LAPORAN PENDAHULUAN ASUHAN KEPERAWATAN PADA PASIEN DENGAN KEGAWATDARURATAN SISTEM ENDOKRIN PEMBERIAN INSULIN
OLEH:
NAMA
: KADEK PONI MARJAYANTI MARJAYANTI
NIM
: P07120214026
TINGKAT 3 SEMESTER VI D IV KEPERAWATAN
KEMENTERIAN KESEHATAN RI POLITEKNIK POLITEKNI K KESEHAT KES EHATAN AN DENPASAR JURUSAN KEPERAWATAN TAHUN TAHUN 2017 2 017
LAPORAN PENDAHULUAN ASUHAN KEPERAWATAN PADA PASIEN DENGAN KEGAWA KEGAWATDARURATAN TDARURATAN SISTEM S ISTEM ENDOKRIN ENDOKRI N PEMBERIAN INSULIN
A. PENG PENGER ERT TIAN IAN
Insulin !l" su#u "$%&$n 'n( !i)%$!u*si $l+" s+l ,+# )ulu -n(+%"ns *+l+n.% )n*%+s/ Insulin &+ns#i&ulsi )+&su*n s& &in$ *+!l& s+l s +l !n *+&u!in &+nin(*#*n sin#+s )%$#+in/ Insulin &+nin(*#*n )+n'i&)nn l+&* !n &+n+(" )+n((unn l+&* s+,(i ,"n +n+%(i/ Insulin Ins ulin &+ns#i&ulsi )+&su*n (lu*$s *+ !l& s+l un#u* !i(un*n s+,(i su&,+% +n+%(i !n &+&,n#u )+n'i&)nn (li*$(+n !i !l& s+l $#$# !n "#i/ Insulin +n!$(+n !l" insulin 'n( !i"sil*n $l+" )n*%+s s+!n(*n insulin +*s$(+n !l" insulin 'n( !isun#i*n !n &+%u)*n su#u )%$!u* %&si/ T+%)i )+&,+%in insulin &+%u)*n #+%)i 'n( !i,+%i*n *+)! *li+n )si+n 'n( &+n(l&i *+*u%n(n "$%&$n insulin !i !l& #u,u"n'/ P+&,+%in insulin !l" su#u *+(i#n &+&su**n insulin *+ !l& .%in(n #u,u" &+llui sun#i**n su,u#n #u in#%+n/ Insulin &+%u)*n #+%)i #+%*"i% un#u* )+n!+%i# DM 5Di,+#+s M+li#us/ T+%)i T+%)i ini ,%u !il*u*n ,il )n*%+s #i!* ,is l(i &+&)%$!u*si insulin/ Insulin &+%u)*n "$%&$n 'n( &+n(u," (lu*$s &+n.!i (li*$(+n !n ,+%un(si &+n(#u% *!% (ul !%" ,+%s& "$%&$n (li*$(+n 5G%++ns)n !n 8#+% 2000/ Di,+#+s &+li#us #i)+ 2 5DMT2 &+%u)*n )+n'*i# )%$(%+si !+n(n *%*#+%is#i* )+nu%unn un(si s+l ,+# )n*%+s/ )n*%+s / S+i%in( &+nin(*#n' n(* *+.!in DM T 2 #+%u#& )! $%n( ,+%usi %+l#i+ &u! !n *+&un(*inn *+ &un(*inn usi "i!u) &si" )n.n( &* s+&*in ,n'* )si+n DM T 2 !+n(n !+isi+nsi insulin/ P! *sus9*sus #+%s+,u# *n !i,u#u"*n insulin !l& )+n#l*snnn'/ K+un#un(n 'n( &+n!s% !%i )+n((unn insulin !i,n!in(*n $,# n#i!i,+#i* $%l !l& )+n($,#n !i,+#+s &+li#us !l" insulin #+%!)# !i !l& #u,u" s+% l&i"/ S+lin i#u )+n($,#n !+n(n insulin !)# !i,+%i*n s+sui !+n(n )$l s+*%+si insulin +n!$(+n/ S+&+n#% i#u *+n!l u#& !l& )+n((unn insulin !l" )+&*inn' !+n(n !+n( n % &+n'un#i* !n "%(n' 'n( %+l#i &"l/ N&un !+&i*in )% "li !n )+n+li#i #+%us &+n(us"*n )+n+&un s+!in insulin !l& ,+n#u* ,u*n sun#i*n s+)+%#i in"ln s&)i ,+n#u* $%l (% )+n((unnn' !)# l+,i" s+!+%"n !n &+n'+nn(*n ,(i )% )si+n/ )s i+n/ B. TAND NDA A GEJ GEJAL ALA A
In!i*si #+%)i !+n(n insulin :
1/ S+&u )+n'n!n( DM #i)+ I &+&+%lu*n insulin +*s$(+n *%+n )%$!u*si insulin $l+" s+l ,+# #i!* ! #u "&)i% #i!* !/ 2/ P+n'n!n( DM #i)+ II #+%#+n#u &un(*in &+&,u#u"*n insulin ,il #+%)i .+nis lin #i!* !)# &+n(+n!li*n *!% (lu*$s !%"/ 3/ K+!n s#%+ss ,+%# s+)+%#i )! in+*si ,+%# #in!*n )+&,+!"n in%* &i$*%! *u# #u s#%$*+/ 4/ DM (+s#si$nl !n )+n'n!n( DM 'n( "&il &+&,u#u"*n insulin ,il !i+# s. #i!* !)# &+n(+n!li*n *!% (lu*$s !%"/ / K+#$si!$sis !i,+#i*/ 6/ ;i)+%(li*+&i* "i)+%$s&$l% n$n *+#$#i*/ 7/ P+n'n!n( DM 'n( &+n!)# nu#%isi )%+n#+%l #u 'n( &+&+%lu*n su)l+&+n #in((i *l$%i un#u* &+&+nu"i *+,u#u"n +n+%(i 'n( &+nin(*# s+% ,+%#") *n &+&+%lu*n insulin +*s$(+n un#u* &+&)+%#"n*n *!% (lu*$s !%" &+n!+*#i n$%&l s+l& )+%i$!+ %+sis#+nsi insulin #u *+#i* #+%.!i )+nin(*#n *+,u#u"n insulin/ %'s#l ?in Insulin >?I / S# ini !i*+nl 2 && insulin >?I 'i#u !l& ,+n#u* s& !n n+#%l/ P%+)%# 'n( ! n#% lin : A#%)i! V+l$sulin S+&il+n#+/ Insulin .+nis ini !i,+%i*n 30 &+ni# s+,+lu& &*n &+n)i )un* s+#+l" 1@ 3 && !n ++*n' !)# ,+%#"n s&)i < .&/ 2/ Insulin K+%. M+n+n(" Yn( !i)*i s# ini !l" N+#%l P%$#&in+ ;+(+!$%n 5 NP; M$n$#%! Insul#%!/ J+nis ini Bl *+%.n' !l" 1/ @ 2/ .&/ Pun*n' #+%)i !l& 4 @ 1 .& !n ++*n' !)# ,+%#"n s&)i !+n(n 24 .&/ 3/ Insulin K+%. Pn.n( M+%u)*n &)u%n !%i insulin !n )%$#&in+ !i,s$%si !+n(n l&,# !%i #+&)# )+n'un#i*n s+"in(( ++* 'n( !i%s*n u*u) l& 'i#u s+*i#% 24 @ 36 .&/ P%+)%#: P%$#&in+ ?in Insulin 5 P?I Cl#%#%!
4/ Insulin Insi* 5>&)u%n M+%u)*n *$&,insi insulin .+nis sin(*# !n &+n+n("/ P%+)%#n': Mi8#%! 30 40 / P+&,+%in insulin s+% sli!in( sl+ !i&*su!*n (% )+&,+%inn' l+,i" +isi+n !n #+)# *%+n !i!s%*n )! *!% (ul !%" )si+n )! B*#u i#u/ Gul !%" !i)+%i*s s+#i) 6 .& s+*li/ Cn#u* &+&+nu"i *+,u#u"n insulin ,sl !)# !i(un*n insulin *+%. &+n+n(" 5 In#+%&+!i+#+#in( insulin #u *+%. )n.n( 5 l$n(9A#in( Insulin/ S+&+n#% un#u* &+&+nu"i *+,u#u"n insulin )%n!il 5s+#+l" &*n !i(un*n insulin *+%. +)# un#u* &+&nu"i *+,u#u"n insulin ,sl ,sl !)# !i(un*n insulin *+%. &+n+n(" 5in#+%&+!i#+#in( insulin #u *+%. )n.n( 5l$n(9#in( insulin s+&+n#% un#u* &+&+nu"i *+,u#u"n insulin )%n!il 5s+#+l" &*n !i(un*n insulin *+%. +)# 5%+(ul+% short-acting insulin #u insulin *+%. sn(# +)# 5rapid- #u ultra-rapid acting insulin/ D$sis )+&,+%in insulin #+%(n#un( )! *!% (ul !%" 'i#u : 1/ Gul !%" 60 &( F 0 uni# 2/ Gul !%" 200 &( F @ < uni# 3/ Gul !%" 200 @ 20 &(F 10 @ 12 uni# 4/ Gul !%" 20 9 300 &(F 1 @ 16 uni# / Gul !%" 300 @ 30 &(F 20 uni# 6/ Gul !%" H 30 &(F 20 @ 24 uni# E+* &+#,$li* #+%)i insulin: 1/ M+nu%un*n *!% (ul !%" )us !n )$s# )us/ 2/ Su)%+si )%$!u*si (lu*$s $l+" "#i/ 3/ S#i&ulsi u#ilissi (lu*$s )+%i+%/ 4/ O*si!si (lu*$s )+n'i&)nn !i $#$#/
/ P+%,i*i *$&)$sisi li)$)%$#+in ,n$%&l/ 6/ M+n(u%n(i (lu$s+ #$8ii#'/ 7/ P+%,i*i *+&&)un s+*%+si +n!$(+n/
G&,% Al($%i#& )+n(+l$ln DMT2/ 1/ Diin(#*n )+n#in(n' )$l "i!u) s+#i) *un.un(n/ 2/ P+%i*s A1> s+#i) 3 ,uln s&)i 7F !n *+&u!in )lin( s+!i*i# s+#i) 6 ,uln/
3/ Wlu)un #i( .+nis $,# n#i!i,+#i* $%l !)# !i(un*n !in.u%*n &+&uli insulin ,+%!s%*n ++*#ii#sn' !n ,i'/ 5N#"n +# l/ Di,+#+s >%+ 2006 2=: 1=6391=72 D. PEMERIKSAAN DIAGNOSTIK
P+n+n#un !i(n$s !i,+#+s &+li#us !l" !+n(n )+&+%i*sn (ul !%" &+nu%u# Su.$n$ Su*%&in 5200< n#% lin: 1/ Gul !%" )us 5GDO 709110 &(!l/ K%i#+%i !i(n$s#i* un#u* DM H 140 &(!l )lin( s+!i*i# !l& 2 *li )+&+%i*sn/ A#u H 140 &(!l !is+%#i (+.l *lsi* "i)+%(li*+&i #u IGT 119140 &(!l/ 2/ Gul !%" 2 .& )$s# )%$n!il 140 &(!l !i(un*n un#u* s*%inin( #u +lusi )+n($,#n ,u*n !i(n$s#i*/ 3/ Gul !%" s+B*#u 140 &(!l !i(un*n un#u* s*%inin( ,u*n !i(n$s#i*/ 4/ T+s #$l+%nsi (lu*$s $%l 5TTGO/ GD 11 &(!l .& 1 .& 1 .& 200 &(!l 2 .& 140 &(!l/ / T+s #$l+%nsi (lu*$s in#%+n 5TTGI !il*u*n .i* TTGO &+%u)*n *$n#%in!i*si #u #+%!)# *+linn (s#%$in#+s#inl 'n( &+&)+n(%u"i ,s$%,si (lu*$s/ 6/ T+s #$l+%nsi *$%#is$n (lu*$s !i(un*n .i* TTGO #i!* ,+%&*n/ K$%#is$n &+n'+,,*n )+nin(*#n *!% (lu*$s ,n$%&l !n &+nu%un*n )+n((unn (ul !%" )+%i+% )! $%n( 'n( ,+%)%+!is)$sisi &+n.!i DM *!% (lu*$s !%" 140 &(!l )! *"i% 2 .& !in(() s+,(i "sil )$si#i/ 7/ Gl'$s+## "+&$(l$,in &+&n#u (lu*$s !%" s+l& l+,i" !%i 3 ,uln/ 9P+)#il+ 192 &(!l 5)us 96 *li &+nin(*# s+#+l" )+&,+%in (lu*$s/ =/ Insulin s+%u& )us: 2920 &u&l )$s# (lu*$s s&)i 120 &u&l !)# !i(un*n !l& !i(n$s ,n!in( "i)$(li*+&i #u !l& )+n+li#in !i,+#+s/ K%i#+%i !i(n$s#i* W;O un#u* Di,+#+s M+li#us )! $%n( !+Bs 'n( #i!* "&il )! s+!i*i#n' 2 *li )+&+%i*sn: 1/ Glu*$s )ls& sewaktu/random H 200 &(!l 5111 &&$l-/ 2/ Glu*$s )ls& puasa/nuchter H 140 &(!l 57< &&$l-/ 3/ Glu*$s )ls& !%i s&)+l 'n( !i&,il 2 .& *+&u!in s+su!" &+n(*$nsu&si 7 (%& *%,$"i!%# 52 .& )$s# )%n!il 5)) H 200 &(!l 5111 &&$l-/ (World Health Organization, Diabetes Melitus, Report o a WHO stud! group" #each Report $eries N$/
727 1=< *u#i)n !l& %unn+% Su!!%#" 52002/
E. PENATALAKSANAAN MEDIS
Psi+n 'n( !i%B# !i %u&" s*i# !)# !i,(i *+ !l& !u *+l$&)$*/ K+l$&)$* )+%#& )si+n 'n( &+&+%lu*n )+%B#n !i %un( in#+nsi &isln' )si+n *+#$si!$sis )s$)+%si #u )si+n )+n'*i# (B# s+)+%#i s+)sis/ K+l$&)$* *+!u !l" )si+n 'n( #i!* &+&+%lu*n )+%B#n !i %un( in#+nsi &isln' )si+n )%$)+%#i #u )si+n !+n(n )+n'*i# 'n( #i!* (B#/ S+% u&u& % )+&,+%in #+%)i insulin ,(i *+!u *+l$&)$* !i #s &+&ili*i )+%,+!n/ Psi+n 'n( !i%B# !i %un( in#+nsi u&u&n' &+&+%lu*n #+%)i in#+nsi !+n(n % )+&,+%in insulin inus 5!%i) in#%+n #u s+% in#%&us*ul%/ >% in#%&usul% .%n( !il*u*n !n "n' !il*u*n ,il sili#s insulin !%i) in#%+n #i!* #+%s+!i/ Psi+n 'n( !i%B# !i %un( ,is u&u&n' #i!* &+&+%lu*n #+%)i insulin inus in#%+n/ T+%)i un#u* )si+n ini u*u) !+n(n )+&,+%in su,*u#n #u !+n(n )$&) insulin 5>SII/ "*n )! *sus 'n( %in(n #+%)i !+n(n $,# n#i!i,+#i* $%l &si" !)# !i,+%i*n un#u* )si+n DM #+%u#& )si+n DMT2/ 1/ Ss%n K+n!li Glu*$s D%" Dulu "l 'n( #+%)+n#in( !l& )+nn(nn )si+n DM 'n( !i%B# !i %u&" s*i# !l" &+n+(" *+!n "i)$(li*+&i/ Ol+" s+,, i#u &unul un(*)n ,"B s+,i*n' )si+n9)si+n #+%s+,u# !i)+%#"n*n #+#) s+!i*i# &nisL #u !l& "s In((%is !i*#*n *++) #"+ )#i+n# li##l+ sB++#/ P+%s+)si #+%s+,u# #+%n'# *+li%u s+,, !i,+#+s !n "i)+%(li*+&i !i %u&" s*i# ,u*n &+%u)*n *$n!isi 'n( %in(n 5,+ni(n/ S+&+n#% i#u #+%)i insulin in#+nsi un#u* &+&)+%#"n*n *!% (lu*$s !%" 110 &(!- !)# &+nu%un*n &$%,i!i#s !n &$%#li#s )si+n !i uni# )+%B#n in#+nsi/ Ss%n *+n!li (lu*$s !%" !l" n$%&$(li*+&i !)# !ili"# !i ,B" ini/
2/ >% P+&,+%in Insulin A(% #+%)i insulin !)# !il*sn*n !+n(n ,i* )! )si+n "i)+%(li*+&i 'n( !i%B# !i %u&" s*i# "%us !i)"&i #+n#n( )$l s+*%+si insulin )! $%n( n$%&l/ ;l #+%s+,u# !is+,,*n )! "*i*#n' ss%n #+%)i insulin !l" &+&,u#
insulin +*s$(+n 'n( !i,+%i*n s+!+&i*in %u) s+"in(( &+n'+%u)i )$l s+*%+si insulin +n!$(+n #u isi$l$(is/ S+*%+si insulin !)# !i,(i &+n.!i s+*%+si insulin ,sl 5s# )us #u s+,+lu& &*n !n insulin )%n!il 5s+#+l" &*n/ Insulin ,sl !l" .u&l" insulin +*s$(+n )+% uni# B*#u 'n( !i)+%lu*n un#u* &+n+(" "i)+%(li*+&i )us *i,# (lu*$n+$(+n+sis s+%# &+n+(" *+#$(+n+sis 'n( #i!* #+%!+#+*si/ Insulin )%n!il !l" .u&l" insulin 'n( !i,u#u"*n un#u* &+n(*$n+%si ,"n &*nn *+ !l& ,+n#u* +n+%(i !n(n s+"in(( #i!* #+%.!i "i)+%(li*+&i )$s#)%n!il/ K%+n s+l& )+%B#n #i!* .%n( !i#+&u*n lu*#usi *!% (lu*$s !%" *i,# ,+%,(i s+,, !l& )+&,+%in #+%)i insulin ,(i )si+n 'n( !i%B# !i %u&" s*i# !i*+nl is#il" insulin *$%+*siL #u insulin su)l+&+n/ Insulin *$%+*si !l" .u&l" insulin 'n( !i)+%lu*n )si+n !i %u&" s*i# *i,# *+ni*n *+,u#u"n insulin 'n( !is+,,*n !n' su#u )+n'*i# #u s#%+s/ S+% u&u& *+,u#u"n insulin !)# !i)+%*i%*n s+,(i ,+%i*u#: insulin ,sl !l" 0F *+,u#u"n #$#l insulin )+% "%i #u 002 C*( insulin )%n!il !l" 0F !%i *+,u#u"n #$#l insulin )+% "%i !n insulin *$%+*si s+*i#% 10920F !%i *+,u#u"n #$#l insulin )+% "%i/ >##n #&,"n: M+n("i#un( *%,$"i!%# 5%,$"'!%#+ $un#in( P+&"&n )si+n #+n#n( % &+n("i#un( *%,$"i!%# sn(# )+n#in( #+%u#& )! )si+n 'n( &+n!)# #+%)i insulin !+n(n !$sis &ul#i)+l/ P+%"i#un(nn' un#u* s+#i) 1 (%& *%,$"i!%# 560 *l !i,u#u"*n 1 uni# insulin/ Csi !n ,+%# ,!n &+&)+n(%u"i *+,u#u"n insulin un#u* *%,$"i!%# 'n( !i*$nsu&si/
/ Insulin Inus In#%+n 1 Ss%n K!% Glu*$s D%"
Ss%n *!% (lu*$s !%" !n ,#s *!% (lu*$s !%" un#u* &+&uli )+&,+%in #+%)i insulin #+%(n#un( !%i s+#i) *sus 'n( !i"!)i/ P! )si+n ,+!" 'n( *%i#is 5s*i# ,+%#(B# ss%n *!% (lu*$s !%" l+,i" %+n!" !%i)! )si+n )+n'*i# *%i#is n$n,+!" #u )+n'*i# ,+!" #i!* *%i#is/ 2 In!i*si Insulin Inus In#%+n P! )%insi)n' )si+n )+n'*i# ,+%# #u *%i#is 'n( !i%B# !i %u&" s*i# &+&+%lu*n #+%)i insulin/ S+,(in ,+s% !%i &+%+* &+&,u#u"*n #+%)i insulin 'n( !i,+%i*n s+% inus in#%+n &isln' )! )si+n *%i#is*u# s+)+%#i "i)+%(li*+&i (B# !%u%# in%* &i$*%! *u# s#%$*+ %*#u% in+*si sis#+&i* s'$* *%!i$(+ni* )si+n #%ns)ln#si $%(n +!+& ns%* *+linn *uli# 'n( lus )+%slinn )si+n 'n( &+n!)# #+%)i (lu*$*$%#i*$i! !$sis #in((i !n )si+n )! )+%i$!+ )+%i$)+%#i/ ;l lin 'n( )+%lu !i)+%"#i*n !l" !n' s#%#+(i un#u* &+n)i !$sis 'n( #+)# s+,+lu& *$n+%si !%i #+%)i insulin inus in#%+n *+ #+%)i insulin su,*u#n/ S+lin i#u "l 'n( .u( )+%lu !i)+%"#i*n !l" !+%.# ,u*#i &n# )+n((unn insulin inus in#%+n/ ;l #+%s+,u# #+l" !is+,u#*n !l& .u%nl 'n( !i#ulis $l+" >l+&+n# +# l 52004/ A!)un ,#s *!% (lu*$s !%" un#u* &+&uli #+%)i insulin !%i) in#%+n 'i#u s+,(i ,+%i*u#/
3 P%$#$*$l Insulin Inus In#%+n In!i*si )+&,+%in insulin inus+ in#%+n )! )si+n ,u*n "&il '*ni s+,(i ,+%i*u#/
(i )si+n *%i#is )s,+!" 'n( !i%B# !i %un( in#+nsi)%$#$*$l #+%)i insulin 'n( !)# !i)*i s+,(i un !l" )%$#$*$l 'n( !i))%*n $l+" Vn !+n +%("+ !i ,B" ini/
P%$#$*$l ini !i&uli !+n(n #") )+%si)n 'i#u !+n(n &+&,+%i*n inus DF 100.&/ S+#+l" i#u ,il #+%!)# sili#s s'%in(+ )u&) si)*n 0 uni# insulin %+(ul+% 5RI !l& s)ui# ,+%u*u%n 0 *+&u!in +n+%*n !+n(n l%u#n N>l 0= F "in(( &+n)i 0 51 N>l 1 uni# RI/ il !i)+%lu*n 1 uni# insulin.& )+#u(s #in((l &+n(#u% *++)#n #+#+sn 1 .&/ D)# )ul !i,+%i*n 12 RI !l& 20 &l l%u#n N>l 0=F 'n( ,+%%#i s+#i) 2 N>l 1 uni# RI/ il #i!* #+%s+!i s'%in(+ )u&) !)# !i(un*n ,$#$l inus 00 l%u#n N>l 0=F/ Msu**n 12 uni# RI 5!)# .u( 6 uni# #u n(* lin s+,, nn#in' *n !i)+%"i#un(*n !l& #+#+sn *+ !l& ,$#$l inus 00 l%u#n N>l 0/=F/ il !i,u#u"*n 1 uni# insulin.& &* !l& ,$#$l inus 'n( ,+%isi 12 uni# RI !i#u% *++)#n #+#+sn 12 .&,$#$l s+"in(( 12 uni# RI *n ",is !l& 12 .&/ il !i,u#u"*n 2 uni# )+%.& *++)#n #+#+sn inus !i#u% &+n.!i 6
.&,$#$l *%+n 12 uni# RI *n ",is !l& 6 .& !+&i*in s+#+%usn' #+#+sn !i#u% s+sui )+%&in#n/ S+,(i )#$*n #+#+sn 1 i%n inus 20 #+#+sn &*%$ 60 #+#+sn &i*%$/ 4 P+%li"n Insulin Inus In#%+n *+ Insulin Su,*u#n S+#+l" *!% (lu*$s !%" s#,il !n )si+n &uli &+n!)#*n &*nn #+%)i insulin !)# !ili"*n &+n.!i .lu% su,*u#n !+n(n #+#) &+&)+%"#i*n *i!" #+%)i insulin ,sl !n ,$lus s+%# !is+sui*n !+n(n )$l %+s)$n insulin isi$l$(is/ S+,+lu& #+%)i insulin inus in#%+n !i"+n#i*n #+%)i insulin su,*u#n s+,i*n' su!" !i&uli su)' !i)+%$l+" B*#u 'n( u*u) un#u* Bi#n *+%. insulin/ T+%)i insulin inus in#%+n !)# !i"+n#i*n 2 .& s+#+l" )+&,+%in insulin su,*u#n/ K+,u#u"n insulin su,*u#n !i"i#un( ,+%!s%*n #$#l *+,u#u"n insulin inus in#%+n !l& 24 .&/ D$sis #$#l "%in insulin su,*u#n !l" <0F !%i !$sis #$#l insulin inus in#%+n s+l& 24 .&/ D$sis #$#l "%in #+%s+,u# !i,(i &+n.!i !$sis insulin ,sl !n insulin ,$lus su,*u#n/ D$sis insulin ,sl !l" s+,+s% 0F !%i !$sis "%in #$#l/ J+nis insulin 'n( !i,+%i*n ,isn' l$n( #in( insulin 5l+,i" ,i* !i(un*n insulin 'n( #i!* &+&ili*i )un* *+%.)+* s+)+%#i insulin (l%(in+ #u !+#+&i%/ D$sis insulin ,$lus su,*u#n !l" 0F !%i !$sis "%in #$#l su,*u#n/ Dl& )+&,+%inn' !$sis !i,(i %# s+sui .u&l" *li &*n u&u&n' 3 *li"%i/ J+nis insulin 'n( !i,+%i*n ,+%u) s"$%# #u %)i! #in( insulin/ >% )+%"i#un(n !$sis insulin su,*u#n !)# !ili"# !i,B" ini/
,/ Insulin Su,*u#n Wlu)un )+n((unn #+%)i $,# n#i!i,+#i* $%l &si" &+&un(*in*n un#u* !i,+%i*n )! )si+n !i,+#+s &+li#us 'n( !i%B# !i %u&" s*i# #)i ,(i )si+n 'n( *n &+n.lni )+&,+!"n #u &+&ili*i )+n'*i# ,+%# s+,i*n' !i(un*n #+%)i insulin/ A! ,+,+%) ,+n#u* )+&,+%in insulin su,*u#n )! )si+n 'n( !i%B# !i %u&" s*i# n#% lin insulin #+%.!Bl 5s"+!ul+! #u )%$(%&&+! insulin !n insulin *$%+*si/ P%$(%& )+&,+%in insulin #+%.!Bl #+%,(i #s *+,u#u"n insulin ,sl !n insulin )%n!il/ Insulin ,sl !)# !i,+%i*n !+n(n &+n((un*n )$&) insulin 5>SII insulin *+%. in#+%&+!i#+ 5NP; #u )%+&i8+! 294 *li s+"%i #u insulin nl$( *+%. )n.n(/ S+&+n#% i#u *+,u#u"n insulin )%n!il !)# !i)+nu"i !+n(n insulin *+%. +)# 5insulin %+(ul% #u %)i! #in( insulin nl$(/ Insulin #+%s+,u# !i,+%i*n s+,+lu& &*n #u s+#+l" &*n 5"n' un#u* )+n((unn %)i! #in( insulin nl$( ),il .!Bl !n .u&l" su)n &*nn #i!* )s#i !)# !ili"# )! #,+l ,+%i*u#/
R+*$&+n!si .+nis !n !$sis )+&,+%in insulin su,*u#n )! )si+n DMT1 !n DMT2 'n( &+n!)#*n &*nn s+% $%l !)# !ili"# )! #,+l ,+%i*u#/
>% )+&,+%in insulin 'n( ,is !il*u*n !l" s+&)%i# !n .%u& )+n insulin #u )$&) insulin 5>SII/ S&)i s# ini )+n((unn >SII !i In!$n+si &si" sn(# #+%,#s/ P+&*in s+&)%i# !n .%u& u*u) l+*si,+l s+%# &+9&un(*in*n *i# un#u* &+n(#u% !$sis !n &+&,u# ,+%,(i $%&ul &)u%n insulin un#u* &+n(u%n(i .u&l" in.+*si )+% "%i/ K+#+%,#snn'
!l" &+&+%lu*n )+n(li"#n 'n( ,i* !n *+#%&)iln 'n( u*u) un#u* &+n%i* !$sis insulin 'n( #+)#/ P+n insulin *ini l+,i" )$)ul% !i,n!in(*n s+&)%i# !n .%u&/ )+n((unnn' l+,i" &u!" !n n'&n s+%# !)# !i,B *+&n9&n/ K+l+&"nn' !l" *i# #i!* !)# &+n&)u% !u .+nis insulin &+n.!i ,+%,(i *$&,insi *+uli 'n( su!" #+%s+!i !l& s+!in #+#) (insulin premi%ed&" T+%)i insulin s+%in( !i*$&,insi*n !+n(n $,# !i,+#i $%l )! )si+n DM T 1 !n DM T 2 'n( &+&ili*i %+sis#+nsi insulin !+n(n *+,u#u"n insulin H 40 C )+% "%in'/ P! )si+n !+n(n *+((ln s+*un!+% sul$nilu%+ !ini )+n&,"n insulin s+,+lu& #i!u% u*u) un#u* &+n)i ss%n (li*+&i* 'n( !iin(in*n/ R+.i&+n *$&,insi n#% insulin s+,+lu& #i!u% !n $,# n#i!i,+#i* $%l sin( "%i #+%,u*#i ,+%"sil !i#+%)*n )! ,n'* )si+n DMT2/ P+n((unn &+#$%&in #u (li#$n s+% ,+%s&n !+n(n insulin .u( &+&,+% &n# ,(i )si+n !+n(n %+sis#+nsi insulin/ K+un#un(n )+n((unn &+#$%&in !l" !)# &+n(u%n(i )+nin(*#n ,+%# ,!n 'n( s+%in( !i#+&u*n )! )si+n 'n( &+n!)#*n #+%)i insulin/ K$&,insi $,# &+#$%&in #u (li#$n !+n(n insulin 'n( #+l" !i,+%i*n )! s+$%n( )si+n !i,+#+s &+lli#us !)# &+n'+!+%"n*n .!Bl )+&,+%in insulin/ P+n&,"n $,# ($l$n(n in"i,i#$% l9(lu*$si!s+ .u( !)# &+n(u%n(i .u&l" sun#i*n insulin )+% "%in'/
NP; neutral protamine Hagedorn OAD oral antigl!cemic drug / Ei*si !n *+&nn %+.i&+n insulin !i)ili" s+sui !+n(n u.i *linis 5e'idence-based recommendation/
NP; !u *li"%i !i)ili" s+,(i #+%)i )ili"n )+%#& un#u* &+n("in!%i &"ln' insulin nl$( #u insulin &)u%n 5 premi%ed insulin *%+n )! )si+n ini s+%in( !i,u#u"*n insulin !$sis ,+s%/ Q O)ini "li
F. PENGKAJIAN
1/ I!+n#i#s N& usi 5DM Ti)+ 1 Csi 30 #"un/ DM Ti)+ 2 Csi H 30 #"un +n!+%un( &+nin(*# )! usi H 6 #"un *+l$&)$* +#ni* !i A&+%i* S+%i*# ($l$n(n ;is)ni* s+%# )+n!u!u* sli A&+%i* #+%#+n#u &+&ili*i *+&un(*inn 'n( l+,i" ,+s% .+nis *+l&in s##us (& l&# #n((l MRS !i(n$s &su*/ P+n!i!i*n !n )+*+%.n $%n( !+n(n )+n!)#n #in((i +n!+%un( &+&)un'i )$l "i!u) !n )$l &*n 'n( sl"/ >+n!+%un( un#u* &+n(*$nsu&si &*nn 'n( ,n'* &+n(n!un( (ul !n l+&* 'n( ,+%l+,i"n/ P+n'*i# ini ,isn' ,n'* !il&i $l+" $%n( 'n( )+*+%.nn' !+n(n *#ii#s isi* 'n( s+!i*i#/ 2/ K+lu"n u#& / K$n!isi "i)+%(li*+&i P+n(li"#n *,u% l+&s %s "us !n ,n'* *+nin( !+"i!%si su"u #u,u" &+nin(*# s*i# *+)l/ ,/ K$n!isi "i)$(li*+&i T%+&$% )+%s)i%si #*i*%!i )l)i#si (+lis" %s l)% s*i# *+)l sus" *$ns+n#%si +%#i($ *$nusi )+nu%unn !' in(# )#i%s !i !+%" ,i,i% )+l$ )+%u,"n +&$si$nl )+nu%unn *+s!%n/ 3/ Su%+' P%i&+% !n R+susi#si / Ai%B' !n K$n#%$l S+%i*l K+!n .ln ns : #in(*# *+s!%n )+%nsn u)' ,+%ns ,+n! sin( !i .ln ns ,un'i ns "+&,usn ns/ ,/ %+#"in( un(si )+%nsn : .+nis )+%nsn %+*B+nsi )+%nsn %+#%*si $#$# ,n#u ns *+linn !in!in( #"$%*s 5si&+#%is )+%lu*n .+.s #%u& ,un'i ns "+&,usn ns/ / >i%ul#i$n K+!n si%*ulsi : #in(*# *+s!%n )+%!%"n 5in#+%nl+*s#+%nl *)il%i %+ill n!i %!il%$#is *%l )+%i+%/ !/ Dis,ili#' P+&+%i*sn N+u%$l$(is: G>S %+l+8 isi$l$(is %+l+8 )#$l$(is *+*u#n $#$#/ 4/ P+n(*.in S+*un!+% Su%+' S+*un!+% / RiB'# K+s+"#n 1 RKD DM !)# #+%.!i s# *+"&iln )+n'*i# )n*%+s (n((un )+n+%i&n insulin (n((un "$%&$nl *$nsu&si $,#9$,#n s+)+%#i
(lu*$*$%#i*$i! u%$s+&i! #"ii! ,+# ,l$*+% *$n#%s+)si 'n( &+n(n!un( +s#%$(+n/ 2 RKS D$&inn &unul !l" s+%in( *+nin( s+%in( l)% !n "us ,+%# ,!n ,+%l+,i"/ isn' )+n!+%i# ,+lu& #"u *lu i#u )+n'*i# DM ,%u #"u s+#+l" &+&+%i*s*n !i%i *+ )+l'nn *+s+"#n/ 3 RKK M+nu%un &+nu%u# silsil" *%+n *+linn (+n 'n( &+n(*i,#*n #u,u"n' #i!* !)# &+n("sil*n insulin !+n(n ,i*/ ,/ RiB'# !n M+*nis&+ T%u& / P+&+%i*sn isi* 5;+! T$ T$+ / K+)l : Kuli# *+)l M# T+lin( ;i!un( Mulu# !n (i(i W." ,/ -+"+% Tn! : )+&,+s%n #i%$i! / D! #"$%*s : K+!n )%u9)%u !n .n#un( 5ins)+*si )l)si )+%*usi !n us*ul#si G+.l: &+%s *+*u%n(n $*si(+n ,#u* !+n(n #u #n) s)u#u&/ Tn!: )+%n)sn +)# !n !l& %+*u+nsi &+nin(*# n)s ,u s+#$n/ !/ A,!$&+n 5ins)+*si )l)si )+%*usi !n us*ul#si !n P$l M*n G+.l: "iln( nsu &*n &ul &un#" #i!* &+n(i*u#i !i+# )+nin(*#n &su*n (lu*$s #u *%,$"i!%# )+nu%unn ,+%# ,!n "us )+n((unn !iu%+#i*/ Tn!: *uli# *+%in( ,+%sisi* #u%($% .+l+* *+**un !is#+nsi ,!$&+n &un#"/ +/ P+lis 5ins)+*si !n )l)si / P+%in+u& !n %+*#u& (/ G+ni#li G+.l: %,s (in i&)$#+n )! )%i *+suli#n $%(s&+ )! Bni#/ "/ E*s#%+&i#s : S##us si%*ulsi !n K+!n in.u%' G+.l: l+&" l+#i" suli# ,+%(+%* #u ,+i.ln *%& $#$# #$nus $#$# &+nu%un (n((un is#i%"# !n #i!u% !n' %iB'# )+n'*i# "i)+%#+nsi in)%* &i$*%! *u# *lu!i*si *+,s *+s+&u#n )! +*s#%+&i#s ul*us )! **i )+n'+&,u"n 'n( l&/
Tn!: #*i*%!i )+%u,"n TD )$s#u%l n!i &+nu%un !is%i#&i *%+*+ls *uli# )ns *+%in( !n *+&+%"n/ i/ N+u%$l$(is : un(si s+ns$%i* !n &$#$%i* G+.l: )usin( *+s+&u#n *+,s *+l+&"n )! $#$# )%s#+si (n((un )+n(li"#n/ Tn!: !is$%i+n#si &+n(n#u* l+#%(i s#u)$%*$& (n((un &+&$%i %+l+*s #+n!$n &+nu%un *+.n(/ ./ In#+(%i#s +($ G+.l: s#%+ss #+%(n#un( )! $%n( lin &sl" innsil 'n( ,+%"u,un(n !+n(n *$n!isi/ Tn!: nsi+#s )+* %n(sn(/ */ Eli&insi G+.l: )+%u,"n )$l ,+%*+&i" 5)$liu%i n$*#u%i %s n'+%i #+%,*% *+suli#n ,+%*+&i" ISK n'+%i #+*n ,!$&+n !i%+/ Tn!: u%in+ +n+% )u# *unin( )$liu%i ,isin( usus l+&" "i)+%*#i )! !i%+/ 6/ ;sil -,$%#$%iu& 7/ ;sil P+&+%i*sn Di(n$s#i*
G. REFERENSI
A&+%in Di,+#+s Ass$i#i$n/ P%#il insulin/ A "n!,$$* $% )%+s%i,+%s/ ADA +!isi 2004/ A!& JM/ P+n#l*snn +n!$*%in !%u%#/ P+%*u&)uln En!$*%in$l$(i In!$n+si/ M*ss% 2002/ $B$ 2011/ Di(n$sis !n Mn.+&+n DM Ti)+ 2/ N#"n DM +# l/ Di,+#+s >%+ 20062=5<:1=63972/ %unn+% Su!!%#" 52002/ u*u A.% K+)+%B#n M+!l*l 9 +!" E!/ /
reenspan /S/ dan )a%ter J/D/ *+++/ En!$*%in$l$(i Ds% !n Klini* E!isi 4/ P+n+%.+&":
Wi.' >/ J*%#: P+n+%,i# u*u K+!$*#+%n EG> Su.$n$ Su*%&in 5200</ Asu"n K+)+%B#n )! Psi+n !+n(n Gn((un E*s$*%in En!$*%in )! Pn*%+s/ Y$('*%#: G%" Il&u/ Vn !+n +%( M/E/-/ >s#+ll$#+ J/M/ M"ill$9+%nn!+ I/ P+!%$>u+s# J/ Ini!+n+ $ T%u&#i / S)inl >$%! In.u%' in A%($n S)in 51=72 9200</ J$u%nl $ N+u%$#%u&/2011 M% 2<:46=9477
M+n(+#"ui P+&,i&,in( P%*#i*>I LEMBAR PENGESAHAN
5// NIP/
M"sisB
5 NIM/ P071202140/
M+n(+#"ui P+&,i&,in( A*!+&i*>T
5// NIP/
