E:\IBUK\NERS DESEMBER 2021\1--j 271Saudah, Lestari, Lukita, Acob, The Effectiveness of Virgin Coconut Oil on the Decrease of ... The Effectiveness of Virgin Coconut Oil on the Decrease of Blood Glucose Levels on Gestational Diabetes Mellitus Noer Saudah1, Indah Lestari2, Catur Prasastia Dewi Lukita3, Sahrir Sillehu4, Joel Rey U. Acob5 1,2,3Nursing Department, Institute of Health Science Bina Sehat Mojokerto, Indonesia 4Nursing Department, Institute of Health science Maluku Husada Seram Maluku, Indonesia 5Faculty of Nursing, Visayas State University Philiphine, Philiphine JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 21/08/2021 Accepted, 02/12/2021 Published, 15/12/2021 Keywords: Virgin Coconut Oil, Blood Glucose Level, Gestational Diabetes Mellitus, Hypoglyicemic Article Information Abstract Gestational Diabetes Mellitus (GDM) was medical complication that occurs during pregnancy and caused preterm labor. Efforts reduce blood glucose levels and improve pancreatic performance must be safe both for mother and fetus. The research aimed to prove VCO can reduce blood glucose levels in GDM. The research design was quasi-experimental with one group pre-test and post-test. The research started on March to September 2020. The popu- lation was pregnant mother with GDM from two hospitals in Mojokerto East Java. The sample was 46 respondents with purposive sampling. The treat- ment given was VCO at a dose of 5 ml, 6 times a day and lowcarb diet. The instrument used to measure the fasting blood glucose was glucose stick. The data was analyzed with paired t-test. The result showed blood glucose levels before intervention average of 155.19 mg/dL and after 153.50 mg/dL. The t-test value 14.442 and p value 0.000 which meant that VCO and low carb diet was more effective in reducing blood glucose levels on GDM. The ad- ministration of VCO with a low carb diet is an effort to restrict glucose intake in the body without hypoglycemia. It is safe to use for both mother and fetus as an alternative non-pharmacological therapy on GDM and prevent preterm labor. © 2021 Journal of Ners and Midwifery 271 Correspondence Address: Institute of Health Science Bina Sehat Mojokerto – East Java, Indonesia P-ISSN : 2355-052X Email: noersaudah15@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p271–275 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://doi.org/10.26699/jnk.v8i3.ART.p271-275 https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p271-275&domain=pdf&date_stamp=2021-12-26 272 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 271–275 INTRODUCTION Diabetes mellitus in pregnancy (Gestational Diabetes Mellitus abbreviated as GDM) is a nor- mal pregnancy accompanied by an increase in in- sulin resistance (pregnant women fail to maintain euglycemia). The risk factors for GDM are a fam- ily history of DM, obesity, and glycosuria. This GDM increases the incidence of preeclampsia so that babies are born preterm and neonatal morbidity, for example hypoglycemia, jaundice, polycythemia, and macrosomia (Setyorogo et.al., 2013). This happens because gestation diabetes mellitus secretes greater insulin and stimulates the growth of the baby and macrosomia. The frequency of about 3-5% and the risk of the mothers increasing to become DM in the future (Setyorogo et.al., 2013). In Indonesia, the prevalence of GDM is around 1.9–3.6% and about 40-60 women who have ex- perienced GDM in postpartum follow-up will de- velop Diabetes Mellitus or impaired glucose toler- ance. Incident of GDM increased in pregnant women with risk factors such as increasing body weight during pregnancy >0.5 kg/week, age more than 25 years, history of family DM, GDM history, and ethnicity (Soelistijo et.al., 2015). Risk factors for women with GDM are women diagnosed with gestational diabetes with 17% -63% of type 2 dia- betes within 5-16 years in ethnic groups different (Daundasekara et al., 2017). Anti-diabetic medicine is drugs work to help enter glucose into cells, so that glucose levels in the blood decreases (Setyorogo et.al., 2013). But this mechanism does not repair cell damage in produc- ing insulin and does not help receptors in binding to insulin. The alternative that is conserved in this study is Virgin Coconut Oil (VCO). VCO is a type of fat that can be consumed by pregnant women with dia- betes mellitus which have no impact to fetal growth and development (Purnamasari et.al., 2013). VCO contains saturated fat from coconuts that can be consumed by people with diabetes mellitus. VCO fat will regulate blood glucose levels and improve the work system of the pancreas that supplies insu- lin in the body. The body will gain energy due to the pancreatic gland being able to convert glucose to energy. In a normal body, insulin functions to convert glucose into energy. VCO contains high chain saturated fatty acids (medium chain fatty acids or MCFA), especially lauric acid with a con- tent of between 43 - 53% of total fatty acids. The presence of MCFA has a dual role, which can in- duce insulin secretion and improve insulin function. In contrast to other fats, MCFA in VCO does not experience deposition during circulation in the blood- stream, but directly to the liver which will soon be converted into 100% energy (Kabisch et al., 2018). Giving VCO with a low carb diet is an attempt to restrict glucose levels in the body. The role of energy sources due to glucose (low carb) restric- tion will be replaced by VCO so that pregnant women with GDM are fulfilled by their caloric needs. VCO is proven to be an antidiabetic alter- native (Iranloye et.al., 2013). The intake of coco- nut oil will soon be converted into energy and not stored as body fat so that it has a very positive ef- fect on weight loss for people with diabetes melli- tus (Kabisch et al., 2018). Intake of coconut oil is also proven to increase the absorption of minerals Ca and Mg if there are deficiencies of both minerals in the body, which is a condition that is often encountered in people with diabetes mellitus. Calcium supplementation can in- crease insulin sensitivity in certain populations, while magnesium supplementation can increase insulin secretion and or increase insulin sensitivity and pe- ripheral glucose intake. In addition, VCO supple- mentation can also improve antioxidant status. The aim of this study is to prove that VCO and low carb diets can reduce blood glucose levels in GDM. So that it can prevent babies born preterm and can reduce neonatal mortality. METHOD Research design used quasi experiments with one group pre-test and post-test design. Population were pregnant with GDM from two hospitals in Mojokerto East Java. There were 46 respondents involved in this research. The sampling technique used purposive sampling. The treatment given was VCO at a dose of 5 ml, 6 times a day and lowcarb diet. Variable research were VCO and blood glu- cose. The instrument used to measure the fasting blood glucose was glucose stick before and after treatment on day 21th. Analysis of data used paired t-test with a 0.05 level of confidence (Setiadi, 2013). The willingness of respondents was stated with in- formed consent and the research had gone through the ethical test from College of Health Science Maluku Husada. The time of research is starting from March to September 2020. 273Saudah, Lestari, Lukita, Acob, The Effectiveness of Virgin Coconut Oil on the Decrease of ... Based on Table 1, it showed, there were 18 respondents (39.2%) age >35 years. Statistic data shows there were 28 respondents first pregnancy (60.9%). The statistical data shows that there were 26 respondents (56.6%) whose gestational age be- tween 28 until 31 weeks. Based on Table 2 mean fasting blood glucose levels before treatment VCO and low carb diets is 155.19 mg/dL and mean fasting blood glucose lev- els after treatment is 151.50 mg/dL. It is mean blood glucose levels after treatment lower than before treatment. Based on data analysis in Table 3 used paired t-test with value correlation p= 0.000. This means the effect of VCO and low carb diets on decrease fasting blood glucose levels in gestational diabetes mellitus. Paired t-test shows value p= 0.000 ( 0.05) this means a significant difference between fasting blood glucose levels before and after given VCO and low carb diets. Combination of VCO and low carb diets could decrease blood glucose in preg- nant women with diabetes mellitus. Characteristic Indicator Treatment  % Age 20-25 years 8 17.4 26-30 years 6 13 31-35 years 14 30.4 >35 years 18 39.2 Parity 1th 28 60.9 2th 12 26.1 3th 6 13 Age gestation 28-31 weeks 26 56.5 32-35 weeks 20 43.5 36-40 weeks 0 0 Total 46 100 Resource : Primary data, 2020 Table 1 The characteristic of Respondent Based on Age, Parity and Age Gestation RESULT The Characteristic of Responden Variable Paired samples correlation Paired sampel t- test correlation significant t-tes Sig. (2-tailed) Blood glucose before and after 0.989 0.000 14.224 0.000 Table 3 Result Paired t-test DISCUSSION Pregnant women over the age of 35 years have a higher risk of developing gestational diabetes due to the influence of pregnancy hormones and risk for preterm labor (Saudah et al., 2015). The first- pregnancy at the age of >35 years are at risk of pregnancy disorders example preeclampsi, gesta- tional diabetes or other disorders (Joeliantina et al., 2019). Statistic data shows there were 28 respon- dents first pregnancy (60.9%). This shows that the first pregnancy at non-productive age >35 years is very risky to the safety of the mother and fetus. It is very important to increase the knowledge and understanding women reproductive and families about gestational age before 35 years. This can prevent the high rate of pregnancy with diabetes mellitus (Tebbani et.al., 2017). There were 26 re- spondents (56.6%) whose gestational age between 28 until 31 weeks. Gestational diabetes mellitus can occur at any gestational age, but usually occurs between 24 and 30 weeks of gestation (Purnamasari et.al., 2013; Soliman et.al., 2018). Examinations Variable Mean Standard Deviation Blood glucose before treatment 155.19 11.365 Blood glucose after treatment 151.50 11.788 Table 2 Results of Descriptive Analysis of Blood Glucose Levels Before and After Given VCO and Lowcarb Diets 274 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 271–275 that must be done to determine the presence of gestational diabetes in pregnant women after fast- ing 8-14 hours and plasma blood sugar after 2 hours of fasting. Diabetes Mellitus in pregnancy causes com- plications in pregnancy and will prevent fetal well- being which can lead to preterm labor. Besides, it can cause metabolic disorders in the mother’s body. Anti-diabetic drugs for a longer period of time may have undesirable effects on both pregnant women and the fetus. In addition, drug dependence will have an impact on the economy. The solution to this prob- lem is in the form of natural anti-diabetic foods with the lowest pain effects and low costs are the most desirable. VCO, contains medium chain saturated fatty acids (MCFA), especially lauric acid with a content of between 43-53% of total fatty acids. Lifestyle intervention reduced the incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as compared with placebo; the lifestyle intervention was more effective than metformin. To prevent one case of diabetes during a period of three years, 6 from 9 persons would have to receive metformin. Person changes and treatment with metformin in persons at high risk The intervention lifestyle was more ef- In this research gestational diabetes mellitus were given VCO and low carb. Giving VCO with a low carb diet is an attempt to restrict glucose lev- els in the body. The role of energy sources due to glucose (low carb) restriction will be replaced by VCO so that gestational diabetes mellitus are ful- filled by their caloric needs. VCO is proven to be Beside that VCO is an antioxidant can increase sen- sitivity to insulin or vice versa can also reduce insu- lin resistance and repair damage to pancreatic beta cells with the process of reactive oxygen (ROS) in diabetic patients. Gestational diabetes has various impacts on the mother and fetus, including increasing the risk of the mother experiencing preterm labor. In addition, large gestational age and macrosomia are often found in infants born to mothers with gestational diabetes. This can be prevented by carrying out various interventions before and during pregnancy. The indicator of the success of prevention is the results of examination of fasting blood glucose lev- els <91 mg/dL and blood sugar after meals <200 mg/dL (WHO, 2013). VCO is an antioxidant can increase sensitivity to insulin or vice versa can also reduce insulin re- sistance and repair damage to pancreatic beta cells with the process of reactive oxygen (ROS) in dia- betic patients (Kabisch et al., 2018; Stocker et al., 2019). Low carb diet is an attempt to restrict glu- cose levels in the body. The role of energy sources due to glucose (low carb) restriction will be replaced by VCO so that pregnant women with diabetes mellitus are fulfilled by their caloric needs (ADA, 2015). CONCLUSION VCO and a low carb diet is way more effec- tive in reducing blood glucose in Gestational Diabe- tes Mellitus. Low carb diet can restrict glucose in- take in the body without hypoglycemia because the role of energy sources were replaced by VCO. It is safe to use for both mother and fetus as an alter- native non-pharmacological therapy on GDM and prevent preterm labor. 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