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 diabetesa 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 DMFamily 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 kehamilanYATDK1Berasal dari etnis risiko tinggi2Obesitas3Riwayat keluarga DM4Usia di atas 25 tahun5Pernah DM kehamilan6Pernah melahirkan bayi mati, atau amat besarJawaban YA dua/lebih berarti risiko tinggi Jawaban YA hanya satu, berarti risiko sedangJawaban YA tidak ada, berarti risiko rendah

Pre-diabetesa 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 educatora 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 agentsmedicines 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 alpha-glucosidase 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 metera 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 C-peptide 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 pre-diabetes 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 pre-diabetes, 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 resistancethe 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 insulinDiet tinggi lemakDiet sangat rendah lemakDiet rendah proteinKekurangan asam lemak essensial, terutama lemak omega 3Diet tinggi karbohidratMakanan berindeks glisemik tinggiTepung dan gula terolahTerlalu banyak/terlalu rendah garamKekurangan elemen kelumit (kalsium, magnesium, kromium, vanadium, seng, karotenoid, dan vitamin A)Asupan sayur rendahKurang bergerak (sedentary)Stress tinggiPenggunaan bahan yang mengan-dung nikotin

Keadaan metabolik yang tertali dengan resistensi insulinResistensi leptinDislipidemiaKadar lipoprotein meningkatHomosistein meningkatTrigliserida tinggiSistem transport glukosa otot lurik terganggu (GLUT-4)HiperkortikolismDHEA menurunKadar GH rendahLipogenesis meningkat, beta oksidasi menurunTNF meningkatDisfungsi hemostatik, ternasuk peningkatanan trombosis, kadar fibrinogen tinggi, kecenderungan agregasi trombositTekanan darah meningkatStres oksidatif meningkat

Ketonea 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 insulina 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 2OnsetAnak/dewasa muda (

Prevalensi1999: 80 juta (Zimmet 1990)1994: 104 juta (Zimmet 1994)2010: 239,3 juta2025: 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 darahDM-DM?DMKadar glukosa darah sewaktuPlasma vena

Pemeriksaan penyaring kelompok risiko DMUsia >45 tahunBB > 110% BBI [BMI > 23]Hipertensi 140/90 mm HgRiwayat keluarga DMRiwayat abortus berulang, melahirkan bayi cacat, atau BBL > 4000 gramKolesterol HDL 35 mg/dl dan/atau trigliserida 250 mg/dlSumber: Konsensus pengelolaan DM tipe 2 Indonesia 2002, PERKENI, 2002

Recommendations for Diabetes Screening of Asymptomatic Persons 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 =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 MelitusJenisEtiologiTipe 1[1]Destruksi sel , umumnya menjurus ke defisiensi insulin absolutautoimunidiopatik Tipe 2Bervariasi mulai yang terutama dominan resistensi insulin disertai defisiensi insulin relatif sampaiyang terutama defek sekresi insulin disertai resistensi insulinTipe lainDefek genetik fungsi sel Defek genetik kerja insulinPenyakit eksokrin pankreasEndokrinopatiKarena obat atau zat kimiaInfeksiSebab immunologi yang jarangSindrom genetik lain yang berkaitan dengan DMDM ges-tasionalCatatan: 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)

PenangananPendidikanPengobatan gizi medisOlahragaObat penurun gula darah

Pengobatan gizi medisStatus metabolik optimalCegah/obati penyulit kronisPerbaiki derajat kesehatanTata gizi perorangan

Macam diit DM dan komposisi zat gizinyaMacamKaloriKarbohidratProteinLemakI1.1001605030II1.3001955535III1.5002256040IV1.7002606545V1.9003007050VI2.1003258055VII2.3003508565VIII2.5003909065Dikutip dari Bagian Gizi RSCM/Persagi, 1993Diit 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

VitaminBkompleks, B6, C, dan E.MineralManganese, Kalium, Khromium As. aminoL-taurine, dan L-carnitine SuplemenYeast (ragi), Lecithin, Serat (guar gum), dan Co-Q10HerbalAlfalfa, Bawang putih, Evening primirose oil (GLA), Golden seal, dan dandelion root

Obat Anti Diabetik Oral (ADO)GenerikMg/tabDosis harianLamakerjaFrek/hariPemberianSebelumMakanSulfonilureaKlorpropamid100-250100-50024-361Glibenklamid2,5-52,5-1512-241-2Glipizid5-105-2010-161-2Gliklazid8080-24010-201-2Glikuidon3030-120--Glimepirid1,2,3,40,5-6241GlinidRepaglinid0,5; 1; 2Nateglinid120Tak bergan-tung jadwal makanTiazolidindionPioglitazon15-3015-30241PenghambatGlukosidase Acarbose50-100100-3003Bersama suap an pertamaBiguanidMetformin500-850250-30006-81-3Bersama/sesudah makanCat. 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)

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

Hypoglycaemiadizzy 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)

*Peristilahan IDDM dan NIDDM sejak tahun 1985 (WHO) tidak lagi digunakan. Alasannya, penggunaan kedua istilah didasarkan semata pada observasi klinis yang terkait dengan dera jat kekurangan insulin; sementara istilah DM tipe 1 dan 2, yang hingga kini tetap terpakai, tertali dengan dampak etiologis. DM tipe 1 berlatar mekanisme autoimmun.(Takeshi Kuzuya Diagnosis and classification of DM, AMJ 40 (6):271-277, 1997). *Peristilahan IDDM dan NIDDM sejak tahun 1985 (WHO) tidak lagi digunakan. Alasannya, penggunaan kedua istilah didasarkan semata pada observasi klinis yang terkait dengan dera jat kekurangan insulin; sementara istilah DM tipe 1 dan 2, yang hingga kini tetap terpakai, tertali dengan dampak etiologis. DM tipe 1 berlatar mekanisme autoimmun.(Takeshi Kuzuya Diagnosis and classification of DM, AMJ 40 (6):271-277, 1997). *Pemeriksaan penyaring kelompok risiko DMUsia >45 tahunBB > 110% BBI [BMI > 23]Hipertensi 140/90 mm HgRiwayat keluarga DMRiwayat abortus berulang, melahirkan bayi cacat, atau BBL > 4000 gramKolesterol HDL 35 mg/dl dan/atau trigliserida 250 mg/dlSumber: Konsensus pengelolaan DM tipe 2 Indonesia 2002, PERKENI, 2002