MANAGEMENT OF DIABETES MELLITUS

Principles of management of diabetes mellitus in general there are five according to the
Consensus Management of DM in Indonesia in 2006 is to improve the quality of life of diabetic
patients. Objectives of Management of DM are short-term, namely loss of complaints and signs
of DM, maintaining a sense of comfort and achieving the target of controlling blood glucose.
The second is long term, which is prevented and hampered the progression of microangiopathic
complications, macroangiopathy and neuropathy.

The ultimate goal of management is a decrease in DM morbidity and mortality. To

achieve these objectives it is necessary to control blood glucose, blood pressure, weight and lipid
profile, through patient management holistically by teaching self-care and behavior change.

1. Diet

The principle of regulating food for people with diabetes is almost the same as the
recommended diet for the general public, namely a balanced diet and according to the individual
caloric and nutritional needs. In people with diabetes, it is important to emphasize the importance
of regular eating in terms of meal schedules, type and amount of food, especially in those who
use blood glucose-lowering drugs or insulin. The recommended standard is food with a balanced
composition in terms of 60-70% carbohydrates, 20-25% fat and 10-15% protein. To determine
nutritional status, calculated by BMI (Body Mass Index). The Body Mass Index (BMI) or Body
Mass Index (BMI) is a simple tool or way to monitor the nutritional status of adults, especially
those associated with underweight and overweight. To find out the value of this IMT, it can be
calculated by the following formula:

IMT =

2. Exercise (physical exercise)

Exercise is recommended regularly (3-4 times a week) for approximately 30 minutes,

which is in accordance with Continuous, Rhythmical, Interval, Progressive, Endurance (CRIPE).
Training according to the patient's ability. For example, 30 minutes of light walking is normal.
Avoid habits of life that are lacking in motion or lazy.

3. Health Education

Health education is very important in management. Primary prevention health education

must be given to high-risk community groups. Secondary health education is given to groups of
DM patients. While health education for tertiary prevention is given to patients who have chronic
diabetes complications.

4. Medication: oral hypoglycemic, insulin If the patient has made arrangements for eating
and physical exercise but has not managed to control blood sugar levels then consider the use of
hypoglycemic drugs

Diabetes Mellitus Drugs

a. Oral antidiabetic

Management of DM patients is done by normalizing blood sugar levels and preventing

complications. More specifically with relieving symptoms, optimizing metabolic parameters, and
controlling body weight. For patients with type 1 diabetes, the use of insulin is the main therapy.
Oral antidiabetic indications are primarily intended for the treatment of mild to moderate type 2
DM patients who fail to be controlled by regulating energy and carbohydrate intake and exercise.
This class of drugs is added if after 4-8 weeks of diet and exercise efforts are carried out, blood
sugar levels remain above 200 mg% and HbA1c above 8%. So this drug does not replace dietary
efforts, but helps. The selection of the right oral antidiabetic drugs greatly determines the success
of diabetes therapy. The choice of therapy using oral antidiabetic can be done with one type of
drug or combination. The selection and determination of the oral antidiabetic regimen used must
consider the severity of DM disease and the general health condition of the patient including
other diseases and complications. In this case oral hypoglycemic drugs include sulfonylureas,
biguanides, alpha glucosidase inhibitors and insulin sensitizing.

b. Insulin
 Insulin is a small protein with a molecular weight of 5808 in humans. Insulin contains 51
amino acids arranged in two chains that are connected with disulfide bridges, there are
differences in the amino acids of the two chains. For patients who are not diet controlled or oral
hypoglycemic administration, a combination of insulin and other drugs can be very effective.
Insulin is sometimes a temporary choice, for example during pregnancy. However, in worsening
type 2 DM patients, total insulin replacement is a necessity. Insulin is a hormone that affects
carbohydrate metabolism and protein and fat metabolism. The function of insulin includes
increasing glucose uptake into cells of most tissues, increasing oxidative glucose breakdown,
increasing glycogen formation in the liver and muscles and preventing glycogen breakdown,
stimulating the formation of proteins and fats from glucose.

Prevention

Prevention of diabetes mellitus is divided into four parts:

1. Premordial Prevention

Premodial prevention is an effort to provide conditions to the community that allow the
disease to not get support from habits, lifestyle and other risk factors. This precondition must be
created with multimitra. Premodial prevention of DM disease, for example, is to create
preconditions so that people feel that westernized food consumption is a poor diet, a relaxed
lifestyle or lack of activity, and obesity is not good for health.

2. Primary Prevention

Primary prevention is an effort aimed at people who belong to high risk groups, those
who have not suffered from DM, but have the potential to suffer from DM including:

a. Old age group (> 45 years)

b. Obesity (BB (kg)> 120% BB dream or BMI> 27 (kglm))

c. High blood pressure (> 140i90mmHg)

d. Family history of DM
 e. History of pregnancy with Body weight babies born> 4000 gr.

f. Disiipidemia (HvL <35 mg / dl and / or triglycerides> 250 mg / dl).

g. Ever TGT or fasting blood glucose is interrupted (GDPT)

For primary prevention must be subject to factors that influence the emergence of DM
and efforts to eliminate these factors. Therefore it is very important in this prevention. Early on,
an understanding of the importance of regular physical activities, patterns and types of healthy
foods should be planted to keep the body from being too fat :, and the risk of smoking to health.

3. Secondary Prevention

Secondary prevention is an effort to prevent or inhibit the emergence of complications by

the act of early detection and treatment since the beginning of the disease. In the management of
DM patients, it must be watched out from the start and wherever possible the possibility of
chronic complications is possible. The main pillars of DM management include counseling, food
planning, physical exercise, and hypoglycemic efficacious drugs.

4. Tertiary Prevention

Tertiary prevention is an effort to prevent further disability and rehabilitate patients as

early as possible, before the disability persists. Holistic and integrated health services between
related disciplines are needed, especially in referral hospitals, for example experts from other
disciplines such as experts in heart disease, eyesight, medical rehabilitation, nutrition and others.