ENGLISH PAPER

DIABETES MELLITUS

Lecturer : AGUS WIWIT S, M.Kep.

Member Seventh

By :
GROUP 4
BENNY ADI PRAMANA (201601008)
DINI HARIANA WATI (201601019)
FEBBY GALIH SAPUTRI (201601023)
KRESNA KOESWARDANA (201601031)
VINA MERI ANJAN (201601059)

Nursing Academy of Ponorogo Regency

Jl. dr. Ciptomangunkusumo, 82 A, Ponorogo
2016/2017

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 FOREWORD

Thanks to Gods Almighty so that The writers can finish a paper entitled "DIABETES
MELLITUS". This paper was prepared in order to fulfill the tasks subjects of English.
With the completion of this paper the authors would like to thank:
1. AGUS WIWIT S, M.Kep. as a mentor and lecturer in English Nursing Academy
of Ponorogo
2. Parents of the writers who always give support morally and materially.
3. And friends who have helped provide advice to this paper.
The author realizes that this paper is not perfect. To that criticism and constructive
suggestions very the writers expect. Hopefully this paper can be useful for readers in
particular and society in general.

Ponorogo, 06 August 2017

The writers

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 TABLE OF CONTENTS

COVER .......................................................................................................i
FOREWORD ..............................................................................................ii
TABLE OF CONTENTS ..........................................................................iii
CHAPTER I INTRODUCTION
1.1 Background ............................................................................................1
1.2 Formulation of The Problem ...................................................................1
1.3 Purpose of Paper .....................................................................................2
1.4 The Benefits of Writing ..........................................................................2
CHAPTER II DISCUSSION
2.1 Definition of Diabetes Mellitus .............................................................3
2.2 Epidemiology .........................................................................................3
2.3 Etiology ...................................................................................................3
2.4 Pathophysiology ....................................................................................4
2.5 Clinical Manifestation .............................................................................6
2.6 Management according to DEPKES .......................................................6
2.7 Family Assignment to Sick Family.........................................................7
CHAPTER III CLOSING
3.1 Conclusion .............................................................................................9
3.2 Suggestion ..............................................................................................9
REFERENCES

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 CHAPTER I
INTRODUCTION

1.1 BACKGROUND
The average life expectancy of people in the world has increased
drastically. Currently, in Indonesia, the proportion of elderly (elderly) aged
above 90 years is estimated to reach 1.2% of the total population. This
number has increased 400% from the 1990 census. The world's eldest survival
rate reaches 115 years in women and in men is shorter.1 This increase affects
the epidemiological transition, which shows a decrease in the prevalence of
infectious and contagious disease along with increased rates of illness Not
infectious in the adult and elderly population.2 Every year, the life expectancy
of Indonesian population continues to increase, in 2010, the number of people
aged above 60 years reaches 20.7 million people, then to 36 million people.
The increase is predicted to continue to grow to reach 71 million people in
2050. The increasing number of elderly population, a new challenge for
Indonesia, as well as an increase in elderly people who experience various
non-communicable diseases or chronic multimorbiditas. (Rosyada &
Trihandini, 2013)

1.2 FORMULATION OF THE PROBLEM

As for the formulation of the problem in the manufacture of this paper are:
1. Students are able to understand diabetes mellitus disease
2. Students are able to understand the epidemiology of diabetes mellitus
3. Students are able to understand the etiology of diabetes mellitus
4. Students are able to understand the pathophysiology of diabetes mellitus
5. Students are able to understand the clinical manifestations of diabetes
mellitus
6. Students are able to understand the investigation of diabetes mellitus
support
7. Students are able to understand the diagnosis of diabetes mellitus
8. Students are able to understand diabetes mellitus management

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1.3 PURPOSE OF PAPER
As for the purpose in making this paper are:
1. Students are able to understand diabetes mellitus disease
2. Students are able to understand the epidemiology of diabetes mellitus
3. Students are able to understand the etiology of diabetes mellitus
4. Students are able to understand the pathophysiology of diabetes mellitus
5. Students are able to understand the clinical manifestations of diabetes
mellitus
6. Students are able to understand the investigation of diabetes mellitus
support
7. Students are able to understand the diagnosis of diabetes mellitus
8. Students are able to understand diabetes mellitus management Googl

1.4 THE BENEFITS OF WRITING

This paper is expected to be useful to all parties related to the discussion
contained in this paper.

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 CHAPTER II
DISCUSSION

2.1 Definition of DIABETES MELIITUS

Diabetes mellitus is a typical syndrome characterized by the presence of
hyperglycemia caused by deiensi oru decrease in the effectiveness of insulin.
This metabolic disorder affects the metabolism of carbohydrates, proteins,
fats, water and electrolytes. Metabolic disorders depend on the loss of insulin
activity in the body and in many cases, endogenous cellular damage,
especially endothelial cells in the eyes, kidneys, and nervous system. Diabetes
mellitus is not a living disease but is a group of diseases. (BRUDENELL &
DODDRIDGE, 1996)

2.2 Epidemiology
Most of the elderly people with diabetes mellitus are in the age group of
60-74 years (83.3%), female (52.9%), married (67%), low socioeconomic
(53.6%), Low education (73.4%) and good nutritional status (52.8%). In terms
of behavioral factors, most elderly people with diabetes mellitus have less
vegetable and fruit consumption (99.4%), less physical activity (97.5%), not
frequent fatty foods (92.2%), and Not smokers (63.2%). In addition,
information obtained that most elderly people with diabetes mellitus who have
access or good use of health services (57.8%). (Estri, Fatimah, & Prawesti,
Desember 2016)

2.3 Etiology
Diabetes mellitus type 1:
Cell Dedruksi generally leads to absolute insulin deficiency
Diabetes mellitus type 2 :
Of predominant insulin resistance with insulin deficits relative to
predominantly secretory defect with insulin resistance
Diabetes mellitus type 3:
This type of DM occurs due to other etiologies, for example in the genetic
defect of beta cell function, genetic defect of insulin work, pancreatic
exocrine disease, other endocrine metabolic diseases, iatrogenic, viral
infections, autoimmune diseases and other genetic disorders. Or it could be
a result of :
a) Genetic defects of beta cell function
b) The genetic defect of insulin work.

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 c) Pancreatic exocrine disease
d) Endocrineopathy
e) Impact of drugs or chemicals
f) Infection
g) Uncommon type of immune-slaughtered diabetes.
h) Other genetic syndromes that are sometimes associated with DM
Diabetes Mellitus Type 4 :
Gestational diabetes mellitus.
This type of DM occurs during pregnancy, where glucose intolerance is
first found during pregnancy, usually in the second and third trimesters.
Gestational DM is associated with increased perinatal complications.
Gestational DM patients have a greater risk of developing permanent DM
within 5 to 10 years after delivery. (Ndraha, 2014)

2.4 Pathophysiology
Diabetes mellitus is divided into 2 main categories based on endogenous
insulin secretion to prevent the emergence of ketoacidosis, namely (1) Insulin
dependent diabetes mellitus (IDDM = insulin dependent diabetes mellitus) or
type I, and (2) Diabetes mellitus is not insulin dependent (NIDDM = non-
Insulin dependent diabetes mellitus) or type II (Rowland and Bellush, 1989;
Kahn, 1995). Diabetes mellitus (DM) type I is mediated by the degeneration
of Langerhans pancreatic cells due to viral infection, administration of
toxin, diabetogenic (streptozotosin, alloxan), or genetically (wolfram
syndrome) resulting in very low insulin production or stopping altogether.
This results in decreased glucose intake in muscle and adipose tissue.
Pathophysiologically, the disease occurs slowly and takes years, usually from
children or early adolescence. Weight loss is a characteristic of patients with
uncontrolled DM I. Symptoms that often accompany the DM I is polyuria,
polydipsia, and polifagia. Increased urine volume occurs due to osmotic
diuresis (due to elevated blood glucose or hyperglycemic levels) and ketones
in the urine. Furthermore, the osmotic diuresis will result in dehydration,
starvation and shock conditions. Symptoms of thirst and hunger are the result
of fluid loss and the inability of the body to use nutrients (Lawrence, 1994;
Karam et al., 1996). In DM I, blood glucose levels are very high, but the body
can not utilize them optimally to form energy. Therefore, energy is obtained
through increased protein catabolism and fat. Along with these conditions,
there is stimulation of lipolysis as well Elevated levels of free fatty acids and

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blood glycerol. In this case there is an increase in the production of acetyl-
CoA by the liver, which in turn is converted to acetic acid and ultimately
reduced to hydroxybutyric acid or decarboxylated to acetone. Under normal
conditions, the concentration of ketone objects is relatively low because
insulin can stimulate the synthesis of fatty acids and inhibit lipolysis. It takes
only small insulin levels to inhibit lipolysis (Unger and Foster, 1992;
Lawrence, 1994).
In the condition of DM II, insulin is still enough to prevent the occurrence
of ketone objects so rarely found ketosis. However, nonketotic hyperosmolar
coma may occur. DM II is likely to occur in elderly individuals and is usually
preceded by a state of illness or stress that requires high insulin levels. In DM
II, the presence of insulin is insufficient to prevent glucosuria. Along with
that, there is loss of fluid and electrolyte body followed by severe
dehydration. Furthermore, there is a decrease in glucose excretion and
ultimately results in an increase in serum osmolarity (hyperosmolarity) and
blood glucose (hyperglycemic) (Unger and Foster, 1992; Lawrence, 1994;
Kahn, 1995).
Pathophysiologically, type II DM is caused by two things: (1) decreased
peripheral tissue response to insulin, the event is called insulin resistance, and
(2) decreased ability of pancreatic cells to secrete insulin in response to
glucose load. Most DM type II begins with Obesity due to overeating. As
compensation, pancreatic cells respond by secreting more insulin to increase
insulin levels (hyperinsulinemia). High insulin concentration causes the
insulin receptor to attempt self-regulation by decreasing the number of
receptors or down regulation. This has an impact on the decrease in receptor
response and further leads to insulin resistance. On the other hand,
hyperinsulinemia may also result in the desensitization of insulin receptors in
the postreceptor stage, ie decreased activation of receptor kinase, glucose
transporter translocation and glycogen synthase activation. This incident
results in insulin resistance. Two events occurred at the beginning of the
process of DM type II.
Pathologically, at the onset of type II DM elevated plasma glucose levels
compared to normal, but still accompanied by excessive insulin secretion
(hyperinsulinemia). This indicates that there has been a defect in both receptor
and postreceptor insulin. In insulin resistance, there is an increase in glucose
production and decreased glucose usage resulting in an increase in blood
sugar (hyperglycemic). Along with these events, pancreatic cells undergo
self-adaptation so that their response to secreting insulin becomes less

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 sensitive, and ultimately results in insulin deficiency. While in late type II DM
there has been a decrease in plasma insulin levels due to decreased ability of
pancreatic cells to secrete insulin, and accompanied by elevated plasma
glucose levels than normal. In patients with DM II, oral drug administration of
antidiabetes sulfonylureas can still stimulate the ability of Langerhans
pancreas cells to secrete insulin. (NUGROHO, 2006)
2.5 Clinical Manifestation
Symptoms of diabetes mellitus are differentiated into acute and chronic.
The symptoms of acute diabetes mellitus are: Poliphagia (lots to eat)
polidipsia (lots of drinking), Polyuria (lots of urine / frequent urination at
night), appetite increases namu weight drops rapidly (5-10 kg within 2-4
weeks) , Easily tired. Chronic symptoms of diabetes mellitus are: Tingling,
skin feels hot or like pricked needle, numbness in the skin, cramps, fatigue,
easy drowsiness, blurred vision, easily wobbly teeth and easily loose,
decreased sexual ability even in men can occur impotence, In pregnant
women often occur miscarriage or death of the fetus in utero or with the
baby's birth weight more than 4kg. (Fatimah, 2015)
2.6 Management according to DEPKES
Management of diabetes has a final goal to decrease Morbidity and
mortality of DM, specifically targeted at 2 Main Targets, namely :
1. Keeping plasma glucose levels within normal range
2. Prevent or minimize the possibility of complications diabetes. The
American Diabetes Association (ADA) recommends some Parameters that
can be used to assess the success of management Diabetes (Table 5).
Table 5.
Parameters Ideal Content
Fasting Blood Glucose Level 80-120mg / dl

Fasting Plasma Glucose 90-130mg / dl

Level
Blood Glucose Level While 100-140mg / dl
Sleeping (Bedtime blood
glucose)
Insulin levels <7%
HbA1c <7mg / dl
HDL Cholesterol Levels > 45mg / dl (male) 24
Triglycerides levels <200mg / dl
Blood Pressure <130 / 80mmHg

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 There are basically two approaches to diabetes management, The first
approach without drugs and the second is the approach With drugs. In DM
management, the first step should be Done is management without drugs in
the form of diet and exercise regulation Body. If by this first step the goal of
management has not Achieved, can be combined with pharmacological steps
in the form of therapy Insulin or oral hypoglycemic drug therapy, or a
combination of both.At the same time, no matter what management steps are
taken,One factor that should not be abandoned is counseling or counseling on
Diabetics by health practitioners, whether doctors, pharmacists, nutritionists
As well as other medical personnel. Of this, especially concerns
Pharmaceutical services and the role of pharmacists in the management of
DM, will Described specifically in Chapters 6.
2.7 Family Assignment to Sick Family
Family is an important factor for everyone, the family in which we share
happiness and sadness, as well as Diabetes mellitus patients. Those who suffer
from DM will be inferior, desperate, and offended. So that in the control of
diabetes mellitus needed family assistance both moral and spiritual support.
(Wardani & Isfandiari, 2014)
A healthy paradigm for DM patients is a health perspective where
management is concerned with the participation of families for healthy living
especially in families with high risk of suffering from DM so as to be self-
sufficient, maintain and enhance and alert for the emergence of DM
complications (Rifki, 2009).
Family support is very important to motivate patients in an effort to create
an environment that is protected from the stress of the treatment. Social family
support as a protector in stress triggering factors and create a comfortable
environment so as to maintain blood sugar control. DM disease if not
managed properly will result in various chronic diseases, such as cerebro
vascular disease, coronary heart disease, leg blood vessel disease, eye disease,
kidney and nerves. If blood glucose levels can always be controlled properly,
it is expected that all chronic diseases can be prevented, at least inhibited
(Waspadji, 2010).
Family support that families can give to patients with DM in the form of
emotional support, awards support, intrumental support and information
support. Emotional support in the form of a sense of attention or empathy,
support pemhargaanya is a positive appreciation of family members so that
family members feel appreciated, instrumental support is the support provided
in the form of equipment or real objects such as giving money for the

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treatment of sick family members, and support information namely support
provided Advice or advice for family members, such as giving advice to
family members for regular treatment (Friedman, 2014 & Hensarling in
Yusra, 2011).
Family support is not influenced by age, patient relationship, religion,
sex, education, occupation, belief in family illness, feelings of family DM,
income, actions taken while sick family members, All these factors are not
related to family support. According to Retnowati (2012), high family support
can be influenced by family form factors. The small arms form gives fewer
family support due to the few family members and the preoccupation of each
family member so that the given family support will be low, otherwise the
large family form consists of many family members so as to provide higher
family support. Family practice also affects family support because families
who provide positive support support family will be high, but if the family
provides negative support then the support of the family will be low (Amelia,
Nurchayati & Elita, 2014). Family support can also be influenced by cultural
backgrounds.
According to Winkelman (2009), cultural background determines the
level of health behavior and family health values, so that with the family
support tribe will increase. In addition, spiritual welfare also affects family
support. In Amelia's study, Nurchayati, Elita (2014), stated that spiritual
welfare can increase the ability of families or individuals to cope with stress in
the face of disease so that family support will be given high. High family
support will provide comfort and tranquility in pederita DM (Suardana,
Rasdini, & Kusmarjathi, 2015). The statement is in line with Friedman (2014)
arguing that, adequate family support is shown to be associated with reduced
mortality making it easier to recover from illness (Chusmeywati, 2016).

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 CHAPTER III
CLOSING
3.1 Conclusion
Provision of motivation and education can improve the behavior of
patients in the management of diabetes mellitus through increased
knowledge, attitude and practice. Furthermore, if the patient's behavior is
good then the blood sugar will be stable. (Ain, Fatmaningrum, & Yusuf,
2011)
3.2 Suggestion
This research is expected to be further done and deepen the scope of his
research so that it can be more useful in the development of science,
especially in the field of health.

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 REFERENCES

BRUDENELL, M., & DODDRIDGE, M. (1996). DIABETES PADA

KEHAMILAN. JAKARTA: BUKU KEDOKTERAN EGC.
Estri, A. K., Fatimah, S., & Prawesti, A. (Desember 2016). JKP-Volume
4 Nomor 3. Perbandingan Abdominal Massage dengan Teknik
Swedish Massage , 226.
Fatimah, R. N. (2015). DIABETES MELITUS TIPE 2. DIABETES
MELITUS TIPE 2 , 94.
Ndraha, S. (2014). Medicius. Diabetes Melitus Tipe 2 Dan Tatalaksana
Terkini , 10.
NUGROHO, A. E. (2006). Hewan Percobaan Diabetes Mellitus : Patologi
Dan Mekanisme. Hewan Percobaan Diabetes Mellitus : Patologi Dan
Mekanisme , 378.
http://binfar.kemkes.go.id/?wpdmact=process&did=MTc2LmhvdGxpbms=

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