Diabetes Mellitus and its Treatment
Introduction
Definition and Classification of Diabetes Mellitus
Based on its etiology, the American Diabetes Association (2005) classifies diabetes mellitus into four types, namely:1,2
I. Diabetes Mellitus Type 1
(beta cell destruction, usually leading to absolute insulin deficiency)
A. Through immunologic processes
B. Idiopathic
II. Diabetes Mellitus Type 2
(varies from predominance of insulin resistance with relative insulin deficiency to predominance of impaired insulin secretion with insulin resistance)
III. Other Types of Diabetes Mellitus
- Genetic defects of beta cell function
- Genetic defects in insulin action
- Diseases of the exocrine pancreas
- Endocrinopathy
- Due to drugs/chemicals
- Infection
- Immunology (rare)
- Another genetic syndrome
- Diabetes Gestational (Gestational)
Diabetes Mellitus Clinical Manifestations
Diagnosis of Diabetes Mellitus
Screener Check
Diagnostic Test
Treatment of Diabetes Mellitus
- Onboarding Education
In the form of education and training on knowledge of managing diabetes mellitus for patients and their families. - Meal planning
Aims to maintain normal levels of blood glucose and lipids, optimal nutrition, and achieve/maintain ideal body weight. The recommended food composition for patients is as follows: 60-70% carbohydrates, 20-25% fat, and 10-15% protein. - Physical exercise
In the form of daily physical activity (walking to the market, gardening, etc.) and regular physical exercise (3-4x/week for ± 30 minutes). - Pharmacological intervention
Given if target blood glucose levels cannot be achieved with meal planning and physical exercise. Pharmacological interventions can be in the form of oral hypoglycemic drugs/OHO (insulin sensitizing, insulin secretagogue, alpha glucosidase inhibitors) and insulin, given in the following conditions:
- Fast weight loss
- Severe hyperglycemia with ketosis
- Diabetic ketoacidosis
- Non ketotic hyperosmolar hyperglycemia
- Hyperglycemia with lactic acidosis
- Failed with almost maximal dose of OHO combination
- Severe stress (systemic infection, major surgery, AMI, stroke)
- Uncontrolled gestational diabetes mellitus with meal planning,
- Severe impaired renal/liver function
- OHO contraindications or allergies
Bibliography
- Gustaviani, R., 2006. Diagnosis and Classification of Diabetes Mellitus. Textbook of Internal Medicine, Publishing Center of the Faculty of Medicine, University of Indonesia, Jakarta, 1879.
- Kurniawan, A., 2005. Current Review of Diabetes Mellitus. Collection of Papers One Day Symposium an Update on the Management of Diabetes Mellitus, Committee for Inauguration of New Doctors Period 151, Faculty of Medicine, Sebelas Maret University, Solo, 5.
- Association of Indonesian Internal Medicine Specialists, 2005. Diabetes Mellitus. Medical Service Standards, PB PAPDI, Jakarta, 7.
- Soegondo, S. 2011. Diagnosis, Classification, and Pathophysiology of Diabetes Mellitus. Collection of Comprehensive Management of Diabetes Mellitus Update Papers, Committee for the National Scientific Seminar on Continuing Medical Education, Faculty of Medicine Universitas Islam Indonesia, Jogjakarta, 11.
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By: dr. Dimas Satya Hendarta
Medical Faculty Educative Staff Universitas Islam Indonesia