The Diabetes Mellitus Type II

7/25/2019 The Diabetes Mellitus Type II

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DIABETES MELITUS

D

I

S

U

S

U

N

Oleh :

Dinny Arianty

11-2004-065

Pe!i!in" :

Dr# S$ryantini % SPD

'e&aniteraan Il$ Penya(it Dala

)a($lta* 'e+,(teran U'IDA

Peri,+e 21 Maret . 2/ May 2005

USPAU +r# E*naan Antari(*a ali Per+ana($*$a

a(arta 2005


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'ATA PEN3ANTA

P$i +an *y$($r *aya &anat(an (e&a+a T$han an" Maha E*a ata* !er(at +an

rahat-Nya *ehin""a reerat ini +a&at *aya *ele*ai(an te&at &a+a a(t$nya#

eerat ini e!aha* tentan" &enya(it Dia!ete* Mellit$* +iana (ita (etah$i

!er*aa% *eirin" +en"an &enin"(atan &en+a&atan +an &er$!ahan "aya hi+$& a(a

&re7alen*i tera+inya &enya(it ini $"a enin"(at *ehin""a +en"an a+anya reerat ini

+ihara&(an +a&at ena!ah aa*an +an &en"etah$an (ita tentan" &eahaanan%

&enye!a!% a(t,r re*i(,% "eala (lini*% &eeri(*aan &en$nan"% &en8e"ahan *erta

&en"en+alian &,la hi+$& *ehat "$na en"hin+ari tera+inya (,&li(a*i yan" +iti!$l(an

&enya(it ini yan" ti+a( (ita in"in(an#

Men"in"at a(an (eter!ata*an yan" a+a a(a reerat ini&$n a$h +ari *e&$rna

*ehin""a +ihara&(an (riti( +an *aran +ari !er!a"ai &iha( "$na (e*e&$rnaan reerat ini

nantinya#

A(hirnya *aya $8a&(an !anya( teria (a*ih (e&a+a *e$a &iha( yan" telah

e!ant$ ter$$+nya reerat ini !ai( *e8ara ,ril a$&$n ateriil# Dihara&(an reerat

ini +a&at !eranaat !a"i yan" e!a8anya#

a(arta% Mei 2005

Peny$*$n

i


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DA)TA ISI

'ATA PEN3ANTA 9999999999999999999999# i

DA)TA ISI 99999999999999999999999999 ii

BAB I PENDAULUAN 99999999999999999999### 1

BAB II ISI 9999999999999999999999999999 2-5

DE)INISI 999999999999999999999999# 2

SINONIM 999999999999999999999999# 2

EPIDEMIOLO3I9999999999999999999999## 2

ETIOLO3IS999999999999999999999999##

Dia!ete* Ty&e I 999999999999999999999

Dia!ete* Ty&e II 999999999999999999999 -4

Dia!ete* Ty&e Lain 9999999999999999999# 4-5

BAB III PATO3ENESIS 99999999999999999999999 6-;

BAB I< MANI)ESTASI 'LINIS 9999999999999999999## /-11

BAB < PEMEI'SAAN9999999999999999999999###12-1=

Sa&lin" $nt$( Peeri(*aan '+r Darah 9999999999 12

Met,+e Peeri(*aan 'a+ar 3l$(,*a 99999999999### 1

Peeri(*aan Peanta$an Pen"el,laan DM 9999999999 1

Peeri(*aan BA18 9999999999999999999 14-15

Peeri(*aan Meanta$ ',&li(a*i DM 9999999999 15-1=

BAB


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BAB I

PENDAHULUAN

Dia!ete* Melit$* >DM? a+alah (elainan eta!,li*e (ar!,hi+rat% +i ana "l$(,*a

+arah ti+a( +a&at +i"$na(an +en"an !ai(% *ehin""a enye!a!(an (ea+aan hi&er"li(eia#

>1%2? DM er$&a(an (elainan en+,(rin yan" ter!anya( +i$&ai#>? Pen+erita DM

e&$nyai ri*i(, $nt$( en+erita (,&li(a*i yan" *&e*ii( a(i!at &eralanan &enya(it

ini% yait$ retin,&ati >!i*a enye!a!(an (e!$taan?% "a"al "inal% ne$r,&ati% ater,*(ler,*i*

>!i*a enye!a!(an stroke)% "an"ren% +an &enya(it arteria (,r,naria >Coronary artery

disease?#>1%2%?

Dia!ete* Melit$* +a&at +ite$(an &a+a ha&ir *e$a a*yara(at +i*el$r$h +$nia%

na$n in*i+en*i +an &re7alen*i +ia!ete* elit$* yan" ter"ant$n" in*$lin > IDDM ? +an

+ia!ete* elit$* yan" ti+a( ter"ant$n" in*$lin > NIDDM ? *erta +i*tri!$*i relati (e+$a

eni* $taa +ia!ete* ini en$n$((an &er!e+aan . &er!e+aan &,(,( antara ne"ara-ne"ara

+an (el,&,( etni( yan" !er!e+a +i+ala *at$ ne"ara >4%5?

Ber+a*ar(an (riteriaAmerican Diabetes Association (ADA)% *e(itar 10%2 $ta ,ran"

+i Aeri(a Seri(at >AS? en+erita DM +an yan" ti+a( ter+ia"n,*i* *e(itar 5%4 $ta#Den"an +ei(ian% +i&er(ira(an le!ih +ari 15 $ta ,ran" +i AS en+erita DM# Seentara

it$% +i In+,ne*ia &re7alen*i DM *e!e*ar 1%5-2%@ &en+$+$( $*ia 15 tah$n% !ah(an +i

+aerah Mana+, &re7alen*i DM *e!e*ar 6%1@#>6? Pa+a tah$n 1/;% &re7alen*i DM +i

a(arta !ar$ *e!e*ar 1%=@% na$n &a+a tah$n 1// &re7alen*inya enin"(at ena+i

5%=@ +an &a+a tah$n 2001 el,na( ena+i 12%;@# >=?

Den"an enin"(atnya &re7alen*i +ia!ete* elit$* +i !e!era&a ne"ara !er(e!an"

a(i!at &enin"(atan &en+a&atan +an &er$!ahan "aya hi+$& ter$taa +i (,ta-(,ta !e*ar%

$"a enye!a!(an &enin"(atan &re7alen*i &enya(it +e"enerati lain *e&erti &enya(it

ant$n" (,r,ner% hi&erten*i% hi&erli&i+eia% +ll# Na$n +ata e&i+ei,l,"i +i ne"ara

!er(e!an" !el$ !anya(# >;?


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BAB II

ISI

DE)INISI

Dia!ete* Melit$* a+alah (elainan en+,(rin yan" +itan+ai +en"an enin"(atnya

(a+ar "l$(,*a +arah#>1%2%? ata$ *$at$ ($&$lan "eala yan" ti!$l &a+a *e*e,ran" yan"

+i*e!a!(an ,leh (arena a+anya &enin"(atan (a+ar "$la > "l$(,*a ? +arah a(i!at

(e($ran"an in*$lin !ai( a!*,l$t ata$&$n relati#>16?

Men$r$t American Diabetes Association ( ADA ) 200% Dia!ete* Melit$*

er$&a(an *$at$ (el,&,( &enya(it eta!,li( +en"an (ara(teri*ti( hi&er"li(eia yan"

tera+i (arena (elainan *e(re*i in*$lin% (era in*$lin ata$ (e+$a-+$anya# i&er"li(eia

(r,ni( &a+a +ia!ete* !erh$!$n"an +en"an (er$*a(an an"(a &anan"% +i*$n"*i +an

(e"a"alan !e!era&a ,r"an t$!$h% ter$taa ata% "inal% *ara% ant$n" +an &e!$l$h

+arah# >/?

SINONIM

Dia!ete* Melit$* *erin" $"a +i(enal *e!a"ai Penya(it 3$la ata$ Penya(it 'en8in"Mani* #>2?

EPIDEMIOLO3I

Dala Dia!ete* Atla* 2000 > Internati,nal Dia!ete* )e+erati,n ? ter8ant$ &er(iraan

&en+$+$( In+,ne*ia +iata* 20 tah$n *e!e*ar 125 $ta +an +en"an a*$*i &re7alen*i

Dia!ete* Melit$* *e!e*ar 4%6 @ &a+a tah$n 2000 a(a &a*ien DM a(an !er$lah 5%6

$ta +an !er+a*ar(an &,la &erta!ahan &en+$+$( &a+a tah$n 2020 nanti a(an +i+a&at(an

;%2 $ta &a*ien +ia!ete* +ari 1=; $ta &en+$+$( +iata* 20 tah$n# S$at$ $lah yan" !e*ar

+an !e!an yan" !erat%(arenanya *e$a &iha( har$* i($t *erta $nt$( en8e"ah +an

enan""$lan"i ti!$lnya le+a(an Dia!ete* Melit$* ini $lai +ari *e(aran"# >10?


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ETIOLO3IS

Men$r$t an$ran PE'ENI yan" *e*$ai +en"an an$ran ADA 1//=%DM !i*a

+i(la*ii(a*i(an *e8ara eti,l,"i ena+i +ia!ete* ti&e 1% +ia!ete* ti&e 2% +ia!ete* +ala

(ehailan% +an +ia!ete* ti&e lain#>2%%6?

Diabetes Tipe 1

DM ti&e 1 ata$ yan" +$l$ +i(enal +en"an naa Insulin Dependent Diabetes

Mellitus >IDDM?% tera+i (arena (er$*a(an *el ! &an(rea* >rea(*i a$t,i$n?# Bila

(er$*a(an *el !eta telah en8a&ai ;0--/0@ a(a "eala DM $lai $n8$l# Per$*a(an

*el !eta ini le!ih 8e&at tera+i &a+a ana(-ana( +ari&a+a +ea*a#>2%%/?

Se!a"ian !e*ar &en+erita DM ti&e 1 e&$nyai anti!,+i yan" en$n$((an

a+anya &r,*e* a$t,i$n% +an *e!a"ian (e8il ti+a( tera+i &r,*e* a$t,i$n# ',n+i*i ini

+i",l,n"(an *e!a"ai type 1 idiopathic# Se!a"ian !e*ar >=5@? (a*$* tera+i *e!el$ $*ia

0 tah$n% teta&i $*ia ti+a( tera*$( (riteria $nt$( (la*ii(a*i#>2?

Diabetes Tipe 2

DM ti&e 2 er$&a(an /0@ +ari (aa$* DM yan" +$l$ +i(enal *e!a"ai non insulin

dependent Diabetes Mellitus (NIDDM).

Pa+a +ia!ete* ini tera+i &en$r$nan (ea&$an in*$lin !e(era +i arin"an &erier

>insulin resistance) +an +i*$n"*i *el !eta# A(i!atnya% &an(rea* ti+a( a&$

e&r,+$(*i in*$lin yan" 8$($& $nt$( en"(,&en*a*i insulin resistance# 'e+$a hal

ini enye!a!(an tera+inya +ei*ien*i in*$lin relati#>2%%/?

3eala inial +an (e"e$(an *erin" !erh$!$n"an +en"an (,n+i*i ini% yan"

$$nya tera+i &a+a $*ia 40 tah$n# 'a+ar in*$lin !i*a n,ral% ren+ah% a$&$n tin""i%*ehin""a &en+erita ti+a( ter"ant$n" &a+a &e!erian in*$lin#>2?

DM Dalam Kehamilan

DM +an (ehailan >Gestational Diabetes Mellitus - 3DM? a+alah (ehailan

n,ral yan" +i*ertai +en"an &enin"(atan insulin resistance >i!$ hail "a"al


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e&ertahan(an eulycemia)# )a(t,r ri*i(, 3DM: riayat (el$ar"a DM% (e"e$(an%

+an "li(,*$ria# 3DM ini enin"(at(an ,r!i+ita* ne,nat$*% i*alnya hi&,"li(eia%

i(ter$*% &,li*iteia% +an a(r,*,ia#

al ini tera+i (arena !ayi +ari i!$ 3DM en*e(re*i in*$lin le!ih !e*ar *ehin""a

eran"*an" &ert$!$han !ayi +an a(r,*,ia# )re($en*i 3DM (ira-(ira --5@ +an

&ara i!$ ter*e!$t enin"(at ri*i(,nya $nt$( ena+i DM +i a*a en+atan"#>2?

Diabetes Tipe Lain (2,9

a? Dee( "eneti( $n"*i *el !eta

- (r,,*, 12% N)-1 ala > +ah$l$ MOD ?

- (r,,*, =% "l$(,(ina*e > +ah$l$ MOD 2 ?

- (r,,*, 20% N)-4 ala > +ah$l$ MOD 1 ?

- DNA Mit,(,n+ria

!? Dee( 3eneti( (era in*$lin

8? Penya(it E(*,(rin Pan(rea* :

- Pan(reatiti*

- Tra$a

- Ne,&la*a

- y*ti8 )i!r,*i*

- e,8hr,at,*i*

- Pan(reat,&ati i!r,(al($l$*

+? En+,(rin,&ati


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- A(r,e"ali

- Sin+r,a $*hin"

- )e,(r,,*it,a

- i&ertir,i+i*e

e? 'arena ,!at C at (iia yan" en"an""$ $n"*i *el !eta *e&erti :

- A*a ni(,tinat

- 3l$(,(,rti(,i+

- ,r,n Tir,i+

- Tiai+

- Dilantin

- Interer,n Ala

? Ine(*i : r$!ella% 8,n"enital +an M aran" ? *e&erti anti!,+y antire*e&t,r in*$lin

h? Sin+r, "eneti( lain *e&erti Sin+r, D,n% Sin+r, 'lineelter% Sin+r, T$rner%

$tin"t,n h,rea% Sin+r, Pra+er illi


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BAB III

PATO3ENESIS

Di+ala t$!$h tera+i *$at$ &r,*e* eta!,li*e +iana +ala hal ini yan"

ee"an" &eranan &entin" yait$ in*$lin "$na ea*$((an "l$(,*a (e+ala *el% $nt$(

*elan$tnya +a&at +i"$na(an *e!a"ai !ahan !a(ar +iana in*$lin er$&a(an *$at$ at

ata$ h,r,n yan" +i(el$ar(an ,leh *el !eta +i &an(rea*# >16?

Pan(rea* >16?

A+alah *$at$ (elenar yan" leta(nya +i!ela(an" la!$n" +iana +i+alanya

ter+a&at ($&$lan *el yan" !er!ent$( *e&erti &$la$ &a+a &eta (arenanya +i*e!$t &$la$-

&$la$ lan"erhan* yan" !eri*i *el !eta yan" en"el$ar(an h,r,n in*$lin# Di*a&in" it$$"a e&r,+$(*i "l$(a",n yan" !e(era *e!ali(nya +ari in*$lin yait$ enin"(at(an

(a+ar "l$(,*a +arah *erta *el +elta yan" en"el$ar(an *,at,*tatin#

'era In*$lin>16?


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In*$lin +ii!arat(an *e!a"ai ana( ($n8i yan" +a&at e!$(a &int$ a*$(nya

"l$(,*a (e+ala *el $nt$( (e$+ian +i +ala *el "l$(,*a it$ +ieta!,li*e(an ena+i

tena"a# Sehin""a !ila in*$lin ti+a( a+a% a(a "l$(,*a ti+a( +a&at a*$( *el +en"an

+ei(ian (a+ar "l$(,*a +ala +arah a(an enin"(at# Dala (ea+aan ini !a+an ena+i

leah +an ti+a( a+a *$!er ener"i +ala t$!$h#

Dia!ete* Ti&e I

Mer$&a(an &enya(it hi&er"li(eia a(i!at (eti+a(a!*,l$t in*$lin# Pen+erita

&enya(it ini har$* en+a&at in*$lin &en""anti# Bia*anya +ite$(an &a+a ,ran" yan"

ti+a( "e$( +an !er$*ia ($ran" +ari 0 tah$n#

Di&er(ira(an ti!$l a(i!at +e*tr$(*i a$t,i$n *el-*el !eta &$la$ Lan"erhan* yan"+i8et$*(an ,leh lin"($n"an# Seran"an a$t,i$n +a&at ti!$l *etelah ine(*i 7ir$*

i*alnya M$&*% $!ella% ata$ *etelah &aanan ,!at ata$ t,(*i(# Pa+a *aat +ia"n,*i*

+ia!ete* ti&e I +ite"a(an +ite$(an anti!,+y terha+a& *el-*el &$la$ lan"erhan* &a+a

*e!a"ian &a*ien# Ter!ent$(nya anti!,+y terha+a& *el-*el &$la$ lan"erhan* ti+a( +i(etah$i

&enye!a!nya#>11?

Dia!ete* Ti&e II

Mer$&a(an *$at$ (elainan yan" heter,"eni( +en"an (ara(teri*ti( $taa

hi&er"li(eia (r,ni*# Me*(i&$n &,la &eari*nya !el$ ela*% a(t,r "eneti( +i(ata(an

eili(i &eran yan" ($at +ala $n8$lnya DM ti&e II ini# )a(t,r "eneti( a(an

!erintera(*i +en"an a(t,r lin"($n"an *e&erti "aya hi+$&% +iet% ren+ahnya a(ti7ita* i*i(%

,!e*ita* +an tin""inya (a+ar a*a lea( !e!a*# >12?

Pa+a +a*arnya &a+a DM ti&e II ini eili(i 2 (elainan +a*ar *e&erti :

e*i*ten*i In*$lin

Da&at enye!a!(an int,leran*i "l$(,*a% hi&erin*$lineia% &enin"(atan

tri"li*eri+a 1? Bia*a tera+i &a+a

,r"an tar"et *e&erti &a+a li7er% arin"an lea(% +an ,t,t ran"(a er$&a(an +ee(


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$taa &a+a &a*ien DM ti&e II *erta &a*ien +en"an "an""$an t,leran*i "l$(,*a

>!ea"en1/;;F#a$ner 1///? >14?

e*i*ten*i In*$lin +i+eini*i(an *e!a"ai (e"a"alan re*&,n* ee( i*i,l,"i* in*$lin

terha+a& eta!,li*e "l$(,*a% li&i+% &r,tein *erta $n"*i en+,tel 7a*8$lar#

Me(ani*e &at,l,"i yan" elatar!ela(an"i re*i*ten*i in*$lin teta& !el$

*e&en$hnya +i(etah$i e*(i&$n telah +ila($(an &enelitian-&enelitian *e8ara inten*i#

A+a&$n +ee( *el$ler +an ,le($ler yan" +i+$"a !ertan""$n"aa! a+alah

(et+(a&$an re*e&t,r in*$lin% a!!erant re8e&t,r *i"nallin" &athay%+an

a!n,ralita* tran*&,rt ata$ eta!,li*e "l$(,*a# >14?

Selaa i&erin*$lineia 8$($& a+e($at en"ata*i re*i*ten*i in*$lin% a(a

t,leran*i "l$(,*a a(n teta& n,ral# Pa+a &a*ien yan" (e$+ian ena+i DM ti&e II

re*&,n (,&en*a*i *el !eta ini en$r$n% *ehin""a a(an !er(e!an" ena+i

+ei*ien*i in*$lin !ai( yan" relati a$&$n a!*,l$t#

Dee( *e(re*i In*$lin

A(an en$r$n(an &enyi&anan "l$(,*a *e!a"ai "li(,"en +i ,t,t +an hati# al ini

!ia* ti!$l *e!a"ian ,leh (arena (,&,nen "eneti( !er(aitan +en"an 3LUT 4Tran*&,rter +an i&er"li(eia 'r,ni( +a&at enye!a!(an "an""$an a!ilan

"l$(,*a ,t,t elal$i +,nre"$lati,n 3LUT 4 Tran*&,rter# Selain it$ $"a *erin"

+ite$(an &en$r$nan a(ti7ita* tir,*in (ina*e +an IS-1 >In*$lin e8e&t,r S$!*trat-1?#

>14?

Salah *at$ e(ani*e &entin" na$n ti+a( *e8ara lan"*$n" &a+a re*i*ten*i in*$lin

a+alah a+anya &enin"(atan a*a lea( !e!a* +ala *ir($la*i# A*a lea( !e!a* +a&at

en"an""$ (era +ari in*$lin +an eta!,li*e "l$(,*a elal$i !e!era&a 8ara# Salah

*at$nya &entin" &a+a ,t,t ran"(a +an li7er#

A*a lea( tin""iGen"an""$ (era in*$lin he&at,*itGe(*tra*i in*$lin he&ar

+an "l$(,ne,"ene*i* enin"(at > (+r a*a lea( !e!a* tin""i ? Gle!ih +i,(*i+a*i ,leh

*el ,t,t +ari&a+a "l$(,*aGa*a lea( a(an e&r,+$(*i &r,+$(*i in*$lin


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>li&,t,Hi8ity?# Diana &a&aran *el !eta +ala an"(a &anan" terha+a& a*a lea( !e!a*

a(an en"an""$ re*&,n *e(re*i in*$lin terha+a& "l$(,*a# >14?

Se8ara U$ &a*ien DM ti&e II en"alai "an""$an &a+a &r,*e* li&,li*i*

*ehin""a ha&ir *e!a"ian !e*ar +ite$(an eili(i !erat !a+an !erle!ih C ,!e*e#

BAB I!

MANI)ESTASI 'LINIS

3eala (ha* aal yan" *erin" +i$&ai > (arena hi&er"li(eia ? !er$&a

&,li$riaC!anya( (en8in" > ter$taa &a+a ala hari ?% &,lia"iaC!anya( a(an%

&,li+i&*iC!anya( in$% &en$r$nan !erat !a+an *e8ara 8e&at#

3eala lain yan" $n"(in +i(el$h(an &a*ien a+alah (e*e$tan C ra*a !aal% "atal%

ata (a!$r% +an i&,ten*i &a+a &ria *erta &r$rit$* 7$l7a &a+a anita#>14%15?

Per!an+in"an antara IDDM +an IDDM >16?

IDDM NIDDM

Naa Lain DM ti&e 1 DM ti&e 2


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Naa Laa DM $7enil DM +ea*a

U$r !ia*a 40 > ta&i ti+a( *elal$ ? !ia*a 40 >t+( *elal$?

'ea+aan 'lini* !erat rin"an

'a+ar In*$lin ta( a+a in*$lin in*$lin 8$($& C tin""i

Berat !a+an !ia*anya ($r$* !ia*anya "e$(

Pen",!atan In*$lin%+iet%,lahra"a Diet%O%ta!let in*$lin

3eala *erin" ti!$l *e8ara &erlahan-lahan +an *erin"nya +ia"n,*i* +ite"a((an

(eti(a *e*e,ran" yan" !el$ a+a (el$han a(an teta&i +i+a&at(an &enin"(atan "l$(,*a

&la*a &a+a &eeri(*aan la!,rat,ri$ r$tin#>?

',&li(a*i a($t yan" +a&at tera+i *e&erti hi&,"li(eia +an hi&er"li(eia#>1/?

i&,"li(eia a+alah (ea+aan (lini( "an""$an *ara yan" +i*e!a!(an &en$r$nan "l$(,*a

+arah# 3eala ini +a&at tera+i +ari rin"an *a&ai !erat !er$&a "eli*ah *a&ai (,a

+en"an (ean"# Penye!a! ter*erin" a+alah ,!at hi&,"li(ei( ",l,n"an *$l,nil$rea%

(h$*$*nya "li!en(lai+#

Pa+a (ea+aan a&a&$n &en",!atan yan" &alin" !ai( a+alah &en8e"ahan na$n !ila

*$+ah telan$r har$* *e"era +iata*i ter$taa "an""$an terha+a& ,ta(% ,r"an yan" &alin"

*en*iti7e terha+a& &en$r$nan "l$(,*a +arah# Da&at +i!eri(an "$la $rni J 0 " ata$

a(anan yan" en"an+$n" hi+rat aran" +an +i!erhenti(an &ea(aian ,!at hi&,"li(ei(

$nt$( *eentara#

Na$n !ila *$+ah tera+i (,a hi&,"li(eia &enan"anan har$* 8e&at% !eri lar$tan

"l$(,*a 40@ *e!anya( 2 la(,n elal$i 7ena *etia& 10-20 enit hin""a &a*ien *a+ar

+i*ertai &e!erian 8airan +eHtr,*e 10@ &er in$* 6 a &er (,l% $nt$( e&ertahan(an"l$(,*a +arah +ala nilai n,ral ata$ +iata* n,ral#

i&er"li(eia *erin" +itan+ai +en"an (e*a+aran en$r$n +i*ertai +ehi+ra*i !erat#

Bia*anya +ite$(an a+anya a*$(an (al,ri yan" !erle!ihan% &en"hentian ,!at ,ral


14/36

a$&$n in*$lin yan" +i+ah$l$i ,leh *tre** a($t# Da&at tera+i (et,a*i+,*i* +ia!eti( +an

hi&er,*,lar n,n-(et,*i*#

'et,a*i+,*i* +ia!eti( > 'AD ? er$&a(an +eien*i in*$lin !erat +an a($t +ari

*$at$ &eralanan &enya(it +ia!ete* ellit$*# Da&at +ilihat +ari "eala (lini( $taa *e&erti

&,li$ria% &,li+i&*ia% hi&er7entila*i > &ernaa*an '$**a$l ?% ta(i(ar+ia% +an +ehi+ra*i#

Pa*ien *erin" en"el$ar(an !a$ (et,n iri& !$ah yan" (ha* +ari naa*nya# M$al-$ntah

+an nyeri &$8at *erin" tera+i#

Se+an"(an &a+a hi&er,*,larita* n,n-(et,a*i+,*i*% in+i7i+$ e&$nyai $lah

in*$lin yan" 8$($& $nt$( en8e"ah (et,a*i+,*i* teta&i ti+a( 8$($& $nt$(

e&ertahan(an h,e,*tati* "l$(,*a yan" n,ral# Pen",!atan +i$lai +ari rehi+ra*i%

&e!erian in*$lin% (,re(*i ele(tr,lit +en"an &e!erian natri$ !i(ar!,nat% (ali$ *erta

&e!erian anti!i,ti(a $nt$( en8e"ah ine(*i#>1/?

',&li(a*i (r,ni( *e&erti : >15?

Ma(r,an"i,&ati% en"enai &e!$l$h +arah !e*ar *e&erti &e!$l$h +arah ant$n"%

&e!$l$h +arah te&i% &e!$l$h +arah ,ta(# Mi(r,an"i,&ati% en"enai &e!$l$h +arah (e8il *e&erti retin,&ati +ia!eti(% ner,&ati

+ia!eti(

Ne$r,&ati( Dia!eti(

entan Ine(*i *e&erti TB &ar$% 3in"i7iti* +an Ine(*i Sal$ran 'eih

'a(i Dia!eti(


15/36

BAB !

PEMEI'SAAN

Unt$( DH DM: &eeri(*aan "l$(,*a +arahChi&er"li(eia >&$a*a% 2 a *etelah

a(anCpost prandial%PP? +an *etelah &e!erian "l$(,*a &er-,ral >TT3O?#>1%2%%6%21%22?

Anti!,+i $nt$( &etan+a >marker? a+anya &r,*e* a$t,i$n &a+a *el !eta a+alah

islet cell cytoplasmic antibodies (ICA)& insulin autoantibodies (IAA)& +an anti!,+i

terha+a&lutamic acid decarbo'ylase (anti-GAD)#

IA !erea(*i +en"an anti"en yan" a+a +i *it,&la*a *el-*el en+,(rin &a+a &$la$-

&$la$ &an(rea*# IA ini en$n$((an a+anya (er$*a(an *el# A+anya IA +an IAA

en$n$((an ri*i(, tin""i !er(e!an"nya &enya(it (e arah +ia!ete* ti&e 1#


16/36

3AD a+alah eni yan" +i!$t$h(an $nt$( e&r,+$(*i ne$r,tran*iter "-

aminobutyric acid (GAA)# Anti 3AD ini !i*a teri+entii(a*i 10 tah$n *e!el$ ,n*et

(lini* tera+i# a+i% &etan+a ini !i*a +i"$na(an *e!a"ai $i *arin" *e!el$ "eala DM

$n8$l#>2?

Unt$( e!e+a(an ti&e 1 +en"an ti&e 2 +i"$na(an &eeri(*aan C-peptide#

',n*entra*i C-peptideer$&a(an in+i(at,r yan" !ai( $nt$( $n"*i *el !eta% $"a !i*a

+i"$na(an $nt$( e,nit,r re*&,n* in+i7i+$al *etelah ,&era*i &an(rea*# ',n*entra*i C-

peptida a(an enin"(at &a+a tran*&lanta*i &an(rea* ata$ tran*&lanta*i *el-*el &$la$

&an(rea*#>2?

Samplin" #nt#$ Peme%i$saan Ka&a% '#la Da%ah

Unt$( "l$(,*a +arah &$a*a% &a*ien har$* !er&$a*a 6--12 a *e!el$ +ia!il

+arahnya# Setelah +ia!il +arahnya% &en+erita +iinta a(an a(anan *e&erti yan"

!ia*a +ia a(anCin$ "l$(,*a &er ,ral >=5 "r ? $nt$( TT3O% +an har$* +iha!i*(an

+ala a(t$ 15--20 enit# D$a a (e$+ian +ia!il +arahnya $nt$( &eeri(*aan

"l$(,*a 2 a PP#>2%%6?

Darah +i*entri$"a*i $nt$( en+a&at(an *er$nya% (e$+ian +i&eri(*a (a+ar

"l$(,*anya# Bila &eeri(*aan ti+a( lan"*$n" +ila($(an >a+a &en$n+aan a(t$?% +arah

+ari &en+erita !i*a +ita!ah +en"an anti"li(,liti( >"li*eral+ehi+a% $luoride& +an

i,+,a*etat? $nt$( en"hin+ari tera+inya "l$(,*a +arah yan" ren+ah &al*$#>2?

Ini *an"at &entin" $nt$( +i(etah$i (arena (e*alahan &a+a a*e ini +a&at

enye!a!(an ha*il &eeri(*aan "$la +arah ti+a( *e*$ai +en"an *e!enarnya% +an a(an

enye!a!(an (e*alahan +ala &enatala(*anaan &en+erita DM#

Met&e Peme%i$saan Ka&a% 'l#$sa

Met,+e &eeri(*aan "$la +arah eli&$ti et,+e re+$(*i% eniati(% +an lainnya#

an" &alin" *erin" +ila($(an a+alah et,+e eniati(% yait$ et,+e "l$(,*a ,(*i+a*e

>3OD? +an et,+e he(*,(ina*e#>1%2?


17/36

Met,+e 3OD !anya( +i"$na(an *aat ini# A($ra*i +an &re*i*i yan" !ai( >(arena

eni 3OD *&e*ii( $nt$( rea(*i &ertaa?% ta&i rea(*i (e+$a raan intereren >ta(

*&e*ii(?# Intereren yan" !i*a en""an""$ antara lain !ilir$!in% a*a $rat% +an a*a

a*(,r!at#>2?

Met,+e he(*,(ina*e $"a !anya( +i"$na(an# Met,+e ini eili(i a($ra*i +an

&re*i*i yan" *an"at !ai( +an er$&a(an et,+e reeren*% (arena eni yan" +i"$na(an

*&e*ii( $nt$( "l$(,*a# Unt$( en+ia",*a DM% +i"$na(an (riteria +ari (,n*en*$*

Per($&$lan En+,(rin,l,"i In+,ne*ia tah$n 1//; >PE'ENI 1//;?>%6%22?

Peme%i$saan #nt#$ Pemanta#an Pen"ellaan DM

an" +i"$na(an a+alah (a+ar "l$(,*a +arah &$a*a% 2 a PP% +an &eeri(*aan

lycated hemolobin% (h$*$*nya !A1% *erta &eeri(*aan r$(t,*ain#>2%%6%22?

Peeri(*aan r$(t,*ain *aat ini aran" +ila($(an (arena &eeri(*aan ini eerl$(an

&r,*e+$r yan" ea(an a(t$ laa#>22? Peeri(*aan lain yan" !i*a +ila($(an ialah

$rinali*a r$tin# Peeri(*aan ini !i*a +ila($(an *e!a"aisel$-assessment$nt$( eanta$

ter(,ntr,lnya "l$(,*a elal$i re+$(*i $rin#>1%22?

Peme%i$saan HbA1

!A1a+alah (,&,nen ! yan" ter!ent$( +ari rea(*i n,n-eniati( antara

"l$(,*a +en"an N terinal 7alin rantai ! ! A +en"an i(atan Ali+in# Pr,+$( yan"

+iha*il(an ini +i$!ah elal$i &r,*e* Aa+,ri ena+i (et,ain yan" *ta!il +an

ire7er*i!el#>22? Met,+e &eeri(*aan !A1: ion-e'chane chromatoraphy& #*C (hih

per$ormance li+uid chromatoraphy)& ,lectro$oresis& Immunoassay& A$$inity

chromatoraphy& +an anali*i* (iiai +en"an (,l,rietri#>1%2?

Met,+eIon ,'chane Chromatoraphyhar$* +i(,ntr,l &er$!ahan *$h$ rea"en

+an (,l,% (e($atan i,n% +an & +ari !$er# Intereren* yan" en""an""$ a+alah a+anya

!S +an ! yan" !i*a e!eri(an ha*il ne"ati &al*$#>2?


18/36

Met,+e PL: &rin*i& *aa +en"an ion e'chane chromatoraphy% !i*a

+i,t,ati*a*i% *erta eili(i a($ra*i +an &re*i*i yan" !ai( *e(ali# Met,+e ini $"a

+ire(,en+a*i(an ena+i et,+e reeren*i#

Met,+e a"ar "el ele(tr,,re*i*: ha*ilnya !er(,rela*i !ai( +en"an PL% teta&i

&re*i*inya ($ran" +i!an+in" PL# ! ) e!eri(an ha*il &,*iti &al*$% teta&i (e($atan

i,n% &% *$h$% !S% +an ! ti+a( !anya( !er&en"ar$h &a+a et,+e ini#>2?

Met,+e Immunoassay >EIA?: hanya en"$($r !A1% ti+a( en"$($r !A1

yan" la!il a$&$n !A1A+an !A1B% e&$nyai &re*i*i yan" !ai(#>2?

Met,+e A$$inity Chromatoraphy: non-lycated hemolobin *erta !ent$( la!il

+ari !A1 ti+a( en""an""$ &enent$an lycated hemolobin% ta( +i&en"ar$hi *$h$#

Pre*i*i !ai(# !)% !S% ata$&$n ! hanya *e+i(it e&en"ar$hi et,+e ini% teta&i

et,+e ini en"$($r (e*el$r$han lycated hemolobin% *ehin""a ha*il &en"$($ran

+en"an et,+e ini le!ih tin""i +ari et,+e PL#>2?

Met,+e 'al,rietri: a(t$ in($!a*i laa >2 a?% le!ih *&e*ii( (arena ti+a(

+i&en"ar$hi non-lycosylated ata$&$n lycosylated la!il# 'er$"iannya a(t$ laa%

*a&el !e*ar% +an *at$an &en"$($ran yan" ($ran" +i(enal ,leh (lini*i% yait$ ,lCL#

Inte%pe%tasi Hasil Peme%i$saan HbA1)

!A1a(an enin"(at *e8ara *i"nii(an !ila "l$(,*a +arah enin"(at# 'arena

it$% !A1!i*a +i"$na(an $nt$( elihat ($alita* (,ntr,l "l$(,*a +arah &a+a &en+erita

DM >"l$(,*a +arah ta( ter(,ntr,l% tera+i &enin"(atan !A1-nya ? *ea( !$lan lal$

>$$r eritr,*it?# !A1 enin"(at: &e!erian TH le!ih inten*i $nt$( en"hin+ari

(,&li(a*i >2%%6%21%22?

Nilai yan" +ian$r(an PE'ENI $nt$( !A1 >ter(,ntr,l?: 4@-5%/@#>6? a+i%

!A1&entin" $nt$( elihat a&a(ah &enatala(*anaan *$+ah a+e($at ata$ !el$#>1%1;?

Se!ai(nya% &enent$an !A1ini +ila($(an *e8ara r$tin tia& !$lan *e(ali#>6?

Peme%i$saan #nt#$ Memanta# Kmpli$asi DM


19/36

',&li(a*i *&e*ii( DM: ater,*(ler,*i*% ner,&ati% ne$r,&ati% +an retin,&ati#

Peeri(*aan la!,rat,ri$ !i*a +ila($(an $nt$( e&re+i(*i !e!era&a +ari (,&li(a*i

*&e*ii( ter*e!$t% i*alnya $nt$( e&re+i(*i ner,&ati +an "an""$an ater,*(ler,*i*#

>2%%6%22?

Peme%i$saan Mi$%alb#min#%ia

Peeri(*aan $nt$( eanta$ (,&li(a*i ner,&ati: i(r,al!$in$ria *erta

he&aran *$lat $rine >&eeri(*aan ini aran" +ila($(an?#>1%2%%6%21%22%2? Peeri(*aan

lainnya yan" r$tin a+alah &eeri(*aan *er$ $re$ +an (reatinin $nt$( elihat $n"*i

"inal#>6?

Mi(r,al!$in$ria: e(*(re*i al!$in +i $rin *e!e*ar 0-00 "C24 a ata$

*e!e*ar 20-200 "Cenit#>2%? Mi(r,al!$in$ria ini +a&at !er(e!an" ena+i

a(r,al!$in$ria# Se(ali a(r,al!$in$ria tera+i a(a a(an tera+i &en$r$nan yan"

eneta& +ari $n"*i "inal# ',ntr,l DM yan" (etat +a&at e&er!ai(i i(r,al!$in$ria

&a+a !e!era&a &a*ien% *ehin""a &eralanan en$$ (e ner,&ati !i*a +i&erla!at#>%6?

Pen"$($ran i(r,al!$in$ria *e8ara *ei($antitati +en"an en""$na(an *tri&

ata$ te* late' alutination inhibition& teta&i $nt$( e,nit,r &a*ien te*-te* ini ($ran"

a($rat *ehin""a aran" +i"$na(an# an" *erin" a+alah 8ara ($antitati: et,+e !adial

Immunodi$$usion (!ID)& !adio Immunoassay (!IA)& ,nym-linked Immunosorbent assay

(,*I/A)& +anImmunoturbidimetry.Met,+e ($antitati eili(i &re*i*i% *en*iti7ita*% +an

raneyan" iri&% *erta *e$anya en""$na(an anti!,+i terha+a& human albumin.>2?

Sa&el yan" +i"$na(an $nt$( &en"$($ran ini a+alah *a&el $rine 24 a#>2?

Inte%p%etasi Hasil Peme%i$saan Mi$%alb#min#%ia

Men$r$t S8hrier et al >1//6?% a+a (ate",ri al!$in$ria% yait$ al!$in$ria

n,ral >20 "Cenit?% i(r,al!$in$ria >20--200 "Cenit?% 0"ert Albuminuria >200

"Cenit?#>2? Peeri(*aan al!$in$ria *e!ai(nya +ila($(an inial 1 K &er tah$n &a+a

*e$a &en+erita DM $*ia 12 tah$n#


20/36

Peme%i$saan #nt#$ Kmpli$asiAte%s$le%sis

Peeri(*aan $nt$( eanta$ (,&li(a*i ater,*(ler,*i* ini ialah &r,il li&i+%

yait$ (,le*ter,l t,tal% lo density lipoprotein cholesterol >LDL-?% hih density

lipoprotein cholesterol >DL-?% +an tri"li*eri+a *er$% *erta i(r,al!$in$ria#

>6%21%22? Pa+a &eeri(*aan &r,il li&i+ ini% &en+erita +iinta !er&$a*a *e+i(itnya 12 a

>(arena i(a ti+a( &$a*a% tri"li*eri+a 2 a +an en8a&ai &$n8a(nya 6 a *etelah

a(an?#

Peme%i$saan #nt#$ Kmpli$asi Lainn*a

Peeri(*aan lainnya $nt$( elihat (,&li(a*i +arah +an anali*a r$tin#

Peeri(*aan ini !i*a $nt$( elihat a+anya ine(*i yan" $n"(in ti!$l &a+a &en+erita

DM#>?

Unt$( &eeri(*aan la!,rat,ri$ ine(*i% *erin" +i!$t$h(an ($lt$r >&e!ia(an?%

i*alnya ($lt$r +arah% ($lt$r $rine% ata$ lainnya# Peeri(*aan lain yan" $"a *erin"(ali

+i!$t$h(an a+alah &eeri(*aan (a+ar in*$lin &$a*a +an 2 a PP $nt$( elihat a&a(ah

a+a (elainan in*$lin +arah ata$ ti+a(# 'a+an"-(a+an" $"a +i!$t$h(an &eeri(*aan lain

$nt$( elihat "eala (,&li(a*i +ari DM% i*alnya a+anya "an""$an (e*ei!an"an

ele(tr,lit +an a*i+,*i*Cal(al,*i* eta!,li( a(a &erl$ +ila($(an &eeri(*aan ele(tr,lit

+an anali*a "a* +arah# Pa+a (ea+aan (et,a*i+,*i* $"a +i!$t$h(an a+anya &eeri(*aan

(et,n !,+ie*% i*alnya a8et,nC(et,n +i $rine% (a+ar a*a la(tat +arah% (a+ar !eta

hi+r,(*i !$tarat +ala +arah% +an lain-lainnya# Selain it$% $n"(in $nt$( &enelitian

a*ih +ila($(an &eeri(*aan !i,,le($ler% i*alnya LA >#uman *ymphocyte

Antien? *erta &eeri(*aan "eneti( lain#


21/36

BAB !I

DIA3NOSIS

Da&at +ila($(an !er+a*ar(an &eeri(*aan "l$(,*a +arah *ea(t$ +en"an "eala

+ia!ete*% (a+ar "l$(,*a +arah &$a*a ata$ te* t,leran*i "l$(,*a# ala$&$n &eeri(*aan

$rin +a&at e!eri(an +$"aan ($at a(an +ia!ete*% ia teta& ti+a( +a&at +i"$na(an *e!a"ai

+a*ar +ia"n,*ti( +ia!ete* ellit$*# >/?

Men$r$t ADA tah$n 1//; 'riteria Dia"n,*ti( Dia!ete* Melit$* : >/%15?

3eala Dia!ete* +en"an "l$(,*a +arah *ea(t$ 200 "C+l


22/36

Sea(t$ : a+alah *etia& a(t$ *e&anan" hari tan&a e&erhati(an a(an tera(hir#

3eala (la*i( *e&erti &,li$ria% &,li+i&*i% +an !erat !a+an t$r$n tan&a *e!a!#

'a+ar "l$(,*a +arah &$a*a 126 "C+l

P$a*a : a+alah tan&a inta(e (al,ri *elaa ; . 10 a# Pa+a O3TT% (a+ar "l$(,*a

+arah 2 a PP 200 "C+l

Den"an a+anya a(t,r re*i(, yan" tin""i >/%16? *e&erti :

'et$r$nan

Ine(*i


23/36

Peeri(*aan &enyarin" $lan"an +ila($(an tia& tah$n% *e+an" !a"i ere(a yan"

!er$*ia 45 tah$n tan&a a(t,r re*i(,% &eeri(*aan &enyarin" +a&at +ila($(an *etia&

tah$n#

Peeri(*aan &enyarin" ini !er"$na $nt$( enyarin" &a*ien DM% T3T +an 3DPT

*ehin""a +a&at +itent$(an lan"(ah tera&i yan" te&at $nt$( ere(a# Peeri(*aan

&enyarin" +a&at +i$lai +en"an &eeri(*aan (a+ar "l$(,*a *ea(t$ ata$ (a+ar "l$(,*a

+arah &$a*a yan" (e$+ian +ii($ti +en"an te* t,leran*i "l$(,*a ,ral >TT3O? *tan+ar# >/?

Beri($t Ta!el &at,(an &enyarin" +an +ia"n,*i* DM +en"an 'a+ar 3l$(,*a Darah

Sea(t$ +an 3l$(,*a Darah P$a*a >/%1=%1;?

B$(an DM Bel$ &a*ti DM DM

Ka&a% 'l#$sa Da%ah Se+a$t#

Pla*a


24/36

'eteran"an :

3DP 3l$(,*a Darah P$a*a

3DS 3l$(,*a Darah Sea(t$

3DPT 3l$(,*a Darah P$a*a Ter"an""$

'el$han 'ha* >? 'el$han 'ha* > - ?

3DP

ata$

3DS

126

200

126

200

126

200

110.125

110-1//

110

Ulan" 3DS ata$ 3DP

TT3O126

200

126

200

126

200

DIABETES MELITUS T3T 3DPT N,ral

200 140-1// 140

- E7al$a*i Stat$* 3ii

- E7al$a*i Peny$lit DM

- E7al$a*i +an Peren8anaan Ma(an

*e*$ai +en"an (e!$t$han

- Na*ihat U$

- Peren8anaan Ma(an

- Latihan a*ani

- Berat I+aan

- Bel$ &erl$ O!at Pen$r$n

3l$(,*a


25/36

T3T T,leran*i 3l$(,*a Ter"an""$

Te* T,leran*i 3l$(,*a Oral +a&at +ila($(an +en"an 8ara :

hari *e!el$ &eeri(*aan a(an *e&erti !ia*a > (ar!,hi+rat 8$($& ?% (e"iataan

a*ani *e&erti !ia*a +ila($(an

P$a*a &alin" *e+i(it ; a $lai ala hari *e!el$ &eeri(*aan% in$ air &$tih

+i&er!,leh(an

Di&eri(*a (a+ar "l$(,*a +arah &$a*a

Di!eri(an "l$(,*a =5 "ra > ,ran" +ea*a ? ata$ 1%=5 "ra C ("!! > ana(-ana( ?

+ilar$t(an +ala air 250 l +an +iin$ +ala a(t$ 5 enit

Di&eri(*a (a+ar "l$(,*a +arah 2 a *e*$+ah !e!an "l$(,*a

Selaa &r,*e* &eeri(*aan *$!ye( yan" +i&eri(*a teta& i*tirahat +an ti+a( er,(,(

Pet$n$( Pra(ti* Pen"el,laan DM Ti&e 2% PE'ENI 2002 >1=?

Ber+a*ar(an +iata* a(a 'riteria Dia"n,*ti( DM +an 3T3 +a&at +ilihat +ari :

- 'a+ar "l$(,*a +arah *ea(t$ > Pla*a Pla*a


26/36

- 'a+ar "l$(,*a &la*a 200 "C+l &+ 2 a **+h !e!an "l$(,*a =5 "ra &+ TT3O

BAB !II

PENATALA'SANAAN >15%1=?


27/36

Dala an"(a Pen+e( &enatala(*anaan DM !ert$$an $nt$( en"hilan"(an

(el$han C "eala DM *e+an"(an an"(a &anan"nya a+alah $nt$( en8e"ah (,&li(a*i

*erta terha!atnya &r,"e*i7ita* &eny$lit (r,ni( *ehin""a ti+a( tera+i &en$r$nan

,r!i+ita* +an ,rtalita* +ini DM#

T$$an ter*e!$t +ila(*ana(an +en"an 8ara en,ral(an (a+ar "l$(,*a% li&i+% +an

in*$lin# Unt$( e&er$+ahnya a(a &enatala(*anaan +ila($(an *e8ara h,li*ti( +an

en"aar(an (e"iataan yan" an+iri#

'eran"(a Utaa &enatala(*anaan DM ter+iri +ari :

1# E+$(a*i >1=?

Pentin" (arena &eralanan &enya(it DM laa +an +i!$t$h(an &en"etah$an yan"

8$($& "$na en"hin+ari tera+inya (,&li(a*i-(,&li(a*i yan" er$"i(an !a"i

&a*ien# Peahaan tentan" &enya(it% a(na +an &erl$nya &en"en+alian *erta

&eanta$an DM &erl$ +i(etah$i $"a tentan" &eny$lit% inter7en*i ara(,l,"i* +an

n,n-ara(,l,"i*% (e$n"(inan tera+inya hi&,"li(eia% a*alah (h$*$* yan"

+iha+a&i +an 8ara e&er"$na(an a*ilita* &eraatan (e*ehatan#

2# Peren8anaan Ma(an >15%1=?

Pa+a ',n*en*$* Per($&$lan En+,(rin,l,"i In+,ne*ia > PE'ENI ? telah

+iteta&(an !aha *tan+ar yan" +ian$r(an a+alah *anta&an +en"an (,&,*i*i

*ei!an" !er$&a (ar!,hi+rat > 60-=0@?% &r,tein >10-15@ ?% lea( > 20-25@ ?#

$lah (al,ri +i*e*$ai(an +en"an &ert$!$han% *tat$* "ii% $$r% *tre** a($t% +an

(e"iatan a*ani $nt$( en8a&ai !erat !a+an i+eal#

Penent$an *tat$* "ii +a&at +i"$na(an BMI C B,+y Ma** In+eH IMT C In+e(*

Ma*a T$!$h +an r$$* Br,8a#

IMT BB > '" ?

TB > M2?

Den"an 'la*ii(a*i *!! :

- BB ($ran" 1;%5

- BB N,ral 1;%5-2%5


28/36

- BB Le!ih 24%0

- Den"an e*i(, 24%0-25%0

- O!e*e I 25 . 2/%/

- O!e*e II 2/%/

Den"an $$* Br,8a +i&a(ai :

BB I+aan > TB . 100 ? . 10 @

Stat$* 3ii BB a8t$al H 100 @ C TB > 8 ? . 100

- BB ($ran" /0@ BB I+aan

- BB N,ral /0 . 110 @ BB I+aan

- BB Le!ih 110 . 120 @ BB I+aan

- 3e$( 120 @ BB I+aan

$lah (al,ri yan" +i&erl$(an +ihit$n" +ari !erat !a+an i+aan +i(ali (e!$t$han

!a*al > 0 ((al C ("BB $nt$( la(i.la(i +an 25 ((al C ("BB $nt$( anita ? (e$+ian

+ita!ah +en"an (e!$t$han (al,ri $nt$( a(tiita* > 10-0@ $nt$( atlet +an &e(era

!erat% *e*$ai +en"an (al,ri yan" +i(el$ar(an +ala (e"iatannya ?#

',re(*i *tat$* "ii > !ila "e$( +i($ran"i +an !ila ($r$* +ita!ah ? *erta (al,ri

yan" +i!$t$h(an en"ha+a&i *tre** a($t i*alnya ine(*i yan" *e*$ai +en"an

(e!$t$han#

$lah (an+$n"an (,le*ter,l 00 "Chari% $lah (an+$n"an *erat J25"Chari%

+i$taa(an *erat yan" lar$t# ',n*$*i "ara +i!ata*i !ila hi&erten*i# Peani* +a&at

+i"$na(an *e8$($&nya#

# Latihan a*ani

Dian$r(an latihan a*ani terat$r . 4 (ali tia& in""$ *elaa J 0 enit yan"

*iatnya )IPE> ),ntin,$* hyti8al Inter7al Pr,"re**i7e En+$ra8e trainin" ?#

),ntin,$*


29/36

Latihan har$* !er(e*ina!$n"an +an +ila($(an ter$*-ener$* tan&a henti# ,nt,h :

!ila +i&ilih ,""in" 0 enit% a(a *elaa 0 enit &a*ien ela($(an ,""in" tan&a

i*tirahat#

yti8al

Latihan ,lahra"a har$* +i&ilih yan" !eriraa% yait$ ,t,t-,t,t !er(,ntra(*i +an

!erela(*a*i *e8ara terat$r#

Inter7al

Latihan +ila($(an *elan"-*elin" antara "era( 8e&at +an la!at# ,nt,h : alan 8e&at

+i*elin"i +en"an alan la!at% +*!#

Pr,"re**i7e

Latihan +ila($(an *e8ara !ertaha& *e*$ai (ea&$an +ari inten*ita* rin"an *a&ai

hin""a en8a&ai 0-60 enit#

Sa*aran eart ate =5-;5 @ +ari Ma(*i$ eart ate

Ma(*i$ eart ate 220-$$r#

En+$ran8e

Latihan +aya tahan $nt$( enin"(at(an (ea&$an (ar+i,re*&ira*i% *e&erti alan

>alan *antaiC8e&at% *e*$ai $$r?%,""in"%!erenan" +an !er*e&e+a#

al yan" &erl$ +i&erhati(an +ala latihan a*ani ini a+alah an"an *a&ai

e$lai ,lahra"a *e!el$ a(an% har$* en""$na(an *e&at$ yan" &a*% +i+a&in"i

,leh ,ran" yan" tah$ !a"aiana 8ara en"ata*i hi&,"li(eia% har$* e!aa

&eren% e!aa tan+a &en"enal *e!a"ai &a*ien DM +ala &en",!atan% +an

eeri(*a (a(i +en"an 8erat *etelah !er,lahra"a#>15?

Se+a&at $n"(in en8a&ai ,na *a*aran ata$ ,na latihan yait$ =5-;5@ +eny$t

na+i a(*ial yan" +a&at +ihit$n" +en"an 8ara *!! :

DNM 220 . U$r > +ala Tah$n ?

4# O!at i&,"li(ei( Oral >15%20?


30/36

a? 3,l,n"an S$l,nilUrea

3,l,n"an ,!at ini !e(era +en"an en*ti$la*i *el !eta &an(rea* $nt$(

ele&a*(an in*$lin yan" ter*i&an *ehin""a hanya !eranaat &a+a &a*ien yan"

a*ih e&$nyai (ea&$an $nt$( en*e(re*i in*$lin +iana ti+a(

!eranaat !a"i +ia!ete* ellit$* yan" !er"ant$n" &a+a in*$lin# Ee( eHtra

&an(rea* yait$ e&er!ai(i *en*iti7ita* in*$lin a+a teta&i ti+a( !eranaat &a+a

&a*ien yan" in*$lin,&eni(#

Me(ani*e (era ,!at ",l,n"an *$l,nil$rea :

Men*ti$la*i &ele&a*an in*$lin yan" ter*i&an

Men$r$n(an a!an" *e(re*i in*$lin

Menin"(at(an *e(re*i in*$lin *e!a"ai a(i!at ran"*an"an "l$(,*a

O!at ",l,n"an ini *e$anya e&$nyai 8ara (era yan" *er$&a%na$n

!er!e+a +ala hal a*a (era% +e"ra+a*i +an a(ti7ita* eta!,litnya# Se$anya

+a&at enye!a!(an hi&,"li(eia#

O!at *$l,nil$rea +en"an a*a (era &anan" *e!ai(nya an"an +i!eri(an

&a+a ,ran" lan$t $*ia% $"a hati-hati &a+a &a*ien "a"al "inal% "a"al hati% inta(e

a(anan ($ran" *erta &ea(aian al(,h,l !erle!ihan (arena enye!a!(an

hi&,"li(eia yan" !er(e&anan"an#

O!at ",l,n"an ini !ia*a +i!eri(an &a+a &a*ien +en"an !erat !a+an n,ral

+an a*ih +a&at +i&a(ai &a+a &a*ien +en"an !erat !a+an *e+i(it le!ih (arena

ei8$ ra*a in"in a(an#

',!ina*i S$l,nil$rea +en"an in*$lin

Pea(aian (,!ina*i (e+$a ,!at ini +i+a*ar(an !aha rerata (a+ar

"l$(,*a +arah *e&anan" hari ter$taa +itent$(an ,leh (a+ar "l$(,*a +arah

&$a*anya# U$nya (enai(an (a+ar "l$(,*a +arah *e*$+ah a(an ($ran" le!ih

*aa% ti+a( ter"ant$n" +ari (a+ar "l$(,*a +arah &$a*anya#

Den"an e!eri(an +,*i* in*$lin (era *e+an" ala hari% &r,+$(*i

"l$(,*a +arah &$a*anya +a&at le!ih ren+ah la"i# Selan$tnya (a+ar "l$(,*a +arah


31/36

*ian" hari +a&at +iat$r +en"an &e!erian *$l,nil$rea *e&erti !ia*a# ',!ina*i

ini le!ih !ai( +ari&a+a in*$lin *aa +an +,*i* in*$lin yan" +i&erl$(an ternyata

le!ih ren+ah#

!? 3,l,n"an Bi"$ani+

Saat ini yan" a*ih +i"$na(an yait$ et,rin (arena (e$n"(inan

tera+i a*i+,*i* la(tat le!ih (e8il +i*!an+in" &en""$naan en,rin +an

!$,rin#

O!at ini en$r$n(an "l$(,*a +arah elal$i &en"ar$hnya terha+a& (era

in*$lin &a+a tin"(at *el$lar% +i*tal +ari re*e&t,r in*$lin *erta $"a &a+a ee(nya

en$r$n(an "l$(,*a hati *ehin""a enin"(at(an &ea(aian "l$(,*a ,leh *el

$*$*#

O!at ini +i*an"(a en"ha!at a!*,r&*i "l$(,*a +ari $*$* &a+a (ea+aan

*e*$+ah a(an *ehin""a !ai( +i!eri(an &a+a &a*ien "e$( > IMT 0 ? *e!a"ai

,!at t$n""al# Pa+a &ea(aian t$n""al% et,rin +a&at n$r$n(an (a+ar

"l$(,*a +arah *a&ai 20@% (a+ar in*$lin $"a en$r$n *ehin""a ti+a(

enye!a!(an (enai(an !erat !a+an *e&erti &a+a ",l,n"an *$l,nil$rea#

',!ina*i +en"an *$l,nil$rea er$&a(an (,!ina*i yan" ra*i,nal

(arena 8ara (era yan" !er!e+a yan" *alin" a+iti# ',!ina*i ini $"a +a&at

en$r$n(an (a+ar "l$(,*a +arah le!ih !anya( +ari&a+a &en",!atan

t$n""al#Selain en$r$n(an (a+ar "l$(,*a +arah% et,rin $"a !er&en"ar$h

&a+a (,&,nen lain re*i*ten*i in*$lin yait$ &a+a li&i+% +an te(anan +arah#

8? Inhi!it,r ala "l$(,*i+a*e

Be(era *e8ara (,&etiti en"ha!at (era eni ala "l$(,*i+a*e +i

+ala *al$ran 8erna *ehin""a +a&at en$r$n(an &enyera&an "l$(,*a +an

en$r$n(an hi&er"li(eia &,*t&ran+ial# O!at ini !e(era +i l$en $*$* +an ti+a(

enye!a!(an hi&,"li(eia *erta ti+a( !er&en"ar$h &a+a (a+ar in*$lin#

Ee( *a&in" a(i!at al+i"e*ti (ar!,hi+rat !er$&a "eala "a*tr,inte*tinal

!er$&a ete,ri*$*% lat$len8e% +an +iare# )lat$len8e er$&a(an ee( yan"


32/36

ter*erin"% tera+i &a+a 50@ &en""$na ,!at ini# O!at ini $"a +a&at en"ha!at

!i,a7aila!ilita* et,rin i(a +i!eri(an !er*aaan &a+a ,ran" n,ral#

+? In*$lin Sen*itiin" A"ent

Thia,li+ine+i,ne* a+alah ",l,n"an ,!at !ar$ yan" e&$nyai ee(

ara(,l,"i* enin"(at(an *en*iti7ita* in*$lin# Da&at +i!eri(an *e8ara ,ral#

3,l,n"an ,!at ini !e(era enin"(at(an "l$(,*a +i*&,*al &a+a *el +an

en"$ran"i &r,+$(*i "l$(,*a +ihati#

Saat ini !el$ !e"it$ !anya( +i&a*aran% +ihara&(an ,!at ini +a&at le!ih

te&at !e(era &a+a *a*aran (elainan yait$ re*i*ten*i in*$lin +an +a&at &$la +i&a(ai

$nt$( en"ata*i !er!a"ai anie*ta*i re*i*ten*i in*$lin tan&a enye!a!(an

hi&,"li(eia +an $"a ti+a( enye!a!(an (elelahan *el !eta &an(rea*#

5# In*$lin >15?

In+i(a*i &e!erian in*$lin &a+a NIDDM a+alah :

- DM +en"an !erat !a+an en$r$n 8e&at C ($r$*

- 'et,a*i+,*i*% a*i+,*i* la(tat% +an (,a hi&er,*,lar

- DM yan" en"alai *tre** !erat > ine(*i *i*tei(% ,&era*i !erat ?

- DM +en"an (ehailan C DM 3e*tati,nal yan" ti+a( ter(en+ali +en"an

&eren8anaan a(an

- DM yan" ti+a( !erha*il +i(el,la +en"an ,!at hi&,"li(ei( ,ral +,*i* a(*ial

ata$ a+a (,ntrain+i(a*i +ari ,!at ter*e!$t#

BAB !III

P-'N-SIS DAN KESIMPULAN


33/36

PO3NOSIS >15?

Se(itar 60@ &a*ien DM yan" en+a&at in*$lin +a&at !ertahan hi+$& *e&erti ,ran"

n,ral% *i*anya +a&at en"alai (e!$taan% "a"al "inal (r,ni*% +an (e$n"(inan $nt$(

enin""al le!ih 8e&at#

'ESIMPULAN

DM a+alah (elainan eta!,li*e (ar!,hi+rat yan" er$&a(an (elainan en+,(rin

ter!anya(## Di In+,ne*ia% &re7alen*i DM *e!e*ar 1%5--2%@ &en+$+$( $*ia 15 tah$n%

!ah(an +i Mana+, +i+a&at(an &re7alen*i DM *e!e*ar 6%1@#

Pen+erita DM e&$nyai ri*i(, (,&li(a*i yan" *&e*ii(% yait$ retin,&ati% "a"al

"inal% ne$r,&ati% ater,*(ler,*i*% *tr,(e% "an"ren% ata$&$n &enya(it arteria (,r,naria#

Peeri(*aan la!,rat,ri$ DM: ene"a((an DH *erta e,nit,r TH +an ti!$lnya

(,&li(a*i# Peeri(*aan DH: (a+ar "$la +arah &$a*a +an 2 a PP% TT3O > (,n*en*$*

PE'ENI 1//; ?#

Peeri(*aan ,nit,r TH: (a+ar "l$(,*a &$a*a% 2 a PP +an !A1% *erta

$rinali*a r$tin# Peeri(*aan yan" en+ete(*i (elainan ner,&ati +ini: i(r,al!$in$ria

>a*ih re7er*i!el?% +an yan" r$tin a+alah *er$ $re$ +an (reatinin $nt$( elihat $n"*i

"inal# Peeri(*aan $nt$( eanta$ (,&li(a*i ater,*(ler,*i*: &r,il li&i+ >(,le*ter,l

t,tal% lo density lipoprotein cholesterol%LDL-% hih density lipoprotein cholesterol

>DL-?% +an tri"li*eri+a *er$?% *erta i(r,al!$in$ria#

Peeri(*aan a+anya (,&li(a*i lain: +arah +an $rinali*a r$tin >a+anya ine(*i?%

($lt$r $rine a$&$n +arah% ele(tr,lit *erta anali*a "a* +arah% (et,n Ca8et,n $rine% a*a

la(tat +arah% in*$lin +arah% +an lain-lain# Den"an +ei(ian ala$&$n !$(an *$at$

&enya(it yan" +a&at +i*e!$h(an ta&i +a&at ter(,ntr,l +en"an !ai( +an (,&li(a*i yan"

er$"i(an +a&at +ihin+ari#

DA.TA PUSTAKA


34/36

1# D,+* #)# Dia!ete* Mellit$*# In lini8al hei*try: The,ry% Analy*i*%

,rrelati,n% E+*% 'a&lan L#A% Pe*8e A#% r+ E+iti,n% M,*!y In8% USA% 1//6#

&61-640#

2# Sa8(* D#B# ar!,hy+rate*# In Tiet )$n+aental* , lini8al hei*try% E+*

B$rti* #A% A*h,,+ E#% 5thE+iti,n% #B# Sa$n+er* ,&any% USA% 2001#

&42=-461

# ),*ter D## Dia!ete* Mellit$*# In arri*,n* Prin8i&le* , Internal Me+i8ine& E+*

)a$8i% Bra$nal+% I**el!a8her% et al% 14thE+iti,n% M83ra-ill ,&anie*% USA%

1//;# &62-=5

4# an+!,,( , re*,l$ti,n* an+ +e8i*i,n* , the ,rl+ ealth A**e!ly an+ the

EHe8$ti7e B,ar+% 7,l$e III% thir+ e+iti,n > 1/;5- 1//2 ?# 3ene7a% ,rl+ ealth

Or"aniati,n% 1//# &11-12#

5# eer* M et al# tren+* in the &re7alen8e an+ in8i+en8e , +ia!ete*: in*$lin-

+e&en+ent +ia!ete* ellit$* in 8hil+h,,+# ,rl+ health *tati*ti8* $arterly%

1/;;F41:1=/-1;/#

6# en+r,art,n,# ,n*en*$* ,n The Mana"eent , Dia!ete* Mellit$* >Per(eni

1//;?# In S$ra!aya Dia!ete* U&+ate


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12# iy,n, P% M$rti I S# 3lie&iri+e : 3enera*i Bar$ S$l,nilUrea# DeHae+ia N,#2

7,l#1= A&ril . $ni 2004#

1# Il$ Penya(it Dala ili+ I# B$($ &ener!it )'UI# a(arta# 1//=

14# en+r,art,n,# e*i*ten*i In*$lin &a+a Dia!ete* Ti&e II# In : Pr,+,*$+ia+i %

Setiati S% Ali I% e+it,r# Perte$an Iliah Na*i,nal I PB PAPDI# a(arta : P$*at

In,ra*i +an Pener!itan Ba"ian Il$ Penya(it Dala )'UI F 200# ;-=

15# Ari Man*,er# '$*&$i Triyanti# a(hi Sa7itri# ahy$ I(a ar+hani# iie(

Seti,$lan# 'a&ita Sele(ta 'e+,(teran# Me+ia Ae*8$la&i$* )'UI# a(arta# 2001#

16# S$y,n, S# Pat,i*i,l,"i Dia!ete* Melit$*# In : S,e",n+, S% S,e,n+, P% S$!e(ti

I% e+it,r# Penatala(*anaan Dia!ete* Melit$* Ter&a+$# 4th e+# a(arta : Balai

Pener!it )'UI F 2004# & =-15#

1=# S,e",n+, S% S$!e(ti I# ',n*en*$* Pen"el,laan Dia!ete* Melit$* Ti&e II +i

In+,ne*ia 2002# PB PE'ENI#

1;# Mar+i Sant,*,# Per(e!an"an Pen"el,laan Dia!ete* Melit$* Ti&e 2 Dea*a ini#

Di&re*enta*i(an &a+a *einar *ian" )' U'IDA +i a(arta 1 Se&te!er 200#

1/# B,e+i*ant,*, A% S$!e(ti I# ',&li(a*i A($t Dia!ete* Melit$*# In : S,e",n+, S%

S,e,n+, P% S$!e(ti I% e+it,r# Penatala(*anaan Dia!ete* Melit$* Ter&a+$ 4 the+#

a(arta : Balai Pener!it )'UI F 2004# -166#

20# a*&ai Sar,n,# Dia!ete* Mellit$* : Me(ani*e Da*ar +an Pen"el,laannya

yan" a*i,nal# In : S,e",n+, S% S,e,n+, P% S$!e(ti I% e+it,r# Penatala(*anaan

Dia!ete* Melit$* Ter&a+$ 4the+# a(arta : Balai Pener!it )'UI F 2004# & 2/-42

21# 'a&lan% L#A#% La!,rat,ry A&&r,a8he*# In Meth,+* in lini8al hei*try% E+*

Aa+e, % 'a&lan L#A# 1/;=# &/4-/6#

22# Al!erti '#3#M#N#% Qiet P#% De)r,n, #A#% Internati,nal TeHt!,,( , Dia!ete*

Mellit$*# Se8,n+ E+iti,n% ,hn iley R S,n* Lt+#% En"lan+# 1//=# &102=-10=4#

2# Nean D% Pri8e #P# enal )$n8ti,n# In Tiet )$n+aental* , lini8al

hei*try% E+* B$rti* #A% A*h,,+ E#% 5thE+iti,n% #B# Sa$n+er* ,&any#

USA# 2001# &6/;-=22#


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Documents

The Diabetes Mellitus Type II