presus ikk pipit
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PRESENTASI KASUS
DIABETES MELLITUS DISERTAI ATHRALGIA DAN CEPHALGIA PADA WANITA
PARUH BAYA DENGAN KEKHAWATIRAN TERHADAP PEKERJAAN DAN
PENYAKITNYA
Diajukan Untuk Memenuhi Sebagian Syarat
Mengikuti Ujian Kepaniteraan Klinik Bagian Ilmu Kedokteran Keluarga
di PUSKESMAS NGAMPIAN !"G!AKA#$A
Disusun oleh:
PIPIT PUSPITA DEWI
2!"!#$
Di%&u'%n 'e(%)%:
)*+ Ti,ie' Hi)%-%,i. M+Kes
B%/i%n Il0u Ke)o',e*%n Kelu%*/%
1%'ul,%s Ke)o',e*%n )%n Il0u Keseh%,%n
Unie*si,%s Muh%00%)i-%h Yo/-%'%*,%
2!3
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HALAMAN PENGESAHAN
P*esen,%si K%sus
DIABETES MELLITUS DISERTAI ATHRALGIA DAN CEPHALGIA PADA
WANITA PARUH BAYA DENGAN KEKHAWATIRAN TERHADAP PEKERJAAN
DAN PENYAKITNYA
Diajukan Untuk Memenuhi Sebagian Syarat
Mengikuti Ujian Kepaniteraan Klinik Bagian Ilmu Kedokteran Keluarga
di Pu%ke%ma% Ngampilan !ogyakarta
Disusun oleh:
PIPIT PUSPITA DEWI
2!"!#$
Di(*esen,%si'%n (%)% :
H%*i. T%n//%l : R%4u. 2 Dese04e* 2!3
Te0(%, : Pus'es0%s N/%0(il%n Yo/-%'%*,%
Men-e,u&ui.
Dosen Pe04i04in/ Unie*si,%s Do',e* Pe04i04in/ Pus'es0%s
)*+ Ti,ie' Hi)%-%,i. M+Kes )*+ Kh%i*%ni 1i,*i
Men/e,%hui.
Ke(%l% Pus'es0%s N/%0(il%n
)*+ Din% K%*,i'% S%*i
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KATA PENGANTAR
Pu&i s-u'u* '%0i (%n&%,'%n 'e(%)% All%h SWT -%n/ ,el%h 0eli0(%h'%n
'%*uni% )%n *%h0%,5N-% sehin//% (enulis )%(%, 0en-eles%i'%n (*esen,%si '%sus
4%/i%n Il0u Ke)o',e*%n Kelu%*/% -%n/ 4e*&u)ul DIABETES MELLITUS DISERTAI
ATHRALGIA DAN CEPHALGIA PADA WANITA PARUH BAYA DENGAN
KEKHAWATIRAN TERHADAP PEKERJAAN DAN PENYAKITNYA+ Penulis
0en-%)%*i seles%in-% (en-usun%n l%(o*%n ini ,i)%' le(%s )%*i 4%n,u%n 4e*4%/%i (ih%'.
un,u' i,u (enulis 0en-%0(%i'%n u6%(%n ,e*i0% '%sih 'e(%)% :
!+ )*+ Din% K%*,i'%. sel%'u Ke(%l% Pus'es0%s N/%0(il%n2+ )*+ Kh%i*%ni 1i,*i. sel%'u )o',e* (e04i04in/ (us'es0%s"+ )*+ Ti,ie' Hi)%-%,i. M+Kes. sel%'u )osen (e04i04in/ unie*si,%s$+ )*+ Nu*. )*+ Ani,% se*,% selu*uh s,%7 )%n '%*-%8%n Pus'es0%s N/%0(il%n3+ Re'%n5*e'%n Co5Assis,ensi )%n selu*uh (ih%' ,e*'%i, %,%s 4%n,u%n )%n
'e*&%s%0%n-%
9+ Se0u% (ih%' -%n/ ,el%h 0en)u'un/ (enulis%n l%(o*%n ini
D%l%0 (enulis%n l%(o*%n ini (enulis 0%sih 0e0ili'i 4%n-%' 'e'u*%n/%n+
K*i,i' )%n s%*%n s%n/%, )ih%*%('%n un,u' 0en-e0(u*n%'%n l%(o*%n ini+
Yo/-%'%*,%. Noe04e* 2!3
Pen-usun.
Pi(i, Pus(i,% De8i. S+Ke)
DAFTAR ISI
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KATA PENGANTAR++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BAB I PENDAHULUAN++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++ +++++++++++
A+ LATAR BELAKANG++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
B+ RUMUSAN MASALAH++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
C+ TUJUAN PENULISAN+++++++++++++++++++++++++++++++++++++++++++++++++Error! Bookmark not defined.
D+ MAN1AAT PENULISAN+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BAB II TINJAUAN PUSTAKA+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
A+ DIABETES MELITUS++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
!+ De7inisi+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
2+ E(i)e0iolo/i++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
"+ 1%',o* *esi'o+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
$+ 'l%si7i'%si+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
3+ P%,o7isiolo/i+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
9+ Di%/nosis++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+ Pen%,%l%'s%n%%n+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
#+ Ko0(li'%si+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
B+ ATRHALGIA+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
C+ CEPHALGIA+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BAB III PRESENTASI KASUS+++++++++++++++++++++++++++++++++++++++++++Error! Bookmark not defined.
A+ IDENTITAS PASIEN+++++++++++++++++++++++++++++++++++++++++++++++++Error! Bookmark not defined.
B+ ANAMNESIS+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++Error! Bookmark not defined.
C+ PEMERIKSAAN 1ISIK++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
D+ PEMERIKSAAN PENUNJANG+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
E+ H;ME
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9+ Geno/*%0+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
+ 1%0il- M%(++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
#+ Ben,u' Kelu%*/%+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
=+ 1%0il- Li7e 6-6le+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
!+ 1%0il- APGAR++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
!!+ 1%0il- SCREEM++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
!2+ 1%0il- li7e Line++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
!"+ Pe*il%'u Hi)u( Be*sih )%n Seh%,++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
1+ DIAGN;SIS KERJA+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
G+ PENATALAKSANAAN++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
BAB I
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Di%4e,es Meli,us >DM? 0e*u(%'%n su%,u 'elo0(o' (en-%'i,
0e,%4oli6 )en/%n '%*%',e*is,i' hi(e*/li'e0i% -%n/ ,e*&%)i '%*en% 'el%in%n
se'*esi insulin. 'e*&% insulin %,%u 'e)u%5)u%n-% >A0e*i6%n Di%4e,es
Asso6i%,ion. 2!?
Ju0l%h (en)u)u' )uni% -%n/ s%'i, )i%4e,es 0elli,us 6en)e*un/
0enin/'%, )%*i ,%hun 'e ,%hun+ H%l ini 4e*'%i,%n )en/%n &u0l%h (o(ul%si
0enin/'%,. (ol% hi)u(. (*e%lensi o4esi,%s 0enin/'%, )%n 'e/i%,%n 7isi'
'u*%n/ >S0el,@e* B%*e. 22?+ L%(o*%n )%*i WH; 0en/en%i s,u)i (o(ul%si
DM )i 4e*4%/%i Ne/%*%. &u0l%h (en)e*i,% )i%4e,es 0elli,us (%)% ,%hun 2
)i In)onesi% 0ene0(%,i u*u,%n 'e5$ ,e*4es%* )%l%0 &u0l%h (en)e*i,% )i%4e,es
0elli,us )en/%n (*e%lensi #.$ &u,% &i8%
S%%, ini. 4%n-%' o*%n/ 0%sih 0en%n//%( (en-%'i, Di%4e,es Melli,us
0e*u(%'%n (en-%'i, o*%n/ ,u% %,%u (en-%'i, -%n/ h%n-% ,i04ul '%*en% 7%',o*
'e,u*un%n+ N%0un. se,i%( o*%n/ )%(%, 0en/i)%( Di%4e,es Melli,us 4%i' ,u%
0%u(un 0u)%+ Tin//in-% '%)%* /lu'os% )%*%h se6%*% ,e*us 0ene*us %,%u
4e*'e(%n&%n/%n )%(%, 0en-e4%4'%n 'o0(li'%si )i%4e,es+ Be*)%s%*'%n
(eneli,i%n Mu**%- >2? ,i%( != 0eni, %)% s%,u o*%n/ )i )uni% -%n/ ,e*'en%
s,*o'e. %)% s%,u o*%n/ -%n/ 4u,% )%n %)% s%,u o*%n/ )i )uni% )i%0(u,%si %'i4%,
'o0(li'%si Di%4e,es Melli,us >M%ul%n%. 2=?+ Be*4%/%i 'o0(li'%si )%(%,
,e*&%)i &i'% (en%,%l%'s%n%%n Di%4e,es Melli,us ,i)%' o(,i0%l
Menu*u, )%,% Rise, Keseh%,%n D%s%* >RIKESDAS. 2? (*e%lensi
)i%4e,es 0eli,us )i P*o(insi D%e*%h Is,i0e8% Yo/-%'%*,% >DIY? 0en6%(%i !.!
-%n/ ,e*)i%/nos% oleh ,en%/% 'eseh%,%n )%n !.9 ,e*)i%/nos% )en/%n
/e&%l% %s0% )%n &%n,un/ %,%u DM )i,e,%('%n (e*n%h )i)i%/nosis 0en)e*i,%
(en-%'i,+ Di%/nosis DM )i,e,%('%n &i'% 0en)e*i,% %,%u 0en/%l%0i /el%&%
)i%4e,es+ P%sien DM )en/%n *%8%, &%l%n )i *u0%h s%'i, sel%0% ,%hun 2
se4es%* ! 9=3 > ="? 0enu*u, l%(o*%n Din%s Keseh%,%n P*o(insi DIY
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Be*)%s%*'%n l%,%* 4el%'%n/ -%n/ )i,e0u'%n )i%,%s. 0%'% 0%s%l%h -%n/ )%(%,
)i*u0us'%n %)%l%h:!+ B%/%i0%n% (ene/%'%n )i%/nosis se*,% (en%,%l%'s%n%%n (en-%'i, Di%4e,es
Meli,us ,i(e II 2+ B%/%i0%n% (*insi(5(*insi( (el%-%n%n 'e)o',e*%n 'elu%*/% )%l%0
(en%n/%n%n 0%s%l%h iniC. TUJUAN PENULISAN
!+ Tu&u%n u0u0L%(o*%n ini )isusun un,u' 0e0enuhi se4%/i%n s-%*%, u&i%n Ke(%ni,e*%%n
Klini' Il0u Ke)o',e*%n Kelu%*/% Unie*si,%s Muh%00%)i-%h
Yo/-%'%*,%+2+ Tu&u%n 'husus
Un,u' 0en/e,%hui )%n 0e0%h%0i ,en,%n/ (en-%'i, Di%4e,es Meli,us se*,%
0ene*%('%n (*insi(5(*insi( (el%-%n%n 'e)o',e*%n 'elu%*/% )%l%0
0en/%,%si 0%s%l%h (en-%'i, )%l%0 'elu%*/%+D. MANFAAT PENULISAN
!+ M%n7%%, 4%/i Pus'es0%s
Se4%/%i s%*%n% 4%/i (e*en6%n%%n (enin/'%,%n (el%-%n%n 'eseh%,%n
'e(%)% 0%s-%*%'%, )%n 0en/o(,i0%l'%n (e*%n%n Pus'es0%s
Dih%*%('%n '%*-% ,ulis ini )%(%, 0e04e*i'%n su04%n/%n
(e0i'i*%n se4%/%i u(%-% un,u' 0en/u*%n/i %n/'% 0o*4i)i,%s )%n
'o0(li'%si %'i4%, )i%4e,es 0eli,us2+ M%n7%%, 4%/i Penulis
Se4%/%i s%*%n% (e04el%&%*%n )%n (en/%l%0%n )%l%0 u(%-%
(enin/'%,%n (el%-%n%n 'eseh%,%n )en/%n 0ene*%('%n il0u5il0u
'e)o',e*%n 'elu%*/%
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BAB II
TINJAUAN PUSTAA
A. DIABETES MELLITUS
" Pen#ertian
Di%4e,es Melli,us >DM? 0e*u(%'%n s%l%h s%,u 'elo0(o' (en-%'i,
0e,%4oli6 -%n/ )i,%n)%i oleh hi(e*/li'e0i% '%*en% /%n//u%n se'*esi
insulin. 'e*&% insulin. %,%u 'e)u%n-%+ Ke%)%%n hi(e*/li'e0i% '*onis )%*i
)i%4e,es 4e*hu4un/%n )en/%n 'e*us%'%n &%n/'% (%n&%n/. /%n//u%n 7un/si.
)%n 'e/%/%l%n 4e*4%/%i o*/%n. ,e*u,%0% 0%,%. /in&%l. s%*%7. &%n,un/. )%n
(e04uluh )%*%h >ADA. 2!2?+ WH; 0e*u0us'%n 4%h8% DM 0e*u(%'%n
su%,u 'u0(ul%n (*o4le0% %n%,o0i' )%n 'i0i%8i %'i4%, )%*i se&u0l%h
7 , )i )i) , & l h ) 7i i i i li 4 l , , l ,i
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P%)% '%sus )i%4e,es 0elli,us. =5=3 %)%l%h '%sus DM ,i(e II
>ADA.2!2?+ DM ,i(e II &u/% se*in/ )ise4u, se4%/%i Non In)e(en)en,
insulin Di%4e,es Melli,us >NIDDM?. '%*en% (en)e*i,% DM ,i(* II ,i)%'
4e*/%n,un/ insulin un,u' )%(%, 4e*,%h%n hi)u(+ Di%4e,es ini 0eli(u,i
in)ii)u -%n/ 0e0ili'i *esis,ensi insulin )%n 4i%s%n-% 0en/%l%0i
)e7isiensi insulin *el%,ie %,%u 'e'u*%n/%n insulin (%)% %8%ln-% )%n
se(%n&%n/ 0%s% hi)u(n-% sehin//% in)ii)u ini ,i)%' 0e04u,uh'%n
(en/o4%,%n insulin un,u' 4e*,%h%n hi)u(+ A)% 4%n-%' 'e0un/'in%n -%n/
0en&%)i (en-e4%4 ,i04uln-% )i%4e,es ini+ W%l%u(un e,iolo/in-%
s(esi7i'n-% ,i)%' )i'e,%hui. ,e,%(i (%)% )i%4e,es ,i(e ini ,i)%' ,e*&%)i
)es,*u'si sel 4e,%+ Ke4%n-%'%n (%sien -%n/ 0en)e*i,% DM ,i(e ini
0en/%l%0i o4esi,%s. )%n o4esi,%s )%(%, 0en-e4%4'%n 4e4e*%(% *esis,ensi
insulin >ADA.2$?
$" E%idemio&o#i
Di%4e,es 0elli,us ,el%h )i'%,e/o*i'%n se4%/%i (en-%'i, /lo4%l oleh
;*/%nis%si Keseh%,%n Duni% %,%u Wo*l) He%l,h ;*/%ni@%,ion >WH;?+
Ju0l%h (en)e*i,% DM ini 0enin/'%, )i se,i%( Ne/%*%+ Be*)%s%*'%n )%,%
)%*i WH; >29?. )i(e*'i*%'%n ,e*)%(%, !! &u,% o*%n/ )i )uni% 0en)e*i,%
)i%4e,es (%)% ,%hun 2 )%n )i(*e)i'si %'%n 0enin/'%, 0en&%)i "99 &u,%
(en)e*i,% (%)% ,%hun 2"+ Se'i,%* $.# &u,% o*%n/ )i )uni% ,el%h 0enin//%l
%'i4%, DM+ se,en/%h )%*i (en)e*i,% DM ini ,i)%' ,e*)i%/nosis
>Pu*n%0%s%*i.2=?Menu*u, l%(o*%n WH;. In)onesi% 0ene0(%,i u*u,%n 'e e0(%,
,e*4es%* )%*i &u0l%h (en)e*i,% )i%4e,es 0eli,us )en/%n (*e%lensi #.9
)%*i ,o,%l (en)u)u' se)%n/'%n (osisi u*u,%n )i%,%sn-% -%i,u In)i%. Chin%
)%n A0e*i'% Se*i'%, )%n WH; 0e0(*e)i'si 'en%i'%n &u0l%h
(en-%n)%n/ DM )i In)onesi% )%*i #.$ &u,% (%)% ,%hun 2 0en&%)i
se'i,%* 2! " &u,% (%)% ,%hun 2" Sen%)% )en/%n WH; In,e*n%,ion%l
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&u0l%h (en-%n)%n/ DM )%*i &u,% (%)% ,%hun 2= 0en&%)i !2 &u,% (%)%
,%hun 2"+ D%*i l%(o*%n ,e*se4u, 0enun&u''%n (enin/'%,%n &u0l%h
(en-%n)%n/ DM se4%n-%' 25" '%li li(%, (%)% ,%hun 2"
>Pu*n%0%s%*i.2=?
'" Faktor Re(iko Dia)ete( Me&&it*(
1%',o* *isi'o DM Ti(e II %n,%*% l%in : *i8%-%, 'elu%*/% 0en)e*i,%
)i%4e,es >o*%n/ ,u% %,%u s%u)%*% 0en)e*i,% DM ,i(e II?. o4esi,%s >BMI
23 '/02?. 'u*%n/ 'e4i%s%%n %',ii,%s 7isi'. *%se,ni' >A7*i'%5%0e*i6%.
A0e*i'% His(%ni'. A0e*i'% %sli. Asi%5A0e*i'%?. se4elu0n-%
)ii)en,i7i'%si'%n '%)%* /lu'os% )%*%h (u%s% ,e*/%n//u %,%u ,ole*%nsi
/lu'os% ,e*/%n//u >TGT?. *i8%-%, )i%4e,es 0elli,us /es,%sion%l >DMG?
%,%u 4%-i l%hi* $ '/. hi(e*,ensi >,e'%n%n )%*%h !$=00H/. HDL F
"3 0/)l )%n ,*i/lise*i)% 23 0/)l. sin)*o0 o%*iu0 (oli'is,i' %,%u
%'%n,osis ni/*%6%ns )%n *i8%-%, (en-%'i* %s6ul%* >Po8e*s.23?
+" &a(ifika(i etio&o#i dia)ete( me&&it*(
!+ Di%4e,es ,i(e ! >)es,*u'si sel 4e,%. 4i%s%n-% 0en-e4%4%'%n )e7isiensi
insulin %4solu,?:
5 )i(e*%n,%*%i oleh sis,e0 i0un.
5 i)io(%,i'
2+ Di%4e,es ,i(e 2 >4e*%*i%si 0ul%i -%n/ ,e*u,%0% )o0in%n *esis,ensi
insulin )ise*,%i )e7isiensi insulin *el%,i7 s%0(%i -%n/ ,e*u,%0% )e7e'
se'*esi insulin )ise*,%i *esis,ensi insulin?
"+ Di%4e,es ,i(e l%in
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o De7e' /ene,i' 'e*&% insulin
M%,u*i,- ;nse, Di%4e,es o7 ,he Youn/ >M;DY?
DNA 0i,o'on)*i%
o Pen-%'i, e'so'*in (%n'*e%s
(%n'*e%,i,is
,u0o* atau(%n'*e%,e',o0i
(%n'*e%,o(%,i 7i4*o'%l'ulus
o En)o'*ino(%,i
%'*o0e/%li
sin)*o0% Cushin/
7eo'h*o0osi,o0%
hi(e*,i*oi)is0e
o K%*en% o4%, %,%u @%, 'i0i%
%6o*. (en,%0i)in. %s%0 ni'o,in%,
/lu'o'o*,i'oi). ho*0on ,i*oi)
,i%@i). )il%n,in. in,e*7e*on5%l7%. )ll
o In7e'si
*u4el% 'on/eni,%l i*us si,o0e/%lo >CM
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%n,i4o)i %n,i insulin
o Sin)*o0 /ene,i' l%in -%n/ 4e*'%i,%n )en/%n DM
sin)*o0 Do8n. Sin)*o0 Kleine7el,e*. sin)*o0 Tu*ne*.
)ll
$+ Di%4e,es 0elli,us /es,%sion%l >DMG? >ADA. !==?
," Patofi(io&o#i
Insulin )ih%sil'%n oleh (%n'*e%s )%n )i )%l%*nn-% ,e*)%(%,
'u0(ul%n sel -%n/ 4e*4en,u' se(e*,i (ul%u (%)% (e,%. '%*en% i,u
)ise4u, (ul%u5(ul%u L%n/e*h%ns -%n/ 4e*isi sel 4e,%
-%n/0en/elu%*'%n ho*0on insulin -%n/ s%n/%, 4e*(e*%n )%l%0
0en/%,u* '%)%* /lu'os% )%*%h+ Insulin -%n/ )i'elu%*'%n oleh sel 4e,%
,%)i )%(%, )ii4%*%,'%n se4%/%i %n%' 'un6i -%n/ )%(%, 0e04u'% (in,u
0%su'n-% /lu'os% 'e )%l%0 sel. un,u' 'e0u)i%n )i )%l%0 sel
/lu'os%,e*se4u, )i0e,%4olis%si'%n 0en&%)i ,en%/%+ Bil% insulin ,i)%'
%)%. 0%'% /lu'os% )%l%0 )%*%h ,i)%' )%(%, 0%su' 'e )%l%0 sel
)en/%n %'i4%, '%)%* /lu'os% )%l%0 )%*%h 0enin/'%,+ Ke%)%%n inil%h
-%n/ ,e*&%)i (%)% )i%4e,es 0eli,us ,i(e ! >Su-ono.23?+P%)% )i%4e,es 0eli,us ,i(e 2 &u0l%h insulin no*0%l. 0%l%h
0un/'in le4ih 4%n-%' ,e,%(i &u0l%h *ese(,o* insulin -%n/ ,e*)%(%,
(%)% (e*0u'%%n sel -%n/ 'u*%n/+ Rese(,o* insulin ini )%(%,
)ii4%*%,'%n se4%/%i lu4%n/ 'un6i (in,u 0%su' 'e )%l%0 sel+ P%)%
'e%)%%n ,%)i &u0l%h lu4%n/ 'un6in-% -%n/ 'u*%n/. hin//% 0es'i(un
%n%' 'un6in-% >insulin? 4%n-%'. ,e,%(i '%*en% lu4%n/ 'un6in-%
>*ese(,o*? 'u*%n/. 0%'% /lu'os% -%n/ 0%su' sel %'%n se)i'i,. sehin//%
sel %'%n 'e'u*%n/%n 4%h%n 4%'%* >/lu'os%? )%n /lu'os% )i )%l%0
(e04uluh )%*%h 0enin/'%,+ Den/%n )e0i'i%n 'e%)%%n ini s%0%
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,in//i %,%u no*0%l+ P%)% )i%4e,es 0eli,us ,i(e 2 &u/% 4is% )i,e0u'%n
&u0l%h insulin 6u'u( %,%u le4ih ,e,%(i 'u%li,%sn-%'u*%n/ 4%i'.
sehin//% /%/%l 0e04%8% /lu'os% 0%su' 'e )%l%0 sel+ Di s%0(in/
(en-e4%4 )i%,%s. )i%4e,es 0eli,us &u/% 4is% ,e*&%)i %'i4%, /%n//u%n
,*%ns(o*, /lu'os% )i )%l%0 sel sehin//%/%/%l )i/un%'%n se4%/%i 4%h%n
4%'%* un,u' 0e,%4olis0e ene*/- >Su-ono.23?+P%)% )i%4e,es 0eli,us ,i(e 2 &u0l%h sel 4e,% 4e*'u*%n/ s%0(%i
359 )%*i no*0%l+ Ju0l%h sel %l7% 0enin/'%,+ Y%n/ 0en-olo'
%)%l%h %)%n-% (enin/'%,%n &u0l%h &%*in/%n %0iloi) (%)% sel 4e,% -%n/
)ise4u, %0ilin+ B%i' (%)% )i%4e,es 0eli,us ,i(e ! 0%u(un (%)%
)i%4e,es 0eli,us ,i(e 2 '%)%* /lu'os %)%*%h &el%s 0enin/'%, )%n 4il%
'%)%* i,u 0ele8%,i 4%,%s %04%n/ /in&%l. 0%'% /lu'os% i,u %'%n'elu%*
0el%lui u*in+ Mun/'in inil%h se4%4n-% (en-%'i, ini &u/% )ise4u,
(en-%'i, 'en6in/ 0%nis >Su-ono.23?+
P%)% Di%4e,es Ti(e II. ,e*)%(%, 2 'e%)%%n -%n/ 0en-e4%4'%n
hi(e*/li'e0i. -%i,u
!+ Resis,ensi Insulin
Penu*un%n 'e0%0(u%n insulin un,u' 4e*%'si (%)% &%*in/%n
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(%)% DM ,i(e II )%n 0e*u(%'%n 'o04in%si )%*i 'e*en,%n%n /ene,i'
)%n o4esi,%s+ Resis,ensi insulin 0en//%n//u (en//un%%n /lu'os% oleh
&%*in/%n -%n/ sensi,i7 insulin )%n 0enin/'%,'%n 'elu%*%n /lu'os%
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P%)% (*insi(n-% *esis,en insulin )%(%, ,e*&%)i )i ,in/'%,
*ese(,o* insulin %,%u )i s%l%h s%,u &%lu* sin-%l (%s6%*ese(,o*+ P%)% DM
,i(e 2 &%*%n/ ,e*&%)i )e7e' 'u%n,i,%,i7 )%n 'u%li,%,i7 (%)% *ese(,o*
insulin+ oleh '%*en% i,u. *esis,en insulin )i(e*'i*%'%n ,e*u,%0%
4e*(e*%n )%l%0 (e04en,u'%n sin-%l (%s6% *ese(,o*+ Poli0o*7is0e (%)%
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0ole'ul (os,*e6e(,o* )%(%, 0en-e4%4'%n *esis,ensi insulin+
P%,o/enesis *esis,ensi insulin ini 4e*7o'us (%)% )e7e' sin-%l P!5"5
'in%se. -%n/ 0enu*un'%n ,*%nslo'%si GLUT $ (%)% 0e04*%n (l%s0%.
)i%n,%*% 'el%in%n l%inn-%+ >Po8e*s.23?
As%0 le0%' 4e4%s &u/% 0e04e*i'%n 'on,*i4usi (%)%
(%,o/enesis DM ,i(e 2+ As%0 le0%' 4e4%s 0enu*un'%n %04il%n
/lu'os% (%) %%)i(osi, )%n o,o, se*,% 0enin/'%,'%n 'elu%*%n /u'os%
he(%,i' -%n/ ,e*'%i, )en/%n *esis,ensi insulin+
Penin/'%,%n (*o)u'si /lu'os% )%n le0%' oleh h%,i &u/%
0e04e*i'%n 'on,*i4usi (%)% (%,o/enesis DM ,i(e II+ P%)% DM ,i(e II.
*esis,ensi insulin 0en/%'i4%,'%n 'e/%/%l%n (en/h%04%,%n (*oses
/lu'oneo/enesis oleh h%,i. -%n/0%n% 0en/h%sil'%n ,e*&%)in-%
hi(e*/li'e0i (u%s% )%n (enu*un%n (en-i0(%n%n /li'o/en oleh h%,i
(%)% s%%, (os, (*%n)i%l+ Penin/'%,%n (*o)u'si /lu'os% ,e*&%)i (%)%
%8%l )i%4e,es. -%i,u s%%, su)%h ,e*)%(%, se'*esi insulin -%n/ %4no*0%l
)%n *esis,ensi insulin (%)% o,o, *%n/'%+ Se4%/%i %'i4%, )%*i *esis,ensi
insulin (%)% &%*in/%n le0%'. %s%0 le0%' 4e4%s )i'elu%*'%n )%*i
&%*in/%n le0%' )%n 0en/%'i4%,'%n (enin/'%,%n sin,esis le0%' (%)%
sel5sel h%,i >Po8e*s.2!?
2+ G%n//u%n Se'*esi Insulin
De7e' (%)% se'*esi insulin 4e*si7%, s%0%* )%n se6%*% 'u%n,i,%,i7
'u*%n/ 4e*%*,i &i'% )i44%n)in/'%n )en/%n -%n/ ,e*&%)i (%)% DM ,i(e I+
P%)% %8%l (e*&%l%n%n (en-%'i, DM ,i(e II. se'*esi insulin ,%0(%'n-%
no*0%l )%n '%)%* insulin )%l%0 (l%s0% ,i)%' 4e*'u*%n/+ N%0un (ol%
se'*esi insulin -%n/ 4e*)en-u, )%n osil%,i7 len-%(. )%n 7%se (e*,%0%
se'*esi insulin >-%n/ 6e(%,? -%n/ )i(i6u oleh /lu'os% 0enu*un+
Se6%*% 'ole',i7 h%l ini )%n (en/%0%,%n l%in 0en/is-%*%,'%n
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sin,es% insulin+ N%0un (%)% (e*&%l%n%n (en-%'i, 4e*i'u,n-%. ,e*&%)i
)e7isiensi %4solu, -%n/ *in/%n s%0(%i se)%n/. -%n/ le4ih *in/%n
)i4%n)in/ DM ,i(e I+ Pen-e4%4 )e7isiensi insulin (%)% DM ,i(e II
0%sih 4elu0 se(enuhn-% &el%s+ Be*)%s%*'%n )%,% 0en/en%i he8%n
(e*6o4%%n )en/%n DM ,i(e II. )i(e*'i*%'%n 0ul%50ul% *esis,ensi
insulin 0en-e4%4'%n (enin/'%,%n 'o0(ens%,o*i' 0%ss% sel 4e,% )%n
(*o)u'si insulinn-%+ P%)% 0e*e'% -%n/ 0e0ili'i 'e*en,%n%n /ene,i'
,e*h%)%( DM ,i(e II. 'o0(ens%si ini /%/%l+ P%)% (e*&%l%n%n (en-%'i,
sel%n&u,n-% ,e*&%)i 'ehil%n/%n 2 5 3 sel 4e,%. ,e,%(i &u0l%h ini
4elu0 )%(%, 0en-e4%4'%n 'e/%/%l%n )%l%0 se'*esi insulin -%n/
)i*%ns%n/ oleh /lu'os%+ N%0un ,%0(%'n-% ,e*&%)i /%n//u%n )%l%0
(en/en%l%n /lu'os% oleh sel 4e,%+ D%s%* 0ole'ule* /%n//u%n se'*esi
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>Theeno). 2#?
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u,%0% %0iloi) -%n/ 0en/en)%( ini. se6%*% no*0%l )ih%sil'%n oleh sel
4e,% (%n'*e%s )%n )ise'*esi'%n 4e*s%0% )en/%n insulin se4%/%i
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)ise4%4'%n *esis,ensi insulin (%)% 7%se %8%l DM ,i(e II 0en-e4%4'%n
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isle,+ A0iloi) -%n/ 0en/elilin/i sel 4e,% 0un/'in 0en-e4%4'%n sel
4e,% %/%' *e7*%',e* )%l%0 0ene*i0% sin-%l /lu'os%+ Y%n/ le4ih
(en,in/. %0iloi) 4e*si7%, ,o'si' 4%/i sel 4e,% sehin//% 0un/'in
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se6%*% sele',i7 0eli4%,'%n se'*esi insulin oleh s,i0ul%si /lu'os%+
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DM ,i(e II 0%sih 4elu0 &el%s+ Di(e*'i*%'%n 4%h8% %)% '%l%in%n (%)%
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'e/%/%l%n sel 4e,% (%n'*e%s+ Kon)isi 0e,%4olis0e (%)% (%sien DM
,i(e II se(e*,i hi(e*/li'e0i. se0%'in 4e*e7e' 4u*u' ,e*h%)%(( (ul%u
l%n/e*h%ns (%n'*e%s )%n se0%'in 0e0(e*(%*%h 'on)isi hi(e*/li'e0i+
M%s% sel 4e,% (%n'*e%s l%0% 'el%0%%n %'%n 4e*'u*%n/ (%)% (%sien
DM ,i(e II &%n/'% (%n&%n/ >Po8e*s. 2!?
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Be*4%/%i 'eluh%n )%(%, )i,e0u'%n (%)% (en-%n)%n/ )i%4e,es
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!+ Ge&%l% 'l%si' DM /lu'os% (l%s0% se8%',u 2 0/)L >!!.! 00olL?Glu'os% (l%s0% se8%',u 0e*u(%'%n h%sil (e0e*i's%%n ses%%, (%)% su%,u
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)il%'u'%n in,e*ensi 7%*0%'olo/is )en/%n o4%, hi(o/li'e0i' o*%l >;H;?
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(en-%'i, '%*)io%s'ul%*. ,i)%' )i%n&u*'%n (en//un%%n
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)en/%n 0enin/'%,'%n &u0l%h (*o,ein (en/%n/'u, /lu'os%.
sehin//% 0enin/'%,'%n %04il%n /lu'os% )i (e*i7e*+ Ti%@oli)in)ion
)i'on,*%in)i'%si'%n (%)% (%sien )en/%n /%/%l &%n,un/ 'l%s I5IPERKENI. 2!!?!+ InsulinK%)%* /lu'os% )%*%h 0e*u(%'%n 'un6i (en/%,u* se'*esi insulin
oleh sel5sel 4e,% (%n'*e%s. 8%l%u(un %s%0 %0ino. 'e,on. (e(,i)%
/%s,*oin,es,in%l )%n neu*o,*%ns0i,,e* &u/% 0e0(en/%*uhi se'*esi
insulin+ K%)%* /lu'os% )%*%h -%n/ ".= 00olL > 0/)l?
0e*%n/s%n/ se'*esi insulin+ Se'*esi insulin 7isiolo/is ,e*)i*i )%*i
se'*esi 4%s%l )%n se'*esi (*%n)i%l+ Te*%(i insulin )iu(%-%'%n 0%0(u
0eni*u (ol% se'*esi insulin -%n/ 7isiolo/is+ De7isiensi insulin 0un/'in
4e*u(% )e7isiensi insulin 4%s%l. insulin (*%n)i%l %,%u 'e)u%n-%+
De7isiensi insulin 4%s%l 0en-e4%4'%n ,i04uln-% hi(e*/li'e0i% (%)%
'e%)%%n (u%s%. se)%n/'%n )e7isiensi insulin (*%n)i%l %'%n
0eni04ul'%n hi(e*/li'e0i% se,el%h 0%'%n+ Te*%(i insulin un,u'
su4s,i,usi )i,u&u'%n un,u' 0el%'u'%n 'o*e'si ,e*h%)%( )e7isiensi -%n/
,e*&%)i+
Jenis )%n l%0% 'e*&% insulin insulin 'e*&% 6e(%, >rapid in%ulin?
'e*&% (en)e' >%hort a&ting?
'e*&% 0enen/%h >intermediate a&ting?
'e*&% (%n&%n/ >long a&ting?
insulin 6%0(u*%n ,e,%( >premi)ed in%ulin?
Pe04e*i%n )%(%, (ul% se6%*% 'o04in%si %n,%*% &enis insulin 'e*&%
6e(%, %,%u insulin 'e*&% (en)e' un,u' 'o*e'si )e7isiensi insulin
(*%n)i%l. )en/%n 'e*&% 0enen/%h %,%u 'e*&% (%n&%n/ un,u' 'o*e'si
)e7isiensi insulin 4%s%l+ Ju/%)%(%, )il%'u'%n 'o04in%si )en/%n ;H;+
Te*%(i insulin ,un//%l %,%u 'o04in%si )isesu%i'%n )en/%n 'e4u,uh%n
(%sien )%n *es(ons in)ii)u ,e*h%)%( insulin. -%n/ )inil%i )%*i h%sil
(e0e*i's%%n '%)%* /lu'os% )%*%h h%*i%n+ Pen-esu%i%n )osis insulin
)%(%, )il%'u'%n )en/%n 0en%04%h 25$ uni, se,i%( "5$ h%*i 4il% s%s%*%n
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Insulin )i(e*lu'%n (%)% 'e%)%%n!+ Penu*un%n 4e*%, 4%)%n -%n/ 6e(%,
2+ Hi(e*/li'e0i% 4e*%, -%n/ )ise*,%i 'e,osis"+ Ke,o%si)osis )i%4e,i6$+ Hi(e*/li'e0i% hi(e*os0ol%* non 'e,o,i'3+ Hi(e*/li'e0i% )en/%n %si)osis l%',%,9+ G%/%l )en/%n 'o04in%si ;H; )osis h%0(i* 0%'si0%l+ S,*es 4e*%, >in7e'si sis,e0i'. o(e*%si 4es%*. IMA. s,*o'e?#+ Keh%0il%n )en/%n DM)i%4e,es 0eli,us /es,%sion%l -%n/ ,i)%'
,e*'en)%li )en/%n (e*en6%n%%n 0%'%n=+ G%n//u%n 7un/si /in&%l %,%u h%,i -%n/ 4e*%,!+ Kon,*%in)i'%si )%n %,%u %le*/i ,e*h%)%( ;H;
6+ Tera%i kom)ina(i 1PERENI2$3?Pe04e*i%n ;H; 0%u(un insulin sel%lu )i0ul%i )en/%n )osis
*en)%h. un,u' 'e0u)i%n )in%i''%n se6%*% 4e*,%h%( sesu%i )en/%n
*es(ons '%)%* /lu'os% )%*%h+ Be*s%0%%n )en/%n (en/%,u*%n )ie, )%n
'e/i%,%n &%s0%ni. 4il% )i(e*lu'%n )%(%, )il%'u'%n (e04e*i%n ;H;
,un//%l %,%u 'o04in%si ;H; se&%' )ini+ Te*%(i )en/%n ;H;
'o04in%si. h%*us )i(ilih )u% 0%6%0 o4%, )%*i 'elo0(o' -%n/
0e0(un-%i 0e'%nis0e 'e*&% 4e*4e)%+ Bil% s%s%*%n '%)%* /lu'os%
)%*%h 4elu0 ,e*6%(%i. )%(%, (ul% )i4e*i'%n 'o04in%si ,i/% ;H; )%*i
'elo0(o' -%n/ 4e*4e)% %,%u 'o04in%si ;H; )en/%n insulin+P%)% (%sien -%n/ )ise*,%i )en/%n %l%s%n 'lini' )i 0%n% insulin
,i)%' 0e0un/'in'%n un,u' )i(%'%i )i(ilih ,e*%(i )en/%n 'o04in%si
,i/% ;H;+ Un,u' 'o04in%si ;H; )%n insulin. -%n/ 4%n-%'
)i(e*/un%'%n %)%l%h 'o04in%si ;H; )%n insulin 4%s%l >insulin 'e*&%
0enen/%h %,%u insulin 'e*&% (%n&%n/? -%n/ )i4e*i'%n (%)% 0%l%0 h%*i
0en&el%n/ ,i)u*+ Den/%n (en)e'%,%n ,e*%(i ,e*se4u, (%)% u0u0n-%
)%(%, )i(e*oleh 'en)%li /lu'os% )%*%h -%n/ 4%i' )en/%n )osis insulin
-%n/ 6u'u( 'e6il+ Dosis %8%l insulin 'e*&% 0enen/%h %)%l%h 95! uni,
-%n/ )i4e*i'%n se'i,%* &%0 22+. 'e0u)i%n )il%'u'%n e%lu%si )osis
,e*se4u, )en/%n 0enil%i '%)%* /lu'os% )%*%h (u%s% 'eeso'%n h%*in-%+
Bil% )en/%n 6%*% se(e*,i )i %,%s '%)%* /lu'os% )%*%h se(%n&%n/ h%*i
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0%sih ,i)%' ,e*'en)%li. 0%'% o4%, hi(o/li'e0i' o*%l )ihen,i'%n )%n
)i4e*i'%n insulin s%&%+
om%&ika(i
Ko0(li'%si )i%4e,es -%n/ )%(%, ,e*&%)i )i4e)%'%n 0en&%)i )u% -%i,u
'o0(li'%si %'u, )%n 'o0(li'%si '*oni'+ Ko0(li'%si %'u, 4e*u(% 'o0%
hi(o/li'e0i. 'e,o%si)osis )i%4e,i'. 'o0% hi(e*os0ol%* non'e,o,i'+
Ko0(li'%si '*oni' )%(%, 4e*u(% 0%'*o%n/io(%,i. 0i'*o%n/io(%,i. neu*o(%,i
)i%4e,i'. in7e'si. '%'i )i%4e,i'. )%n )is7un/si e*e'si+
B. ATRHAL4IA
%? Pen#ertianA*,h*%l/i% 4e*%s%l )%*i 4%h%s% Yun%ni. %*h,*o -%n/ %*,in-% sen)i
)%n %l/os %*,in-% n-e*i+ J%)i %*,h*%l/i% %)%l%h n-e*i sen)i. 4%i' s%,u
0%u(un 4e4e*%(% sen)i+ Is,il%h %*,h*%l/i% e*%, '%i,%nn-% )en/%n %*,h*i,is
%,%u (e*%)%n/%n sen)i+ A*,h*%l/i% 0e*u(%'%n s%l%h s%,u /e&%l% ,e*se*in/
)%*i %*,h*i,is+
)" Etio&o#i
Pen-e4%4 u0u0 %*,h*%l/i% %)%l%h:
! Pe*/e*%'%n -%n/ ,i)%' 4i%s% %,%u 'es%l%h%n 4e/e*%'. se(e*,i 'eseleo
)%n s,*%in2 Te*'%)%n/ 6e)e*%. ,e*0%su' (%,%h ,ul%n/" Gou, >'hususn-% &e0(ol '%'i?$ ;s,eo%*,*i,is. (en-%'i, sen)i )e/ene*%,ie3 Se(,i6 %*,h*i,is
9 Ten)ini,is Bu*si,is# In7e'si (en-%'i, se(e*,i in7luen@%. 6%0(%'. )e0%0 *e0%,i'. he(%,i,is.
/on)o'. *u4ell% %,%u 6%6%* %i*+= ;s,eo0ieli,iss+! %u,oi0un (en-%'i, se(e*,i *heu0%,oi) %*,h*i,is )%n lu(us
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S%n/%, 0u)%h un,u' 0e0%h%0i *%s% s%'i, ini &i'% An)%
0en/%n//%( 4%h8% %(% -%n/ ,e*&%)i %)%l%h 4%h8% %)% se)i'i, (elu0%s
4e*s%0% 4%n,%l%n )en/%n 'e*us%'%n ,ul%n/ *%8%n 'onse'uen+ Sinoiu0
)%n 4%n,%l ,ul%n/ *%8%n (elin)un/ 0e04u%, 'ehil%n/%n e7e',ii,%s
0e*e'% -%n/ 0en-e4%4'%n ,ul%n/ 4e*%)% )%l%0 'on,%' s%,u s%0% l%in.
0en-e4%4'%n /ese'%n -%n/ se*in/ 4%h'%n ,ul%n/ 4e*)e*i' ,e*)en/%* un,u'
0e04u%, /e*%'%n ,e*,en,u. )%n 0en/h%sil'%n e*osi )%n (en%04%h%n5
(en%04%h%n+
d" Faktor Re(iko
A)% 4e4e*%(% (en-%'i, -%n/ )%(%, 0en-e4%4'%n n-e*i )i sen)i.
se(e*,i *heu0%,oi) %*,h*i,is. /%n//u%n %u,oi0un -%n/ 0en-e4%4'%n
'e'%'u%n )%n n-e*i )i )%l%0n-%+ ;s,eo%*,h*i,is %)%l%h )e/ene*%si ,ul%n/
*%8%n sen)i )%n (e,u04uh%n ,ul%n/ ,%&i. -%n/ s%n/%, se*in/ ,e*&%)i (%)%
o*%n/ )e8%s% )en/%n usi% le4ih )%*i $3 ,%hun )%n 4is% 0en-e4%4'%n n-e*i
sen)i+
N-e*i ini &u/% 4is% )ise4%4'%n oleh 4u*si,is %,%u (e*%)%n/%n (%)%
4u*s%. -%n/ ,e*)i*i )%*i '%n,un/ 4e*isi 6%i*%n (%)% ,ul%n/ (*o0inen6es.
0e0un/'in'%n /e*%'%n 4e4%s )%*i o,o, )%n ,en)on (%)% ,ul%n/+
C. CEPHAL4IA
a" Pen#ertian
N-e*i 'e(%l% %,%u 6e(h%l/i% %)%l%h n-e*i %,%u *%s% ,i)%' en%' )i 'e(%l%.
se,e0(%, %,%u 0en-elu*uh )%n )%(%, 0en&%l%* 'e 8%&%h. 0%,%. /i/i. *%h%n/
4%8%h )%n lehe*+)" &a(ifika(i
N-e*i 'e(%l% )i'l%si7i'%si'%n 0en&%)i )u% -%i,u n-e*i 'e(%l% (*i0e* )%n
n-e*i 'e(%l% se'un)e*+ N-e*i 'e(%l% (*i0e* 'e0u)i%n )i4%/i 0en&%)i
e0(%, '%,e/o*i -%i,u 0i/*%ine. n-e*i 'e(%l% ,i(e ,e/%n/. n-e*i 'e(%l%
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!+ Mi#raine
Is,il%h 0i/*%ine 4e*%s%l )%*i '%,% Yun%ni -%n/ 4e*%*,i s%'i, 'e(%l% sesisi+
Te*)%(%, )u% s-n)*o0e 'linis 0i/*%ine. -%i,u 0i/*%ine )en/%n %u*% )%n
0i/*%ine ,%n(% %u*%+ Sel%0% 4e4e*%(% ,%hun. 0i/*%ine )en/%n %u*%
)i'%,%'%n se4%/%i 0i/*%ine 'l%si' )%n sin)*o0 -%n/ 'e)u% )i'%,%'%n
se4%/%i 0i/*%ine u0u0+ Mi/*%in )ise*,%i %u*% )i%8%li )en/%n %)%n-%
/%n//u%n (%)% 7un/si s%*%7. ,e*u,%0% isu%l. )ii'u,i oleh n-e*i 'e(%l%
he0i'*%ni%l >unil%,e*%l?. 0u%l. )%n '%)%n/ 0un,%h. 'e&%)i%n ini ,e*&%)i
4e*u*u,%n sel%0% 4e4e*%(% &%0 '%)%n/(ul% ,e*&%)i )%l%0 seh%*i (enuh
4%h'%n le4ih+ Mi/*%in ,%n(% %u*% 0e*u(%'%n n-e*i 'e(%l% he0i'*%ni%l
)ise*,%i %,%u ,%n(% 0u%l 0un,%h -%n/ ,e*&%)i se6%*% ,i4%5,i4% ,%n(%
/%n//u%n 7un/si s%*%7 se4%/%i (e*,%n)% )%n /e&%l% ini ,e*&%)i )%l%0
4e4e*%(% 0eni, %,%u &%0+ As(e' he0i'*%ni%l )%n sens%si 4e*)en-u,
0e*u(%'%n '%*%',e*is,i' (%lin/ 'h%s -%n/ 0e04e)%'%n 0i/*%ine )en/%n
&enis n-e*i 'e(%l% l%inn-%2+ N7eri e%a&a C&*(ter
N-e*i 'e(%l% 6lus,e* 0e*u(%'%n sin)*o0% n-e*i 'e(%l% -%n/ le4ih se*in/
,e*&%)i (%)% (*i% )i4%n)in/ 8%ni,%+ N-e*i 'e(%l% 6lus,e* ini (%)% u0u0n-%
,e*&%)i (%)% usi% -%n/ le4ih ,u% )i4%n)in/ )en/%n 0i/*%ine+ N-e*i (%)%
sin)*o0 ini ,e*&%)i he0i'*%ni%l (%)% )%e*%h -%n/ le4ih 'e6il )i4%n)in/
0i/*%ine. se*in/ '%li (%)% )%e*%h o*4i,%l. sehin//% )i'%,%'%n se4%/%i
'l%s,e*+ Ji'% se*%n/%n ,e*&%)i. n-e*i ini )i*%s%'%n s%n/%, 4e*%,. n-e*i ,i)%'
4e*)en-u, 'ons,%n sel%0% 4e4e*%(% 0eni, hin//% 2 &%0+Ti)%' se(e*,i 0i/*%ine. n-e*i 'e(%l% 6lus,e* sel%lu unil%,e*%l )%n 4i%s%n-%
,e*&%)i (%)% *e/ion -%n/ s%0% se6%*% 4e*ul%n/5ul%n/+ N-e*i 'e(%l% ini
u0u0n-% ,e*&%)i (%)% 0%l%0 h%*i. 0e04%n/un'%n (%sien )%*i ,i)u*.
,e*&%)i ,i%( h%*i. se*in/'%li ,e*&%)i le4ih )%*i se'%li )%l%0 s%,u h%*i+ N-e*i
'e(%l% ini 4e*0ul%i se4%/%i sens%si ,e*4%'%* >4u*nin/ sens%s,ion? (%)%
%s(e' l%,e*%l )%*i hi)un/ %,%u se4%/%i sens%si ,e'%n%n (%)% 0%,% In&e'si
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sin)*o0 Ho*ne*. 4%h'%n )i,e0u'%n (ul% (%sien )en/%n /e&%l%
/%s,*oin,es,in%l"+ N-e*i 'e(%l% ,i(e ,e/%n/ >NKTT? 0e*u(%'%n is,il%h -%n/ )i/un%'%n un,u'
0en)es'*i(si'%n n-e*i 'e(%l% ,%n(% se4%4 -%n/ &el%s )%n 'u*%n/ 0e0ili'i
/%04%*%n 'h%s )i4%n)in/ 0i/*%ine )%n n-e*i 'e(%l% 6lus,e*+ P%)%
u0u0n-%. NKTT 0e*u(%'%n /%n//u%n '*oni' -%n/ 4e*0ul%i se,el%h
u0u* 2 ,%hun+ G%n//u%n ini )i,%n)%i )en/%n se*%n/%n n-e*i 'e(%l%
4il%,e*%l (%)% 4%/i%n o66i(i,%l ,%n(% sens%si )en-u,%n )%n ,i)%' )ise*,%i
*%s% 0u%l. 0un,%h. %,%u /%n//u%n (en/lih%,%n+ N-e*i 4i%s% )i)es'*i(si'%n
se(e*,i %)% (i,% -%n/ 0en/i'%, 'e(%l% )en/%n 'e,%,+ W%ni,% le4ih se*in/
,e*'en% )i4%n)in/ (*i%+
Ta)e& '.. Jeni(86eni( N7eri e%a&a
N7eri
e%a&a
Sifat
N7eri
Loka(i Lama
N7eri
Frek*en(i 4e6a&a
Ik*tan
Mi/*en
u0u0
Be*)en-u, Unil%,e*%l %,%u
Bil%,e*%l
95$# &%0 S(o*%)i'
Be4e*%(% '%li
se4ul%n
Mu%l.
0un,%h.
0%l%ise.
7o,o4i%
Mi/*en
'l%si'
Be*)en-u, Unil%,e*%l "5!2 &%0 S(o*%)i'
Be4e*%(% '%li
se4ul%n
P*o)*o0%
isu%l. 0u%l.
0un,%h.
0%l%ise.
7o,o4i%
Kl%s,e* Men&e0u5
'%n. ,%&%0
Unil%,e*%l.
o*4i,%
!352
0eni,
Se*%n/%n
4e*'elo0(o'
)en/%n
*e0isi l%0%
L%'*i0%si
i(sil%,e*%l.
8%&%h
0e*%h.
hi)un/
,e*su04%,.
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,e/%n/ )i,e'%n 0ene*us %nsie,%s
Neu*%l/i%
,*i/e0inus
Di,usu'5
,usu'
De*0%,on s%*%7
%8%l?. Bil%,e*%l
>l%n&u,?
Be*%*i%si.
(*o/*esi7
Be*%*i%si.
se0%'in
se*in/
P%(ile)e0%.
)e7isi,
neu*olo/i'
7o'%l.
/%n//u%n
0en,%l %,%u
(e*il%'u.
'e&%n/. )ll
6? Manife(ta(i &ini(
Menu*u, A*i7 M%ns&oe*. )'' >2? 0%ni7es,%si 'linis %)%n-% n-e*i 'e(%l%
%,%u 6e(h%l/i% 0e0e*lu'%n %n%0nesis 'husus -%i,u:
!+ A8i,%n )%n l%0% se*%n/%n
2+ Ben,u' se*%n/%n (%*o'sis0%l (e*io)i' %,%u ,e*us 0ene*us
"+ Lo'%lis%si n-e*i
$+ Si7%, n-e*i 4e*)en-u,5)en-u,. *%s% 4e*%,. 0enusu'5nusu'. )ll
3+ P*o)*o0%l
9+ Ge&%l% (en-e*,%
+ 1%',o* (*esi(i,%si
#+ 1%',o* -%n/ 0en/u*%n/i %,%u 0e04e*%,'%n n-e*i 'e(%l%
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!!+ Ri8%-%, 'elu%*/%
!2+ Ri8%-%, ,*%u0% 'e(%l%
!"+Ri8%-%, (en-%'i, 0e)i' (e*%)%n/%n sel%(u, o,%'. hi(e*,ensi. )e0%0
,i7oi). sinusi,is. /l%u'o0%. )s4+
!$+ Ri8%-%, o(e*%si
!3+ Ri8%-%, %le*/i
!9+ Pol% h%i) 4%/i 8%ni,%
!+ Ri8%-%, (e0%'%i%n o4%, %n%l/e,i'. n%*'o,i'. (enen%n/. %so)il%,o*
BAB III
PRESENTASI KASUS
A. IDENTITAS PASIEN
N%0% : N-+SJenis 'el%0in : Pe*e0(u%n
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Al%0%, : Gen)in/%n RT != RW "No+ RM : 22 $9 !
T%n//%l (e0e*i's%%n : 2$ noe04e* 2!3Kun&un/%n Ru0%h : 23 noe04e* 2!3
B. ANAMNESIS
. e&*0an Utama
Kon,*ol *u,in Di%4e,es Melli,us$. Ri9a7at Pen7akit Sekaran#
Seo*%n/ (%sien 8%ni,% )%,%n/ 'e Pus'es0%s N/%0(il%n un,u'
'on,*ol *u,in Di%4e,es Melli,us+ P%sien 0en/%'u ,e*'en% (en-%'i,
Di%4e,es Melli,us su)%h se&%' ! ,%hun -%n/ l%lu >23?+ ;s 0en/e,%hui
&enis o4%, DM -%n/ )i 0inu0. os 0inu0 o4%, DM ,e*se4u, *u,in
0es'i(un os 0en/e,%hui )%n 0e0i'i*'%n 4%h8% /in&%ln-% %'%n *us%'
'%*en% 0inu0 o4%, ,e*us50ene*us+ ;s ,i)%' 0e*%s% 'ese0u,%n (%)% 'e)u%
u&un/5u&un/ &%*i ,%n/%n )%n '%'i se*,% os &u/% ,i)%' 0e*%s%'%n (%n)%n/%n
0%,%n-% '%4u*+ ;s 0en/%,%'%n 4%h8% '%)%* /ul%n-% n%i' ,u*un+Sel%in i,u os &u/% 0e*%s%'%n (e/%l5(e/%l (%)% 4%)%n )%n linu5linu
(%)% selu*uh (e*sen)i%n Q ! 4ul%n ini+ Keluh%n )i*%s%'%n 0e04e*%, 'e,i'%
os 4e*%',ii,%s )%n 4e*'u*%n/ 'e,i'% 0inu0 o4%,+ ;s &u/% 0e*%s%'%n n-e*i
'e(%l% -%n/ )i*%s%'%n )i 4%/i%n )e(%n+ N-e*i 'e(%l% 0e04e*%, &i'%
0e0i'i*'%n sesu%,u )%n 4e*'u*%n/ 'e,i'% 4e*is,i*%h%,+'. Ri9a7at Pen7akit Da0*&*
Ri8%-%, 'eluh%n -%n/ s%0% >?Ri8%-%, (en-%'i, /in&%l. %s0%. hi(e*,ensi. %le*/i lie*. s,*o'e. )%n &%n,un/
)i s%n/'%l+. Ri9a7at Pen7akit e&*ar#a
%+ Ri8%-%, hi(e*,ensi >? i4u4+ Ri8%-%, Pen-%'i, &%n,un/ >? i4u6+ Ri8%-%, DM >? %-%h)+ Ri8%-%, %s0%. %le*/i. s,*o'e. )%n /in&%l )is%n/'%l
,. Ri9a7at Per(ona& So(ia& Ekonomi
Pen)i)i'%n
P%sien 0e*u(%'%n ,%0%,%n SMP+ Ti)%' 0el%n&u,'%n 'e &en&%nh
4e*i'u,n-% '%*en% 'e,e*4%,%s%n 4i%-%+ Pe'e*&%%n
P%sien 0en/%,%'%n 4%h8% (%sien 0e0(un-%i us%h% '%n,in -%n/
su)%h )i&%l%ni Q !3 ,%hun+ P%sien 0e*u(%'%n (en6%*i n%7'%h u,%0%
)%l%0 'elu%*/% se,el%h su%0in-% (ensiun+ P ' i
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Lin/'un/%n
S%%, ini (%sien ,in//%l 4e*s%0% su%0i )%n %n%' 'eli0% (%sien -%n/
4elu0 0eni'%h+ Me*e'% ,in//%l )i (in//i* &%l%n *%-% -%n/ ,i)%'
,e*l%lu le4%*+ Lin/'un/%n ,e0(%, ,in//%l (%sien ,e*0%su'
lin/'un/%n -%n/ ,i)%' ,e*l%lu (%)%, (en)u)u'. &%*%' %n,%* *u0%h
,i)%' s%lin/ 4e*)e'%,%n+ Lin/'un/%n se'i,%* *u0%h (%sien 6u'u(
4e*sih )%n 0en)%(%, sin%* 0%,%h%*i -%n/ 6u'u(+ G%-% hi)u(
P%sien 0en-u'%i )%n se*in/ 0en/'onsu0si /o*en/%n se*,%
s%-u*%n+ P%sien ,i)%' (e*n%h 4e*ol%h*%/% se*,% &i'% %)% 0%s%l%h
sel%lu 0e0i'i*'%n 0%s%l%h ,e*se4u,+ S%%, ini (%sien ,e*l%lu
0e0i'i*'%n ,en,%n/ us%h% '%n,in -%n/ )i0ili'in-% %'%n )i/usu*+-. Re:ie9 S7(tem
Sis,e0 Neu*olo/is : n-e*i 'e(%l% >?
Sis,e0 Res(i*%si : ,i)%' %)% 'eluh%n+
Sis,e0 '%*)io%s'ule* : ,i)%' %)% 'eluh%n+
Sis,e0 /%s,*oin,es,in%l : ,i)%' %)% 'eluh%n+ Sis,e0 u*olo/is : ,i)%' %)% 'eluh%n+
Sis,e0 0us'ulos'ele,%l : (e/%l5(e/%l )%n n-e*i sen)i
. Anamne(i( I&&ne(
Pe*%s%%n
P%)% s%%, )i)i%/nosis 0en/%l%0i DM ,%hun 23. (%sien 0en/%'u
4i%s% s%&%+ S%%, ini (%sien 0en/'h%8%,i*'%n ,en,%n/ %'i4%, &i'%
se*in/ 0inu0 o4%, ,e*h%)%( /in&%ln-% se*,% (%sien s%%, ini se)%n/
,e*4e4%ni 0e0i'i*'%n 0%s%l%h '%n,inn-% -%n/ %'%n )i/usu* I)e
Menu*u, (%sien. )i*in-% 0en/%l%0i DM '%*en% )ulu se*in/ 0%'%n
-%n/ ,i)%' ,e*'on,*ol+ Sel%in i,u (%sien &u/% 0en/%'u ,i)%' (en%h
4e*ol%h*%/%+ H%*%(%n
P%sien 4e*h%*%( %/%* 4is% se04uh ,o,%l. %'%n ,e,%(i (%sien s%)%*
4il% s%'i,n-% ,i)%' 4is% )ise04uh'%n n%0un h%n-% )%(%,
)i'en)%li'%n+ E7e' ,e*h%)%( 7un/si
P%sien 0ene*i0% 'on)isin-% )%n ,e,%( 4e*se0%n/%, se*,% (%s*%h
,e*h%)%( (en-%'i,n-%+ A'%n ,e,%(i. (%sien 0en/%'u 'eluh%nn-%
%'hi* %'hi* ini se)i'i, 0en//%n//u )%l%0 4e*%',ii,%s ,e,%(i h%l
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!+ Ke%)%%n u0u0 : B%i'2+ Kes%)%*%n : Co0(os Men,is
"+ T%n)% 55?. 6on&un/,i% %ne0is >55?.
s'le*% i',e*i' >55? Hi)un/ : se'*e, >55?. e(is,%'sis >55?
Telin/% : n-e*i ,e'%n >55?. se*u0en >55?
4? Pe0e*i's%%n lehe*Li07ono)i ,i)%' ,e*%4%. J
5?. 'e,in//%l%n /e*%' >5?5 (%l(%si : o6%l 7*e0i,us '%n%n'i*i5 (e*'usi : sono* >?5 %us'ul,%si : su%*% )%s%* esi'ule* >?.
*on6hi >5?. 8he@in/ >5?
5 ins(e'si : )in)in/ )%)% si0e,*is. *e,*%'s
in,e*'os,%l >5?. 'e,in//%l%n /e*%' >5?5 (%l(%si : o6%l 7*e0i,us '%n%n'i*i5 (e*'usi : sono* >?5 %us'ul,%si : su%*% )%s%* esi'ule* >?.
*on6hi >5?. 8he@in/ >5?
Co*
Ins(e'si : i6,us 6o*)is ,%' ,%0(%'P%l(%si : i6,us 6o*)is ,e*%4% )i SIC < line% 0i) 6l%i6ul%
sinis,*%Pe*'usi : 4%,%s &%n,un/
K%n%n %,%s : SIC II (%*%s,e*n%l )e,*%
K%n%n 4%8%h : SIC I< (%*%s,e*n%l )e,*%
Ki*i %,%s : SIC II (%*%s,e*n%l sinis,*%
Ki*i 4%8%h : SIC < line 0i)6l%i6ul% sinis,*%
Aus'ul,%si : 4un/i &%n,un/ S! )%n S2 *e/ule*. 4isin/ >5?.
/%llo( >5?
)? Pe0e*i's%%n %4)o0enIns(e'si : &e&%s >5?. s(i)e*ne*i >5?. %si,es >5?Aus'ul,%si : (e*is,%l,i' >? no*0%lP l i l >? i , ' > ? h ) li ,i) ' , 4
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D. PEMERISAAN PENUNJAN4
T%n//%l Gul% )%*%h
!!2!3 GDS "!GDP !#3.9
!=#2!3 GDS 2"3
!3!2!3 GDP 2=$2JPP 29#
2$!!2!3 GDP 2292JPP 22"
E+ H;ME
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D%,% 7oo) *e6%ll (%)% ,%n//%l 2$ noe04e* 2!3
W%',u Jenis
0%'%n%n
U'u*%n K%lo*i
URT Be*%, >/*?
P%/i Ai* (u,ihN%siTe0(eB%-%0Min-%'Gul%
2 /el%s!!2/el%s! (,/
2 s),2 s)0
523!!2
5"333233
Si%n/ Ai* (u,ihN%siTe0(eS%-u* so(Min-%'Pis%n/
2 /el%s!!2/el%s! (,/! 6en,on/2 s),! 4u%h
5232=!!3
5"333233
M%l%0 Ai* (u,ihN%siT%huTu0is 4un6isMin-%'
2 /el%s!!2/el%s! (,/
2 s),
5223!!
5"333223
To,%l !3
Kl%si7i'%si s,%,us /i@i 4e*)%s%*'%n IMT 0enu*u, N.BI "be%ity
Edu&ation Initiati+eun,u' o*%n/ in)onesi%. (%sien 0e0ili'i BMI 22.93
No*0%lD%l%0 (*%',e'. (e)o0%n &u0l%h '%lo*i -%n/ )i(e*lu'%n un,u' )i%4e,esi
-%n/ 4e'e*&% 4i%s% 0enu*u, PERKENI %)%l%h :Norma& ; BB < '3 a&ori Se0ari
,= < '3 a&ori (e0ari > +3 ka&ori (e0ari
9+ Geno/*%0/eno/*%0 Kelu%*/% N-+ S )i4u%, ,%n//%l 23 noe04e* 2!3
N-+S 9 ,hDMB
Ke,e*%n/%n : L%'i5l%'i (e*e0(u%n
L%'i5l%'i 0enin//%l (e*e0(u%n 0enin//%l P%sienHThi(e*,ensiDM)i%4e,es Melli,usB B*e%)8inne* >(en6%*i n%7'%h?DDe6ision 0%'e* >(e04u%, 'e(u,us%n?
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Ke,e*%n/%n : 7un/sion%l
)is7un/sion%l
#+ Ben,u' 'elu%*/%Ben,u' 'elu%*/% nu6le%* 7%0il- >'elu%*/% in,i? -%n/ ,e*)i*i )%*i su%0i. is,*i
)%n %n%' '%n)un/+
=+ 1%0il- li7e 6-6leT%h%( 3 l%un6hin/ 6hil)*en %n) 0oin/ on
!+ 1%0il- APGAR
KRITERIA PERTANYAAN AMPIR
!E"A"# %2&
KA'AN()
KA'AN( %1&
TI'AK A'A
%0&
A'APTA!I *+agaimana angg,ta -./uarga sa/ing
m.mantu satu sama /ain disaat
m.mutu-an s.suatuApa-a pasi.n
puas d.ngan -./uarga -ar.na masing)
masing angg,ta -./uarga suda
m.na/an-an -.aian s.suai d.ngan
s.arusna
PARTNER!IP *+agaimana angg,ta -./uarga
.r-,muni-asi satu sama /ain t.ntang
masa/a)masa/a t.rt.ntu s.p.rti
/iuran nansia/ p.ng./uaran ang
.sar dan masa/a priadi Apa-a
pasi.n puas d.ngan -./uarga -ar.na
dapat m.mantu m.m.ri-an s,/usi
t.radap p.rmasa/aan ang diadapi
PERT#M+#AN *+agaimana p.ruaan angg,ta
-./uarga s./ama taun)taun t.ra-ir
apa-a pasi.n di.ri -..asan untu-
m.ng.mang-an diri *Apa-a pasi.n puas d.ngan -..asan
ang di.ri-an -./uarga untu-
Ka-a- pasi.n
Ana- pasi.n
ana- pasi.n
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KA!I !AYAN( Apa-a i-a pasi.n sa-it -./uargana
m.m.ri p.ratian p.rdu/i dan
m.nunu--an -asi saangna d.ngan
m.raatApa-a pasi.n puas d.ngan
-.angatan ang di.ri-an -./uarga
KE+ER!AMAAN *+agaimana angg,ta K./uarga anda
.ragi a-tu ruang dan uangApa-a pasi.n puas d.ngan a-tu ang
dis.dia-an -./uarga untu- m.na/in
-..rsamaan
T:TA" 9
!-,r -/asi-asi AP(AR ;8)10
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!2+ 1%0il- Li7e Line
T%4el 1%0il- Li7e Line
Ye%* Li7e een, See*i,- o7 illnes
!=$ Meni'%h 5
!==3 Me04u'% us%h% '%n,in 5
2 I4u (%sien 0enin//%l S,*esso* (si'olo/is
23 Te*)i%/nosis DM S,*esso* (si'olo/is
!"+ Pe*il%'u Hi)u( Be*sih )%n Seh%,T%4el PHBS
no K*i,e*i% -%n/ )inil%i &%8%4%n S'o*
! Pe*s%lin%n )i,olon/ ,en%/%
'eseh%,%n
Y% !
2 Me04e*i ASI e's'lusi7 Y% !
" Meni04%n/ 4%li,% se,i%(
4ul%n
Ti)%'
$ Men//un%'%n %i* 4e*sih Y% !
3 Men6u6i ,%n/%n )en/%n %i*
4e*sih )%n s%4un
Y% !
9 Men//un%'%n &%04%n seh%, Y% !
Me04e*%n,%s &en,i' n-%0u'
)i *u0%h se'%li se0n//u
Ti)%'
# M%'%n 4u%h )%n s%-u* se,i%(
h%*i
Y% !
= Mel%'u'%n %',ii,%s 7isi'
se,i%( h%*i
Ti)%'
! Ti)%' 0e*o'o' )i )%l%0
*u0%h
Y% !
To,%l &%8%4%n -%
Kesi0(ul%n : PHBS ,e*(enuhi %(%4il% selu*uh in)i'%,o* ,e*(enuhi+ P%sien
0e0enuhi '*i,e*i% )%*i ! '*i,e*i%. 0%'% (%sien 4e*5PHBS+
1+ DIAGN;SIS KERJADi%4e,es Melli,usA,h*%l/i%Ce(h%l/i%
G+ PENATALAKSANAAN!+ Non 1%*0%'olo/i
E)u'%si 'e(%)% (%sien )%n 'elu%*/% ,en,%n/ (en-%'i, DM
>) 7i i i 7 ', i' ' li' i? , ' i ' ,'
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K%lo*i -%n/ )i'onsu0si (%sien (%)% 7oo) *e6%ll 2$ &%0
su)%h 4%i'. 0%'% (%s%ien h%*us 0e0(e*,%h%n'%n (ol%
0%'%n Be*ol%h*%/% 0ini0%l " se0in//u se'%li sel%0% " 0eni,
Mel%'u'%n sen%0 '%'i DM un,u' 0en6e/%h 'o0(li'%si
Me04e*i'%n e)u'%si 'e(%)% 'elu%*/% (%sien %/%* ,e,%(
0e04e*i'%n su((o*, 'e(%)% (%sien )%l%0 *%n/'% 'on,*ol
)%n 0inu0 o4%, *u,in2+ 1%*0%'olo/i
R Gli4en6l%0i) 3 0/ No+ S !55R Me,7o*0in 3 0/ No+ S !55!R K+ Di6lo7en%6 23 0/ No
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'e(%l% -%n/ )i*%s%'%n )i 4%/i%n )e(%n+ N-e*i 'e(%l% 0e04e*%, &i'%
0e0i'i*'%n sesu%,u )%n 4e*'u*%n/ 'e,i'% 4e*is,i*%h%,+Be*)%s%*'%n %n%0nesis )%n (e0e*i's%%n 7isi'. (%sien )i)i%/nosis
)en/%n Di%4e,es Melli,us ,i(e II+ Belu0 ,e*)%(%, 'o0(li'%si ,e*h%)%(
(en-%'i, (%sien sesu%i )en/%n 'eluh%n (%sien -%i,u *i8%-%, (%n)%n/%n
0%,% '%4u* )is%n/'%l. '%'u5'%'u %,%u 'ese0u,%n (%)% u&un/ &%*i5&%*i
,%n/%n )%n '%'i &u/% )is%n/'%l+D%*i (e0e*i's%%n %n,*o(o0e,*i )en/%n h%sil 4e*%, 4%)%n 3# '/
)%n ,in//i 4%)%n !9 60+ H%sil (e*hi,un/%n In)e's M%s% Tu4uh >IMT?
%)%l%h 22.93+ In,*e(e,%si )%*i IMT menurut N.BI "be%ity Edu&ation
Initiati+e%)%l%h no*0%l+D%l%0 (*%',e'. (e)o0%n &u0l%h '%lo*i -%n/ )i(e*lu'%n un,u' )i%4e,esi
-%n/ 4e'e*&% 4i%s% 0enu*u, PERKENI %)%l%h :Norma& ; BB < '3 a&ori Se0ari
,= < '3 a&ori (e0ari > +3 ka&ori (e0ari
K%lo*i -%n/ )i'onsu0si (%sien (%)% 7oo) *e6%ll 2$ &%0 su)%h 4%i'.
0%'% (%sien h%*us 0e0(e*,%h%n'%n (ol% 0%'%nn-%+P%sien ,in//%l 4e*s%0% su%0i )%n %n%' 'eli0%n-% -%n/ 4elu0
0eni'%h+ Lin/'un/%n se'i,%* *u0%h (%sien 6u'u( 4e*sih )%n *u0%h
(%sien 0en)%(%,'%n sin%* 0%,%h%*i -%n/ 6u'u(+ P%sien )il%'u'%n
(enil%i%n 7un/si 'elu%*/% 0e,o)e APGAR )i)%(%,'%n 7un/si 'elu%*/%
4%i'+
R%s% 'h%8%,i*. /elis%h. ,%'u,. 8%s8%s. (%ni' )%n se4%/%in-%
0e*u(%'%n /e&%l% u0u0 %'i4%, 6e0%s+ N%0un s%0(%i se4%,%s 0%n%
si,u%si &i8% 4e*u(% 6e0%s i,u )%(%, )i,ole*%nsi oleh seo*%n/ in)ii)u
se4%/%i 'es%,u%n u,uh+ K%*en% se*in/'%li 6e0%s 0eni04ul'%n 'eluh%n
7isi' 4e*u(% 4e*)e4%*5)e4%*. 4e*'e*in/%,. s%'i, 'e(%l%. 4%h'%n /%n//u%n
7un/si se'su%l )%n 4e*%/%0 l%inn-%+ Ke%)%%n 6e0%s -%n/ 8%&%*
0e*u(%'%n *es(ons ,e*h%)%( %)%n-% %n6%0%n %,%u 4%h%-% lu%* -%n/ n-%,%
&el%s )%n ,i)%' 4e*su04e* (%)% %)%n-% 'on7li'+ Se)%n/'%n 6e0%s -%n/
s%'i, >%nie,%s? 0e*u(%'%n *es(ons ,e*h%)%( %)%n-% 4%h%-% -%n/ le4ih
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'o0(le's. ,i)%' &el%s su04e* (en-e4%4n-%. )%n le4ih 4%n-%' 0eli4%,'%n
'on7li' &i8% -%n/ %)% )%l%0 )i*i sen)i*i+
Ce0%s %,%u 'e'h%8%,i*%n i,u ,i04ul %'i4%, %)%n-% *es(ons
,e*h%)%( 'on)isi s,*es %,%u 'on7li'+ R%n/s%n/%n 4e*u(% 'on7li'. 4%i' -%n/
)%,%n/ )%*i lu%* 0%u(un )%l%0 )i*i sen)i*i. i,u %'%n 0eni04ul'%n *es(ons
)%*i sis,e0 s%*%7 -%n/ 0en/%,u* (ele(%s%n ho*0on ,e*,en,u+ A'i4%,
(ele(%s%n ho*0on ,e*se4u,. 0%'% 0un6ul (e*%n/s%n/%n (%)% o*/%n5o*/%n
se(e*,i l%04un/. &%n,un/. (e04uluh )%e*%h 0%u(un %l%,5%l%, /e*%'+
K%*en% 4en,u' *es(ons -%n/ )e0i'i%n. (en)e*i,% 4i%s%n-% ,i)%'
0en-%)%*i h%l i,u se4%/%i hu4un/%n se4%4 %'i4%,+
P%)% s%%, ,e*&%)i s,*ess (si'ososi%l %,%u e0osion%l. %'%n ,e*&%)i
(e*u4%h%n 'esei04%n/%n @%, 'i0i% %',i7 (%)% o,%' 0%nusi%+ P%)% s%%,
s,*ess 0enin/'%,. ,u4uh %'%n 0en/elu%*'%n %)*en%lin )%n 'o*,isol + Ji'%
s,*es ,e*&%)i 4e*'e(%n&%n/%n. 0%'% %'%n 0enu*un'%n sis,e0 i0un ,u4uh.
%04%n/ n-e*i )%n ,ole*%nsi ,e*h%)%( n-e*i le4ih &%uh l%/i. sehin//% *%s%
n-e*i 'e(%l% %'%n le4ih se*in/ ,e*&%)i )en/%n in,ensi,%s -%n/ le4ih s%'i,+
B. PENERAPAN PRINSIP ED/TERAN ELUAR4A!+ P*i0%*- C%*e :
P*insi( ini su)%h )i,e*%('%n (%)% (%sien ini. )i0%n% (%sien )%,%n/
(e*i's% 'e (el%-%n%n (*i0e* ,e*le4ih )hulu. -%i,u (us'es0%s+2+ Pe*son%l 6%*e :
Pel%-%n%n -%n/ )i4e*i'%n 0e04e*i'%n 'en-%0%n%n 'e(%)% (%sien"+ Holis,i' 6%*e :
S%%, 0ene/%''%n )i%/nosis (%sien (%)% '%sus )ilih%, ,i)%' h%n-% )%*
se/i 'linisn-% s%&% ,e,%(i &u/% 0en%n-%'%n )%*i se/i (si'is. %)%'%h
0%s%l%h %,%u 4e4%n (i'i*%n -%n/ 0e0(en/%*uhi (e*&%l%n%n (en-%'i,
(%sien+$+ Co0(*ehensie 6%*e :
D%l%0 0en%n/%ni '%sus (%)% (%sien ini. )il%'u'%n (en%,%l%'s%n%%n
se6%*% 0en-elu*uh 0ul%i )%*i (*o0o,i7. (*een,i7. 'u*%,i7 0%u(un
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Dil%'u'%n ho0eisi, (%)% ,%n//%l 23 noe04e* 2!3 )%n 29
noe04e* 2!3 un,u' 0e0oni,o* 'e%)%%n (%sien )i lin/'un/%n *u0%h9+ E0(h%sis on P*een,ie Me)i6ine :Pene'%n%n (%)% us%h% (en6e/%h%n (en-%'i, 4e*'e04%n/ 0en&%)i
le4ih 4%i' )en/%n e)u'%si (e0%h%0%n (en-%'i, )%n 0o)i7i'%si /%-%
hi)u( (%)% (%sien++ P%,ien,56en,e*e) C%*e. 1%0il- 1o6use) Co00uni,-5o*ien,e) C%*e :
P%)% '%sus ini ,el%h )il%'u'%n e's(lo*%si 0en/en%i %s(e' )ise%se )%n
illnes )%*i (%sien ini. -%i,u DIABETES MELLITUS DISERTAI
ATHRALGIA DAN CEPHALGIA PADA WANITA PARUH BAYA
DENGAN KEKHAWATIRAN TERHADAP PEKERJAAN DAN
PENYAKITNYA+#+ Coll%4o*%,ie C%*e :
P%)% (%sien ini )%(%, )il%'u'%n 'ol%4o*%si )en/%n 4i)%n/ l%in se(e*,i
%hli /i@i un,u' 0e04%n,u 0e0(e*,%h%n'%n (ol% 0%'%n+
C. DIA4N/SIS H/LISTI
DIABETES MELLITUS DISERTAI ATHRALGIA DAN CEPHALGIA
PADA WANITA PARUH BAYA DENGAN KEKHAWATIRAN
TERHADAP PEKERJAAN DAN PENYAKITNYA
D. USULAN PEMERISAAN PENUNJAN4
%+ U*in len/'%(4+ Pe0e*i's%%n (*o7il li(i) len/'%( >'oles,*ol ,o,%l. HDL. LDL?6+ Pe0e*i's%%n 7un/si /in&%l >u*eu0. 6*e%,inin?
E. PENATALASANAAN /MPREHENSIF
!+ P*o0o,i7 E)u'%si 'e(%)% (%sien )%n 'elu%*/% ,en,%n/ (en-%'i, DM
>)e7inisi. 7%',o* *esi'o. 'o0(li'%si? un,u' 0enin/'%,'%n
(e0%h%0%n (%sien )%n 'elu%*/% ,en,%n/ (en-%'i, (%sien+ K%lo*i -%n/ )i'onsu0si (%sien (%)% 7oo) *e6%ll 2$ &%0 su)%h
4%i'. 0%'% (%s%ien h%*us 0e0(e*,%h%n'%n (ol% 0%'%n Be*ol%h*%/% 0ini0%l " se0in//u se'%li sel%0% " 0eni,
Mel%'u'%n sen%0 '%'i DM un,u' 0en6e/%h 'o0(li'%si
Me04e*i'%n e)u'%si 'e(%)% 'elu%*/% (%sien %/%* ,e,%(
0e04e*i'%n su((o*, 'e(%)% (%sien )%l%0 *%n/'% 'on,*ol )%n
0inu0 o4%, *u,in
2+ P*een,i7
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Men/'onsu0si 4u%h54u%h%n. s%-u*5s%-u*%n )%n %i* (u,ih
"+ Ku*%,i7Be*)%s%*'%n PERKENI 2!!. (en/en)%li%n '%)%* /lu'os% )%*%h )%(%,
0e0%'%i 'o04in%si 2 o4%, %n,i hi(e*/li'e0i o*%l )i0ul%i )%*i )osis
*en)%h -%i,u Me,7o*0in 3 0/ (e* !2 &%0 s%%, 0%'%n )%n
Gli0e(i*i)e ! 0/ (e* 2$ &%0 se4elu0 0%'%n+
BAB ?
ESIMPULAN DAN SARAN
A. ESIMPULAN
D%*i h%sil %n%0nesis )%n (e0e*i's%%n 7isi' se*,% 'un&un/%n 'e *u0%h
(%sien (en)e*i,% Di%4e,es Melli,us. )%(%, )i%04il 'esi0(ul%n se4%/%i
4e*i'u,:P%sien 8%ni,% 9 ,%hun )en/%n *i8%-%, Di%4e,es Melli,us -%n/
)ise4%4'%n oleh 7%',o* /ene,i' '%*en% %-%h (%sien 0en)e*i,% h%l -%n/
s%0% )en/%n (%sien+ Se,el%h ,e*)i%/nosis (en-%'i, DM (%sien *u,in
'on,*ol se,i%( se(uluh h%*i se'%li )%n *%&in 0inu0 o4%, se,i%( h%*in-%.
(%sien (%,uh 0en&%l%ni h%l ,e*se4u, 0es'i(un (%sien 'h%8%,i* &i'% 0inu0
o4%, ,e*us 0ene*us %'%n 0e04u%, /in&%ln-% *us%'+ D%*i h%sil 7oo) *e6%ll
2$ &%0. (%sien 0e0ili'i (ol% 0%'%n -%n/ 4%i'+D%*i %n%lisis /eno/*%0. (%sien %)%l%h %n%' 'e e0(%, )%*i e0(%,
4e*s%u)%*%+ A-%h (%sien 0e0ili'i (en-%'i, se*u(% )en/%n (%sien %'%n
,e,%(i %-%h (%sien su)%h 0enin//%l+ D%*i (enil%i%n 0e,o)e APGAR
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B. SARAN
!+ Me04e*i'%n le%7le, 'e(%)% se,i%( (%sien 0en/en%i (en-%'i, DM.
)%7,%* 0enu sesu%i )en/%n 'e4u,uh%n '%lo*i un,u' 0e0(e*,%h%n'%n
(ol% 0%'%n (%sien2+ Men-%*%n'%n sen%0 '%'i )i%4e,es un,u' 0enu*un'%n 'o0(li'%si
0i'*o%s'ule* DM"+ Mel%'u'%n (e0e*i's%%n (enun&%n/ )%l%0 *%n/'% u(%-% )e,e'si )ini
'o0(li'%si se(e*,i u*in *u,in. (*o7il li(i) )%n 7un/si /in&%l$+ Me04e*i'%n e)u'%si 'e(%)% 'elu%*/% (%sien %/%* ,e,%( 0e04e*i'%n
,e*%(i su((o*, 'e(%)% (%sien )%l%0 *%n/'% 'on,*ol )%n 0inu0 o4%,
*u,in+
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LAMPIRAN
Usul%n Menu Die,
Con,oh 0enu )ie, 4e*)%s%*'%n &u0l%h '%lo*i !"$" 'C%l (e* h%*i
W%',u Jenis 0%'%n%n B%h%n U'u*%n K%lo*i
URT Be*%,
>/*?
P%/i Teh M%nis
N%si Pu,ih
T%hu /o*en/
Telu* )%)%*
S%-u* so(
(e(%-%
Teh
Ai* Pu,ihGul% (%si*
N%si
T%hu
Min-%'
Te0(e
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Kol
Wo*,el
(e(%-%
! /el%s
2 s)0
/el%s
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2 s),
2 (,n/
2 s),
!
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2 (,n/
4es%*
29
!
!!
3
2#
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!3
3
"
=3
"
23
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Si%n/ Ai* (u,ih
N%si (u,ih
S%-u* 4%-%0
Te0(e /o*en/
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5
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S%-u* 4%-%0
8o*,el
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/el%s
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2 (,n/
2 s),
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3
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!3
"9
23
3
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!
M%l%0 Ai* (u,ih
N%si (u,ih
Lele /o*en/
Pis%n/
5
N%si
! i'%n
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(is%n/
/el%s
! (,n/ s)n/
2 s),
2 4u%h
$
"
!3
3
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!To,%l '%lo*i !"$"
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45/45
PERKENI+Pengelolaan dan Pen&egahan Diabete% Melitu% $ipe ( di Indone%ia+
Pe*'u0(ul%n En)o'*inolo/i In)onesi% 2!!+
PERKENI+Kon%en%u% Pengelolaan Di%lipidemia di Indone%ia/ J%'%*,%: Pus%, Pene*4i,%n
Il0u Pen-%'i, D%l%0 1%'ul,%s Ke)o',e*%n UI 2!2+
9+
Perkumpulan Endokrinologi Indonesia *PERKENI. Konsensus Pengendalian
dan Pen4egahanDiabetes Melitus tipe 2 di Indonesia
M6(hee/%non/+ 2!2+ P%,o7isiolo/i (en-%'i, (en/%n,%*0enu&u 'e)o',e*%n 'linis e)isi 3+
J%'%*,% : EGC
h,,(s:888+s6*i4)+6o0)o6!$#=$""=2A*,h*%l/i%5)o6
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