tag:Tips Diabetes Mellitus, insulin, diabetic neuropathy, diabetes test, about diabetes
A. Understanding
Diabetes mellitus is a heterogeneous group of disorders characterized by an increase in blood glucose levels or hyperglycemia. (Brunner and Suddarth, 2002).
Melllitus Diabetes is a collection of symptoms that occur in someone who is caused by an increase in blood sugar (glucose) insulin deficiency due to blood relative and absolute (Arjatmo, 2002).

B. Classification
Classification of diabetes mellitus as follows:
1. Type I: insulin-dependent diabetes mellitus (IDDM)
2. Type II: insulin-dependent diabetes mellitus was not (NIDDM)
3. Diabetes mellitus associated with other conditions or syndromes
4. Gestational diabetes mellitus (GDM)

C. Etiology
1. Type I diabetes:
a. Genetic factors
Diabetes type I diabetes do not inherit it themselves, but inherit a genetic predisposition or a tendency toward the occurrence of diabetes mellitus type I. This genetic predisposition is found in individuals with an HLA antigen type.
b. Immunological factors
The existence of autoimmune response which is an abnormal response in which antibodies directed at the body by normal tissues react to the network which is considered as if they were foreign tissue. Namely autoantibody against islets cells and endogenous insulin.
c. Environmental factors
Viruses or certain toxins can trigger the autoimmune process that causes destruction selbeta.
2. Type II Diabetes
Exact mechanism that causes insulin resistance and insulin secretion disorders 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 at age above 65 years)
b. Obesity
c. Family history

D. Patofisiologi/Pathways

E. Singns and Symptoms
E. Signs and Symptoms
DM patients with common complaints such as polyuria, polydipsia, polifagia on DM is generally no. Instead of disturbing the patient is often due to complaints of chronic degenerative complications in blood vessels and nerves. In the elderly there are changes in the pathophysiology of DM due to the aging process, so that the clinical picture varies from asymptomatic cases to cases with extensive complications. Complaints that often arises is the existence of visual impairment due to cataract, tingling and muscle weakness in the legs (peripheral neuropathy) and the wound healed at a difficult leg with usual treatment.
According Supartondo, the symptoms caused by diabetes mellitus in the elderly that are often found are:
1. Cataract
2. Glaucoma
3. Retinopathy
4. Itching all over body
5. Pruritus Vulvae
6. Bacterial skin infections
7. Fungal infections in the skin
8. Dermatopati
9. Peripheral neuropathy
10. Visceral neuropathy
11. Amiotropi
12. Neurotropik ulcer
13. Kidney disease
14. Peripheral vascular disease
15. Coronary Disease
16. Brain blood vessel 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 is less felt, as a result they do not react adequately against dehydration. Because it does not occur or new polydipsia occurs at an advanced stage.
Disease that initially was only mild and usually found in elderly diabetic patients may change suddenly, when the patient experienced an acute infection. Insulin deficiency is relative had now become absolute and ketoacidosis with symptoms arising from circumstances peculiar hyperventilation and dehydration, decreased consciousness with hyperglycemia, dehydration and ketonemia. Symptoms usually occurred in hypoglycemia, such as hunger, yawning and sweating a lot is generally not present in the elderly diabetic. Usually looks manifests as sudden headache and confusion.
Vegetative reactions in the elderly may disappear. While the symptoms of confusion and coma which is a cerebral metabolic disturbances appear more clearly.
F. Examination Support
1. When blood glucose
2. Fasting blood glucose levels
3. Glucose tolerance test
Blood levels during fasting and diabetes diagnosis as a standard filter (mg / dl)
DM Not sure yet
WHO diagnostic criteria for diabetes mellitus at least two times the examination:
1. While plasma glucose> 200 mg / dl (11.1 mmol / L)
2. Fasting plasma glucose> 140 mg / dl (7.8 mmol / L)
3. Plasma glucose from a sample taken two hours later after consuming 75 grams of carbohydrate (2 hours post prandial (pp)> 200 mg / dl

G. Treatment
The main goal of therapy of diabetes mellitus is trying to normalize the activity of insulin and blood glucose levels in an effort to reduce vascular complications and neuropathy. Therapeutic purposes in any type of diabetes is to achieve normal blood glucose levels.
There are five components in the management of diabetes:
1. Diet
2. Exercise
3. Monitoring
4. Therapy (if needed)
5. Education

H. Assessment
? Family Health History
Are there families who suffer from diseases such as client?
? Patient Medical History and Prior Treatment
How long do clients suffer from diabetes, how to handle it, what kind 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, Hard Moves / walking, muscle cramps, decreased muscle tone.

? Circulation
Is there a history of hypertension, AMI, klaudikasi, numbness, tingling in the extremities, leg ulcer healing in long, tachycardia, changes in blood pressure
? Ego Integrity
Stress, anxiety
? Elimination
Changes in the pattern of urination (polyuria, nocturia, anuria), diarrhea
? Food / Fluids
Anorexia, nausea, vomiting, do not follow the diet, weight loss, thirst, the use of diuretics.
? Neurosensori
Dizziness, headache, tingling, numbness weakness in muscles, parestesia, vision problems.
? Pain / Leisure
Tense abdomen, pain (moderate / severe)
? Respiratory
Cough with or without purulent sputum (tergangung of infection / no)
? Security
Dry skin, itching, skin ulcer.

I. Nursing Issues
1. High risk of nutritional deficiencies: lack of demand
2. Lack of fluid volume
3. Impaired skin integrity
4. Risk of injury

J. Intervention
1. High risk of nutritional deficiencies: lack of demand reduction associated with oral input, anorexia, nausea, increase in metabolism of protein, fat.
Objective: The patient’s nutritional needs are met
Results Criteria:
? Patients can digest the amount of calories or the right nutrients
? Stable or increasing weight toward the range usually
Intervention:
? Weigh weight each day or according to the indication.
? Determine the diet and eating habits of patients and compare it with the foods that can be spent on patients.
? Auscultation bowel sounds, record the existence of abdominal pain / abdominal bloating, nausea, vomit that has not had time to digest food, maintain a state of fasting according to the indication.
? Give a liquid diet containing food substances (nutrients) and the electrolyte immediately if the patient is able to tolerate it through oral administration.
? Involve the patient’s family at this meal digestion according to the indication.
? Observation of the signs of hypoglycemia, such as changes in level of consciousness, skin moist and cold, rapid pulse, hunger, sensitive stimulation, anxiety, headaches.
? Collaboration checking blood sugar.
? Collaboration of insulin treatment.
? Collaboration with a dietitian.

2. Lack of fluid volume associated with osmotic diuresis.
Objective: The need for fluids or hydration of patients fulfilled
Results Criteria:
Patients showed an adequate hydration evidenced by stable vital signs, peripheral pulse can be palpated, the skin turgor and capillary filling good, right haluaran individually and urine electrolyte levels within normal limits.

Intervention:
? Monitor vital signs, note the change of orthostatic BP
? Monitor breathing patterns such as the respiratory kusmaul
? Assess the frequency and quality of breathing, use of auxiliary respiratory muscles
? Kaji peripheral pulse, capillary filling, skin turgor and mucous membranes
? Monitor input and expenditure
? Preserve to provide fluids for at least 2500 ml / day within a tolerable limit cardiac
? Record such things as nausea, vomiting and gastric distension.
? Observations of increased fatigue, edema, increased body weight, irregular pulse
? Collaboration: give normal fluid therapy with or without dextrosa copy, monitor laboratory examinations (Ht, BUN, Na, K)

3. Impaired skin integrity related to changes in metabolic status (peripheral neuropathy).
Objective: The disorder of skin integrity can be reduced or showed healing.
Results Criteria:
Condition wounds showed tissue repair and uninfected
Intervention:
? Assess the wound, the epitelisasi, discoloration, edema, and discharge, the frequency of dressing change.
? Assess vital signs
? Review of pain
? Perform wound care
? Collaboration of insulin and medication.
? Collaboration antibiotics as indicated.

4. Risk of injury associated with decreased visual function
Objective: The patient suffered no injury
Criteria Results: The patients can fulfill their needs without experiencing injury
Intervention:
? Avoid slippery floors.
? Use a low bed.
? Orient the client to the room.
? Assist clients in performing daily activities
? Assist patients in ambulation or position changes

REFERENCES

Luecknote, Annette Geisler, Assessment Gerontologi Maryunani Aniek translation, Jakarta: EGC, 1997.

Doenges, Marilyn E, Nursing Care Plans Guidelines for Planning and Documenting Patient Care third edition of the translation I Made Kariasa, Ni Made Sumarwati, Jakarta: EGC, 1999.

Carpenito, Lynda Juall, Pocket Books edition of Nursing Diagnosis 6 YasminAsih translation, Jakarta: EGC, 1997.

Smeltzer, Suzanne C, Brenda G Bare, Medical Surgical Nursing Textbook Brunner & Suddarth Issue 8 Vol 2 over language H. Y. Renowned, Andry Hartono, Monica Ester, Yasmin love, Jakarta: EGC, 2002.

Ikram, Ainal, Books Subjects Science Medicine: Diabetes Mellitus In Elderly vol third edition, Sydney: Faculty of medicine, 1996.

Arjatmo Tjokronegoro. Management of Diabetes Mellitus Terpadu.Cet 2. Jakarta: Balai FKUI Publishers, 2002

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