Diabetes mellitus

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Diabetes mellitus (dari kata Yunani διαβαίνειν, diabaínein, "tembus" atau "pancuran air", dan kata Latin mellitus, "rasa manis"[1]) yang umum dikenal sebagai kencing manis adalah penyakit yang ditandai dengan hiperglisemia (peningkatan kadar gula darah) yang terus-menerus dan bervariasi, terutama setelah makan. Semua jenis diabetes mellitus memiliki gejala yang mirip dan komplikasi pada tingkat lanjut. Hiperglisemia sendiri dapat menyebabkan dehidrasi dan ketoasidosis. Komplikasi jangka-lama termasuk penyakit kardiovaskular (risiko ganda), kegagalan kronis ginjal (penyebab utama dialisis), kerusakan retina yang dapat menyebabkan kebutaan, serta kerusakan saraf yang dapat menyebabkan impotensi dan gangren dengan risiko amputasi. Komplikasi yang lebih serius lebih umum bila kontrol kadar gula darah buruk.

Pembentukan diabetes yang penting adalah dikarenakan kurangnya produksi insulin (diabetes mellitus tipe 1, yang pertama dikenal), atau kurang sensitifnya jaringan tubuh terhadap insulin (diabetes mellitus tipe 2, bentuk yang lebih umum). Selain itu, terdapat jenis diabetes mellitus yang juga disebabkan oleh resistansi insulin yang terjadi pada wanita hamil. Tipe 1 membutuhkan penyuntikan insulin, sedangkan tipe 2 diatasi dengan pengobatan oral dan hanya membutuhkan insulin bila obatnya tidak efektif. Diabetes mellitus pada kehamilan umumnya sembuh dengan sendirinya setelah persalinan.

Pemahaman dan partisipasi pasien sangat penting karena tingkat glukosa darah berubah terus, karena kesuksesan menjaga gula darah dalam batasan normal dapat mencegah terjadinya komplikasi diabetes. Faktor lainnya yang dapat mengurangi komplikasi adalah: berhenti merokok, mengoptimalkan kadar kolesterol, menjaga berat tubuh yang stabil, mengontrol tekanan darah tinggi, dan melakukan olah raga teratur.

Daftar isi

[sunting] Jenis-jenis

Organisasi Kesehatan Dunia (WHO) mengakui tiga bentuk diabetes mellitus, yaitu tipe 1, tipe 2, dan diabetes gestasional (terjadi selama kehamilan) [2].

[sunting] Diabetes mellitus tipe 1

Diabetes mellitus tipe 1 — dulu disebut insulin-dependent diabetes (IDDM, "diabetes yang bergantung pada insulin"), atau diabetes anak-anak, dicirikan dengan hilangnya sel beta penghasil insulin pada pulau-pulau Langerhans pankreas sehingga terjadi kekurangan insulin pada tubuh. Ini harusnya dicatat bahwa tidak ada ukuran pencegahan yang dapat diambil untuk melawan diabetes tipe 1. Most people affected by type 1 diabetes are otherwise healthy and of a healthy weight when onset occurs. Diet dan olaragan tidak bisa membaikkan atau mencegah diabetes tipe 1. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages.

Penyebab terbanyak dari kehilangan sel beta pada diabetes tipe 1 adalah kerusakan yaitu autoimun, accompanied by antibodies directed against insulin and islet cell proteins. The principal treatment of type 1 diabetes, even from the earliest stages, is replacement of insulin. Without insulin, ketosis and diabetic ketoacidosis can develop and coma or death will result.

Currently, type 1 diabetes can be treated only with insulin, with careful monitoring of blood glucose levels using blood testing monitors. Emphasis is also placed on lifestyle adjustments (diet and exercise). Apart from the common subcutaneous injections, it is also possible to deliver insulin by an pump, which allows continuous infusion of insulin 24 hours a day at preset levels and the ability to program doses (a bolus) of insulin as needed at meal times. It is also possible to deliver insulin with an inhaled powder.

Type 1 treatment must be continued indefinitely. Treatment does not impair normal activities, if sufficient awareness, appropriate care, and discipline in testing and medication is taken. The average glucose level for the type 1 patient should be as close to normal (80–120 mg/dl, 4–6 mmol/l) as possible. Some physicians suggest up to 140–150 mg/dl (7-7.5 mmol/l) for those having trouble with lower values, such as frequent hypoglycemic events. Values above 200 mg/dl (10 mmol/l) are often accompanied by discomfort and frequent urination leading to dehydration. Values above 300 mg/dl (15 mmol/l) usually require immediate treatment and may lead to ketoacidosis. Low levels of blood glucose, called hypoglycemia, may lead to seizures or episodes of unconsciousness.

[sunting] Diabetes mellitus tipe 2

Diabetes mellitus tipe 2 — dulu disebut non-insulin-dependent diabetes mellitus (NIDDM, "diabetes yang bergantung pada insulin") — is due to a combination of defective insulin secretion and insulin resistance or reduced insulin sensitivity (defective responsiveness of tissues to insulin), which almost certainly involves the insulin receptor in cell membranes. In the early stage the predominant abnormality is reduced insulin sensitivity, characterized by elevated levels of insulin in the blood. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver, but as the disease progresses the impairment of insulin secretion worsens, and therapeutic replacement of insulin often becomes necessary. There are numerous theories as to the exact cause and mechanism for this resistance, but central obesity (fat concentrated around the waist in relation to abdominal organs, not it seems, subcutaneous fat) is known to predispose for insulin resistance, possibly due to its secretion of adipokines (a group of hormones) that impair glucose tolerance. Abdominal fat is especially active hormonally. Obesity is found in approximately 90% of developed world patients diagnosed with type 2 diabetes. Other factors may include aging and family history, although in the last decade it has increasingly begun to affect children and adolescents.

Type 2 diabetes may go unnoticed for years in a patient before diagnosis as visible symptoms are typically mild or non-existent, without ketoacidotic episodes, and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, vascular disease (including coronary artery disease), vision damage, etc.

Type 2 diabetes is usually first treated by changes in physical activity (usually increase), diet (generally decrease carbohydrate intake), and through weight loss. These can restore insulin sensitivity, even when the weight loss is modest, for example, around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. The next step, if necessary, is treatment with oral antidiabetic drugs. As insulin production is initially unimpaired, oral medication (often used in combination) can still be used to improve insulin production (e.g., sulfonylureas) and regulate inappropriate release of glucose by the liver (and attenuate insulin resistance to some extent (e.g., metformin), and substantially attenuate insulin resistance (e.g., thiazolidinediones). If these fail, insulin therapy will be necessary to maintain normal or near normal glucose levels. A disciplined regimen of blood glucose checks is recommended in most cases, most particularly and necessarily when taking most of these medications.

[sunting] Diabetes mellitus gestasional

Diabetes mellitus gestasional (gestational diabetes mellitus, GDM) also involves a combination of inadequate insulin secretion and responsiveness, resembling type 2 diabetes in several respects. It develops during pregnancy and may improve or disappear after delivery. Even though it may be transient, gestational diabetes may damage the health of the fetus or mother, and about 20%–50% of women with gestational diabetes develop type 2 diabetes later in life.

Gestational diabetes mellitus (GDM) occurs in about 2%–5% of all pregnancies. It is temporary and fully treatable but, if untreated, may cause problems with the pregnancy, including macrosomia (high birth weight), fetal malformation and congenital heart disease. It requires careful medical supervision during the pregnancy.

Fetal/neonatal risks associated with GDM include congenital anomalies such as cardiac, central nervous system, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental profusion due to vascular impairment. Induction may be indicated with decreased placental function. Cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

[sunting] Gejala

The classical triad of diabetes symptoms is polyuria (frequent urination), polydipsia (increased thirst and consequent increased fluid intake) and polyphagia (increased appetite). These symptoms may develop quite fast in type 1, particularly in children (weeks or months) but may be subtle or completely absent — as well as developing much more slowly — in type 2. In type 1 there may also be weight loss (despite normal or increased eating) and irreducible fatigue. These symptoms may also manifest in type 2 diabetes in patients whose diabetes is poorly controlled.

[sunting] Referensi

  1. ^ Diabetes mellitus, Wikipedia Bahasa Inggris (per 15 Februari 2007).
  2. ^ World Health Organization Department of Noncommunicable Disease Surveillance (1999). Definition, Diagnosis and Classification of Diabetes Mellitus and its Complications. (PDF)

[sunting] Pranala luar

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