ENGLISH III

“ DIABETES MELLITUS “

By:
Group 1
 Anjely Hessa Yoneta
 Rinda Nabela Sari
 Tari Afrima Adha

College Teacher :
Mrs. Rosy Kumala S.Pd

Akademi Keperawatan
Bina Insani Sakti Sungai Penuh
2020/2021
 PREFACE

First of all, the writer wants to express his thanks to Allah SWT, because of His
bless and grace, the entitled ” Diabetes Mellitus” can be finished on time.

This paper is a requirement to fulfill the assignment from Mrs. Rosy Kumala,
S.pd., the English teacher of AKPER YBIS. The writer also thanks to her for all
the guidance to complete it.

In completing this paper, the writer faced many problems, but with the help of
many people, all the problems could be passed. May Allah SWT give the blessing
for them. It provides the intrinsic elements in the Happy Prince short story with
detail explanation. Although this paper has many deficiencies in the arrangement
and explanation, the writer hope that it can be used as a reference for the reader to
understand the intrinsic elements of a short story.

Sungai Penuh, October 2020

Group 1

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 Table of Content
Reference …………………………………………………………. I
Table of Content …………………………………………………… Ii
Chapter I Introduction
1. Issue Background …………………………………………………... 1
2. Problem Identification …………………………………………….... 2
3. Purpose ……………………………………………………………. 2
Chapter II Discussion
1 Diabetes Mellitus …………………………………………………… 3
2 Diabetes Mellitus Type 1 ……………………………………………. 4
3 Diabetes Mellitus Type 2 …………………………………................. 8
4 Diabetes Mellitus Risks …………………………………………….. 15
Chapter III Final
3.1 Conclution ………………………………………………………. 17
3.2 Suggestion ……………………………………………………….. 17
Reference ………………………………………………………….. 18

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 CHAPTER I
Introduction

1. Issue Background

Diabetes is a group of metabolic diseases characterized by hyperglycemia

resulting from defects in insulin secretion, insulin action, or both. The chronic
hyperglycemia of diabetes is associated with long-term damage, dysfunction, and
failure of differentorgans, especially the eyes, kidneys, nerves, heart, and blood
vessels.

Several pathogenic processes are involved in the development of diabetes.

These range from autoimmune destruction of the β-cells of the pancreas with
consequent insulin deficiency to abnormalities that result in resistance to insulin
action. The basis of the abnormalities in carbohydrate, fat, and protein metabolism
in diabetes is deficient action of insulin on target tissues. Deficient insulin action
results from inadequate insulin secretion and/or diminished tissue responses to
insulin at one or more points in the complex pathways of hormone action.
Impairment of insulin secretion and defects in insulin action frequently coexist in
the same patient, and it is often unclear which abnormality, if either alone, is the
primary cause of the hyperglycemia.

The vast majority of cases of diabetes fall into two broad etiopathogenetic
categories (discussed in greater detail below). In one category, type 1 diabetes, the
cause is an absolute deficiency of insulin secretion. Individuals at increased risk of
developing this type of diabetes can often be identified by serological evidence of
an autoimmune pathologic process occurring in the pancreatic islets and by
genetic markers. In the other, much more prevalent category, type 2 diabetes, the
cause is a combination of resistance to insulin action and an inadequate
compensatory insulin secretory response. In the latter category, a degree of
hyperglycemia sufficient to cause pathologic and functional changes in various
target tissues, but without clinical symptoms, may be present for a long period of

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time before diabetes is detected. During this asymptomatic period, it is possible to
demonstrate an abnormality in carbohydrate metabolism by measurement of
plasma glucose in the fasting state or after a challenge with an oral glucose load.
As of 2019, an estimated 463 million people had diabetes worldwide
(8.8% of the adult population), with type 2 diabetes making up about 90% of the
cases. Rates are similar in women and men. Trends suggest that rates will
continue to rise. Diabetes at least doubles a person's risk of early death. In 2019,
diabetes resulted in approximately 4.2 million deaths. It is the 7th leading cause of
death globally. The global economic cost of diabetes related health expenditure in
2017 was estimated at US$727 billion. In the United States, diabetes cost nearly
US$327 billion in 2017. Average medical expenditures among people with
diabetes are about 2.3 times higher.

2. Problem Identification
a. What is Diabetes Mellitus ?
b. How is Diabetes Meliitus type 1 ?
c. How is Diabetes Meliitus type 2?
d. What is Diabetes Mellitus risk ?

3. Purpose
The purpose of writing this paper is:
a. Hope the readers can understand about Diabetes Mellitus
b. The readers know about Diabetes Meliitus type 1
c. The readers know about Diabetes Meliitus type 1
d. The readers know about Diabetes Meliitus risk

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 CHAPTER II

Discussion

1. Diabetes Mellitus

Diabetes mellitus (DM), commonly known as diabetes, is a group

of metabolic disorders characterized by a high blood sugar level over a
prolonged period of time. Symptoms often include frequent
urination, increased thirst, and increased appetite. If left untreated, diabetes
can cause many complications. Acute complications can include diabetic
ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term
complications include cardiovascular disease, stroke, chronic kidney
disease, foot ulcers, damage to the nerves, damage to the eyes and cognitive
impairment.

Diabetes is a group of metabolic diseases characterized by hyperglycemia

resulting from defects in insulin secretion, insulin action, or both. The chronic
hyperglycemia of diabetes is associated with long-term damage, dysfunction,
and failure of differentorgans, especially the eyes, kidneys, nerves, heart, and
blood vessels.

Diabetes mellitus is a disorder in which the amount of sugar in the blood

is elevated. Doctors often use the full name diabetes mellitus, rather than
diabetes alone, to distinguish this disorder from diabetes insipidus . Diabetes
insipidus is a relatively rare disorder that does not affect blood glucose levels
but, just like diabetes mellitus, also causes increased urination.

Diabetes is due to either the pancreas not producing enough insulin, or the

cells of the body not responding properly to the insulin produced. There are
three main types of diabetes mellitus:

 Type 1 diabetes results from the pancreas's failure to produce enough

insulin due to loss of beta cells. This form was previously referred to as
"insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes".The loss

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 of beta cells is caused by an autoimmune response. The cause of this
autoimmune response is unknown.
 Type 2 diabetes begins with insulin resistance, a condition in which cells
fail to respond to insulin properly. As the disease progresses, a lack of insulin
may also develop.[14] This form was previously referred to as "non insulin-
dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes".The most
common cause is a combination of excessive body weight and insufficient
exercise.
 Gestational diabetes is the third main form, and occurs when pregnant
women without a previous history of diabetes develop high blood sugar
levels.

2. Diabetes Mellitus Type 1

A. overview
Type 1 diabetes, once known as juvenile diabetes or insulin-dependent
diabetes, is a chronic condition in which the pancreas produces little or no insulin.
Insulin is a hormone needed to allow sugar (glucose) to enter cells to produce
energy.

Different factors, including genetics and some viruses, may contribute to

type 1 diabetes. Although type 1 diabetes usually appears during childhood or
adolescence, it can develop in adults.

Despite active research, type 1 diabetes has no cure. Treatment focuses on

managing blood sugar levels with insulin, diet and lifestyle to prevent
complications.

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 B. Symptoms

Type 1 diabetes signs and symptoms can appear relatively suddenly and
may include:

 Increased thirst

 Frequent urination

 Bed-wetting in children who previously didn't wet the bed during the night

 Extreme hunger

 Unintended weight loss

 Irritability and other mood changes

 Fatigue and weakness

 Blurred vision

C. Causes

The exact cause of type 1 diabetes is unknown. Usually, the body's own
immune system — which normally fights harmful bacteria and viruses —
mistakenly destroys the insulin-producing (islet, or islets of Langerhans) cells in
the pancreas. Other possible causes include:

 Genetics

 Exposure to viruses and other environmental factors

The role of insulin

Once a significant number of islet cells are destroyed, you'll produce little
or no insulin. Insulin is a hormone that comes from a gland situated behind and
below the stomach (pancreas).

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  The pancreas secretes insulin into the bloodstream.

 Insulin circulates, allowing sugar to enter your cells.

 Insulin lowers the amount of sugar in your bloodstream.

 As your blood sugar level drops, so does the secretion of insulin from your
pancreas.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up
muscles and other tissues.

 Glucose comes from two major sources: food and your liver.

 Sugar is absorbed into the bloodstream, where it enters cells with the help
of insulin.

 Your liver stores glucose as glycogen.

 When your glucose levels are low, such as when you haven't eaten in a
while, the liver breaks down the stored glycogen into glucose to keep your
glucose levels within a normal range.

In type 1 diabetes, there's no insulin to let glucose into the cells, so sugar
builds up in your bloodstream. This can cause life-threatening complications.

D. Risk factors

Some known risk factors for type 1 diabetes include:

 Family history. Anyone with a parent or sibling with type 1 diabetes has a

slightly increased risk of developing the condition.

 Genetics. The presence of certain genes indicates an increased risk of

developing type 1 diabetes.

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  Geography. The incidence of type 1 diabetes tends to increase as you
travel away from the equator.

 Age. Although type 1 diabetes can appear at any age, it appears at two

noticeable peaks. The first peak occurs in children between 4 and 7 years
old, and the second is in children between 10 and 14 years old.

E. Complications

Over time, type 1 diabetes complications can affect major organs in your
body, including heart, blood vessels, nerves, eyes and kidneys. Maintaining a
normal blood sugar level can dramatically reduce the risk of many complications.

Eventually, diabetes complications may be disabling or even life-threatening.

 Heart and blood vessel disease. Diabetes dramatically increases your risk

of various cardiovascular problems, including coronary artery disease with
chest pain (angina), heart attack, stroke, narrowing of the arteries
(atherosclerosis) and high blood pressure.

 Nerve damage (neuropathy). Excess sugar can injure the walls of the

tiny blood vessels (capillaries) that nourish your nerves, especially in the
legs. This can cause tingling, numbness, burning or pain that usually begins
at the tips of the toes or fingers and gradually spreads upward. Poorly
controlled blood sugar could cause you to eventually lose all sense of feeling
in the affected limbs.

Damage to the nerves that affect the gastrointestinal tract can cause
problems with nausea, vomiting, diarrhea or constipation. For men, erectile
dysfunction may be an issue.

 Kidney damage (nephropathy). The kidneys contain millions of tiny

blood vessel clusters that filter waste from your blood. Diabetes can damage
this delicate filtering system. Severe damage can lead to kidney failure or

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 irreversible end-stage kidney disease, which requires dialysis or a kidney
transplant.

 Eye damage. Diabetes can damage the blood vessels of the retina

(diabetic retinopathy), potentially causing blindness. Diabetes also increases
the risk of other serious vision conditions, such as cataracts and glaucoma.

 Foot damage. Nerve damage in the feet or poor blood flow to the feet
increases the risk of various foot complications. Left untreated, cuts and
blisters can become serious infections that may ultimately require toe, foot
or leg amputation.

 Skin and mouth conditions. Diabetes may leave you more susceptible to

infections of the skin and mouth, including bacterial and fungal infections.
Gum disease and dry mouth also are more likely.

 Pregnancy complications. High blood sugar levels can be dangerous for

both the mother and the baby. The risk of miscarriage, stillbirth and birth
defects increases when diabetes isn't well-controlled. For the mother,
diabetes increases the risk of diabetic ketoacidosis, diabetic eye problems
(retinopathy), pregnancy-induced high blood pressure and preeclampsia.

F. Prevention

There's no known way to prevent type 1 diabetes. But researchers are working on
preventing the disease or further destruction of the islet cells in people who are
newly diagnosed.

3. Diabetes Mellitus Type 2

A. Overview

Type 2 diabetes is a chronic condition that affects the way your body
metabolizes sugar (glucose) — an important source of fuel for your body.

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 With type 2 diabetes, your body either resists the effects of insulin — a
hormone that regulates the movement of sugar into your cells — or doesn't
produce enough insulin to maintain normal glucose levels.

Type 2 diabetes used to be known as adult-onset diabetes, but today more

children are being diagnosed with the disorder, probably due to the rise in
childhood obesity. There's no cure for type 2 diabetes, but losing weight, eating
well and exercising can help manage the disease. If diet and exercise aren't
enough to manage your blood sugar well, you may also need diabetes medications
or insulin therapy.

B. Symptoms

Signs and symptoms of type 2 diabetes often develop slowly. In fact, you
can have type 2 diabetes for years and not know it. Look for:

 Increased thirst

 Frequent urination

 Increased hunger

 Unintended weight loss

 Fatigue

 Blurred vision

 Slow-healing sores

 Frequent infections

 Areas of darkened skin, usually in the armpits and neck

C. Causes

Type 2 diabetes develops when the body becomes resistant to insulin or

when the pancreas is unable to produce enough insulin. Exactly why this happens

9
is unknown, although genetics and environmental factors, such as being
overweight and inactive, seem to be contributing factors.

How insulin works

Insulin is a hormone that comes from the gland situated behind and below the
stomach (pancreas).

 The pancreas secretes insulin into the bloodstream.

 The insulin circulates, enabling sugar to enter your cells.

 Insulin lowers the amount of sugar in your bloodstream.

 As your blood sugar level drops, so does the secretion of insulin from your
pancreas.

The role of glucose

Glucose — a sugar — is a main source of energy for the cells that make up
muscles and other tissues.

 Glucose comes from two major sources: food and your liver.

 Sugar is absorbed into the bloodstream, where it enters cells with the help
of insulin.

 Your liver stores and makes glucose.

 When your glucose levels are low, such as when you haven't eaten in a
while, the liver breaks down stored glycogen into glucose to keep your
glucose level within a normal range.

In type 2 diabetes, this process doesn't work well. Instead of moving into your
cells, sugar builds up in your bloodstream. As blood sugar levels increase, the
insulin-producing beta cells in the pancreas release more insulin, but eventually

10
these cells become impaired and can't make enough insulin to meet the body's
demands.

In the much less common type 1 diabetes, the immune system mistakenly destroys
the beta cells, leaving the body with little to no insulin.

D. Risk factors

Factors that may increase your risk of type 2 diabetes include:

 Weight. Being overweight is a main risk factor for type 2 diabetes.

However, you don't have to be overweight to develop type 2 diabetes.

 Fat distribution. If you store fat mainly in the abdomen, you have a
greater risk of type 2 diabetes than if you store fat elsewhere, such as in your
hips and thighs. Your risk of type 2 diabetes rises if you're a man with a
waist circumference above 40 inches (101.6 centimeters) or a woman with a
waist that's greater than 35 inches (88.9 centimeters).

 Inactivity. The less active you are, the greater your risk of type 2 diabetes.
Physical activity helps you control your weight, uses up glucose as energy
and makes your cells more sensitive to insulin.

 Family history. The risk of type 2 diabetes increases if your parent or

sibling has type 2 diabetes.

 Race or ethnicity. Although it's unclear why, certain people — including

Black, Hispanic, American Indian and Asian American people — are at
higher risk.

 Age. The risk of type 2 diabetes increases as you get older, especially after
age 45. That's probably because people tend to exercise less, lose muscle
mass and gain weight as they age. But type 2 diabetes is also increasing
dramatically among children, adolescents and younger adults.

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  Prediabetes. Prediabetes is a condition in which your blood sugar level is
higher than normal, but not high enough to be classified as diabetes. Left
untreated, prediabetes often progresses to type 2 diabetes.

 Gestational diabetes. If you developed gestational diabetes when you

were pregnant, your risk of developing type 2 diabetes increases. If you gave
birth to a baby weighing more than 9 pounds (4 kilograms), you're also at
risk of type 2 diabetes.

 Polycystic ovarian syndrome. For women, having polycystic ovarian

syndrome — a common condition characterized by irregular menstrual
periods, excess hair growth and obesity — increases the risk of diabetes.

 Areas of darkened skin, usually in the armpits and neck. This

condition often indicates insulin resistance.

E. Complications

Type 2 diabetes can be easy to ignore, especially in the early stages when
you're feeling fine. But diabetes affects many major organs, including your heart,
blood vessels, nerves, eyes and kidneys. Controlling your blood sugar levels can
help prevent these complications.

Although long-term complications of diabetes develop gradually, they can

eventually be disabling or even life-threatening. Some of the potential
complications of diabetes include:

 Heart and blood vessel disease. Diabetes dramatically increases the risk

of heart disease, stroke, high blood pressure and narrowing of blood vessels
(atherosclerosis).

 Nerve damage (neuropathy). Excess sugar can cause tingling, numbness,

burning or pain that usually begins at the tips of the toes or fingers and
gradually spreads upward. Eventually, you may lose all sense of feeling in
the affected limbs.

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 Damage to the nerves that control digestion can cause problems with nausea,
vomiting, diarrhea or constipation. For men, erectile dysfunction may be an
issue.

 Kidney damage. Diabetes can sometimes lead to kidney failure or

irreversible end-stage kidney disease, which may require dialysis or a kidney
transplant.

 Eye damage. Diabetes increases the risk of serious eye diseases, such as

cataracts and glaucoma, and may damage the blood vessels of the retina,
potentially leading to blindness.

 Slow healing. Left untreated, cuts and blisters can become serious

infections, which may heal poorly. Severe damage might require toe, foot or
leg amputation.

 Hearing impairment. Hearing problems are more common in people with

diabetes.

 Skin conditions. Diabetes may leave you more susceptible to skin

problems, including bacterial and fungal infections.

 Sleep apnea. Obstructive sleep apnea is common in people with type 2

diabetes. Obesity may be the main contributing factor to both conditions.
Treating sleep apnea may lower your blood pressure and make you feel
more rested, but it's not clear whether it helps improve blood sugar control.

 Alzheimer's disease. Type 2 diabetes seems to increase the risk of

Alzheimer's disease, though it's not clear why. The worse your blood sugar
control, the greater the risk appears to be.

F. Prevention

Healthy lifestyle choices can help prevent type 2 diabetes, and that's true
even if you have diabetes in your family. If you've already received a diagnosis of
diabetes, you can use healthy lifestyle choices to help prevent complications. If

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you have prediabetes, lifestyle changes can slow or stop the progression to
diabetes.

A healthy lifestyle includes:

 Eating healthy foods. Choose foods lower in fat and calories and higher
in fiber. Focus on fruits, vegetables and whole grains.

 Getting active. Aim for a minimum of 30 to 60 minutes of moderate

physical activity — or 15 to 30 minutes of vigorous aerobic activity — on
most days. Take a brisk daily walk. Ride a bike. Swim laps. If you can't fit
in a long workout, spread your activity throughout the day.

 Losing weight. If you're overweight, losing 5 to 10 percent of your body

weight can reduce the risk of diabetes. To keep your weight in a healthy
range, focus on permanent changes to your eating and exercise habits.
Motivate yourself by remembering the benefits of losing weight, such as a
healthier heart, more energy and improved self-esteem.

 Avoiding being sedentary for long periods. Sitting still for long periods
can increase your risk of type 2 diabetes. Try to get up every 30 minutes and
move around for at least a few minutes.

Sometimes medication is an option as well. Metformin (Glucophage,

Glumetza, others), an oral diabetes medication, may reduce the risk of type 2
diabetes. But even if you take medication, healthy lifestyle choices remain
essential for preventing or managing diabetes.

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4. Diabetes Mellitus Risk
Risk factors for diabetes depend on the type of diabetes.

A. Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may
signal an increased risk include:

 Family history. Your risk increases if a parent or sibling has type 1

diabetes.

 Environmental factors. Circumstances such as exposure to a viral illness

likely play some role in type 1 diabetes.

 The presence of damaging immune system cells

(autoantibodies). Sometimes family members of people with type 1
diabetes are tested for the presence of diabetes autoantibodies. If you have
these autoantibodies, you have an increased risk of developing type 1
diabetes. But not everyone who has these autoantibodies develops diabetes.

 Geography. Certain countries, such as Finland and Sweden, have higher

rates of type 1 diabetes.

B. Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes

and type 2 diabetes and others don't. It's clear that certain factors increase the risk,
however, including:

 Weight. The more fatty tissue you have, the more resistant your cells
become to insulin.

 Inactivity. The less active you are, the greater your risk. Physical activity
helps you control your weight, uses up glucose as energy and makes your
cells more sensitive to insulin.

 Family history. Your risk increases if a parent or sibling has type 2

diabetes.

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 Race or ethnicity. Although it's unclear why, certain people — including
Black, Hispanic, American Indian and Asian American people — are at
higher risk.

 Age. Your risk increases as you get older. This may be because you tend
to exercise less, lose muscle mass and gain weight as you age. But type 2
diabetes is also increasing among children, adolescents and younger adults.

 Gestational diabetes. If you developed gestational diabetes when you

were pregnant, your risk of developing prediabetes and type 2 diabetes later
increases. If you gave birth to a baby weighing more than 9 pounds (4
kilograms), you're also at risk of type 2 diabetes.

 Polycystic ovary syndrome. For women, having polycystic ovary

syndrome — a common condition characterized by irregular menstrual
periods, excess hair growth and obesity — increases the risk of diabetes.

 High blood pressure. Having blood pressure over 140/90 millimeters of

mercury (mm Hg) is linked to an increased risk of type 2 diabetes.

 Abnormal cholesterol and triglyceride levels. If you have low levels of

high-density lipoprotein (HDL), or "good," cholesterol, your risk of type 2
diabetes is higher. Triglycerides are another type of fat carried in the blood.
People with high levels of triglycerides have an increased risk of type 2
diabetes. Your doctor can let you know what your cholesterol and
triglyceride levels are.

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 CHAPTER III
Final
Conclition
Diabetes mellitus is a disorder in which the amount of sugar in the blood
is elevated. Doctors often use the full name diabetes mellitus, rather than
diabetes alone, to distinguish this disorder from diabetes insipidus . Diabetes
insipidus is a relatively rare disorder that does not affect blood glucose levels
but, just like diabetes mellitus, also causes increased urination.

The underlying cause of diabetes varies by type. But, no matter what type
of diabetes you have, it can lead to excess sugar in your blood. Too much sugar in
your blood can lead to serious health problems.

Chronic diabetes conditions include type 1 diabetes and type 2 diabetes.

Potentially reversible diabetes conditions include prediabetes — when your blood
sugar levels are higher than normal, but not high enough to be classified as
diabetes

Suggestion
It is hoped that it will supplement nursing students’ reading sources
especially on Diabetes Mellitus.

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 REFERENCE
https://en.wikipedia.org/wiki/Diabetes
https://www.mayoclinic.org/diseases-conditions/type-1-
diabetes/symptoms-causes/syc-20353011
https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/symptoms-
causes/syc-20351193
https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-
20371444

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