Toxins and carcinogens that arise from burning tobacco can trigger cancer. At first cigarette contains 8 to 20 mg of nicotine and nicotine after the fuel that goes into the blood circulation is only 25 percent. However a small amount of time it has only 15 seconds to get to the human brain.
Nicotine was accepted by acetylcholine receptor-nikotinik which then divide into the path of return and adrenergic path. On the return path, smokers will feel a sense of pleasure, stimulate dopaminergic system. Result smokers will feel more calm, seemed to think the more brilliant, and able to suppress hunger. While the adrenergic path, this substance activates the adrenergic system in the locus ceruleus of the brain that emit sorotonin. Increased serotonin caused excitement and stimulation of desire for another cigarette. (Agnes Tineke, Compass Sunday, May 5, 2002: 22). This is what causes smokers is very difficult to leave the cigarettes, because it's dependence on nicotine. When he quit smoking pleasure gained would be reduced.
Effects of cigarette / tobacco stimulate mild depression, disorders of perception, feelings, mind, behavior and psychomotor function. When compared to substances other addictive effects of cigarettes is very low, then the dependence on cigarettes was not considered serious (Roan, soul medicine, psychiatry, 1979: 33).
Types of Smokers
They are saying very heavy smokers go round if you consume more than 31 cigarettes per day and hose stem smoking five minutes after waking in the morning. Heavy smokers smoked about 21-30 cigarettes a day with intervals ranging from up in the morning between 6 - 30 minutes. Cigarette smokers was spending 11 to 21 bar with an interval of 31-60 minutes after waking in the morning. Light cigarette smokers spend about 10 bars with an interval of 60 minutes up in the morning.
According to Silvan Tomkins (in Al Bachri, 1991) there are 4 types of smoking behavior on Management of affect theory, into four types are:
Type of smokers are affected by positive feelings. With the addition of smoking a person feels a positive sense. Green (in the Psychological Factor in Smoking, 1978) adds a sub-type 3 is:
Pleasure relaxation, smoking behavior only to add or enhance the enjoyment which is obtained, such as smoking after drinking coffee or eating.
Stimulation to pick them up. Smoking behavior Sekedarnya only done for fun feeling.
Pleasure of handling the cigarette. Pleasure obtained by holding a cigarette. Very specific to the pipe smoker. Pipe smoker will spend the time to fill the pipe with tobacco while to suck it only takes a few minutes. Or smokers prefer to linger to play out his cigarette with his fingers long before he lit the fire.
Smoking behavior is influenced by negative feelings. Many people use cigarettes to reduce the negative feelings, such as when he was angry, anxious, nervous, cigarettes are considered as a savior. They use a cigarette when feeling bad happened, so avoid feeling even more uncomfortable.
Smoking behavior is addictive. Green referred to as psychological Addiction. Those who have addiction, smoking will increase the dose used any time after the effects of reduced cigarette dihisapnya. They generally will go out to buy cigarettes, even though the middle of the night, because he was worried that cigarettes are not available every time he wants.
Smoking behavior that has become a habit. They used cigarettes was not due to control their feelings, but because it really has become a regular habit. Can be said to people this type of smoking is a behavior that is automatic, often without thought and without conscious. He started the fire smoking a cigarette when the former has been completely discharged.
Government itself in protecting non-smokers, had made a breakthrough step with the issuance of Government Regulation (PP) No. 81 of 1999. Article 23 requires that the government made all public places and health service facilities, teaching-learning process, of worship, and public transportation is basically non-smoking area. Unfortunately, the implementation of this regulation is not as real as on paper. The government should seriously implement it.
COMPLICATIONS diabetes mellitus
Registrar of Medical gerontology
Trumanagara University School of Medicine
Tresna Werda Sasana Karya Bakti Foundation Development RIA
1. Acute Complications
Diabetic ketoacidosis
When low levels of insulin, the body can not use glucose for energy and therefore mobilized body fat storage. Destruction of fat to release energy to produce fatty acid formation. These fatty acids through the liver and form a group of chemical compounds called ketone bodies, ketone body through urine expelled is called ketonuria.
Levels of ketone bodies is increased in the body called ketosis. Ketosis can increase the acidity of body fluids and tissues, so levels are very high and causing a condition called acidosis. Acidosis resulting from the increased ketone body called ketoacidosis.
Symptoms-Symptoms:
a. Dehydration: dryness in the mouth and loss of skin elasticity
b. Sour-smelling breath
c. Nausea, vomiting and stomach pains
d. Heavy breathing
e. Increased breathing
f. Feeling very weak and sleepy
Hypoglycemia
Is one of the acute complications that are not rare and often life threatening penderitannya and marked with blood sugar levels rise falls below 50-60 mg / dl. These complications can be caused by exogenous and endogenous factors.
Table 3. Causes of Hypoglycemia in Patients with Diabetes mellitus
Endogenous factors exogenous factors
Insulin
Hypoglycemia Oral Drugs
Alcohol
The drugs include:
- Salicylic
- Hipoglisin
- Pentamidine
- Drugs β receptor-blocking
Organic hypoglycemia
Insulinoma
Malignancy Ekstrapankreatik
Congenital Metabolic Disorder
- Hereditary fructose intolerance
- Deficiency of fructose-1 ,6-difosfatase
- Galaktosemia
- Deficiency fosfoenolpiruvat
karboksikinase
Source: Inzucchi SE: The Diabetes Mellitus Manual, 2005
Exogenous factors such as resulting from the use of insulin or oral hypoglycemia drugs that are not controlled and not accompanied by adequate caloric intake. In developed countries, hypoglycemia is often found in people with diabetes who use insulin or oral hypoglycaemia drugs along with excessive alcohol without good calorie intake.
The symptoms of hypoglycemia early form of adrenergic symptoms such as: pale, sweating, tachycardia, palpitations, hunger, weakness, and nervous. Then on the next phase which followed neuroglikopenia symptoms include: rapid tired, irritable, headache, loss of concentration, disturbances of consciousness, sensory and motor disturbances, confusion, seizures and even coma.
Infection
People with diabetes, tend to become infected due to 3 main reasons:
a. Bacteria grow well if the high blood glucose levels
b. Lower the body's defense mechanism in people with diabetes
c. Diabetes-related complications that increase the risk of infection.
Infection is generally attacks people with diabetes including skin infections, urinary tract infections, gum disease, tuberculosis, and some types of fungal infections.
2. Chronic Complications
Heart disease and blood vessel
Atherosclerosis is a condition where the arteries thicken and narrow due to buildup of fat on the inside of blood vessels. Menebalnya artery in the leg can affect your leg muscles because of reduced blood supply resulting in cramps, discomfort or weakness when walking. If the blood supply to the leg was very poor or interrupted for a prolonged period can occur in tissue death.
Damage to the kidneys (nephropathy)
Diabetes affects the small blood vessels as a result the efficiency of the kidneys to filter blood of kidney disturbed. Patients with nephropathy showed images such as chronic kidney failure, weakness, nausea, pale to complain shortness of breath due to fluid retention. The presence of renal failure evidenced by increased levels of serum creatinine or urea in the range of 2% to 7.1% of patients with diabetes mellitus. The presence of persistent proteinuria without other renal disease is one of the early signs of diabetic nephropathy.
Nerve damage (neuropathy)
High blood sugar destroys nerve fibers and a layer of fat around the nerve. Damaged nerves can not send signals to the brain and the brain very well, so the result could be loss of sense of taste, increased sense of taste or pain in the affected part. Damage to the body's nerves are more common. The damage starts from the big toe and continued until the soles of the feet and the legs that causes numbness, tingling, burning, pain, feeling pierced, or cramping in the leg muscles.
Damage to the eyes (retinopathy)
Disrupted retina occurs, thus losing part or all of the vision. Patients with diabetic retinopathy will experience symptoms of blurred vision to blindness
Physical state of DM Patients
Circumstances the patient's head DM
a. Hair
DM patients who have chronic and not well maintained, usually thinner hair. When attacked by the hair root, hair fall out easily.
b.Telinga:
Because the hearing nerve can be easily damaged DM, frequent ear and if mendenging untreated hearing loss can occur.
c. Eyes:
• If levels of glucose in the blood high sudden, a convex lens
• DM can cause disease eye lens becomes opaque (white), the patient complained blurred vision (cataract).
• Complications of chronic in the other eye is increased eye pressure, called glaucoma.
• Disturbances in the retina of the eye due to DM is called diabetic retinopathy which occurs constriction of blood vessels and capillaries accompanied eksudasi bleeding in the retina.
Circumstances the patient's mouth cavity DM
a. Tongue:
DM patient's tongue often feels enlarged and thick so that an interruption in her tongue tasting
b. Saliva:
Saliva DM patients often become more viscous, so the dry mouth, called xerostomia diabetic
c. Teeth and gums:
Because the tissue that binds the teeth in the jaw called the periodontium easily damaged, teeth easily shaken DM patients and easy to loose, so the teeth swollen gums look out (modot).
Lung and heart condition sufferers DM
a. Lung:
DM patients easily occur pulmonary tuberculosis.
b. Heart:
DM patients susceptible to coronary heart disease, heart disease caused by narrowing of the coronary arteries, myocardial infarction easily happen where the heart muscle becomes weak from lack of oxygen supply.
People with liver conditions DM
DM patients will have liver disease due to diabetes is the disorder called "Diabetic Heart Disease". DM patients more prone to developing inflammation of the liver due to hepatitis B virus and hepatitis C than those who do not suffer from DM.
State means sufferers DM digestion
a.Lambung:
In DM patients, the maintenance of nerves eventually be damaged stomach, bulging stomach so that the process of disturbed gastric emptying.
b.usus:
In DM patients complained difficult obstipasi CHAPTER called diabetic
Things kidney and bladder
a. Kidneys:
In DM patients have a tendency to seventeen times more prone to kidney function disorders caused by recurrent infections that occurs in DM and the narrowing of blood vessels called capillaries of diabetic mikroangiopati
b. Bladder
In DM patients often experience urinary tract infections (UTI) are repeated, except that the maintenance of nerves of the bladder are often damaged so that the bladder wall becomes weak. The nature of the control nerve causes sufferers often disrupted or urine wetting myself out unwittingly called inkontinesia urine.
Sexual ability diabetes mellitus
If the nerve damage is usually severe and permanent DM patients will suffer permanent impotence. Impotent in DM patients can be distinguished 2 types, impotence, neurogenic and psychogenic impotence.
Fibril state of DM patients
Because the blood glucose in DM patients so high, will damage the nervous patient if the process is long lasting. Nerve disorders DM disease called diabetic neuropathy.
Symptoms often appear:
• tingling
• Heat or sense pricked - acupuncture
• Sense of place in the thick soles of the feet
• Cramping
• Body pain especially at night
• If there is nerve damage called diabetic polineuropati.
Condition of blood vessels in people with DM
If the blockage occurs in blood vessels in the medium or large limbs (makroangiopati diabetic), the leg will be more susceptible to diabetic gangrene, which is wound on the red leg blackness - hitaman and rotten. When blockage occurs in blood vessels larger DM patients will feel leg pain when he walked in a certain distance because the blood flow to the legs is reduced and is called intermittent claudicatio.
