, such as smoking and drinking liquor or taking drugs all of which can cause adverse impacts to health. Among those health problems will result in the occurrence of Diabetes Mellitus, Heart, Kidney, rheumatism and so on. From the above diseases is include diabetes mellitus a heterogeneous group of or known disorders

diabetes. Diabetes

Mellitus

characterized by increased levels of glucose in the blood or hyperglycemia (C Smeltzer, Suzanne, 2001). Diabetes Mellitus has two types, the first Diabetes Mellitus Type (IDDM) is an insulin-dependent diabetes mellitus and the second type diabetes mellitus (NIDDM) diabetes mellitus who are not insulin dependent. Diabetes mellitus type I usually occurs in less than 30 years of age with the percentage of 5% - 10% of all patients with diabetes mellitus. While in the case of diabetes mellitus type II are often found in more than 30 years of age with the percentage of 90% - 95% of all patients with diabetes mellitus, obesity 80% and 20% non-obese (Suzanne C. Smeltzer, 2001).

According to research, people with diabetes mellitus in Indonesia reached 12 million or 5% of the population. About 30% of patients experiencing blindness due to complications and 10% had to undergo amputation. To the risk of death 4-5 times higher than in nondiabetic with causation of 50% and 30% of coronary heart failureduetorenal (www.google.com).

Diabetes mellitus requiring medical and nursing management to prevent

complications that can lead to coma and even death and can also cause longterm complications, such as diseases of the eye and heart. Diabetes mellitus requires attention and good handling. Diabetes mellitus is a chronic disease that requires long-term treatment even up to a lifetime. Management of "lifestyle" such as exercise and diet are carried out regularly is an important and effective therapy in improving the state of glucose, but it is probably not enough to warrant additional therapy in the form of oral anti-diabetic medication or insulin (Tjay and Rahardja, 2002). However, today, not a few people switched from conventional treatment to traditional medicine because of the trend back to nature so that the use of herbs in complementary and alternative medicine (CAM, complementary and alternative medicine) is increasing. In addition, empirical evidence and scientific support more and more cause the more popular herbs among the people of the world (Subroto, 2006). One of the traditional medicines are constantly being developed towards phytopharmaca are antidiabetic drugs. Leaves of bitter melon is one of traditional medicinal plants that are empirically used as a diabetes drug. Diabetes is characterized by high blood glucose levels (hyperglycemic) so the treatment is intended to lower blood glucose levels

(hypoglycemic). Selection of medicinal plant materials or ingredients in the form of single herbal medicine industry is usually based on empirical use, ie usage by the community for generations.From several sources of information, plants - medicinal plants that could be used as a lowering of blood sugar include: bitter, petai china, pule, bay leaves, brotowali and others, and the plants there that have been tested in preclinical, there are even studies that have until the discovery of active compounds responsible for the hypoglycemic effect, ie on garlic (Alium sativum), pule (Alstonia scholaris), brotowali (Tinospora crispa) and the fruit of bitter melon (Momordica charantia, L) (Soedarsoeno, 2002). Search and test the efficacy of various medicinal plants have been many studies done. Pare empirically plants used for traditional medicine, among others, the sap or foliage. Pare leaves can

serve as an anti-inflammatory, anti-fungal, anti bacterial and cell regeneration. In addition, bitter melon is useful for lowering blood sugar levels for diabetics to control blood pressure, stimulates the immune system to attack cancer. Leaves and roots contain saponins and flavonoids, in addition to leaves also contain tannins and polyphenols. Other Ingredients barbaloin, iso barbaloin, aloe-emodin, aloenin, aloesin, aloin, aloe emodin, antrakinon, resins, polysaccharides.(Syamsuhidayat and Hutapea, 1991), chromium, Inositol(Duke,2002).

B. Reason of choosing title

Choosing a title of this paper due to the increasing incidence of diabetes mellitus in Indonesia and including the types of diseases that can attack the body's organs if not treated immediately. Diabetes mellitus can be controlled with a healthy lifestyle and treatment using oral

medications. Moreover, lately most of Indonesian people tend to consume natural products as medicines, one example is the benefits of bitter melon as a treatment of diabetes mellitus, where the ingredients are mostly found in the environment around us. Medicinal plants as an option for health, it is associated with the assumption that compared to synthetic drugs, traditional medicine is relatively safer with fewer side effects. Based on the description above, there should be a clearer discussion of the benefits of fruit extracts.

C. Formulation of the problem 1. What the definition diabetes mellitus? 2. What the causes of diabetes mellitus? 3. What the classification of diabetes mellitus? 4. What the symptoms of diabetes mellitus? 5. How to examination diabetes mellitus? 6. What the diagnosis of diabetes mellitus? 7. What the kind of treatment diabetes mellitus?

8. What the description and variety of bitter melon? 9. What the compotition of bitter melon? 10. What the benefit bitter melon for treatment diabetes mellitus?

D. Purpose of study 1. To know the diabetes mellitus 2. To know the classification of diabetes mellitus 3. To know the symptoms of diabetes mellitus 4. To know the treatment of diabetes mellitus 5. To know the description and variety of bitter melon 6. To know the compotition of bitter melon 7. To know the benefit of bitter melon E. Methodology of study In manufacture this scholary paper are used literature methods and observation in life. Where the date are taken from the books, articles and the relevant reference from internet. F. Systematics of writing In manufacture this paper, me used the systematic of writing by following: A. General background B. The reason for choosing title C. Purpose of study D. Methodology of writing E. System of scholary paper CHAPTER II:DISSCUSSION 1. Definition of diabetes mellitus 2. Causes of diabetes mellitus 3. Classification of diabetes mellitus

4. Symptoms of diabetes mellitus 5. Diagnosis of diabetes mellitus 6. Treatment of diabetes mellitus a. Nonfarmakology b. Farmakology c. Herbal treatment Bitter melon extract for diabetes mellitus Compotition of bitter melon Benefit of bitter melon Step to make bitter melon extract for treatment

CHAPTER III : CLOSING

1. Conclucing 2. Suggestion 3. Closing word

CHAPTER II DISSCUSSION Diabetes Mellitus

A. Definition of diabetes mellitus Diabetes mellitus, often simply referred to as diabetes, is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger). There are three main types of diabetes: Type 1 diabetes: results from the body's failure to produce insulin, and presently requires the person to inject insulin. (Also referred to as insulindependent diabetes mellitus, IDDM for short, and juvenile diabetes.) Type 2 diabetes: results from insulin resistance, a condition in which cells fail to use insulin properly, sometimes combined with an absolute insulin deficiency. (Formerly referred to as non-insulin-dependent diabetes mellitus, NIDDM for short, and adult-onset diabetes.) Gestational diabetes: is when pregnant women, who have never had diabetes before, have a high blood glucose level during pregnancy. It may precede development of type 2 DM. All forms of diabetes have been treatable since insulin became available in 1921, and type 2 diabetes may be controlled with medications. Both type 1 and 2 are chronic conditions that usually cannot be cured. Pancreas transplants have been tried with limited success in type 1 DM; gastric bypass surgery has been successful in many with morbid obesity and type 2 DM. Gestational diabetes usually resolves after delivery. Diabetes without proper treatments

can cause many complications. Acute complications include hypoglycemia, diabetic ketoacidosis, or nonketotic hyperosmolar coma. Serious long-term complications include cardiovascular disease, chronic renal failure, retinal damage. Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cessation and maintaining a healthy body weight. As of 2000 at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Type 2 diabetes is by far the most common, affecting 90 to 95% of the U.S. diabetes population.

B. Causes of Diabetes Mellitus

The cause of diabetes depends on the type: Type 1 diabetes is partly inherited and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic "self" identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger.

Type 2 diabetes is due primarily to lifestyle factors and genetics. Following is a comprehensive list of other causes of diabetes: Genetic defects of -cell Function Maturity onset diabetes of the young (MODY) Mitochondrial DNA mutations Genetic defects in insulin processing or insulin action Defects in proinsulin conversion Insulin gene mutations Insulin receptor mutations Exocrine Pancreatic Defects Chronic pancreatitis Pancreatectomy Pancreatic neoplasia Cystic fibrosis Hemochromatosis Fibrocalculous pancreatopathy Endocrinopathies Growth hormone excess (acromegaly) Cushing syndrome Hyperthyroidism Pheochromocytoma Glucagonoma Infections Cytomegalovirus infection Coxsackievirus B Drugs Glucocorticoids Thyroid hormone -adrenergic agonists

C. Classification of diabetes mellitus Most cases of diabetes mellitus fall into three broad

categories: type 1, type 2, and gestational diabetes. A few other types are described. The term diabetes, without qualification, usually refers to diabetes mellitus. The rare disease diabetes insipidus has similar symptoms as diabetes mellitus, but without disturbances in the sugar metabolism (insipidus meaning "without taste" in Latin).

Comparison of type 1 and 2 diabetes Feature Onset Age at onset Body habitus Ketoacidosis Autoantibodies Endogenous insulin Concordance in identical twins Type 1 diabetes Sudden Any (mostly young) Thin or normal Common Usually present Low or absent age Type 2 diabetes Gradual Mostly in adults Often obese Rare Absent Normal, decreased

or increased 90% More prevalent

50%

Prevalence

Less prevalent

- 90 to 95% of U.S. diabetics[3]

The

term "type 1 diabetes" has replaced several former terms, including

childhood-onset diabetes, juvenile diabetes, and insulin-dependent diabetes mellitus (IDDM). Likewise, the term "type 2 diabetes" has replaced several

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former terms, including adult-onset diabetes, obesity-related diabetes, and non-insulin-dependent diabetes mellitus (NIDDM). Beyond these two types, there is no agreed-upon standard nomenclature. Various sources have defined "type 3 diabetes" as: gestational diabetes, insulin-resistant type 1 diabetes (or "double diabetes"), type 2 diabetes which has progressed to require injected insulin, and latent autoimmune diabetes of adults (or LADA or "type 1.5" diabetes). Type 1 diabetes Type 1 diabetes mellitus is characterized by loss of the insulin-producingbeta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmuneattack. There is no known preventive measure against type 1 diabetes, which causes

approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally termed "juvenile diabetes" because it represents a majority of the diabetes cases in children. Brittle diabetes, also known as unstable diabetes or labile diabetes, refers to a type of insulin-dependent diabetes characterized by dramatic and recurrent swings in glucose levels, often occurring for no apparent reason. The result can be irregular and unpredictablehyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias. Brittle diabetes occurs no more frequently than in 1% to 2% of diabetics. Type 2 diabetes Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus due

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to a known defect are classified separately. Type 2 diabetes is the most common type. In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. Gestational diabetes Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%5% of all pregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%50% of affected women develop type 2 diabetes later in life. Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby includemacrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress

syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment.Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia. A 2008 study completed in the U.S. found that the number of American women entering pregnancy with preexisting diabetes is increasing. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years.[11] This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

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Other types Pre-diabetes indicates a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many people destined to develop type 2 diabetes spend many years in a state of pre-diabetes which has been termed "America's largest healthcare epidemic." Latent autoimmune diabetes of adults is a condition in which Type 1 diabetes develops in adults. Adults with LADA are frequently initially misdiagnosed as having Type 2 diabetes, based on age rather than etiology. Some cases of diabetes are caused by the body's tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects inbeta

cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-

antagonistic hormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

D. Symptoms of diabetes mellitus The classical symptoms of diabetes are polyuria (frequent

urination), polydipsia (increased

thirst)

and polyphagia (increased

hunger). Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent.

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E. Diagnosis of diabetes mellitus Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following:[13]

Fasting plasma glucose level 7.0 mmol/L (126 mg/dL). Plasma glucose 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test. Symptoms of hyperglycemia and casual plasma glucose 11.1 mmol/L (200 mg/dL). Glycated hemoglobin (Hb A1C) 6.5%.[18] A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.[19] According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus. People with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered to have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.[

F. Treatment of diabetes mellitus Diabetes mellitus is a chronic disease which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal ("euglycemia") as possible, without causing

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hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications as well as possibly insulin in type 2 diabetes). Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher. Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Lifestyle There are roles for patient education, dietetic support, sensible exercise, with the goal of keeping both short-term and long-term blood glucose levels within acceptable bounds. In addition, given the associated higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood pressure. Medications Oral medications Metformin is generally recommended as a first line treatment for type 2 diabetes as there is good evidence that it decreases mortality. Routine use of aspirin however has not been found to improve outcomes in uncomplicated diabetes. Insulin Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect. Support In countries using a general practitioner system, such as the United Kingdom, care may take place mainly outside hospitals, with hospital-based specialist care used only in case of complications, difficult blood sugar control, or

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research projects. In other circumstances, general practitioners and specialists share care of a patient in a team approach. Optometrists,

podiatrists/chiropodists, dietitians, physiotherapists, nursing specialists (e.g., DSNs (Diabetic Specialist Nurse)), nurse practitioners, or certified diabetes educators, may jointly provide multidisciplinary expertise. Diabetes mellitus is not only suffered by elderly people, but also suffered by adolescents because of the influence of today's modern lifestyle. Diabetes Mellitus High prices of drugs manufactured by the factory and the market seems quite an impact on people's purchasing power is less, even more so for people who categorized in public medium. So this causes sufferers are reluctant to buy medicines and may eventually lead to disease of diabetes mellitus who suffered more severe and can lead to death. Therefore, we tried to find alternatives to overcome this disease using natural remedies, namely by using pare. The reason we use the fruit for the fruit of bitter melon bitter melon is already familiar among the common people, can be utilized in a variety of processing and the price is relatively cheap. Pare plants is one alternative in the treatment of diabetes mellitus, since this plant contains saponins, flavonoids, and polyphenols (powerful antioxidants), as well as cucurbitacin glycosides, momordicin, and charantin which can lower blood sugar.

Bitter mellon
Momordica charantia, called bitter melon or bitter gourd in English, is a tropical and subtropical vine of the family Cucurbitaceae, widely grown in Asia, Africa, and the Caribbean for its edible fruit, which is among the most bitter of all fruits. There are many varieties that differ substantially in the shape and bitterness of the fruit. This is a plant of the tropics, but its original native range is unknown.

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A. Scientific classification Kingdom (unranked) (unranked) Order Family Genus Species : : : : : : : Plantae Eudicots Rosids Cucurbitales Cucurbitaceae Momordica M. charantia

Binomial name : Momordica charantia

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A. Description

Ripe fruit

This herbaceous, tendril-bearing vine grows to 5 meters. It bears simple, alternate leaves 412 cm across, with 37 deeply separated lobes. Each plant bears separate yellow male and female flowers. In the Northern Hemisphere, flowering occurs during June to July and fruiting during September to November. The fruit has a distinct warty exterior and an oblong shape. It is hollow in cross-section, with a relatively thin layer of flesh surrounding a central seed cavity filled with large flat seeds and pith. The fruit is most often eaten green, or as it is beginning to turn yellow. At this stage, the fruit's flesh is crunchy and watery in texture, similar to cucumber, chayote or green bell pepper, but bitter. The skin is tender and edible. Seeds and pith appear white in unripe fruits; they are not intensely bitter and can be removed before cooking. As the fruit ripens, the flesh becomes tougher, more bitter, and too distasteful to eat. On the other hand, the pith becomes sweet and intensely red; it can be eaten uncooked in this state, and is a popular ingredient in some southeast Asian salads. When the fruit is fully ripe it turns orange and mushy,

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and splits into segments which curl back dramatically to expose seeds covered in bright red pulp.

B. Varieties
Bitter melon comes in a variety of shapes and sizes. The China phenotype is 2030 cm long, oblong with bluntly tapering ends and pale green in color, with a gently undulating, warty surface. The bitter melon more typical of India has a narrower shape with pointed ends, and a surface covered with jagged, triangular "teeth" and ridges. It is green to white in color. Between these two extremes are any number of intermediate forms. Some bear miniature fruit of only 610 cm in length, which may be served individually as stuffed vegetables. These miniature fruit are popular in India and elsewhere in Southeast Asia.

China phenotype

Sub-continent phenotype

Indian variety

C. Bitter Melon for treatment Diabetes mellitus

Bitter melon has been used in various Asian and African traditional medicine systems for a long time. The plant contains several biologically active compounds, chiefly momordicin I and II, and cucurbitacin B. The plants contains also several bioactive glycosides (including momordin, charantin, charantosides, goyaglycosides, momordicosides) and other

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terpenoid

compounds

(including

momordicin-28,

momordicinin,

momordicilin, momordenol, and momordol). It also contains cytotoxic (ribosome-inactivating) proteins such as momorcharin and momordin. In 1962, Lolitkar and Rao extracted from the plant a substance, which they called charantin, which had hypoglycaemic effect on normal and diabetic rabbits. Another principle, active only on diabetic rabbits, was isolated by Visarata and Ungsurungsie in 1981. Bitter melon has been found to increase insulin sensitivity. In 2007, a study by the Philippine Department of Health determined that a daily dose of 100 mg per kilogram of body weight is comparable to 2.5 mg/kg of the anti-diabetes drug glibenclamide taken twice per day. Tablets of bitter melon extract are sold in the Philippines as a food supplement and exported to many countries. Other compounds in bitter melon have been found to activate the AMPK, the protein that regulates glucose uptake (a process which is impaired in diabetics). Bitter melon also contains a lectin that has insulin-like activity due to its non-protein-specific linking together to insulin receptors. This lectin lowers blood glucose concentrations by acting on peripheral tissues and, similar to insulin's effects in the brain, suppressing appetite. This lectin is likely a major contributor to the hypoglycemic effect that develops after eating bitter melon. D. Nutritional Content of Pare

Diabetes mellitus is often called the great imitator, because this disease can affect all organs of the body and cause various kinds of complaints will typically experience lethargy, lack of energy, always feeling thirsty, frequent urination, and vision becomes blurred. The use of flora or plant potential for therapy in diabetes seems to be quite effective altrenatif and affordable by people with diabetes mellitus. In Indonesia is quite a lot of plants that have the potential to serve foods that can help in diabetes mellitus mengatasai is especially bitter melon crop.

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Pare plants (Momordica charantia L.) originating from the AsiaTropical. Plant this one is famous for its bitter fruit. Reversed sense of bitterness that is beneficial to health pare. Nutrient content in pare quite well. Pare-containing protein, carbohydrates, and little lemakmineral pare rich in calcium, iron and phosphorus. Vitamins are prominent in them is vitamin A and vitamin C. Savor pare (Momordica charantia L.) as a medicine in China has been noted Li since 1578. Initially as a tonic, anthelmintic, cough medicines, antimalarial, ulcers, wound healing, and appetite enhancer. Hundreds of research in many developing countries which laid bare the bitter fruit of this effect on lowering blood sugar levels (hypopglycemic effect). The cause of diabetes mellitus is the lack of production and availability of insulin in the body or an interruption of insulin function, none of the fairly. Insulin deficiency caused by damage to a small part or most of the beta cells of Langerhans islands in the pancreas gland that function to produce insulin. Insulin is a polypeptide (protein). Under normal circumstances, if blood glucose levels rise, gland and pancreas will release insulin into the bloodstream. By the blood insulin receptor that is distributed to the liver by 50%, kidney around 10-20%, as well as blood cells, muscle, and fat tissue around 30-40%. As long as there is no insulin, sugar in the blood can not enter the cells - the cells of the body tissues such as muscle and fat tissue. It could be argued that insulin is the key that opens the door of the cell network, put the sugar into the cells, and closed again. Inside the cell, burnt sugar into useful energy to move. Similar research in Germany, Britain, India, Japan, Thailand, and Malaysia confirm pare nutritious as antidiabetic agents. Pare who have not been cooked contain saponins, flavonoids, and polyphenols (powerful antioxidants), as well as cucurbitacin glycosides, momordicin, and charantin.

Pare the effect in lowering blood sugar in experimental animals to work by preventing the intestines absorb sugar is eaten. In addition alleged

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bitter melon has a component that resembles a sulfonylurea (antidiabetic drugs oldest and most widely used). This type of drug stimulates the body's beta cells of the pancreas gland to produce more insulin, in addition to increasing the deposit reserve sugar in the liver glycogen. Pare the effect in lowering blood sugar in rabbits also estimated similar to the mechanism of insulin. Of so much research pare as lowering blood sugar, there is a common thread that in lowering blood sugar, bitter melon has more than one mechanism. Moreover, pare research in Germany managed to find an effective dose of bitter melon in lowering blood sugar healthy rabbits of 0.5 g / kg body weight, and 1 to 1.5 grams / kg body weight for rabbits that deliberately contrived diabetes. Table 1. The content of nutrient per 100 grams of leaves and pare Fruit
Zat gizi Air Kalori Protein Lemak Karbohidrat Kalsium Zat Besi Fosfor Vitamin A Vitamin B Vitamin C Folasin Pare fruits 91,2 gram 29 gram 1,1 gram 1,1 gram 0,5 gram 45 mg 1,4 mg 64 mg 18 SI 0,08 mg 52 mg Pare Leaf 80 gram 44 gram 5,6 gram 0,4 gram 12 gram 264 mg 5 gram 666 mg 5,1 mg 0,05 mg 170 mg 88 mg

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E. Utilization Pare In Treating Diabetes Mellitus Based on the clinical or medical symptoms, diabetes mellitus (DM) can be divided into the following: - DM type 1 or DMTI (Diabetes Mellitus Insulin Depends) Most of the island of Langerhans beta cells that produce insulin in the pancreas is damaged. As a result, insulin levels become less or none. - DM type 2 or DMTTI Due to lack of nutrition or nutrition in diabetisi - Diabetes Mellitus associated with a particular condition or syndrome Included in this group is a pancreatic disease, hormonal disease, condition caused by drugs or chemical substances, disorders of insulin receptor, and certain genetic syndromes or symptoms of hereditary diseases such as diabetes mellitus.

Nutrient content in pare quite well. Pare-containing protein, carbohydrate, and less fat. Minerals do not lose much. Pare is rich in calcium, iron and phosphorus. Vitamins are prominent in them is vitamin A and vitamin C. From research conducted in Japan in 2003 is also known that the seeds of bitter melon is a pretty strong anti-oxidant to fight free radicals in the body that trigger the formation of cancer cells, accelerate aging, clogged arteries, stroke, and diabetes mellitus. Pare contain karatin,

hydroxytryptamine, vitamins A, B, and C. Meanwhile, its seeds contain momordisin. Almost all parts of this plant, good seeds, flowers, leaves, or roots, efficacious for the drug. However, bitter melon fruit most often used for medicinal ingredients, especially diabetes mellitus. Pharmacological effects of this plant and its bitter cold, pare efficacious as anti-inflammatory, lowers blood glucose levels, to treat coughs, sore throat, sore red eyes, rheumatism and dysentery thrush.

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F. Mechanism of Pare Step for use pare to treatment diabetes: 1. The first step: Take 2 pieces of melon, wash and mash then add half a glass of clean water. Stir and squeeze. Day as much as a potion to drink. Repeated for 2 weeks.

2. The second step: To use bitter melon seeds, that is by providing 200 grams of seeds of bitter melon, bitter melon seeds and then toasted until dry and finely ground. After the cold stored in jars. How to use 10 grams of powdered beans brewed pare with boiled water to drink 3 times sehari.Mekanisme Working Pare

3. The third step: Preparation of extract of bitter melon fruit

Prepare pare approximately 500 grams. Pare initially cleaned, washed with water, and cut into small pieces. Then dried in a way laid out in the open with good air circulation and are not exposed to direct sunlight and covered with black flannel cloth, because the drying temperature is too high due to exposure to direct sunlight can damage the active component in pare. Pare who already dried then extracted by maceration method, by immersing the dried fruit of bitter melon in a solvent of 70% alcohol for 24 hours, then filtered with filter cloth and soaked again in 70% alcohol to distilled or extracted perfectly marked in alcohol becomes clear again. Thereafter, the remaining alcohol solvent was evaporated on a water bath or water bath and aerated so that the obtained extract with a strong concentration of 100%. Then extract obtained pare also weighed and the weight obtained pare pure extract.

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CHAPTER III CLOSING

A. Conclucing Diabetes mellitus is a disease caused by declining hormone produced by the pancreas gland. The decline of these hormones resulted in the sugar (glucose) consumed the body can not produce perfectly, so that glucose levels in the body will increase. Pare plants (Momordica charantia L.) originating from the AsiaTropical. Plant this one is famous for its bitter fruit. Reversed sense of bitterness that is beneficial to health pare. Nutrient content in pare quite well. Pare-containing protein, carbohydrates, and little lemakmineral pare rich in calcium, iron and phosphorus. Vitamins are prominent in them is vitamin A and vitamin C. Almost all parts of this plant, good seeds, flowers, leaves, or roots, efficacious for the drug. However, bitter melon fruit most often used for medicinal ingredients, especially diabetes mellitus. Pharmacological effects of this plant and its bitter cold, pare efficacious as anti-inflammatory, lowers blood glucose levels, to treat coughs, sore throat, sore red eyes, rheumatism and dysentery thrush .. Pare utilization ways to cope with Diabetes Mellitus, ie by Take 2 pare, wash and mash then add half a glass of clean water. Stir and squeeze. Day as much as a potion to drink. Repeated for 2 weeks. To use bitter melon seeds, that is by providing 200 grams of seeds of bitter melon, bitter melon seeds and then toasted until dry and finely ground. After the cold stored in jars. How to use 10 grams of powdered beans brewed pare with boiled water to drink 3 times a day.

B. Suggestion 1. For people with diabetes mellitus should try diet

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2. For people with diabetes mellitus should try to drink the bitter melon extract 3. For all people should maintain a diet and lifestyle 4. To all the people should exercise regularly

C. Closing word
Maybe this is from my scholary paper, about benefit bitter melon extract. Because still in the lerning process, Im so apologize for any lack of my scholary paper, thanks.