diabetes mellitus diet plan

A. Calorie needs.

Appropriate caloric needs to achieve and maintain ideal weight composition
energy is 60-70% from carbohydrates, 10-15% from protein and 20-25% from fat.
There are several ways to determine the amount of calories needed people with
of diabetes. Among them is by calculating calorie needs based on basal
magnitude of 25-30 calories / kg ideal, plus and minus depending on several factors
namely gender, age, aktifikasi, pregnancy / lactation, presence of complications and weight.
Another way is as table 1. While a more easy way again is to
rough grip, ie for thin patients 2300 - 2500 calories, normally 1700 - 2100 calories and
fat 1300 - 1500 calories.
Table 1. Calorie Needs People With Diabetes
Calories / kg ideal
Working adults are relaxed weight
Fat 25 30 35
Normal 30 35 40
Skinny 35 40 40-50
Weight Calculation Idaman.
Brocca with the modified formula is as follows:
Ideal body weight = 90% x (TB in cm - 100) x 1 kg.
For men with a height below 160 cm and women under 150 cm, or for those
older than 40 years, the formula is modified to be.
Ideal body weight = (TB in cm - 100) x 1 kg.
Meanwhile, according to Body Mass Index (BMI) or Body Mass Index (BMI) ie weight
weight (kg) SO 2 as follows:
Ideal weight: BMI 21 for women
BMI 22.5 for men.

The factors that determine your caloric needs.
1. Sex.
Caloric needs in women less than men, for it can be worn number 25
cal / kg for women and the figure of 30 cal / kg for men.
2. Age.
In infants and children's caloric needs are much higher than those
adult, in the first year can reach 112 kg / kg.
Age 1 year requires about 1000 calories and then the children
more than a year get an extra 100 calories for each year.
Decrease in caloric needs over 40 years should be reduced 5% for each decade
between 40 and 59 years, while between 60 and 69 years minus 10%, above 70
year minus 20%.
3. Physical Activity or Work.
Different types of activities require different calories. Type of activity
grouped as follows:
Resting state: basal caloric requirement plus 10%.
Lightweight: office workers, clerks, teachers, lawyers, housewives, and
others need to be added 20% of basal needs.
Medium: employees in insdustri lightweight, students, military is not war,
requirement was increased to 30% of basal.
Weight: farmers, in a state of military exercises, dancers, athletes, plus the 40% requirement.
Very heavy: handyman beca, digger, blacksmith, needs to be added
50% of basal.
4. Pregnancy / Lactation.
At the beginning of pregnancy required an additional 150 calories / day and in the second and third trimester
350 calories / day. At the time of lactation is needed as much as 550 extra calories / day.
5. The presence of complications. Infection,
Trauma or surgery that causes the rise in temperature require additional calories
by 13% for each increase of 1 degree Celsius.
6. Body Weight.
When overweight / too thin, minus / plus about 20-30% depending on
level

B. Sugar.
Sugar and other products of the sugar is reduced, except in certain circumstances, for example
patients with low-protein diet and who received the liquid diet, sugar should be given to
caloric sufficiency, in limited quantities. The applicability of a little sugar in the seasoning
allowed to enable the patient can eat family meals. The applicability
sugar to drinks can be given appropriate help when needed.

C. Standard Diet Diabetes Mellitus.
To plan a day diet, patients were given instructions how material requirements
food at each meal of the day in the form of exchanger (P). See attachment (one) 1.
Based on the patient's diet and food exchange lists, can disuusn
daily food menu.

D. List of Food exchanger.
Exchanger grocery list is a list of food ingredients with
certain size and are grouped based on the content of calories, protein, fat and hydrates
charcoal. Each food group is considered to have nutritional value or less the same.
Grouped into seven food groups namely:
Group 1: food sources of carbohydrates.
Group 2: food sources of animal protein.
Group 3: food sources of vegetable protein.
Group 4: vegetables.
Group 5: fruits.
Group 6: Milk.
group 7: Oil
Group 8: food without the calories.

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Virus Can Trigger Type 1 Diabetes Mellitus

Rejekine. Diabetes that strikes children, mostly caused by certain viruses that enter the body through water and air. Among other things, coxsackie virus causes disease hand, foot and mouth, and polio virus.

Children with the pattern of most unclean living, and lack of rest, Could have contracted the virus-the virus. In the body, the virus does not only cause infection, but also Disrupt the cells, including Those That Produce insulin to trigger diabetes mellitus (DM) type 1 in early child. detection in children with type 1 diabetes need to avoid delay in handling the disease and Prevent complications from the effects more severe.

Type 1 diabetes mellitus is a chronic metabolic disease that could potentially interfere with child development. Therefore, the basic philosophy of governance of this disease, such as discipline and regularity of treatment and a healthy lifestyle, so the recommended treatment to obtain maximum results.
Symptoms of type 1 diabetes in children, need to be careful because it is not easily diagnosed by a physician. Early symptoms are not so clear and the new note after an advanced stage. With early detection, treatment can be performed on people with type 1 diabetes and therefore reduces the risk of disability and death

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Pathophysiology of Type 2 Diabetes Mellitus

REJEKINE. Insulin resistance means that body cells do not respond appropriately when insulin is present. Unlike type 1 diabetes mellitus, insulin resistance is generally "post-receptor", which means it is a problem with the cells that respond to insulin rather than a problem with insulin production.

Other important contributing factors:

increase in hepatic glucose production (eg, from glycogen -> glucose conversion), especially at inappropriate times (a common cause is insane levels of insulin, such that control levels of these functions in liver cells)
decrease in insulin-mediated glucose transport in (primarily) muscle and adipose tissues (receptor and post-receptor defects)
beta-cell dysfunction-loss of early phase insulin release in response to hyperglycemic stimuli
This is a more complex problem than type 1, but sometimes it is easier to treat, especially in the early years when insulin is often still produced internally. Type 2 may go unnoticed for years before diagnosis, since symptoms are usually mild (eg, no ketoacidosis, coma, etc.) and can be sporadic. However, severe complications can result from not properly managed type 2 diabetes, including renal failure, erectile dysfunction, blindness, slow healing wounds (including surgical incisions), and arterial disease, including coronary artery disease. Onset of type 2 has been most common in middle age and old age, although it became more commonly seen in adolescents and young adults due to the increase of child obesity and inactivity. This type of diabetes called MODY increasingly seen in adolescents, but is classified as diabetes due to specific causes and not as type 2 diabetes.

Type 2 diabetes mellitus is unknown etiology (ie, origin). Diabetes mellitus with a known etiology, such as other secondary diseases, known gene defects, trauma or surgery, or the effects of the drug, more appropriately called secondary diabetes mellitus or diabetes due to specific causes. Examples include diabetes mellitus as MODY or caused by hemochromatosis, pancreatic deficiency, or certain drugs (eg, long-term use of steroids).

According to the CDC, approximately 23,613,000 people in the United States, or 8% of the population, have diabetes. Total prevalence of diabetes increased 13.5% from 2005-2007. It is estimated that only 24% of undiagnosed diabetes now, down from 30% expected in 2005 and from 50% previously estimated at ca 1995.

Approximately 90-95% of all North American cases of type 2 diabetes, and about 20% of the population over age 65 have type 2 diabetes mellitus. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons, though this is not known in detail. Diabetes affects more than 150 million people worldwide and this number is expected to double by 2025 .. Approximately 55 percent of type 2 are obese-chronic obesity causes increased insulin resistance that can develop into diabetes, most likely because adipose tissue (especially in the abdomen around internal organs) is the source (currently identified) of the chemical signal several other tissues (hormones and cytokines ). Other studies have shown that type 2 diabetes causes obesity as a result of changes in cell metabolism and behavior of other officers crazy on insulin resistance. However, genetics plays a relatively minor role in the widespread occurrence of type 2 diabetes. It can be logically inferred from the large increase in the occurrence of type 2 diabetes who have correlated with significant changes in western lifestyles.

Type 2 diabetes mellitus is often associated with obesity, hypertension, high cholesterol (combined hyperlipidemia), and with the condition often called metabolic syndrome (also known as Syndrome X, Reavan syndrome, or CHAOS). Secondary causes of type 2 diabetes mellitus are: acromegaly, Cushing's syndrome, thyrotoxicosis, pheochromocytoma, chronic pancreatitis, and cancer drugs.

Drug-induced hyperglycemia:

Atypical antipsychotics - Alter the characteristics of receptor binding, leading to increased insulin resistance.
Beta-blockers - inhibits insulin secretion.
Calcium channel blockers - inhibits insulin secretion by interfering with the release of cytosolic calcium.
Corticosteroids - The cause of peripheral insulin resistance and gluconeogensis.
Fluoroquinolones - Inhibit insulin secretion by blocking ATP-sensitive potassium channels.
Naicin - They cause increased insulin resistance due to increased mobilization of free fatty acids.
Phenothiazines - inhibits insulin secretion.
Protease Inhibitor - Inhibiting the conversion of proinsulin to insulin.
Thiazide diuretic - inhibits secretion of insulin due to hypokalemia. They also lead to increased insulin resistance due to increased mobilization of free fatty acids.
Additional factors found to increase risk of type 2 diabetes include aging, high-fat diets and less active lifestyle ..

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Methods of prevention of diabetes mellitus

if you do not want to develop diabetes disease, there are someprecautions you can take are:

primary prevention
Primary prevention is the effort devoted to people who fall into high risk categories, namely those who have not been affected by this disease but it has the potential to get it. For primary prevention, it is necessary to know first what are the factors that influence the occurrence of diabetes mellitus, as well as the efforts made to eliminate these factors. Education plays an important role in primary prevention.

secondary prevention
Secondary prevention is an effort to prevent and inhibit the onset of the disease by early detection and provide early treatment. Early detection is done by screening. Only checks will require a considerable cost. Treatment of early disease should be done immediately to prevent the possible occurrence of chronic diseases. Education about diabetes mellitus and its management, will affect the enhancement of patient adherence to treatment.

tertiary prevention
If the chronic disease diabetes mellitus occurs to you, then the experts must try to prevent further disability and rehabilitation of patients as early as possible before the patient experienced a permanent disability. For instance, acetosal low dose (80-325 mg) can be given routinely to patients with diabetes mellitus who have had makroangiopati disease (heart blood vessels, peripheral blood vessels, blood vessels of the brain, retinal capillary blood vessels, renal capillary blood vessels). Health services that are holistic and integrated inter-related disciplines is required.

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Type of Diabetes Mellitus

Diabetes mellitus There are two types namely:

1. Type 1 diabetes mellitus (IDDM: Insulin Dependent Diabetes Mellitus), tioe is highly dependent diabetes with insulin.

In this second type there is damage cells in the pancreas can not produce insulin so again, as a result the cells can not absorb glucose from the blood.

Type 1 affects many young people are under the age of 30 years and most often begins in adolescence between the ages of 10-13 years. Type 1 is usually treated by administering insulin injections.

2. Type 2 diabetes mellitus (NIDDM: Non Insulin Dependent Diabetes Mellitus), this type is not dependent diabetes with insulin.

because of the aging process and lifestyle and poor diet are many sufferers of this type has decreased function of the cells in the pancreas so that insulin produced reduced amounts.

In general, this type begins in adults over the age of 40 years with a greater incidence in overweight people (overweight). Type 2 begins with minor complaints that are often not recognized until symptoms advanced stage, even until complications occur. Therefore if there are symptoms of diabetes, immediately consult a doctor.

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Classification of Diabetes Mellitus

Rejekine. is a heterogeneous group of disorders characterized by increased levels of glucose in the blood or hyperglycemia rapidly and suddenly.
Melllitus Diabetes is a collection of symptoms that arise in a person caused by the presence of elevated levels of sugar (glucose) in the blood caused by a deficiency of insulin both absolute and relative
Classification of Diabetes Mellitus

Classification of diabetes mellitus as follows:

Type I: insulin-dependent diabetes mellitus (IDDM)
Type II: Diabetes mellitus is insulin dependent (NIDDM)
Diabetes mellitus is associated with other conditions or syndromes
Gestational diabetes mellitus (GDM)
Etiology of Diabetes Mellitus

Based on the clustering of diabetes is divided into two types namely:

Diabetes type I:

a. Genetic factors
Diabetics do not inherit type I diabetes itself, but inherit a genetic predisposition or tendency toward the occurrence of diabetes mellitus type I. Genetic predisposition is found in individuals who have HLA antigen type.
b. Immunological Factors
The existence of an autoimmune response in which antibodies directed an abnormal response to normal tissue reacts to the body in a way that considers the network as if they were foreign tissue. Ie autoantibodies against islet cells of Langerhans and endogenous insulin.
c. Environmental factors
Viruses or certain toxins can trigger autoimmune process that causes destruction selbeta.

Diabetes Type II

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 tends to increase in age above 65 years)
b. Obesity
c. Family history
Pathophysiology / Pathways Diabetes Mellitus

Pathophysiology of DM
Signs and Symptoms of Diabetes Mellitus

A common complaint of patients DM like polyuria, polydipsia, polyphagia in DM is generally no. Instead the patient is often disturbing complaints from complications of chronic degenerative blood vessels and nerves. In the elderly there is a change in the pathophysiology of DM due to the 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, tingling in the limbs and muscle weakness (peripheral neuropathy) and injuries to the legs which are difficult to recover with treatment prevalent.

According Supartondo, the symptoms caused by diabetes mellitus in the elderly are often found are:

1. Cataract
2. Glaucoma
3. Retinopathy
4. Itching around the body
5. Pruritus Vulvae
6. Bacterial infections of skin
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10. Visceral neuropathy
11. Amiotropi
12. Neurotrophic ulcer
13. Kidney disease
14. Peripheral vascular disease
15. Coronary Disease
16. Cerebral vascular disease
17. Hypertension

Osmotic diuresis due to glucosuria delayed due to high renal threshold, and can occur with nocturia complaints of sleep disturbance, or even urinary incontinence. Feelings of thirst in elderly diabetic patients are less felt, as a result they do not respond adequately to the dehydration. Because it does not happen polydipsia or just happened at an advanced stage.
The disease is initially mild and there was the usual course in elderly patients with DM can change suddenly, if the patient has an acute infection. Deficiency of insulin which had now become relative and absolute state of ketoacidosis occur 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 elderly DM. Usually appears manifest as sudden headache and confusion.
Vegetative reactions in the elderly may disappear. While the symptoms are confusion and coma of cerebral metabolic disturbances appear more clearly.
Examination Support Diabetes Mellitus
Blood glucose during

check GDS
Fasting blood glucose levels
Glucose tolerance test
Blood levels during fasting as a standard filter and the diagnosis of DM (mg / dl)

WHO diagnostic criteria for diabetes mellitus at least 2 times the examination:
1. When 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-hour post-prandial (pp)> 200 mg / dl
Management of Diabetes Mellitus
The main goal of therapy of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an attempt to reduce vascular complications, and neuropathy. Therapeutic purposes in any 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

Nursing Assessment of Diabetes Mellitus
Family Health History
Are there families who suffer from diseases such as client?
Patient Medical History and Previous Treatment
How long a client suffering from diabetes, how to handle, gets what type of insulin therapy, how to take her medicine whether regular or not, what is being done to address the client's illness.
Activity / Rest:
Tired, weak, difficult Moving / walking, muscle cramps, decreased muscle tone.
Circulation
Is there a history of hypertension, AMI, claudication, numbness, tingling in the extremities, foot ulcers are healing old, tachycardia, changes in blood pressure
Ego Integrity
Stress, anxiety
Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
Food / fluid
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, use of diuretics.
Neurosensori
Dizziness, headache, tingling, numbness in the muscle weakness, paresthesias, visual disturbances.
Pain / Leisure
Abdomen tense, pain (moderate / severe)
Breathing
Cough with / without purulent sputum (tergangung presence of infection / no)
Security
Dry skin, itching, skin ulcers.
Nursing Problems in Diabetes Mellitus
High risk of nutritional deficiencies: lack of requirement
Lack of fluid volume
Impaired skin integrity
Risk of injury


Diabetes Mellitus Nursing Intervention
1. High risk of nutritional deficiencies: lack of demand associated with decreased oral input, anorexia, nausea, increased metabolism of protein, fat.
Goal: patient's nutritional needs are met
Criteria Results:
Patients can digest the amount of calories or the right nutrients
Stable weight or additions to the range normally
Intervention:
Weigh the body weight per day or according to the indication.
Determine the diet and eating patterns of patients and compare it with foods that can be spent on patients.
Auscultation bowel sounds, record the presence of abdominal pain / abdominal bloating, nausea, vomit that have not had time to digest food, maintain a state of fasting according to the indication.
Give liquid foods that contain nutrients (nutrients) and electrolytes immediately if the patient is able to tolerate it orally.
Involve the patient's family at this meal digestion according to the indication.
Observed signs of hypoglycemia such as altered levels of consciousness, skin moist / cold, rapid pulse, hunger, sensitive excitatory, anxiety, headaches.
Collaboration perform blood sugar checks.
Collaboration of insulin treatment.
Collaboration with a dietitian.
2. Lack of fluid volume associated with osmotic diuresis
Purpose: fluid or hydration needs of patients are met
Criteria Results:
Patients showed adequate hydration evidenced by stable vital signs, palpable peripheral pulse, skin turgor and good capillary refill, individually appropriate haluaran urine and electrolyte levels within normal limits.
Intervention:
Monitor vital signs, note the presence of orthostatic BP changes
Monitor breathing patterns such as the respiratory kusmaul
Assess the frequency and quality of breathing, use of auxiliary respiratory muscles
Assess peripheral pulses, capillary refill, skin turgor and mucous membranes
Monitor input and expenditure
Keep up to provide fluid at least 2500 ml / day within a tolerable limit of cardiac
Record such things as nausea, vomiting and gastric distention.
Observations of increased fatigue, edema, increased weight, irregular pulse
Collaboration: give normal saline fluid therapy with or without dextrosa, monitor laboratory tests (hematocrit, BUN, Na, K)
3. Impaired skin integrity related to changes in metabolic status (peripheral neuropathy)
Objectives: impaired skin integrity can be reduced or showed healing.
Criteria Results:
Condition of the wound showed the existence of tissue repair and uninfected
Intervention:
Assess the wound, the presence of epithelialization, discoloration, edema, and discharge, the frequency of dressing change.
Assess vital signs
Assess the pain
Perform wound care
Collaboration administration of insulin and medication.
Collaboration antibiotics as indicated.
4. Risk of injury associated with decreased visual function
Objectives: patients do not experience injury
Criteria Results: The patients can meet their needs without suffering injury
Intervention:
Avoid slippery floors.
Use a low bed.
Orient the client to the room.
Assist client in performing daily activities
Assist patients in ambulation or position changes

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complications of diabetes mellitus

Diabetes Mellitus (DM) with characteristics of hyperglycemia (high blood sugar levels) can lead to various serious consequences or complications of acute complications (occurring suddenly) and chronic complications (which occur in chronic). things that you should be aware

Acute complications of diabetes mellitus are as follows:

1. Hypoglycemia is reduced blood sugar levels <60 mg / dl

2. Diabetic keto-acidosis (KAD) is DM with metabolic acidosis and hiperketogenesis

3. Koma lacto hypoxic acidosis that is loss of consciousness caused by hyperlactatemia.

4. Non Ketotik hyperosmolar coma, with no symptoms at 2 and 3 except that there is no hiperketogenesis and hyperlactatemia.

Chronic complications due to diabetes mellitus:

It usually occurs in people with uncontrolled diabetes mellitus in a period of approximately 5 years. Can be divided based on the blood vessels and neural Based taxable or organ. The division simply as follows:

1. Makroangiopati, the large blood vessels (blood vessels that can be seen microscopically) among other cardiovascular / coronary heart disease, cerebrovascular / stroke, and peripheral blood vessels / Peripheral Artery Disease.

2. Microangiopathic, the microscopic blood vessels such as diabetic retinopathy (retina of the eye) and diabetic nephropathy (the kidney).

3. Neuropathy, the peripheral nerve. Patients may complain of feeling in the feet / hands is reduced or thick in the legs or feet were burning / vibrate itself.

In addition to the above, chronic complications of DM can be divided based on the organs affected are:

1. Skin: furuncle, karbunkel, itching, shinspot (dermopati diabetic: black spot in the shin area of ​​skin), necrobiosis lipoidica diabeticorum (oval sores, chronic, white edge), cellulitis gangrene,

2. Head / brain: stroke, with all deficit neurologinya

3. Eyes: convex lens during hyperglycemia (myopia-reversible, irreversible katarax), glaucoma, vitreous hemorrhage corpus, DM retinopathy (non proliperative, makulopati, proliferative), N 2,3,6 (neuritis optics) & other nerve centralis

4. Nose: olfactory decline

5. Mouth: dry mouth, thick saliva = verostamia diabetic, Tongue (thick rugae, taste disturbance), gingival (edematus, scarlet, gingivitis, atrophy), periodontium (makroangiopati periodontitis), tooth (Dental caries)

6. Heart: Coronary Heart Disease, Silent infarction of 40% kr autonomic neuropathy, diabetic cardiomyopathy (heart disease diabetic)

7. Lung: easy contracted Tuberculosis (TB) with a variety of pulmonary complications.

8. Digestive Tract: Gastrointestinal (esophageal neuropathy, diabetic gastroparese (gastroparese diabeticum), gastroatropi, diabetic diarrhea)

9. Kidney and urinary tract: diabetic neuropathy, syndrome kiemmelstiel Wilson, pyelonephritis, necrotizing pappilitis, Diabetic Neurogenic Vesical Disfunction, urinary tract infection, erectile dysfunction / impotence, vulvitis.

10. Nerves: Peripheral: paresthesia, anesthesia, neuropathy gloves, stockings, neuropathy, kramp

11. Joints: poliarthritis

12. Diabetic foot (diabetic foot), is a combination makroangiopati, mikroangopati, neuropathy and infection of the feet.

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Complete Definition of Diabetes Mellitus

Rejekine. Common understanding of diabetes mellitus is a disease or medical disorder characterized by increased blood sugar levels quickly. High levels of sugar because it is less the maximum utilization of sugar by the body as an energy source because of the lack of the hormone insulin produced by the pancreas or non-functioning of the hormone insulin to absorb sugar maximally therefore the disease is also commonly referred to or defined as a disease of blood sugar

Diabetes mellitus, commonly known as sugar diabetes or disease can be divided into 3 types of diseases, namely:

1. Type 1 Diabetes Mellitus
2. Type 2 Diabetes Mellitus
3. Gestational Diabetes Mellitus

In normal people, the content of carbohydrates in the form of starchy foods when consumed is converted into glucose in the digestive tract, with the help of insulin glucose will then be carried by the blood throughout the body and enter into cells to be used as an energy source the body.

In patients with diabetes mellitus or sugar can not enter the cells difficult. this is caused by the pancreas gland produces less insulin than is needed or it could be caused by decreased activity of insulin receptors so that cells can not respond well to insulin, although insulin sufficiency so that increased blood glucose levels in

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7 Symptoms of Diabetes mellitus

REJEKINE. Diabetes mellitus or diabetes or blood sugar is a condition in which the body can not regulate or control the content of sugar in the blood so that the glucose or sugar which is usually supplied to the cells of the body as an energy source instead scattered body in the bloodstream, even go wasted in the the urine. Arrangement of blood sugar by the body is done with the help of the hormone insulin from the pancreas.

Diabetes mellitus is composed of two kinds:

Diabetes Type 1 is because the body does not produce insulin, so patients must be injected insulin daily to control blood sugar levels. Type 1 diabetes occurs in children and adolescents and their development is rapid.

In type 2 diabetes : The pancreas produces insulin, but the body's cells do not respond normally. This type of diabetes is usually associated with obesity and some cases of pregnancy as well as a new outbreak of the age of 40 years.
High blood sugar levels will eventually cause damage to blood vessels and nerves that lead to impaired function of the eyes, kidneys and nerves as well as increase the risk of heart attack, stroke and impotence.

Symptoms or signs of diabetes
In type 2 diabetes, blood sugar control can be done through changes in lifestyle and diet. According to various studies, the changes are shown to effectively reduce the risk of diabetes. Therefore, it is very important for you to realize when diabetes already exists within you. Approximately 8.6% of Indonesia's population according to the WHO diabetes, unfortunately many do not realize until the case becomes chronic.
Someone said to suffer from diabetes when blood sugar levels above 126 mg / dl (fasting) or 200 mg / dl (not fasting). However, the most visible symptoms of new onset diabetes when blood sugar is above 270 mg / dl. Do not rely on symptoms to know the presence of diabetes. The only accurate way to find out is to test blood and urine.

Symptoms or signs of diabetes that commonly occur are:
Dehydration
Constant thirst
Increased frequency of urination
Fatigue
Weight loss
Impaired vision
Healing old wounds
if you have the above then you should consult a doctor as quickly.

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Diabetes mellitus in pregnancy

Rejekine. Diabetes Mellitus is defined as impaired glucose tolerance are known to varying degrees the first time during pregnancy regardless of whether the patient needs to receive insulin or not. In the first trimester of pregnancy (3 months) glucose levels will fall by between 55-65% and this is a response to the glucose transport from mother to fetus. DMG largely asymptomatic, so the diagnosis is determined by chance during a routine examination.


In pregnant women, to this day it is best to check with the glucose challenge test with a load of 50 grams of glucose and glycated blood levels were measured 1 hour later. If blood glucose levels after 1 hour of loading exceeds 140 mg%, then proceed with the examination of the oral glucose test tolesansi.


Patofiologi Diabetes Mellitus In Pregnancy

At DMG, in addition to these physiological changes, there will be a state in which the number / function of insulin to be not optimal. Change the kinetics of insulin and resistance to insulin effects. As a result, the composition of energy sources in maternal plasma increased (high blood sugar levels, insulin levels remain high).

Facilitated diffusion through the membrane of the placenta, where fetal circulation also occur abnormal composition of energy sources. (Causing the possibility of various complications). In addition there are also so that fetal hyperinsulinemia also experience metabolic disturbances (hypoglycemia, hipomagnesemia, hypocalcemia, hyperbilirubinemia, and so on.


Management of Diabetes Mellitus in Pregnancy

Medical management

In accordance with the medical management of diabetes mellitus in general, management is also primarily based DMG for the management of nutrition / diet and weight control mothers.

1. Strict control of blood sugar, because if birth control is less well try it early, consider fetal lung maturity. Memdadak fetal death can occur. Provide fast-acting insulin, if possible given through drips.

2. Avoid a urinary tract infection or other infections. Perform prevention of infection with both.

3. In the newborn hypoglycemia can occur quickly so it needs to be given intravenous glucose.

4. DMG is handling that particular diet, it is recommended given 25 calories / kg ideal, except in patients with the fat calories are more easily considered.

5. The recommended way is the way of Broca's BB ideal = (TB-100) -10% BB.

6. Caloric needs are taken into account the total number of calories from:

- Basal Calories 25 cal / kg ideal

- Calories physical activity by 10-30%

- 300 calories for pregnancy heat

- Keep in mind the needs of pregnant women 1-1.5 g protein / kg

If a therapeutic diet for 2 weeks of blood glucose levels have not reached normal or normoglycaemia, ie fasting blood glucose levels below 105 mg / dl and 2 hours pp below 120 mg / dl, then insulin therapy should be started immediately.

Monitoring can be done by using capillary blood glucose meter. Calculation of a balanced diet together with the calculation in the case of DM generally, with the added number of 300-500 calories per day for fetal growth during pregnancy to lactation is completed.

Management of DM in pregnancy aims to:

- Maintain a fasting blood glucose <105 mg / dl - Maintaining blood glucose levels 2 hours pp <120 mg / dl - Maintaining glikosilat Hb (Hb ALC) <6% - Preventing episodes of hypoglycemia - Prevent ketonuria / ketoacidosis deiabetik - Ensuring optimal fetal growth and normal. Regular blood glucose monitoring is recommended at least 2 times a week (ideally every day, if possible by means of self-examination at home). Recommended antenatal control schedule, getting close to the approximate birth control is increasingly frequent. Hb glikosilat ideally be checked once every 6-8 weeks. Maternal weight gain is recommended around 1-2.5 kg in the first trimester and then average 0.5 kg per week. Until the end of pregnancy, the recommended weight gain depends on the initial nutritional status of mothers (mothers less weight 14-20 kg, 12.5-17.5 kg of normal weight mothers and mothers more weight / obesity 7.5-12.5 kg). If the management of diet alone is not successful, then the insulin directly used. Insulin used to be human insulin preparations (human insulin), because insulin is not derived from a human (non-human insulin) can cause formation of antibodies against endogenous insulin and these antibodies can penetrate the blood barrier placenta (placental blood barrier) so that it can affect the fetus. At DMG, the insulin used is a low-dose insulin with intermediate and long work is given 1-2 times a day. In the DMH, insulin administration may be more frequent, can be combined between short-and intermediate-acting insulin, to achieve the expected glucose levels. Oral hypoglycemic drugs are not used in DMG because of the effects of high teratogenitasnya and can be excreted in large quantities through breast milk. Management of obstetric At the antenatal monitoring of maternal and fetal keadaanklinis, especially blood pressure, enlargement / fundus height, fetal heart rate, maternal blood sugar levels, ultrasound examination and kardiotokografi (if possible). At the level Polindes maternal and fetal monitoring performed by fundus height measurements and listening to the fetal heart rate. At the health center level monitoring of mother and fetus by uterine fundal height measurements and listening to the fetal heart rate. At the hospital level, maternal and fetal monitoring is done by: Fundus height measurements - NST - serial ultrasound - A thorough assessment with a score of dynamic fetal fetal placenta (FDJP), FDJP value <5 is a sign of fetal distress. - This assessment is done every week since 36 weeks of gestation. The presence of macrosomia, fetal growth stunted (IUGR) and fetal distress is an indication to perform a Caesarean section delivery. - In a healthy fetus, with a value FDJP> 6, can be born at the time of pregnancy (40-42 mg) with a normal delivery. Monitoring of fetal movement (normal> l0x/12 hours).

- Babies born to mothers DMG require special care.

- When will perform amniocentesis pregnancy termination should be done beforehand to ensure the maturity of the fetus (if gestational age <38 mg).

- Pregnancy DMG with complications (hypertension, preeclampsia, vascular abnormalities and infections such as glomerulonephritis, cystitis and monilisasis) should be treated since the age of 34 weeks gestation. DMG Patients with complications usually require insulin.

- The most ideal assessment is the assessment of fetuses with a score of fetal-placental function dynamic

do strict control in diabetes mellitus therapy for pregnant mothers

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Healthy foods for people with diabetes mellitus

Rejekine. To support the therapeutic treatment of diabetes mellitus, diet becomes very determines the success rate of therapy of this disease, for those of you who are currently doing or how the treatment of diabetes mellitus diet, the following is the recommended diet to support the level of success that will be found, I hope this can help you

The first diet

In the morning: Chicken Porridge
10:00 AM: bean juice
Afternoon and evening: White rice, egg contents, yellow Pickles, Watermelon
at 16.00: Ice cheerful


Menu foods into two

Paagi: Fried Vermicelli
at 10.00: Carrot juice
Afternoon or evening: white rice, fried fish, tofu vegetable bacem lodeh
16:00 hours: Lettuce yogurt sauce


Menu foods into three

Morning: steak fish
at 10.00: Juice of tomatoes
Afternoon or evening: White rice, beef seasoning lime bean vegetable nodes
at 16.00: Fruit pudding

1. Rice / potatoes / oatmeal / bread: 3.5 exchange (1 exchange forrice = 100gr, 80gr = bread, and potatoes = 200gr)
2. Fish / meat / shrimp: 25 exchanger (125gr)
3. Tofu / Tempe / beans: 2 pieces / 2 servings (each 25 g)
4. 3 cups vegetables
5. Fruit: 4 pcs.

please try additional therapy for those of you who may currently conducting a program or diet therapy of diabetes mellitus. p

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an easy way to know the cause of diabetes mellitus

REJEKINE.diabetes is usually found in densely populated areas like cities. some people think diabetes is a hereditary disease but it is not entirely true because of the number of people with diabetes is very little recorded because it is caused by heredity, the biggest risk factors of this disease is due to diet and bad lifestyle or unhealthy.
diabetes disease generally caused by the consumption of foods that are not well controlled or as a side effect of the use of certain chemical drugs.

here are some factors that could cause a person to be at risk for diabetes mellitus attack:

1. Heredity
2. Overweight / obesity usually occurs at age 40 years
3. High blood pressure
4. Figures Triglycerid (a type of fat molecule) High
5. High cholesterol levels
6. Modern lifestyle that tends to consume the instant food
7. Smoking and Stress
8. Too much consumption of carbohydrates
9. Damage to the pancreas cells

The characteristics & symptoms of diabetes diabetes

Disorders of carbohydrate metabolism causes the body lacks energy, which is why people with diabetes mellitus generally look weak, weak and unfit.

general symptoms that arise for people with diabetes are:

• Many of urine (polyuria), especially at night
• Easy Haus and lots of drinking (polydipsia)
• Easy hungry and a lot of eating (polyphagia)
• Easily exhausted and often sleepy
• Blurred vision
• Dizziness and nausea
• Impaired motor coordination of the limbs
• Weight loss continues
• Frequent tingling and itching on the hands and feet

terms of the above is an effect of high blood sugar levels that will affect the kidneys produce urine in excessive amounts to dilute the glucose, so people often urinate in significant amounts (polyuria) and polyuria result of this the patient felt the thirst Excessive drinking so much (polidipsi). A large number of calories lost into the urine, patients experience weight loss. as a result of this sufferers often feel hungry, so many incredible meals (polifagi).
if you run into the causes of diabetes such as the above treatment therapies done immediately, or it will be much better to prevent disease before diabetes mellitus

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an easy way to see the early symptoms of diabetes mellitus

REJEKINE. know the early symptoms of diabetes mellitus in order to conduct their treatments quickly.
Diabetes Mellitus is a group of metabolic diseases with signs of blood glucose or blood sugar often called increased dramatically or drastically, where the cause is the occurrence of disorders of the hormone insulin or insulin action or both are not able to function normally.

Blood glucose increased dramatically and uncontrolled it could have been an early sign of people will suffer from diabetes mellitus, but it is uncertain and needs further examination with a test in the laboratory.
Blood glucose content ranged fairly normal for approximately between 70-110 mg / dl.
When more than the normal threshold, it means experiencing a condition prediabetik or impaired glucose tolerance and should be done immediately in the medical follow-up action.

The initial symptoms experienced by sufferers diabetes mellitus are:

Easy hungry.
Easy thirsty.
Frequent urination.

When you experience the above symptoms you should conduct tests to determine whether you suffer from diabetes or not.

immediately consult with your doctor

Tests carried out consisted of:

Blood sugar during
If more than 200 mg / dl, mean you are suffering from diabetes.
TTGO examination (glucose tolerance test)
For TTGO, you may be able to consult directly with a specialist in internal medicine.
HbA1c.
If more than 7, this means you suffer from DM.

Routine checks Patients.

If you suffer from diabetes mellitus positive, the routine checks you should do is as follows:

GDP.
Glucose 2 hours after meals.
HbA1c.
Total cholesterol.
LDL.
HDL.
Triglycerides.
Or other examinations for blood vessels

careful with this disease and do the treatment with fast. p

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learn more about the disease diabetes mellitus

REJEKINE. Diabetes Mellitus (DM), also known as diabetes or blood sugar disease merupkan dangerous type of chronic disease characterized by elevated levels of blood sugar in a very extreme (above normal) as a result of disturbances in the body's metabolic system, this caused by organ pancreas unable to produce insulin the body needs.

Insulin is a hormone produced by the pancreas that serves to control the amount / blood sugar levels and insulin is needed to convert carbohydrates, fats, and proteins into energy or calories it takes the human body. The hormone insulin controls and lowers blood sugar levels in order not to exceed the normal limits

Symptoms or traits of Diabetes Mellitus

Early signs that can be seen that if a person suffering from diabetes or diabetes that can be seen directly from the effect of increased blood sugar levels rose sharply, which increases blood sugar levels reach 160-180 mg / dL and urine (urine) containing people with diabetes sugar (glucose). urine usually invite ants diabetics because it contains sugar

The People with diabetes will show signs and symptoms of early below, although not all be experienced by the patient:

1. The amount of urine released more (Polyuria)
2. Often or quickly feel thirsty / thirst (Polydipsia)
3. Excessive hunger or eat a lot (Polyphagia)
4. Increased urinary frequency / urine kept (glycosuria)
5. Losing weight is not clear why
6. Tingling / numbness in the nerve endings zip hands & feet
7. Tired and weak all the time
8. Experiencing myopic vision suddenly
9. If the wound / etched (korengan) slower cure
10. Particularly susceptible to infection of the skin.

If the sugar content would decrease very rapidly causes a person to faint or even worse the coma. Symptoms of diabetes can develop rapidly over time in a matter of weeks or months, especially in a child who suffered from diabetes mellitus type 1.

Another case in patients with type 2 diabetes mellitus, patients usually do not experience the symptoms mentioned above. Even they may not have been aware of this disease.

any type of Diabetes Mellitus:

1. Diabetes mellitus type 1

Type 1 diabetes is insulin-dependent diabetes where the body lacks the hormone insulin, known as Insulin Dependent Diabetes Mellitus (IDDM). This is due to the loss of insulin-producing beta cells in the islands of Langerhans of the pancreas. Type 1 diabetes is usually found in infants, children and adolescents.

Until recently, type 1 Diabetes Mellitus can only be treated by administering insulin therapy performed continuously ongoing. Family history, diet and environmental factors influenced the treatment of type 1 diabetes. In patients with type 1 diebetes be considered controlling and monitoring blood sugar levels, you should use a blood sugar test. Especially in children or toddlers where they are very easy to become dehydrated, vomiting and often prone to various diseases.

2. Diabetes mellitus type 2
Type 2 diabetes is where the hormone insulin in the body can not function properly, known as Non-Insulin Dependent Diabetes Mellitus (NIDDM). This is because the various possibilities such as defects in insulin production, insulin resistance or reduced sensitivity (response) cells and tissues to insulin which is marked by rising levels of insulin in the blood.

There are several theories that express cause of insulin resistance, including obesity factor. In patients with type 2 diabetes, controlling blood sugar levels can be done with some measures such as diet, weight loss, and the provision of diabetic tablets. If the provision is not maximal response handling tablets in blood sugar levels, then injecting the drug began to be considered.

calculate Blood Sugar Levels In:

Normal blood sugar levels ranged from 70-150 mg / dL {millimoles / liter (United Kingdom unit)} or 4-8 mmol / l {milligrams / deciliter (United State unit)}, where 1 mmol / l = 18 mg / dl.

Nevertheless, of course sugar levels increase after eating and decreased at a time when early morning waking. Someone said to hyperglycemia when blood sugar levels well above normal values, whereas hypoglycemia is a condition where a person experiences a decrease in blood sugar values ​​below normal.

Diabetes Diagnosis can be sure if the results of the blood sugar reached 126 mg / dl or more, and check your blood sugar 2 hours after fasting (at least 8 hours) achieved a level of 180 mg / dl. While blood sugar checks are done at random (subject) can help diagnose diabetes if the blood sugar levels reach levels between 140 mg / dL and 200 mg / dL, even more so when he is above 200 mg / dl.

Many blood sugar test is currently traded and can be purchased in many places selling medical equipment or pharmacies such as Accu-Chek, BCJ Group, Accurate, OneTouch UltraEasy machine. you can buy it if you have diabetes indicated

Diabetes Treatment and Handling

People with type 1 diabetes generally undergo treatment of insulin therapy (Lantus / Levemir, Humalog, Novolog or Apidra) is continuous, but it is by exercising moderation and controlling diet

In patients with type 2 diabetes mellitus, management of medication and treatment focuses on lifestyle and physical activity. Controlling the blood sugar levels is the key to treatment programs, namely by reducing the weight, diet, and exercise. If this does not achieve the expected results, then the tablet drug delivery will be required. Even the co-administration of insulin injections required if the tablet does not address the control of blood sugar levels. p

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