DIABETES MELLITUS

A. Definition
Diabetes mellitus is a heterogeneous group of disorders characterized by increased levels of glucose in the blood or hyperglycemia. (Brunner and Suddarth, 2002).Melllitus Diabetes is a collection of symptoms that arise in a person caused by an increase in blood sugar (glucose), blood due to insulin deficiency both absolute and relative terms.

B. Classification 
Classification of diabetes mellitus as follows:
1. Type I: insulin-dependent diabetes mellitus (IDDM) 
2. Type II: Diabetes mellitus is independent of insulin (NIDDM) 
3. Diabetes mellitus associated with other conditions or syndromes 
4. Gestational diabetes mellitus (GDM)

C. Etiology 
1. Diabetes Type I: 
a. Genetic factorsPeople with diabetes do not inherit the type I diabetes itself, but inherit a genetic predisposition or a tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type. 
b. Immunological FactorsThe existence of autoimmune responses, which is an abnormal response in which antibodies directed at the normal tissues of the body by way of reacting to network which is considered as if in a foreign network. Namely autoantibody against the island of Langerhans cells and endogenous insulin. 
c. Environmental factorsViruses or certain toxins can trigger the autoimmune process that causes destruction selbeta. 
2. Type II Diabetes 
The exact mechanism that causes insulin resistance and impaired insulin secretion in type II diabetes is still unknown. Genetic factors play a role in the process of insulin resistance. 

Risk factors: 

a. Age (insulin resistance tended to increase at the age of 65 years) 
b. Obesity 
c. Family History

D. Pathophysiology / Pathways

E. Signs and Symptoms 
Common complaints such as diabetes mellitus patients polyuria, polydipsia, polifagia the DM generally do not exist. Instead of disturbing the patient is a complaint often from complications of chronic degenerative diseases of the blood vessels and nerves. In the elderly there are changes in the pathophysiology of DM due to aging process, so that the clinical picture varies from asymptomatic cases to cases with extensive complications. A recurring complaint is the presence of impaired vision due to cataracts, a sense of numbness in the limbs and muscle weakness (peripheral neuropathy) and wounds on limbs that are hard to heal with normal treatment. 
The symptoms due to diabetes mellitus in the elderly are often found are: 
1. Cataract 
2. Glaucoma 
3. Retinopathy 
4. Itching all over body 
5. Pruritus vulvae 
6. Bacterial infection of skin 
7. Fungal infections in the skin 
8. Dermatopati 
9. Peripheral neuropathy 
10. Visceral neuropathy 
11. Amiotropi1
2. Neurotrophic ulcer 
13. Kidney disease 
14. Peripheral vascular disease 
15. Coronary Disease 
16. Brain blood vessel disease 
17. Hypertension





Osmotic diuresis due to glucosuria delayed due to a high renal threshold, and can appear along with nocturia complaints of sleep disturbance, or even incontinence of urine. Feelings of thirst in elderly diabetic patients is less felt, as a result they do not react adequately against dehydration. Because it does not occur or new polydipsia occurs at an advanced stage.The disease is initially mild and the usual mediocrity found in elderly diabetic patients can change suddenly, when patients had acute infection. Insulin deficiency that had now become an absolute relative and circumstances arise ketoacidosis with typical symptoms of hyperventilation and dehydration, decreased consciousness with hyperglycemia, dehydration and ketonemia. Symptoms usually occur in hypoglycemia such as hunger, yawning and sweating a lot is generally not present in the elderly diabetic. Usually appears manifest as sudden headache and confusion.Vegetative reactions in the elderly may disappear. While symptoms of confusion and coma which is a disorder of cerebral metabolism appear more clearly.

F. Examination Support 
1. Blood glucose during 
2. Fasting blood glucose levels 
3. Glucose tolerance testWhen blood levels and fasting as a benchmark filter DM diagnosis (mg / dl)Not yet sure DM DM DMBlood glucose levels during- Plasma venous- Blood capillaryFasting blood glucose levels- Plasma venous- Blood capillary<100<80
<110 
<90 

100-200 
80-200

110-120 
90-110 

> 200 
> 200

> 126 
> 110 
WHO diagnostic criteria for diabetes mellitus at least 2 times the examination: 
1. While plasma glucose> 200 mg / dl (11.1 mmol / L) 
2. Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
3. Plasma glucose from samples taken 2 hours later after consuming 75 g carbohydrate (2 hours post prandial (pp)> 200 mg / dlG. ManagementThe main purpose of treatment of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an effort to reduce vascular complications and neuropathy. Therapeutic goal in each type of diabetes is to achieve normal blood glucose levels.There are 5 components in the management of diabetes: 
1. Diet 
2. Exercise 
3. Monitoring 
4. Therapy (if needed) 
5. Education

H. Assessment 
? Family Health 
HistoryAre there families who suffer from diseases such as client? 
? Patient Medical History and Prior Treatment 
How long a client suffering from diabetes, how to handle, gets what kind of insulin therapy, how to take her medicine whether regular or not, what is being done to tackle the disease clients. 
? Activity / Rest: 
Tired, weak, Difficult Moves / walking, muscle cramps, decreased muscle tone.
? Circulation 
Is there a history of hypertension, AMI, klaudikasi, numbness, tingling in the extremities, ulcers on the feet that long healing, tachycardia, changes in blood pressure
? Ego 
IntegrityStress, anxiety 
? Elimination 
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea 
? Food / Fluids 
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.
? Neurosensori 
Dizziness, headache, tingling, numbness in muscle weakness, paresthesias, visual disturbances. 
? Pain / Leisure 
Abdomen tense, pain (moderate / severe) 
? Respiratory 
Cough with or without purulent sputum (dipend on an infection / no) 
? Security 
Dry skin, itching, skin ulcer.