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 SYMPTOMS ASSESSMENT
CASE DM (DIABETES MELLITUS)
IDENTITY
Name: Mrs. U
Age: 45 Years
Occupation: Housewife
Gender: Female
Status: Married
Religion: Hindu
Address: Jl. Gunung Kawi E2 Denpasar Barat
 
HEALTH HISTORY
- Chief Complaint: Tingling in the extremities
- History of Present Disease
The patient came to the geriatric poly at Sanglah Hospital accompanied by his son with complaints of frequent tingling
sensations. This tingling has been felt by the patient since being diagnosed with DM in 2006. This tingling usually
appears when the patient is doing activities. Tingling occurs in all four extremities but is most commonly felt in both
legs. At first the patient will stop doing activities if he feels tingling, after that the patient will ignore if the tingling
occurs again. The tingling that is felt does not really interfere with daily activities because the patient can still hold it.
There were no other symptoms that the patient complained about other than tingling.
- Past medical history
The patient for the first time went to Sanglah Hospital in 2006, came to the ER with complaints of weakness and
dizziness that did not go away with rest. The patient also complains that he often wakes up at night to urinate, in a day
the patient can urinate 8-10 times with a volume of more than 200 cc each time. After checking blood sugar, the
results were high blood sugar levels (285 mg/dL), so the patient was diagnosed with DM
- Family Disease History
From the patient's family, his father was diagnosed with DM and died due to complications he experienced.
 
PHYSICAL EXAMINATION

> General Condition: Good

> Consciousness: Composmentis
> Vital Signs:
- Blood Pressure: 120/73 mmHg
- Pulse: 86x/minute
- Respiration: 20 breaths/minute
- Temperature: 35,70C
- Head: Symmetrical head shape, black hair color, no lumps and tenderness
- Neck: No wound or scar, no enlargement of the thyroid gland and no enlargement of the jugular vein
- Abdomen: No wounds or scars on the abdomen, no lumps, no tenderness and no bowel sounds were examined.
- Skin: Wet palms (-), sweaty (-)
- Extremities: Patient feels tingling in both extremities
 
 
 DIABETES MELLITUS
 
DEFINITION
Diabetes mellitus is a disease characterized by hyperglycemia caused by the inability of
the pancreas to produce insulin or a lack of insulin sensitivity in the target cells.
Abnormalities in carbohydrate, fat and protein metabolism found in patients with diabetes
mellitus occur due to lack of insulin activity in target cells.

SIGNS and SYMPTOMS

1. Increased frequency of urination
2. Excessive thirst
3. Weight loss
4. Starving
5. Slow healing
6. Tingling or numbness
PATHOPHYSIOLOGY OF DIABETES MELLITUS
Diabetes mellitus is a disease in which glucose levels in the blood are high because
the body cannot release or use insulin sufficiently, resulting in a buildup of sugar in
the blood which causes hyperglycemia. Glucose normally circulates in certain
amounts in the blood. Glucose in the body is formed in the liver from the food
consumed into the body. Insulin is a hormone produced by the pancreas that
functions to facilitate or control glucose levels in the blood by regulating its
production and storage. This insulin deficiency causes the use of glucose in the body
to decrease which will cause high blood glucose levels in plasma or hyperglycemia.
This hyperglycemic state will cause glucosuria because glucose fails to be absorbed
by the kidneys into the blood circulation where this situation will cause common
symptoms of diabetes mellitus, namely polyuria, polydipsia, and polyphagia.
 
RISK FACTORS
- Heredity (Genetic)
- Obesity
- Age
- Hypertension (high blood pressure)

Classification of Diabetes Mellitus

- Diabetes Mellitus Type-1
Type 1 diabetes mellitus is a chronic disease characterized by the body's inability to produce or produce insulin caused by damage to -cells in the pancreas.
- Type-2 Diabetes Mellitus
Type-2 diabetes is characterized by a progressive defect of pancreatic -cell function that causes our body to not produce insulin properly.
- Gestational Diabetes Mellitus
The definition of gestational diabetes mellitus is glucose intolerance during pregnancy, in women who are normal or who have impaired glucose tolerance
after termination of pregnancy. Gestational diabetes mellitus occurs in about 5–7% of all cases in pregnancy.
- Other Types of Diabetes Mellitus
This other type of diabetes is caused by genetic abnormalities in insulin action, abnormalities in -cells, pancreatic disease, endocrinopathies, infections, and
due to drugs or chemicals as well as other disease syndromes.
MANAGEMENT
The modalities in the management of Diabetes Mellitus consist of:
1. Non-pharmacological therapy which includes lifestyle changes by adjusting the diet, known as medical nutrition therapy, increasing physical activity and educating various problems related to diabetes that are carried out continuously.
2. Pharmacological therapy, which includes administration of oral anti-diabetic drugs and insulin injections. However, this pharmacological therapy is given if the application of non-pharmacologic therapy that has been carried out cannot control blood glucose levels as expected. Giving pharmacological therapy still does not leave non-pharmacological therapy.
 
THERAPY
1. Medical Nutrition Therapy (Diet)
The general goals of nutritional therapy are to help people with diabetes improve their habits of daily activities to gain better metabolic control, maintain near normal blood glucose levels, achieve optimal serum lipid levels, provide sufficient energy to achieve or maintain an adequate body weight and improve the level of overall health through optimal nutrition.
2. Pharmacological therapy
given along with dietary regulation and physical exercise. Pharmacological therapy consists of oral hypoglycemic drugs and insulin injections. Oral or injection drug administration can help use sugar in the body of diabetics.
 
CONVERSATION
 
Nurse: Good morning mom
Patient: Yes morning
Nurse: Right with U's mother?
Patient: Yes that's right
Nurse: introduce me nurse A who is on duty today, first I will ask you some questions, is it okay?
Patient: Yes you can
Nurse: how old are you now?
Patient: 45 Years old
Nurse: May I know what is your mother's occupation?
Patient: I am a housewife
Nurse: Are you married
Patient: Yes
Nurse: Ok, before you went to the hospital, why if I may know?
Patient: I often feel tingling in my hands and feet
Nurse: May I know what kind of work do you usually feel tingling in doing?
Patient: Usually there is a tingling sensation when I do housework such as sweeping, washing clothes
Nurse: May I know if you have been in the hospital before?
Patient: Yes I did, it was the first time I went to SANGLAH hospital and came to the ER
Nurse: At that time, what complaints or symptoms did you experience?
Patient: I feel weak and dizzy at that time I have tried to rest but it still doesn't go away
Nurse: Apart from weakness and dizziness, were there any other complaints at that time?
Patient: Yes, at night I often wake up to pee usually up to 8-10 times
Nurse: After the mother was examined in the ER at that time did the doctor talk about her illness?
Patient: Yes, at that time the doctor said that I was diagnosed with diabetes mellitus
Nurse: Previously, did anyone in your family have a disease like your mother?
Patient: Yes, my father also has diabetes mellitus
Nurse: Have you recovered from your illness?
Patient: My father died because of his diabetes mellitus
Nurse: For now, do you have any complaints?
Patient: Yes, I feel a tingling sensation in my hands and feet but the most painful is in my feet
Nurse: Ok mom, thank you for your time and for answering a few questions from me, then I'll
excuse myself, I hope you get well soon
Patient: Yes thank you
 OM
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