Diabetes mellitus

a condition characterized by hyperglycemia

resulting from the body's inability to use
blood glucose for energy. In type 1 diabetes,
the pancreas no longer makes insulin and
therefore blood glucose cannot enter the cells
to be used for energy. In type 2 diabetes,
either the pancreas does not make enough
insulin or the body is unable to use insulin
correctly.

Type 1 diabetes
a condition characterized by high blood
glucose levels caused by a total lack of
insulin. Occurs when the body's immune
system attacks the insulin-producing beta
cells in the pancreas and destroys them.
The pancreas then produces little or no
insulin. Type 1 diabetes develops most
often in young people but can appear in
adults.

Type 2 diabetes:
a condition characterized by high blood
glucose levels caused by either a lack of
insulin or the body's inability to use
insulin efficiently. Type 2 diabetes
develops most often in middle-aged and
older adults but can appear in young
people.

Major Risk Factors for Type 2 DM

Family history of diabetes (parents or siblings with
diabetes)
Obesity (120% over desired body weight
or BMI 27 kg per m2)
Race/ethnicity (e.g., black, Hispanic, native American,
Asian American, Pacific Islander)
Age 45 years
Previously identified IFG or IGT
Hypertension (140/90 mm Hg)
HDL cholesterol level 35 mg/dL (0.90 mmol/L)
and/or a trigyceride level 250 mg/dL (2.83 mmol/L)
History of gestational diabetes mellitus or delivery of
babies over 4,032 g

Gestational diabetes mellitus (GDM)

a type of diabetes mellitus that develops
only during pregnancy and usually
disappears upon delivery, but increases
the risk that the mother will develop
diabetes later. GDM is managed with
meal planning, activity, and, in some
cases, insulin.

Uji risiko diabetes kehamilan

YA
1

Berasal dari etnis risiko tinggi

Obesitas

Riwayat keluarga DM

Usia di atas 25 tahun

Pernah DM kehamilan

Pernah melahirkan bayi mati, atau amat besar

Jawaban YA dua/lebih berarti risiko tinggi

Jawaban YA hanya satu, berarti risiko sedang
Jawaban YA tidak ada, berarti risiko rendah

TDK

Pre-diabetes
a condition in which blood glucose
levels are higher than normal but are
not high enough for a diagnosis of
diabetes. People with pre-diabetes are
at increased risk for developing type 2
diabetes and for heart disease and
stroke. Other names for pre-diabetes
are impaired glucose tolerance and
impaired fasting glucose.

Diabetes educator
a health care professional who teaches
people who have diabetes how to manage
their diabetes. Some diabetes educators are
certified diabetes educators (CDEs).
Diabetes educators are found in hospitals,
physician offices, managed care
organizations, home health care, and other
settings.

Diabetes Prevention Program (DPP):

a study by the National Institute of Diabetes and
Digestive and Kidney Diseases conducted from
1998 to 2001 in people at high risk for type 2
diabetes. All study participants had impaired
glucose tolerance, also called pre-diabetes, and
were overweight. The study showed that people
who lost 5 to 7 percent of their body weight
through a low-fat, low-calorie diet and moderate
exercise (usually walking for 30 minutes 5 days a
week) reduced their risk of getting type 2 diabetes
by 58 percent. Participants who received
treatment with the oral diabetes drug metformin
reduced their risk of getting type 2 diabetes by 31
percent.

Oral hypoglycemic agents

medicines taken by mouth by people with
type 2 diabetes to keep blood glucose
levels as close to normal as possible.
Classes of oral hypoglycemic agents are
alpha-glucosidase inhibitors, biguanides,
D-phenylalanine derivatives, meglitinides,
sulfonylureas, and thiazolidinediones.

Acarbose
an oral medicine used to treat type 2
diabetes. It blocks the enzymes that digest
starches in food. The result is a slower and
lower rise in blood glucose throughout the
day, especially right after meals. Belongs to
the class of medicines called alphaglucosidase inhibitors. (Brand name:
Precose.)

Alpha-glucosidase inhibitor:
a class of oral medicine for type 2
diabetes that blocks enzymes that digest
starches in food. The result is a slower
and lower rise in blood glucose
throughout the day, especially right after
meals. (Generic names: acarbose and
miglitol.)

A1C:
a test that measures a person's average blood
glucose level over the past 2 to 3 months.
Hemoglobin is the part of a red blood cell that
carries oxygen to the cells and sometimes
joins with the glucose in the bloodstream.
Also called hemoglobin A1C or glycosylated
hemoglobin, the test shows the amount of
glucose that sticks to the red blood cell,
which is proportional to the amount of
glucose in the blood.

Blood glucose meter

a small, portable machine used by people
with diabetes to check their blood
glucose levels. After pricking the skin
with a lancet, one places a drop of blood
on a test strip in the machine. The meter
(or monitor) soon displays the blood
glucose level as a number on the meter's
digital display.

Blood glucose monitoring

checking blood glucose level on a regular
basis in order to manage diabetes. A
blood glucose meter (or blood glucose
test strips that change color when
touched by a blood sample) is needed for
frequent blood glucose monitoring.

C-peptide (see-peptide):
"Connecting peptide," a substance the
pancreas releases into the bloodstream in
equal amounts to insulin. A test of Cpeptide levels shows how much insulin
the body is making.

Diabetic ketoacidosis (DKA)

an emergency condition in which
extremely high blood glucose levels,
along with a severe lack of insulin, result
in the breakdown of body fat for energy
and an accumulation of ketones in the
blood and urine.
Signs of DKA are nausea and vomiting, stomach
pain, fruity breath odor, and rapid breathing.
Untreated DKA can lead to coma and death.

Fasting blood glucose test

a check of a person's blood glucose
level after the person has not eaten for
8 to 12 hours (usually overnight). This
test is used to diagnose pre-diabetes
and diabetes. It is also used to monitor
people with diabetes.

Human leukocyte antigens (HLA)

proteins located on the surface of the
cell that help the immune system
identify the cell either as one belonging
to the body or as one from outside the
body. Some patterns of these proteins
may mean increased risk of developing
type 1 diabetes.

Hyperglycemia
excessive blood glucose. Fasting
hyperglycemia is blood glucose above a
desirable level after a person has fasted
for at least 8 hours. Postprandial
hyperglycemia is blood glucose above a
desirable level 1 to 2 hours after a person
has eaten.

Hypoglycemia
a condition that occurs when one's blood
glucose is lower than normal, usually less
than 70 mg/dL. Signs include hunger,
nervousness, shakiness, perspiration,
dizziness or light-headedness, sleepiness,
and confusion. If left untreated,
hypoglycemia may lead to unconsciousness.
Hypoglycemia is treated by consuming a
carbohydrate-rich food such as a glucose
tablet or juice. It may also be treated with
an injection of glucagon if the person is
unconscious or unable to swallow. Also
called an insulin reaction.

Impaired fasting glucose (IFG)

a condition in which a blood glucose
test, taken after an 8- to 12-hour fast,
shows a level of glucose higher than
normal but not high enough for a
diagnosis of diabetes. IFG, also called
pre-diabetes, is a level of 110 mg/dL to
125 mg/dL. Most people with prediabetes are at increased risk for
developing type 2 diabetes.

Impaired glucose tolerance (IGT)

a condition in which blood glucose levels are
higher than normal but are not high enough for
a diagnosis of diabetes. IGT, also called prediabetes, is a level of 140 mg/dL to 199 mg/dL
2 hours after the start of an oral glucose
tolerance test. Most people with pre-diabetes
are at increased risk for developing type 2
diabetes. Other names for IGT that are no
longer used are "borderline," "subclinical,"
"chemical," or "latent" diabetes.

Insulin resistance
the body's inability to respond to and
use the insulin it produces. Insulin
resistance may be linked to obesity,
hypertension, and high levels of fat in
the blood.

Kemungkinan gaya hidup pemicu resistensi insulin

Diet tinggi lemak
Diet sangat rendah lemak
Diet rendah protein
Kekurangan asam lemak essensial, terutama lemak omega 3
Diet tinggi karbohidrat
Makanan berindeks glisemik tinggi
Tepung dan gula terolah
Terlalu banyak/terlalu rendah garam
Kekurangan elemen kelumit (kalsium, magnesium, kromium,
vanadium, seng, karotenoid, dan vitamin A)
Asupan sayur rendah
Kurang bergerak (sedentary)Stress tinggi
Penggunaan bahan yang mengan-dung nikotin

Keadaan metabolik yang tertali dengan resistensi insulin

Resistensi leptin
Dislipidemia
Kadar lipoprotein meningkat
Homosistein meningkat
Trigliserida tinggi
Sistem transport glukosa otot lurik terganggu (GLUT-4)
Hiperkortikolism
DHEA menurun
Kadar GH rendah
Lipogenesis meningkat, beta oksidasi menurun
TNF meningkat
Disfungsi hemostatik, ternasuk peningkatanan trombosis, kadar
fibrinogen tinggi, kecenderungan agregasi trombosit
Tekanan darah meningkat
Stres oksidatif meningkat

Ketone
a chemical produced when there is a
shortage of insulin in the blood and the
body breaks down body fat for energy.
High levels of ketones can lead to
diabetic ketoacidosis and coma.
Sometimes referred to as ketone
bodies.

Ketosis
a ketone buildup in the body
that may lead to diabetic
ketoacidosis. Signs of ketosis
are nausea, vomiting, and
stomach pain.

Rapid-acting insulin
a type of insulin that starts to lower
blood glucose within 5 to 10 minutes
after injection and has its strongest
effect 30 minutes to 3 hours after
injection, depending on the type used.
See aspart insulin and lispro insulin.

Regular insulin
short-acting insulin. On average,
regular insulin starts to lower blood
glucose within 30 minutes after
injection. It has its strongest effect
2 to 5 hours after injection but
keeps working 5 to 8 hours after
injection. Also called R insulin.

Self-management
in diabetes, the ongoing process of managing
diabetes. Includes meal planning, planned
physical activity, blood glucose monitoring,
taking diabetes medicines, handling episodes
of illness and of low and high blood glucose,
managing diabetes when traveling, and more.
The person with diabetes designs his or her
own self-management treatment plan in
consultation with a variety of health care
professionals such as doctors, nurses,
dietitians, pharmacists, and others.

Short-acting insulin
a type of insulin that starts to
lower blood glucose within 30
minutes after injection and has
its strongest effect 2 to 5 hours
after injection. See regular
insulin.

Somogyi effect
(rebound hyperglycemia)
when the blood glucose level swings
high following hypoglycemia. The
Somogyi effect may follow an
untreated hypoglycemic episode
during the night and is caused by the
release of stress hormones.

Perbedaan antara IDDM dan NIDDM

(IDDM) DM tipe 1

(NIDDM) DM tipe 2

Onset

Anak/dewasa muda (<25 th)

Biasanya setelah usia pertengahan

Proporsi

<10% dari total penderita DM

>90% dari total penderita Diabetes

Melitus

Riwayat keluarga

Tidak lazim

Amat lazim

Gejala

Akut/sub-akut

Lambat

Ketoasis

Sering sekali

Jarang, kecuali sakit/stres

Antibodi ICA, GAD

Sangat sering positif

Biasanya negatif

Obesitas waktu onset

Non-obese

Biasanya obes sebelum onset

Kaitan dengan HLA tipe tertentu

Ada

Tidak ada

Kaitan dengan penyakit autoimum

Kadang ada

Tidak ada

C-peptida darah/urin

Sangat rendah

Rendah, normal, atau tinggi

Kegunaan insulin

Penyelamat nyawa

Kadang diperlukan untuk control gula

darah

Penyebab

Pankreas tak mampu buat insulin

Produksi insulin masih ada, namun target

sel tak sensitive.

Kegunaan diit

Kontrol gula darah (makan/jajan

harus diatur di seputar
pemberi-an insulin agar tak
hipoglisemia.

Guna latihan fisik

Rangsang sirkulasi dan bantu tubuh gunakan insulin

Turunkan BB, jadwal tak harus ketat,

kecuali diberi-kan pula insulin

Buat tubuh lebih sensitif terhadap

insulinnya sen-diri, dan gunakan
energi untuk kurangi BB.

Prevalensi
1999: 80 juta (Zimmet 1990)
1994: 104 juta (Zimmet 1994)
2010: 239,3 juta
2025: 300 juta (WHO, IDF,
1999)

Prevalensi (Indonesia)
1995: 4,5 juta
2025: 12,4 juta
(International Diabetes Monitor,
April 1999)

Diagnosis DM berdasarkan kadar gula darah

DM-

DM?

DM

Kadar glukosa
darah sewaktu

Plasma vena

<110

110-199

200

Darah kapiler

<90

90-199

200

Kadar glukosa
darah puasa

Plasma vena

<110

110-125

126

Darah kapiler

<90

90-109

110

Smber: Pengelolaan DM tipe 2 di Indonesia, PERKENI 2002

Pemeriksaan penyaring
kelompok risiko DM
Usia >45 tahun
BB > 110% BBI [BMI > 23]
Hipertensi 140/90 mm Hg
Riwayat keluarga DM
Riwayat abortus berulang,
melahirkan bayi cacat,
atau BBL > 4000 gram
Kolesterol HDL 35 mg/dl
dan/atau trigliserida 250 mg/dl
Sumber: Konsensus pengelolaan DM tipe 2
Indonesia 2002, PERKENI, 2002

Recommendations

Persons

for Diabetes Screening of Asymptomatic

Timing of first test and repeat tests

Test at age 45; repeat every three years for patients 45 years of age or
older
Test before age 45; repeat more frequently than every three years if
patient has one or more of the following risk factors:
* Obesity: >=20% of desirable body weight or BMI >=27 kg per m2
* First-degree relative with diabetes mellitus
* Member of high-risk ethnic group (black, Hispanic, Native American,
Asian)
* History of gestational diabetes mellitus or delivering a baby weighing
more than 4,032 g (9 lb)
* Hypertensive (>=140/90 mm Hg)
* HDL cholestrol level <=35 mg per dL (0.90 mmol per L) and/or
triglyceride level >=250 mg per dL (2.83 mmol per L)
* History of IGT or IFG on prior testing
(BMI=body mass index;
HDL=high-density lipoprotein;
IGT=impaired glucose tolerance;
IFG=impaired fasting glucose)

Klasifikasi Etiologis Diabetes Melitus

Jenis

Etiologi

Tipe 1[1]

Destruksi sel , umumnya menjurus ke defisiensi insulin absolut

autoimun
idiopatik

Tipe 2

Bervariasi mulai yang terutama dominan resistensi insulin disertai

defisiensi insulin relatif sampaiyang terutama defek sekresi insulin
disertai resistensi insulin

Tipe lain

Defek genetik fungsi sel

Defek genetik kerja insulin
Penyakit eksokrin pankreas
Endokrinopati
Karena obat atau zat kimia
Infeksi
Sebab immunologi yang jarang
Sindrom genetik lain yang berkaitan dengan DM

DM gestasional
Catatan: DM pada sirosis hati belum bisa dikelompokkan ke dalam klasifikasi di atas,
karena mekanismenya belum dapat ditentukan dengan pasti (dikutip dari Konsensus
pengelolaan DMtipe 2 di Indonesia 2002, PERKENI, 2002)

Penanganan
Pendidikan
Pengobatan gizi medis
Olahraga
Obat penurun gula darah

Pengobatan gizi medis

Status metabolik optimal

Cegah/obati penyulit kronis
Perbaiki derajat kesehatan
Tata gizi perorangan

Macam diit DM dan komposisi zat gizinya

Macam

Kalori

Karbohidrat

Protein

Lemak

1.100

160

50

30

II

1.300

195

55

35

III

1.500

225

60

40

IV

1.700

260

65

45

1.900

300

70

50

VI

2.100

325

80

55

VII

2.300

350

85

65

VIII

2.500

390

90

65

Dikutip dari Bagian Gizi RSCM/Persagi, 1993

Diit I, II, III diperuntukan bagi penderita obesitas.
Diit IV, V untuk penderita berberat badan normal.
Diit VI, VII, VIII untuk penderita kurus, remaja, atau
DM dengan penyulit

Vitamin

Bkompleks, B6, C, dan E.

Mineral

Manganese, Kalium, Khromium

As. amino

L-taurine, dan L-carnitine

Suplemen

Yeast (ragi), Lecithin, Serat (guar gum),

dan Co-Q10

Herbal

Alfalfa, Bawang putih, Evening primirose oil

(GLA), Golden seal, dan dandelion root

Obat Anti Diabetik Oral (ADO)

Sulfonilurea

Dosis harian

Lama
kerja

Frek/
hari

100-250

100-500

24-36

Glibenklamid

2,5-5

2,5-15

12-24

1-2

Glipizid

5-10

5-20

10-16

1-2

Gliklazid

80

80-240

10-20

1-2

Glikuidon

30

30-120

Glimepirid

1,2,3,4

0,5-6

24

Repaglinid

0,5; 1; 2

Nateglinid

120

Pioglitazon

15-30

Generik

Mg/tab

Klorpropamid

Glinid

Tiazolidindion
Penghambat
Glukosidase

Acarbose

Biguanid

Metformin

50-100

500-850

Pemberian
Sebelum
Makan

Tak bergan-tung
jadwal makan
15-30

24

100-300

250-3000

6-8

1
3

Bersama
suap
pertama

1-3

Bersama/sesudah
makan

Cat. OHO dimulai dari dosis kecil, dan ditingkatkan secara bertahap, susuai dengan respons kadar glukosa darah; dan dapat ditingkatkan hingga dosis
maksimal. Sulfonil urea ditelan 15-30 menit sebelum makan. (dikutip dari Konsensus pengelolaan DM tipe 2 di Indonesia 2002,
PERKENI, 2002)

an

delaying or skipping a meal

eating too little food at a meal
getting more exercise than usual
taking too much diabetes medicine
drinking alcohol

Hypoglycaemia

dizzy or light-headed
hungry
nervous and shaky
sleepy or confused
sweaty

1/2 cup (4 oz.) of any fruit juice

1 cup (8 oz.) of milk
1 or 2 teaspoons of sugar or honey
1/2 cup (4 oz.) of regular soda
5 or 6 pieces of hard candy
glucose gel or tablets (take the amount
noted on the package to add up to 15
grams of carbohydrate)