GRANDMED Hospital record Lubuk Pakam,
sufferers of internal medicine who were treated since
January 2018 - December 2018 as many as 20,506
people. Among patients with internal diseases, there
were 568 people with disorders of the "Diabetes
Mellitus Type 2" endocrine system with a prevalence
of 2.77% consisting of 328 (57.8%) men and 240
(42.2%) women. Meanwhile, in handling to reduce
blood sugar levels in patients with Type 2 Diabetes
Mellitus, RS. GRANDMED Lubuk Pakam itself still
relies on pharmacological therapy, such as the
administration of insulin injections to control blood
sugar levels of Type 2 Diabetes Mellitus patients and
various types of oral drugs such as Metformin.
Diabetes mellitus is a collection of symptoms in a
person caused by an increase in blood glucose levels
due to a progressive decrease in insulin secretion by
insulin resistance. This condition is characterized by
the inability of the organ's inability to use insulin, so
insulin cannot function optimally in regulating
glucose metabolism. As a result, blood glucose levels
increase (hyperglycemia). Hyperglycemic
characteristics aside from abnormalities of insulin
secretion can also occur because insulin does not
work or both (Bustan, 2012).
Hyperglycemia is characterized by blood sugar
levels when more than 11.1 mmol / l (> 200 mg / dl)
(WHO, 2012). Increased blood sugar levels in
patients with diabetes mellitus associated with stress.
Stress conditions with people with diabetes mellitus
are very closely related. Stress is a condition where
the body's needs are not met adequately, so that it will
result in disruption of balance. Stress activates the
neuroendocrine system and the sympathetic nervous
system through the pituitary-adrenal hypothalamus,
causing the release of hormones such as epinephrine,
thyroid, cortisol, and glucagon which can affect blood
sugar levels (Hasaini, 2015).
In normal insulin conditions glucose intake or
glucose production in the body will be facilitated (by
insulin) to enter the body's cells. Glucose is then
processed to become energy materials. If the energy
material needed is still remaining, it will be stored as
glucogen in liver cells and muscle cells (as muscle
cell mass). The process of glycogenesis (formation of
glycogen) from the element of glucose can prevent
hyperglycemia. In patients with diabetes mellitus this
process cannot take place properly so that glucose
accumulates in the blood (hyperglycemia).
Hyperglycemia will result in the rapid growth of
various microorganisms such as fungi and bacteria.
Because these microorganisms are well suited to
areas that are rich in glucose. Every time
inflammation arises, there will be an inflammation
mechanism, there will be an increase in blood
mechanism in the injured tissue. That condition
makes microorganisms get a supply of nutrients. This
condition will cause diabetes milletus sufferers to be
easily infected by bacteria and fungi.
Relaxation technique is one of the nursing actions
that can reduce anxiety and can automatically reduce
blood sugar levels. Relaxation can influence the
hypothalamus to regulate and decrease sympathetic
nervous system activity. Stress can not only increase
blood sugar levels physiologically. Patients in stress
can also change their good habits, especially when it
comes to eating, exercise and medication. Progressive
muscle relaxation can be widely applied to all people
in various conditions (Setyohadi and Kushariyadi,
2011). Progressive muscle relaxation is known to
help reduce blood glucose levels in patients with
diabetes mellitus because it can suppress the release
of hormones that can increase blood glucose levels,
namely epinephrine, cortisol, glucagon,
adrenocorticotropic hormone (ACHT),
corticosteroids, and thyroid. The sympathetic system
will dominate when a person is relaxed and calm, the
dominance of the sympathetic nervous system
stimulates the hypothalamus to decrease the secretion
of Corticotropin-Realizing Hormones (CRH).
Cell starvation also results in increased
mobilization and metabolism of free fatty acids
(lipolysis), triglycerides and glycerol which circulates
and makes the liver substrate available for the
ketogenesis process used by cells to carry out cell
activity. Ketogenesis results in increased levels of
organic acids (ketones), while ketones use the body's
alkaline reserves to decrease blood PH buffer.
Kusmaul breathing is stimulated to compensate for
the state of metabolic acidosis. Osmotic diuresis is
made worse by the presence of ketoanemia and from
protein catabolism which increases protein intake to
the kidneys so that the body loses a lot of protein. The
existence of cellular starvation will increase the
body's adjustment mechanism will increase income
with the emergence of a feeling of wanting to eat
continuously (polifagi). Cellular stravation will also
cause clinical symptoms of bodily weakness due to
decreased energy production. And damage to various
reproductive organs, one of which can arise
impotence and other organs such as peripheral
innervation and eyes (appear numbness and blurred
eyes).
The reduction in CRH will also affect
adenohipofisis to reduce the secretion of
adrenocorticotropic hormone (ACHT), which is
carried through the bloodstream to the adrenal cortex.
This condition can eliminate the adrenal cortex to
release the hormone cortisol. Decreased cortisol