1. IMAM TRI SUTRISNO 2. RIFANTIKA PUSPITASARI 3. NOVIE PRAWITANINGSIH 4. APRILIYA PUSPITA SARI 5. MIFTACHUL JANNAH 6. ENGGAR RATNA KUSUMA 7. RAFIKA ROSYDA 8. FITRIANI • Diabetes Mellitus is metabolic disorder that characterized by hyperglycemia (elevated blood glucose level) (Munden, 2007). • Diabetes Mellitus is abnormal metabolism requiring lifelong treatment with diet, exercise and medication (Carpenito, 2008). • • • • A parent or sibling with diabetes Obesity Age older than 45 years old. History of diabetes during pregnancy (gestational diabetes) or delivering a neonate weighing more than 4,1 kg. • High blood pressure • High triglyceride levels • High cholesterol levels (Munden, 2007). The classic symptoms of diabetes mellitus are : polyuria, polydipsia, polyphagia, and loss of weight. may develop rapidly (weeks or months) in type 1 diabetes, while they usually develop much more slowly and may be absent in type 2 diabetes Table Criteria For The Diagnosis Of Diabetes HbA1C ≥ 6.5% OR FPG(Fasting Plasma Glucose) ≥ 126 mg/dl OR In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥ 200 mg/dl OR 2-hours plasma glucose ≥ 200 mg/dl during an OGTT. MANAGEMENT • • • - The principles of food management for people with diabetes : Limit intake of foods high in fat, salt and sugar Eat regular meals with carbohydrate making up approximately 50% of meals Diet : Carbohydrates - 60% Fats - 30% Protein - 12-20% Try to increase fruit and vegetable intake • Insulin therapy: 1. Rapid-acting insulin 2. Long-acting insulin 3. Intermediate options Examples include: Insulin lispro (Humalog), Insulin aspart (Novolog), Insulin glargine (Lantus), Insulin detemir (Levemir), Insulin isophane (Humulin N, Novolin N). PREVENTIONS OF COMPLICATIONS • • • • • • • • Control the value of blood glucose Diet Pressure control Enough of rest Exercise Decreasing salt’s consumption Stop smoking Make schedule to consult with doctor 1.Chronic 2.Acute a. Cardiovascular disease b. Cerebrovascular disease c. Retinopathy (vision) problems d. Diabetic neuropathy e. Diabetic nephropathy a. Diabetic ketoacidosis b. Hyperglycemic-hyperosmolarnonketotic syndrome c. Hypoglycemia from too much insulin or too little glucose 1. Activity / Rest weakness, fatigue, difficulty moving / walking, muscle cramps, decreased muscle tone, decreased muscle strength. 2. Circulation ulcers on the legs, a long healing process, numbness in the extremities, skin hot, dry and reddish. 3. Ego integrity depend on others, anxiety, sensitive stimuli. 4. Elimination changes in the pattern of urination (polyuria), nocturia, dilute urine, pale dry, poliurine. 5. Food / fluid loss of appetite, nausea / vomiting, do not follow the diet, weight loss, dry skin / scaly, ugly turgor. 6. Pain / comfort pain in the ulcer wound, face grimacing with palpitations, looks very carefully. 7. Security dry skin, itching, skin ulcers, fever, diaphoresis, damaged skin, lesion / ulceration 8. Counseling / learning family risk factors diabetes, heart disease, stroke, hypertension, long healing. The use of drugs such as steroids, diuretics (thiazides): diantin and phenobarbital (may increase blood glucose levels). • Fluid volume deficit related to osmotic diuresis, nausea, vomiting. • Imbalanced nutrition less than body requarements related to decreased oral input: anorexia, nausea, vomitting. • Risk of infection related to inadequate peripheral defense, changes in circulation, high blood sugar levels, invasive procedures and skin damage. • Risk for impaired skin integrity related to Diabetic process, altered pigmentation from microangiopathy, skin changes related to the aging process, pressure on skin surfaces, bed rest, immobility, intermittent claudication, alterations in tissue perfusion. • Disturbance of daily activity related to weakness and fatigue. • Risk of injury related to disturbance of vision. 1). Fluid Volume Deficit related to osmotic diuresis, nausea, vomiting. Expected outcomes : Patients showed an improvement in fluid balance, spending adequate urine (normal range), vital signs stable, clear peripheral pulse pressure, good skin turgor, capillary refill well and mucous membranes moist or wet. Intervention / Implementation: 1. Monitor vital signs, note the presence of orthostatic blood pressure. R: Hypovolemia can be manifested by hypotension and tachycardia. 2. Assess breathing and breath patterns. R: The lungs secrete carbonic acid is produced through respiration compensated respiratory alkalosis, the state of ketoacidosis. 3. Assess temperature, color and moisture. R: Fever, chills, and diaphoresis is common in the infection process. Fever with skin redness, dry, maybe a picture of dehydration. 4. Assess peripheral pulses, capillary refill, skin turgor and mucous membranes. R: Is an indicator of the level of dehydration or adequate circulating volume. 5. Monitor intake and output. Record the urine specific gravity. R: Provide the estimated need for fluid replacement, renal function and the effectiveness of a given therapy. 6. Measure body weight every day. R: Provide the best results of the assessment of the status of ongoing fluid and further in giving replacement fluids. 7. Collaboration fluid therapy as indicated R: Type and amount of fluid depends on the degree of dehydration and individual patient response. 2). Imbalanced Nutrition, Less Than Body Requirements related to decreased oral input: anorexia, nausea, vomitting. Goal : weight can be increased with normal laboratory values and no signs of malnutrition. Expected outcomes : Patients are able to express an understanding of substance abuse, decrease the amount of intake (diet on nutritional status). Demonstrate behaviors, lifestyle changes to improve and maintain a proper weight. Intervention / Implementation : 1. Measure body weight as indicated. R: Knowing eating adequate income. 2. Determine the diet program and diet of patients compared with food that can be spent on the patient. R: Identify deviations from the requirements. 3. Auscultation of bowel sounds, record the presence of abdominal pain / abdominal bloating, nausea, vomiting, keep fasting as indicated. R: Influence of intervention options. 4. Observation of the signs of hypoglycemia, such as changes in level of consciousness, cold / humid, rapid pulse, hunger and dizziness. R: Potentially life-threatening, which must be multiplied and handled appropriately. 5. Collaboration in the delivery of insulin, blood sugar tests and diet. R: It is useful to control blood sugar levels.