The Decreased Blood Sugar Levels of Type 2 Diabetes Mellitus
Patients with Progressive Muscle Technique
Anita Sri Gandaria Purba, Arfah May Syara, Samuel Ginting, Juni Mariati, Syatriawati
Institut Kesehatan Medistra Lubuk Pakam, Faculty of Nursing and Physiotherapy
Keywords: Type 2 diabetes mellitus, progressive muscle relaxation therapy, sugar content
Abstract: The prevalence of diabetes that occurred in 2015 was 9.3% and is estimated to increase every year. Type 2
diabetes occurs because of insulin resistance, where glucose fails to enter cells, usually at the age of 30 years.
One modality therapy that can be done is progressive muscle relaxation. The purpose of this study was to
identify the effect of progressive muscle relaxation therapy on reducing blood sugar levels in patients with
type 2 diabetes mellitus at GRANDMED Lubuk Pakam hospital. This research method uses a pre-
experimental design with one group pretest-posttest. The sample size of 10 respondents was selected by using
non-probability sampling type consecutive sampling. The paired hypothesis test results from the uij-t sample
at a significance level of 95% obtained p value <α, which is 0.001, showed that there was an effect of
progressive muscle relaxation therapy to reduce blood glucose levels in patients with type 2 diabetes mellitus.
The conclusion was that there was a significant difference between blood glucose levels before and after
progressive muscle relaxation therapy. It is recommended that health care institutions need to implement new
policies related to the application of progressive muscle relaxation technique therapy.
1 INTRODUCTION
Based on 2015 International Diabetes Federation
(IDF) estimates, there are 177 million people in the
world who suffer from type 2 diabetes mellitus and it
is predicted that in the next 25 years it will increase
to 300 million people (Sudoyo, et al. 2006). The
prevalence of type 2 diabetes in 2016 in the
population of the United States aged 65 years or more
is around 10.9 million people (26.9%).
This disease is a major cause of heart disease and
stroke, and is a leading cause of death. For handling
reduced blood sugar levels only rely on
pharmacological therapy, such as the use of insulin
injection. Surwit et al. (2014) from Duke University
Medical Center, USA, stated that stress management
techniques when accompanied by standard treatments
can help reduce blood glucose levels. The reduction
achieved was also almost as large as the results one
would expect from diabetes control drugs. Surwit and
his team studied 108 type 2 DM patients and acute
DM patients in adults.
All respondents underwent DM education
sessions for 30 minutes and half of the respondents
were also asked to follow guidelines for dealing with
stress. After a year, as many as 32% of patients who
have knowledge about stress management are
recorded to have decreased blood sugar by one
percent or more. While a decrease in blood sugar
levels was only 12% among respondents who did not
have the knowledge to deal with stress. Surwit further
stated that stress directly affects DM.
In Indonesia the number of type 2 diabetes
mellitus patients has increased, from 8.4% million
people in 2017 and is estimated to be around 21.3%
million people in 2022. The high morbidity rate
makes Indonesia ranks fourth in the world after the
United States, India , and China (Wild et al, 2018).In
North Sumatra, especially H.Adam Malik Hospital in
Medan based on disease patterns and various age
levels, the number of cases of diabetes mellitus
occupies number two after malignant neoplasm,
while based on data on death patterns according to the
disease causing the death of patients treated in
H.Adam MalikMedanDM ranks 16th with 430 people
out of 37,279 people with other disease deaths (North
Sumatra Health Office, 2009).Based on data obtained
by researchers on November 4, 2018 at the Grandmed
Lubuk Pakam Hospital, there were 340 patients with
type 2 diabetes mellitus in the past year, and based on
preliminary studies conducted by the author on
November 4, 2018 data obtained from medical
188
Purba, A., Syara, A., Ginting, S., Mariati, J. and Syatriawati, .
The Decreased Blood Sugar Levels of Type 2 Diabetes Mellitus Patients with Progressive Muscle Technique.
DOI: 10.5220/0009469201880195
In Proceedings of the International Conference on Health Informatics and Medical Application Technology (ICHIMAT 2019), pages 188-195
ISBN: 978-989-758-460-2
Copyright
c
 2020 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

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
The Decreased Blood Sugar Levels of Type 2 Diabetes Mellitus Patients with Progressive Muscle Technique
189

hormone will inhibit the process of gluconeogenesis
and increase the use of glucose cells (Guyton & Hall,
2008; Sherwood, 2014).
Progressive muscle relaxation can be done by
everyone in a variety of conditions. 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 (ACTH),
corticosteroids, and thyroid. The sympathetic system
will dominate the situation of someone who is relaxed
and calm, the dominance of the sympathetic nervous
system will stimulate the hypothalamus to decrease
the secretion of Corticotropin-Releasing Hormone
(CRH). The reduction in CRH will also affect
adenohipofisis to reduce the secretion of
Adenocorticotropic hormone (ACTH), which is
carried through the bloodstream to the adrenal cortex.
This condition can inhibit the adrenal cortex to
release the hormone cortisol. Decreased cortisol
hormone will inhibit the process of gluconeogenesis
and increase the use of glucose by cells
2 RESEARCH METHODS
This type of research is quantitative with quasi-
experimental design (quasi-experimental) using a
one-group pretest-posttest approach. The location of
this research was conducted at GRANDMED
Hospital Lubuk Pakam. The sample in this study was
type 2 diabetes mellitus patients at Grandmed Lubuk
Pakam Hospital. The sampling technique used is
nonprobability sampling, namely purposive
sampling. The number of samples is 10 people.
The analysis technique used is the T-test with a
confidence level of 95% or paired (p) ≤ 0.05
(Notoatmodjo). T-test is done when analyzing data.
The type of data used in the independent variable is
categorical and the dependent variable is numeric.
(Sugiyono, 2012).
The sample is a portion of the entire object studied
and is considered to represent the entire population
(Notoatmodjo, 2012). The sample in this study were
patients with type 2 diabetes mellitus at Lubuk Pakam
GRANDMED Hospital. This research was conducted
for 2 weeks
Figure 1: Research flow.
Here are what need to be considered in doing
progressive muscle relaxation techniques. a) Don't
overexert muscle tension because it can hurt yourself.
b) it takes around 20-50 seconds to relax the muscles.
c) pay attention to body position. d) tensing muscle
groups twice the tension. e) do the right part of the
body twice, then the left part twice. f) check whether
the client is really relaxed
The steps for progressive muscle relaxation are as
follows. The main goal of diabetes therapy is to
normalize insulin activity and blood glucose levels to
reduce complications caused by diabetes mellitus.
The trick is o maintain glucose levels within normal
limits without hypoglycemia and maintain a good
quality of life.
The following is a standard operational procedure
for progressive muscle training can be seen in the
figure 2 below
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
190

Figure 2: Standart Operational Procedur.
3 RESULTS AND DISCUSSION
Based on the results of data analysis, it can be seen
that blood sugar levels in diabetic patients before
progressive muscle relaxation techniques that only
use insulin injection therapy are 10 respondents, with
an average blood sugar level of 244 mg / dl. From the
results of the study it can be assumed that the
administration of progressive muscle relaxation
techniques to patients with type 2 diabetes mellitus is
significant.
The results of this study are in line with research
conducted by Widianingsih (2017), in Pukesmas
Pondok Jagung, South of Tangerang City that the
provision of progressive muscle relaxation
techniques in patients with type 2 diabetes mellitus
can reduce blood sugar levels with a value of p =
0.001, from the study muscle relaxation techniques
progressive significant effect to reduce blood sugar
levels.
Type of 2 diabetes mellitus is a complex chronic
disease that involves carbohydrate, protein and fat
metabolism disorders and the development of
macrovascular and neurological complications.
Progressive muscle relaxation techniques are deep
muscle relaxation techniques that do not require
imagination, perseverance, or suggestion. Based on
the belief that the human body responds to anxiety
and events that stimulate the mind with muscle
tension. Progressive muscle relaxation techniques
focus on a muscle's activity by identifying tense
muscles and then reducing tensionby doing relaxation
techniques to relax. (Kustanti and Widodo, 2008).
The results showed blood sugar levels in patients with
type 2 diabetes mellitus before progressive muscle
relaxation was carried out at 243.90, with a standard
deviation (SD) of 11.210 and an error standard (SE)
of 3, 54.
From the results of the study it can be assumed
that the administration of insulin injection therapy in
patients with type 2 diabetes mellitus without the
provision of progressive muscle relaxation
techniques, the results are not so significant. From the
results of Damayanti's study (2017), in the pondok
mukut of pondok pondok in south tangerang city that
the provision of progressive muscle relaxation
techniques in type 2 diabetes mellitus patients can
reduce blood sugar levels by p = 0,000, from the study
progressive muscle relaxation techniques
significantly influence levels to reduce levels blood
sugar.
Progressive muscle relaxation technique is a
relaxation therapy given to the client by tensing
certain muscles and then relaxation. Progressive
Gambar 1. Menggenggam
otot tangan bawah
Gambar 2. Latihan
otot bagian belakang
Gambar 3. Latihan otot-
otot bisep
Gambar 4. Latihan otot-
otot bahu
Gambar 5. Latihan untuk
otot-otot wajah (dahi,
mata, rahang, mulut)
Gambar 6. Latihan otot
leher
Gambar 7. Latihan otot
punggung
Gambar 9. Latihan
otot paha
Gambar 8. Latihan otot
dada dan otot perut
Gambar 10. Latihan
otot betis
The Decreased Blood Sugar Levels of Type 2 Diabetes Mellitus Patients with Progressive Muscle Technique
191

relaxation is a method of relaxation technique that
combines deep breathing exercises and a series of
series of contractions and certain muscle relaxation
(Thomson, 2014).
Results of Analysis of Blood Sugar Levels After
the Progressive Muscle Relaxation Technique of
200.80 with standard deviation (SD) 31.407 and
standard error (SE) 9.932. significant effect to reduce
blood sugar levels. The researcher's assumption is
that progressive muscle relaxation techniques can be
used to reduce blood sugar levels in patients with type
2 diabetes mellitus so that they can gradually
maintain and improve conducive health
Someone with a chronic disease or serious illness
can experience a stressful condition that will trigger
the release of several hormones that contribute to
increasing blood sugar levels, namely glucagon,
epinephrine, growth hormone and glucocorticoids.
Stress patients can change their good habits,
especially eating, exercise and treatment. One of the
actions that can be taken in patients with chronic
stress is complementary therapy. This therapy is a
natural treatment to deal with the causes of disease
and stimulate the body itself to cure the disease.
Complementary therapies include herbal therapy,
breathing exercises, meditation and relaxation.
Relaxation is an effort to relieve emotional tension so
that individuals can think more rationally. That is why
the production of liver sugar can be controlled
properly, so that blood sugar can be stabilized
normally.
One form of a way to ease emotional tension that
is quite easy to do is progressive muscle relaxation.
This technique forces the individual to concentrate on
his muscle tension and then train him to relax. People
who are stressed, emotionally tense and experiencing
muscle tension. This technique seeks to relieve
muscle tension in the hope that emotional tension is
reduced, so this progressive muscle relaxation
technique can be used to accompany conventional
techniques that are usually given.
Progressive muscle relaxation therapy which is a
form of mind-body therapy in complementary
therapy. In relaxing individual muscles will be given
the opportunity to learn how to tense a certain group
of muscles and then release that tension (Widyawati
& Yulianti, 2015).
Progressive muscle relaxation therapy, it is
important to note that it must be ended by returning
the position to the initial condition before being tense
so that you can feel the difference between feeling
tense and relaxing. This therapy needs to be done
repeatedly to give the best effect.
When the client meets the therapist for
progressive muscle relaxation therapy, if done
correctly it will certainly bring positive changes.
Therefore, this exercise needs to be repeated to have
a lasting positive effect.
Juniadi's research results (2018) at Woha Bima
Health Center, West of Nusa Tenggara, with p =
0.004, from 30 respondents there were 23 who
experienced a decrease in blood sugar levels with
direct and indirect approaches and outreach on
progressive muscle relaxation techniques can reduce
blood sugar levels in type 2 diabetes mellitus patients.
Based on the belief that the human body responds to
anxiety and events that stimulate the mind with
muscle tension
Progressive muscle relaxation techniques focus
on muscle activity by identifying tense muscles and
then reducing tension by using relaxation techniques
to relax. (Herod, 2010).
Results of Analysis of Blood Sugar Levels Before
And After The Progressive Muscle Relaxation
Technique At GRANDMED Hospital Lubuk Pakam
in 2019 was 43,100, with a standard deviation (SD)
27, 795 and an error standard (SE) of 8,789.
Statistical test results obtained p value = 0.001 α =
0.05, it can be concluded that there is an influence of
progressive muscle relaxation techniques on blood
sugar levels in patients with type 2 diabetes mellitus.
According to Barnedh (2006) physical activity has a
significant relationship with extremity disorders
where activity low physical, one of which does not
regularly exercise the risk of movement disorders.
This mechanism can increase blood sugar levels in
type 2 DM patients.
The results of this study are in accordance with
Nakayama et al (2012) saying that muscle contraction
and exercise can reduce blood glucose levels in
patients with Type 2 Diabetes Mellitus by increasing
glucose uptake in skeletal muscle through
translocation of glucose transporter 4 (GLUT 4) to the
surface cell. According to Ghazavi, et al (2007), that
relaxation exercises given to DM patients can reduce
HbA1C levels.
This research is in accordance with existing
theories and in line with previous studies. The results
of a study conducted by Widianingsih (2017), about
the effect of progressive muscle relaxation techniques
on reducing blood sugar levels in type 2 diabetes
mellitus patients. This study used a pretest-posttest
control group design method with a sample of 40
people, 20 as a treatment group and For 20 control
groups, the sampling technique used purposive
sampling and used pairede sample t-test.
ICHIMAT 2019 - International Conference on Health Informatics and Medical Application Technology
192

This research is supported by Duning's (2013)
statement that complementary therapy provides
benefits for diabetic patients by increasing the
acceptance of current conditions, reducing stress,
anxiety and depression, developing strategies to
prevent ongoing stress, increasing patient
involvement in the process of healing diabetes
mellitus. The same study conducted by Yildirman &
Fadiloglu (2016) states that progressive muscle
relaxation decreases anxiety and improves the quality
of life of patients undergoing dialysis.
Progressive muscle relaxation techniques activate
the sympathetic nervous system and stop the work of
the sympathetic nerves so that the hormone cortisol
decreases. Pawlow's study (2015) shows that there is
an effect of muscle relaxation on salivary cortisol
levels and if done regularly will reduce the risk of
diabetes mellitus. The same study conducted by
Maghrifah (2015) shows that there is an effect of the
progression of muscle relaxation on stress in patients
with type 2 diabetes mellitus.
Type 2 diabetes mellitus is a disease characterized
by an increase in blood sugar levels (hyperglycemia)
due to impaired insulin secretion, insulin activity or
both, so insulin is needed. As for the attention to be
given insulin is given at the peak, how to store insulin,
preparation and rotation, and injection techniques. As
a result, the range of insulin doses is quite far, ranging
from 24 units to 36 units. This disease can be
influenced by age, lifestyle, sex, and can cause
complications. Based on research relaxation can
reduce blood sugar levels significantly.
Physical exercise is one of the pillars of DM
management (Perkeni, 2011). Progressive muscle
relaxation exercises can be done as one of the
physical exercises for DM patients. This exercise is
done to get relaxation by tensing and stretching the
muscles routinely to have an impact on increasing
glucose transference into the cell membrane. This
increase makes the use of glucose levels more
effective so that levels can be near normal or stable.
Blood sugar levels in DM patients are related to the
stress they face. Stress activates the neuroendocrine
system and the sympathetic nervous system through
the hypothalamic pituitary-sdrenal system which
causes the release of hormones such as epineprin,
cortisol, ACT glucagon, corticosteroids, and thyroid
which can affect blood glucose levels in people with
DM. In addition during emotional stress, DM patients
are also associated with poor self-care such as
education, nutritional therapy or meal planning,
pharmacological techniques, monitoring blood sugar
levels and physical exercise (Hasaini, 2015).
One form of a way to ease emotional tension that
is quite easy to do is progressive muscle relaxation.
This technique forces the individual to concentrate on
his muscle tension and then train him to relax. People
who are stressed, emotionally tense and experiencing
muscle tension. This technique seeks to relieve
muscle tension in the hope that emotional tension is
reduced, so this progressive muscle relaxation
technique can be used to accompany conventional
techniques that are usually given
The benefits of progressive muscle relaxation
exercises are improving blood circulation. Increasing
blood circulation will help the process of absorption
and removal of metabolic remnants from the tissues
and facilitate the distribution of nutrients. Increased
circulation allows more efficient absorption of insulin
by cells because of the blood circulation of people
with DM oftendisturbed due to the effects of
increased blood sugar levels on body cells.
Progressive muscle relaxation works by
alternating movements between stretching and
relaxation, easy to learn and the results are quickly
felt. Progressive muscle relaxation will inhibit stress
feedback pathways and relax the patient's body. The
parasympathetic system will dominate in a relaxed
state where some of the effects are caused by reducing
the speed of heart contractions and stimulating the
secretion of the hormone insulin.
The results of this study indicate that progressive
muscle relaxation for patients with type 2 diabetes
mellitus greatly affects a decrease in blood sugar
levels, compared with those who do not. Relaxation
can reduce blood sugar levels in patients with type 2
diabetes mellitus by suppressing the release of
hormones that can increase blood sugar levels,
namely epinephrine, cortisol, glucagon,
adrenocorticotropic hormone (ACTH),
corticosteroids and thyroid.
According to Barneth (2016) physical activity has
a significant relationship with physical limb disorders
that are very low, one of which is not regularly
exercising the risk of movement disorders. This
mechanism can increase blood sugar levels in Type 2
DM patients.
Thus, progressive muscle relaxation can help
reduce blood sugar levels by: a) suppressing
epinephrine release thereby inhibiting the conversion
of glycogen to glucose, b) suppressing cortisol
expenditure inhibiting glucose metabolism, so that
amino acids and lactate remain stored in the liver in
the form of glycogen as energy reserves, c) restrain
the release of gluagon inhibit the conversion of
glycogen in the liver into glucose and d) relaxation
can suppress ACTH and glucorticoids in the adrenal
The Decreased Blood Sugar Levels of Type 2 Diabetes Mellitus Patients with Progressive Muscle Technique
193

cortex so that it can suppress the formation of new
glucose by the liver so as to reduce blood sugar levels.
4 CONCLUSION
Based on the results of the statistical tests and the
discussion above, it can be concluded that there is an
effect of progressive muscle relaxation techniques on
reducing blood sugar levels in type 2 diabetes
mellitus patients at GRANDMED Lubuk Pakam
Hospital in 2019:
 Average blood sugar level results before
progressive muscle relaxation techniques from 10
respondents with type 2 diabetes mellitus patients
with a result of 244 mg / dl.
 Average blood sugar level results after
progressive muscle relaxation techniques from 10
respondents with type 2 diabetes mellitus patients
with a yield of 201 mg / dl.
 There is an effect of progressive muscle relaxation
techniques on reducing blood sugar levels in
patients with type 2 diabetes mellitus. Based on
the results of statistical tests using paired t-test, it
shows that the p value is 0.001, which means the
p value <of α = 0.05.
ACKNOWLEDGEMENT
Thanks to:
 Chancellor of the Medical Institute Medistra
Lubuk Pakam who has provided financial
support and facilities so that research can be
carried out properly and smoothly
 All patients who have agreed to be research
samples
 Director of the Grandmed Lubuk Pakam Hospital
who has given permission to carry out this
research
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