MAKALAH INTERAKSI OBAT PADA PADA PENDERITA DIABETES DIABETE S MELITUS MELIT US TIPE 2
Disusun oleh:
Kelompok 5 Erna Erliawati A%e Hikmawati Nan(i Sitor)* A%it+a Ha%i Ken(ana An,,it Dea Rama* ma*wara T-at)r D-oko .i/owo Ren, Ren,,o ,o Sap Sap)t )tra ra Ra0 Ra0ma man n Ri1k+ Al Aliani 30 30a*ana0 Alin Nail)l M)na
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Dosen Pembimbing : Dra. Refdanita, MSi, Apt
INSTITUT SAINS DAN TEKNOLOGI NASIONAL FAKULTAS MATEMATIKA DAN ILMU PENGETAHUAN ALAM PROGRAM STUDI FARMASI
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DA4TAR ISI
halaman
DAFTAR DAFTAR ISI....... ISI............ .......... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ........ ...
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BAB I PENDAHULU PENDAHULUAN AN .......... .............. ......... .......... .......... .......... .......... .......... ............ ................ ................... ............
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BAB II TINJAU TINJAUAN AN PUST PUSTAKA AKA ...... ........... .......... .......... .......... .......... .......... .......... .......... .......... .......... ............ .......
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BAB III HASIL..... HASIL.......... .......... .......... .......... .......... ......... ......... .......... .......... .......... .......... .......... .......... .............. ................... ............ 23
BAB IV PEMBAHASAN PEMBAHASAN .......... ............... .......... .......... .......... .......... .......... .......... .......... .............. ................... ............. ... 25
BAB VI SIMPULAN SIMPULAN DAN SARAN SARAN ........... ................ .......... ......... ......... .......... ........... ................ .............. .... 30
A. Sm!"lan.. Sm!"lan....... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... ..... 30
B. Sa#an..... Sa#an.......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .......... .............. ................... .................. ........ 30
DAFTAR PUSTAKA
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BAB I PENDAHULUAN
In$%#a&' ()a$ a*alah !%#")ahan %+%& '"a$" ()a$ a&)a$ !%ma&aan ()a$ lan ,n$%#a&' ()a$-()a$ a$a" (l%h ma&anan/ ()a$ $#a*'(nal *an '%naa &ma lan. In$%#a& In$%#a&' ' ()a$ ()a$ an an 'n+ 'n+&a &an n *a!a$ *a!a$ $%#a* $%#a* &a *"a a$a" l%)h ()a$ ()a$ *"na *"na&an &an )%#'ama-'ama. In$%#a&' In$%#a&' ()a$ *an %+%& 'am!n 'am!n ()a$ !%#l" m%n*a!a$ !%#ha$an. !%#ha$an. S%)"ah S%)"ah '$"* * Am%#&a m%n"n"&&an )aha '%$a! $ah"n ham!# 100.000 (#an ha#"' ma'"& #"mah 'a&$ a$a" ha#"' $nal * #"mah 'a&$ l%)h lama *a# !a*a '%ha#"'na/ )ah&an hna $%#a* &a'"' &%ma$an &a#%na n$%#a&' *an4a$a" %+%& 'am!n ()a$. Pa'%n an *#aa$ * #"mah 'a&$ '%#n m%n*a!a$ $%#a! *%nan !(l+a#ma' ,6-10 maam ()a$ &a#%na '%)aa '")%& "n$"& l%)h *a# 'a$" *(&$%#/ '%hna 'ana$ m"n&n $%#a* n$%#a&' ()a$ $%#"$ama an *!%na#"h $n&a$ &%!a#ahan !%na&$ a$a" "'a. In$%#a& In$%#a&' ' ()a$ ()a$ '%a#a '%a#a &ln' &ln' !%n$n !%n$n )la )la )%#a& )%#a&)a$ )a$ !%nn !%nn&a$ &a$an an $(&'' $(&''$a' $a' *an4 *an4a$ a$a" a" !%n !%n"# "#an ana an n %+%&$ %+%&$ $a $a'' ()a$ ()a$.. Ja* Ja* !%#l !%#l" " *!% *!%#h #ha$ a$&a &an n $%#" $%#"$am $amaa )la )la m%nan&"$ ()a$ *%nan )a$a' &%amanan an '%m!$ ,n*%&' $%#a! an #%n*ah/ m'alna l&('*a an$"n/ an$&(a"lan *an ()a$-()a$ '$('$a$&. S%lan $" "a !%#l" *!%#ha$&an ()a$-()a$ an )a'a *"na&an )%#'ama-'ama. K%a*an n$%#a&' ()a$ *alam &ln' '"&a# *!%#&#a&an &a#%na 7 a. *(&"m%n$a'na ma'h 'ana$ &"#an ). '%#n '%#n& &al al l(l( l(l('' *a# *a# !%n !%nam ama$a a$an/ n/ &a#% &a#%na na &"#an &"#ann naa !%n !%n%$a %$ah" h"an an a&an a&an m%&an'm% *an &%m"n&nan $%#a* n$%#a&' ()a$. Hal n m%na&)a$&an n$%# n$%#a& a&' ' ()a$ ()a$ )%#" )%#"!a !a !%n !%nn n&a &a$a $an n $(&' $(&'' '$a $a'' *an *an a! a! '%)a '%)aa a #%a&' #%a&' *('n&#a' *('n&#a' $%#ha*a! 'alah 'a$" ()a$/ '%*an&an '%*an&an n$%#a&' )%#"!a )%#"!a !%n"#"na&n !%n"#"na&n %+%&$$a' *ana! *a&)a$&an )%#$am)ah !a#ahna !%na&$ !a'%n . &%a*an a$a" &%!a#ahan n$%#a&' ()a$ *!%na#"h (l%h a#a' n**"al/ * mana !(!"la' $%#$%n$" l%)h !%&a m'alna !a'%n %#a$# a$a" )%#!%na&$ !a#ah/ *an )'a "a &a#%na !%#)%*aan &a!a'$a' m%$a)(l'm% an$a# n**". 8
S%lan $" +a&$(# !%na&$ $%#$%n$" $%#"$ama aal nal a$a" !%na&$ ha$ an !a#ah *an +a&$(#-+a&$(# lan ,*('' )%'a#/ ()a$ *$%lan )%#'ama-'ama/ !%m)%#an &#(n&.
Da)%$%' M%ll$"' ,DM m%#"!a&an !%na&$ m%$a)(l &#(n& an m%n%na '%ala la!' ma'a#a&a$ ma'a#a&a$ *"na. *"na. P%na&$ n '%#n *'%)"$ the great imitator &a#%na !%na&$ n *a!a$ m%n%na '%m"a (an *an m%nm)"l&an )%#)aa maam &%l"han. P%na&$ n $*a& *a!a$ '%m)"h m%'&!"n *a!a$ *a$a'. B%#*a'a#&an &la'+&a' an )a#" *a)%$%' *)a m%na* )%)%#a!a &%la' *an an $%#ma'"& *alam &%la' "$ama alah *a)%$%' *a)%$%' $!% I *an *a)%$%' *a)%$%' $!% II. S%)ana& S%)ana& l%) *a# 95 : &a'"' DM a*alah DM $!% $!% 2. DM *a!a *a!a$$ m%n m%nm) m)"l "l&a &an n )%#) )%#)a aa a &(m! &(m!l l&a &a' ' )a& )a& a&"$ a&"$ ma"! ma"!"n "n &(m!l&a' &#(n&. ;l%h &a#%na $" !%#l" !%nananan '%#"' $%#ha*a! *a)%$%' an *la&" *la&"&an &an m%lal" m%lal" Pana Pana U'aha U'aha P%n(l P%n(laha ahan n Da)%$% Da)%$%'' a$" a$" %*"&a' %*"&a'/ / !%na$ !%na$"#a "#an n ma&an/ la$han a'man/ !%n"naan ()a$ '%#$a m%na$a' an"an *an &(m!l&a' "a !%#")ahan !(la h*"! !%n*%#$a !%n*%#$a *a)%$%' m%ll$"'. Dalam ma&alah n !%n"l' $%#$a#& "n$"& m%n"l' m%n%na n$%#a&' ()a$ *an ma&anan $%#ha*a! !%n*%#$a *a)%$%' m%ll$"' $!% II.
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BAB II TINAUAN PUSTAKA DIABETES MELLITUS A6 Deini*i
Da)%$%' M%ll$"' a*alah &%lanan an )%#'+a$ &#(n& an *$an*a (l%h an"an m%$a)(l'm m%$a)(l'm &a#)(h*#a$ &a#)(h*#a$// !#($%n/ !#($%n/ *an l%ma& an *&"$ *&"$ (l%h &(m!l &(m!l&a' &a' m&#( m&#(a'& a'&"l% "l%## ma"!"n ma"!"n ma&#( ma&#(a'& a'&"l% "l%#/ #/ *an $%lah $%lah *&%$ah *&%$ah" " )%#&a$an *%nan +aa&$(# %n%$& *%nan %ala &ln& an !aln "$ama a*alah n$(l%#an' l"&('a ,<l'(n/2000. Da)%$%' M%ll$"' $!% 2 $%#*# *a# )%#)aa maam &%lanan *%nan &a#a&$%#'$& an 'ama a$" n'"+'%n' &%#a n'"ln "n$"& m%m!%#$ahan&an &a*a# l"&('a *a#ah *alam )a$a' n(#mal. In'"+'%n' &%#a n'"ln m%#"!a&an &(m) &(m)n na' a' *a# *a# #%' #%''$ '$%n %n' ' n'" n'"l ln n *an *an '%&# '%&#%' %' n'" n'"l ln n an an a)n( a)n(#m #mal al ,Da#m(n(/2000. B6 Epi%emiolo,i J"mlah !%n*%#$a *a)%$%' *'%l"#"h *"na/ m%n"#"$ *a$a $ah"n 1==3 a*alah
100 "$a/ an an )%#a#$ )%#a#$ '"a$" '"a$" &%na& &%na&an an 3 &al &al l!a$ l!a$ *)an* *)an*n n&an &an $ah"n $ah"n 1=9>. 1=9>. D In*(n%'a/ an&a &%a*an *a)%$%' )%#&'a# 1-2 : )%#a#$ 'a$" * an$a#a 50 ? 100 !%n*"*"& In*(n%'a m%n*%#$a *a)%$%'. Salah 'a$" +a$(# an **"a m%nn&a$&an &%a*anna * A'a *an A+#&a a*alah a*ana !%#")ahan an na$a *alam !(la ma&an/ a$" an )ana& n%#l%ma& *%nan &"#an 'a"#/ &%%m"&an/ *an h*"! an 'ana$ 'an$a ,Ha#$a$/2002. 36 Etiolo,i %an Pato,ene*i* Pato,ene*i* A*a )"&$ an m%n"n"&&an )aha %$(l( *a)%$%' m%ll$"' )%#maam ?
maam. A&an $%$a!/ !%na&$ n '%#n *h")"n&an *%nan +a&$(# %n%$& an a"$( a"$('( '(m mal
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man+% man+%'$a' '$a'n naa $%#"$am $%#"$amaa !a*a !a*a (#an (#an ? (#an (#an *%nan *%nan !#%*' !#%*'!(' !('' ' %n%$& %n%$&.. Da# !%n%l$an *&%$ah" )aha !a*a &%m)a# m(n(@($ &%a*an DM $!% 2 m%nn&a$ hna =1 : *an $*a& )%#")ah m%'&!"n !%#)%*aan )%#a$ )a*an $%lah *h$"n. B%'a#na #%'&( $%#&%na DM $!% 2 a*alah '%)%'a# 18 : &a $a& 'a$" !"n (#an $"a 6
m%n*%#$a DM/ 25 : &a 'alah 'a$" (#an $"a m%n*%#$a DM *an 85 : &a &%*"a (#an $"a m%n*%#$a DM ,Da#m(n(/2000. a. S%&#%' In'"ln S%lan +a&$(# %n%$&/ !a$(%n%'' DM $!% 2 "a *h")"n&an *%nan an"an '%&#%' n'"ln. S%m"a !%n%l$an m%n"n"&&an )aha !a*a +a'% aal !%n*%#$a *%nan DM $!% 2 m%ml& &a*a# n'"ln an n(#mal a$a" m%nn&a$/ an &%m"*an *h")"n&an *%nan $%#a*na ()%'$a' m%'& ()%'$a' $*a& '%lal" $%#a*. P%nn&a$&an &a*a# n'"l n m%n"n"&&an )aha !a*a 'aa$ $" l%)h )ana& n'"ln ha#"' *'%&#%'&an "n$"& m%m!%#$ahan&an &a*a# l"&('a *a#ah *alam )a$a' n(#mal. S%lan"$na &a*a# &a*a# n'"l n'"ln n m%na* m%na* n(#mal n(#mal// )a& )a& *alam *alam !#(!( !#(!(#' #' !#(n' !#(n'"l "ln n ma"!"n ma"!"n )(a&$$a'na. M%'& &a*a# n'"ln n(#mal/ a)n(#mal$a' '%&#%' n'"ln *a!a *a!a$$ **% **%n$ n$+ +&a &a' ' '%$%la '%$%lah h '$m" '$m"la la' ' '%l
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m%m)%#&an l"&('a n$#a %na. D mana &a*a# n'"ln m%nn&a$ a&an $%$a! l"&('a *a#ah $%$a! n(#mal/ m%n"n"&&an a*ana #%''$%n' n'"ln. Pa*a Pa*a +a'% +a'% &%*" &%*"a/ a/ #%''$ #%''$%n %n' ' n'" n'"l ln n %n* %n*%# %#"n "n m%m) m%m)"# "#"& "& '%hn '%hn aa m%'&! m%'&!"n "n &(n'%n$ &(n'%n$#a' #a' n'"l n'"ln n m%nn m%nn&a$/ &a$/ $am!a& $am!a& )%n$"& )%n$"& n$(l%# n$(l%#an' an' l"& l"&(' ('aa *alam *alam )%n$ )%n$"& "& h!% h!%# #l l&%m &%ma a '%$% '%$%lah lah ma&a ma&an. n. Ba Ba )%)% )%)%#a #a!a !a !%n*%#$a n$(l%#an' l"&('a n *a!a$ )%#$ahan )%#$ah"n ? $ah"n )%#&%m)an m%na* DM/ $a! )a '%)aan !%n*%#$a/ n a*alah +a'% n$%#m%*a$% '%)%l"m m%na* *a)%$%'. Um"mna !a'%n $*a& m%ml& &%l"han/ a&an $%$a! !%#")ahan ma&#(an(!a$ *an l%' ? l%' a'&"l%# $%lah *a!a$ *$%m"&an *alam +a'% n. A&h#na !a*a +a'% &%$a/ #%''$%n' n'"ln $*a& )%#")ah $%$a! '%&#%' n'"ln m%n"#"n *%nan a&)a$ &a*a# l"&('a *a#ah an 'ana$ $n m%n%)a)&an h!%#l&%ma !"a'a *an *a)%$%' an na$a ,Sla/1==5. ,S la/1==5. ). R%''$%n' In'"ln Ka*a# n'"ln !la'ma an n(#mal a$a" m%nn&a$ !a*a !%n*%#$a DM $!% 2 m%n"n"&&an #%''$%n' n'"ln an m"n"l '%)aa a&)a$ a*ana *%+%& !a*a )%)%#a!a $%ha!an &%#a n'"ln. Dalam &%a*aan n(#mal/ n'"ln $%#&a$ !a*a #%'%!$( * m%m)#an% '%l an '%lan"$na m%n$#an'm'&an '%(n* m%''%n%# "n$"& m%m"la !%#")ahan m%$a)(l'm l"&('a **alam '%l. Pa*a DM $!% 2 **%+%& !%#$ama a*alah a*ana !%n"#"nan "mlah #%'!% #%'!%$( $(## n'" n'"l ln/ n/ '%*an '%*an& &an an *%+%& *%+%& &%*" &%*"aa a*al a*alah ah a*an a*anaa *%+% *%+%& & !a*a !a*a >
!%n#man 'nal4 !%'an n$#a'%l"l%# an **"a $%#&a$ *%nan a)n(#mal$a' m%$a)(l'm &a#)(h*#a$ ,Sla/1==5. , Sla/1==5. D6 Manie*ta*i Manie*ta*i Klini* Man+%'$a' &ln' *a)%$%' m%ll$"' *&a$&an *%nan &(n'%&"%n' m%$a)(l
*%+'%n' n'"ln. Pa'%n ? !a'%n an m%nalam *%+'%n' n'"ln $*a& *a!a$ m%m!%#$ahan&an &a*a# l"&('a !la'ma !"a'a an n(#mal/ a$a" $(l%#an' l"&('a '%'"*ah ma&an &a#)(h*#a$. J&a h!%#l&%mana !a#ah *an m%l%)h am)an nal/ ma&a $m)"l l"&('"#a. Dl"&('"#a n a&an m%na&)a$&an *"#%'' ('m($ an m%nn&a$&an *"#%'' ('m($ an m%nn&a$&an !%n%l"a#an &%mh ,!(l"# *an $m)"l #a'a ha"' ,!(l*!'a. Ka#%na l"&('a hlan )%#'ama &%mh/ ma&a !a'%n m%nalam &%'%m)anan &al(# n%a$% *an )%#a$ )a*an )%#&"#an. P(l+a a&an $m)"l '%)aa a&)a$ &%hlanan &al(. Pa'%n m%n%l"h l%lah *an m%nan$"&. Pa*a !a'%n NIDDM,n(n n'"ln *%!%n*%n$ *a)%$%' m%ll$"' m"n&n 'ama '%&al $*a& m%m!%#lha$&an %ala a!a!"n/ *an *an('' hana *)"a$ )%#*a'a#&an !%m%#&'aan *a#ah * la)(#a$(#"m *an m%la&"&an $%' $(l%#an' l"&('a. P%#$(l(nan m%*' !aln '%#n '%#n *a# *a# &a#%na &a#%na %ala %ala an an )%#&a )%#&a$an $an *%nan *%nan h!%# h!%#l& l&%m %ma/ a/ $%$a! $%$a! &%a*a &%a*an n !%#$ama m"n&n )%#"!a *%&(m!%n'a' m%$a)(l a&"$ an m%n%)a)&an &(ma *a)%$&. Ka*an ? &a*an !%nam!a&an aal )%#"!a !%n"l$ *%%n%#a$% '%!%#$ n%"#(!a$ $an!a h!%#l&%ma )%#%ala ,Ka!$a S%l%&$a/2001. am)a#an &ln' an &ha' *a# NIDDM7 Um"# a$an C80 • B%n$"& $")"h %m"& a$a" $*a& %m"& • In'"ln !la'ma n(mal hna $n • P%n"l$ a&"$ &(ma h!%#('m(la# • R%'!(n'% hna #%''$%n $%#ha*a! $%#a! n'"ln • R%'!(n'% $%#ha*a! $%#a! '"l+(nl"#%a •
E6 Dia,no*i* Dan('' &ln' DM "m"mna a&an *!&#&an )la a*a &%l"han &ha' DM )%#"!a !(l"#/
!(l*!'/ !(l+aa/ *an !%n"#"nan )%#a$ )a*an an $*a& *a!a$ *%la'&an '%)a)na. K%l"han lan an m"n&n *&%m"&a&an !a'%n a*alah &%l%mahan/ &%'%m"$%n/ a$al/ ma$a &a)"#/ *an *'+"n' %#%&' !a*a !#a/ '%#$a !#"#$"' "la% !a*a !a'%n an$a. J&a &%l"ha &%l"han n &ha'/ &ha'/ !%m%#& !%m%#&'aan 'aan l"&(' l"&('aa *a#ah *a#ah '%a&$ '%a&$" " 200 m4*l '"*ah '"*ah "&"! "&"! "n$"& "n$"& m%n%a&&an *an('' DM. "n$"& &%l(m!(& $an!a &%l"han &ha' DM/ ha'l !%m%#&'aan l"&('a *a#ah an )a#" 'a$" &al 'aa a)n(#mal/ )%l"m "&"! &"a$ "n$"& m%n%a&&an 9
*an('' DM. *!%#l"&an !%ma'$an l%)h lan"$ *%nan m%n*a!a$ '%&al la an&a a)n(#mal/ )a& &a*a# l"&('a *a#ah !"a'a 126 m4*l/ &a*a# l"&('a *a#ah '%a&$" 200 m4*l !a*a ha# n/ a$a" *a# ha'l $%' $(l%#an' l"&('a (#al ,TT; **a!a$&an &a*a# l"&('a *a#ah !a'a !%m)%)anan 200 m4*l ,P%#&%n/2006. 46 Komplika*i Dia/ete* Mellit)* K(m!l&a' ? &(m!l&a' *a)%$%' m%ll$"' *a!a$ *)a m%na* *"a &a$%(#7
,1 &(m!l& &(m!l&a' a' m%$a)( m%$a)(l l a&"$/ a&"$/ *an ,2 &(m!l &(m!l&a' &a' ? &(m!l &(m!l&a' &a' a'"l a'"la# a# an&a an&a !anan. K(m!l&a' m%$a)(l *a)%$%' m%#"!a&an a&)a$ !%#")ahan an #%la$% a&"$ *a# *a# &a*a &a*a## l"& l"&(' ('aa !la'm !la'ma. a. K(m! K(m!l l&a &a' ' m%$a) m%$a)(l (l an an !al !aln n '%#" '%#"'/ '/ a*al a*alah ah &%$(a' &%$(a'*( *('' '' *a)%$ *a)%$&. &. A!a) A!a)la la &a*a# &a*a# n'"l n'"ln n 'ana$ 'ana$ m%n"#" m%n"#"n/ n/ !a'%n !a'%n m%nala m%nalam m h!%#l&% h!%#l&%ma ma *an l"&('"#a l"&('"#a )%#a$/ !%n"#"nan !%n"#"nan l!(%n%''/ l!(%n%''/ !%nn&a$& !%nn&a$&an an l!(l''/ l!(l''/ *an !%nn !%nn&a$ &a$&an &an (&'*a (&'*a' ' a'am l%ma& l%ma& )%)a' )%)a' *'%#$a *'%#$a !%m)%n !%m)%n$"& $"&an an )a*an )a*an &%$(n &%$(n ,a'% ,a'%$( $(a' a'%$ %$a$ a$//
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4ARMAKOLO7I A6 4armakokinetik 6 A/*orp*i A)'(#! A)'(#!' ' a*alah a*alah !#('%' !#('%' ma'"&n ma'"&na a ()a$ ()a$ *a# *a# $%m!a$ $%m!a$ !%m)%# !%m)%#an an &%
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10
an m%#"!a&an m%#"!a&an *#n *#n +(#% !#('%' !#('%' *+"'/ *+"'/ *an *%nan l"a'na a#%a !%#m"&aan m%m)#an% *+"'. K%)ana&an ()a$ m%#"!a&an %l%&$(l$ l%mah/ a&n a'am l%mah a$a" )a'a l%mah. Dalam a#/ %l%&$(l$ l%mah n a&an $%#(n'a' m%na* )%n$"& (nna. D%#aa$ (n'a' ()a$ $%#an$"n !a*a &(n'$an$a (n'a' ()a$ *an !H la#"$an * mana ()a$ )%#a*a. 26 Di*tri/)*i Dalam Dalam *a#ah *a#ah// ()a$ ()a$ a&an a&an *& *&a$ a$ (l%h (l%h !#($ !#($% %n n !la' !la'ma ma *%n *%nan an
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Mekani*me Ker-a o/at
K%)ana&an ()a$ m%nm)"l&an %+%& m%lal" n$%#a&' *%nan *%nan #%'%!$(#na #%'%!$(#na !a*a '%l (#an'm. (#an'm. In$%#a&' ()a$ *%nan *%nan #%'%!$(#na #%'%!$(#na n m%n%$ m%n%$"'& "'&an an !%#") !%#")ahan ahan )(&m )(&ma a *an +'(l( +'(l( an an m%#"!a m%#"!a&an &an 18
#%'!(n' &ha' "n$"& ()a$ $%#'%)"$. R%'%!$(# ()a$ m%#"!a&an &(m!(n%n ma&#(m(l%&"l +"n'(nal hal n m%na&"! 2 &(n'%! !%n$n. P%#$ama/ ()a$ *a!a$ m%n")ah &%%!a$an &%a$an +aal $")"h. K%*"a/ ()a$ $*a& m%nm)"l&an +"n' )a#"/ $%$a! hana m%m(*"la' +"n' an '"*ah a*a.
)%#la )%#la&" &" 'am! 'am!a a '%&a# '%&a#an an. . S%$ S%$a! a! &(m! &(m!(n (n%n %n ma&# ma&#(m (m(l (l%& %&"l "l
+"n'(nal *a!a$ )%#!%#an '%)aa #%'%!$(# +'(l(' "n$"& lan* %n*%n. ;)a$ an m%n%#"!a '%naa %n*(%n *'%)"$ a(n'. S%)al&na. ;)a$ an an $*a& $*a& m%m!"n m%m!"na a a&$$ a&$$a' a' n'$n n'$n'& '& '%hn '%hnaa m%nm) m%nm)"l& "l&an an %+%& %+%& an m%nham)a$ &%#a '"a$" a(n' *'%)"$ an$a(n'. D'am!n $"/ a*a ()a$ an &a )%#&a$an *%nan #%'%!$(# +'(l(' m%nm)"l&an %+%& n'$#n'& an )%#laanan *%nan %+%& a(n'/ *'%)"$ a(n' n%a$%. INSULIN DAN OBAT DIABETIK ORAL
INSULIN
In'"ln ma'h m%#"!a&an ()a$ "$ama "n$"& DM $!% I *an )%)%#a!a %n' DM $!% II/ $%$a! m%man ma'h )ana& !a'%n DM an %nan *'"n$&/ &%"al *alam &%a*aan $%#!a&'a. Ka#%nana $%#a! %*"&a' !a'%n DM 'ana$lah !%n$n/ aa# !a'%n 'a*a# a&an !%#l"na !%#l"na $%#a! n'"ln n'"ln m%'& *)%#&an '%a#a '"n$&an. '"n$&an. S"n$&an n'"ln *a!a$ *a!a$ *la&" *la&"&an &an *%nan *%nan )%#)a )%#)aa a a#a/ a#a/ an$a#a an$a#a lan7 lan7 n$#a n$#a%na %na// n$#am n$#am"'& "'&"l% "l%#/ #/ *an "m"mna !a*a !%n"naan an&a !ananl%)h *'"&a !%m)%#an '%a# a '")&"$an. In%ika*i %an T)-)an Terapi Terapi
In'"ln '")&"$an $%#"$ama *)%#&an !a*a DM $!% I. DM $!% II an $*a& *a!a$ *a$a' hana *%nan *%$ a$a" an$*a)%$& (#al/ !a'%n DM !a'a!an&%a$(m a$a" a$a" DM *%n *%nan an &%ham &%hamla lan/ n/ DM *%n *%nan an &%$( &%$(a' a'*( *(' ''/ '/ &(ma &(ma n(n& n(n&%$ %$(' (''/ '/ a$a" a$a" &(m!l&a' &(m!l&a' lan/ '%)%l"m $n*a&an (!%#a'. T""an T""an n'"ln n'"ln !a*a &%a*aan $%#'%)"$ $%#'%)"$ )"&an 'aa "n$"& m%n(#mal&an l"&('a *a#ah $%$a! "a m%m!%#)a& '%m"a a'!%& m%$a)( m%$a)(l'm l'm// *an an an $%#a&h $%#a&h# # nlah nlah "m"mn "m"mna a '"&a# '"&a# *a!a *a!a. . Ha'l Ha'l $%#a! $%#a! an an
15
(!$mal (!$mal m%m)"$"h& m%m)"$"h&an an !%n*%&a$an !%n*%&a$an *(&$%# !a*a !a'%n *an &%l"a#an &%l"a#ana/ a/ aa# a*a &((#*na' an$a#a *%$/ la$han +'&/ *an !%m)%#an n'"ln. Eek Sampin, 6 Hipo,likemia H!(l&%ma m%#"!a&an %+%& 'am!n !aln '%#n $%#a* *an $%#a* a&)a$
*('' *('' n'"l n'"ln n an an $%#lal" $%#lal" )%'a#/ )%'a#/ $*a& $%!a$n $%!a$naa a&$" a&$" ma&an ma&an *%nan *%nan a&$" a&$" $%#a $%#a!a !an naa &a*a &a*a## !"n !"na& a& n'" n'"l ln/ n/ a$a" a$a" &a#%n &a#%naa a*an a*anaa +a$( +a$(## an an *a!a *a!a$$ m%nn&a$&a m%nn&a$&an n '%n'$$a' '%n'$$a' $%#ha*a! $%#ha*a! n'"ln/ n'"ln/ m'alna m'alna n'"+'%n' n'"+'%n' a*#%nal a$a" !$"a#/ a$a"!"n a&)a$ &%#a +'& an )%#l%)han. 26 Reak*i aler,i %an re*i*ten*i P%n" P%n"naa naan n n'"l n'"ln n #%&(m) #%&(m)na nan n *an n'"l n'"ln n an an l%) l%) m"#n/ m"#n/ $%lah $%lah *a!a$ *a!a$ m%n"#" m%n"#"n&a n&an n n'*% n'*%n n #%a&' #%a&' al%# al%# *an #%''$%n #%''$%n'. '. M%'& *%m&an *%m&an//
&a*an &a*an ?
&a*an#%a&' $%#'%)"$ ma'h *a!a$ $%#a*a&)a$ a*ana )%&"an a$a" $%#a*na *%na$"#a' !#%!a#a$ n'"ln/ a$a" &(n$amnan/ a$a" a&)a$ !a'%n '%n'$% $%#ha*a! '%naa an *$am)ah&an !a*a !#('%' +(#m"la' !#%!a#a$ n'"ln. R%a&' al%# l(al !a*a &"l$ an '%#n $%#a* a&)a$ IE a$a" #%''$%n' a&)a$ $m)"lna an$)(* I. Interak*i B%)%#a!a h(#m(n% )%#'+a$ an$a(n' $%#ha*a! %+%& h!(l&%ma n'"ln an$a#a
lan/ lan/ h(#m( h(#m(n% n% !%#$"m !%#$"m)"h )"han/ an/ &(#$& &(#$&($# ($#(! (!n/ n/ l"&(& l"&(&(#$ (#$&( &(*/ */ $#(* $#(*// %'$%#( %'$%#(%n/ %n/ !#(%'$n/ *an l"a(n. A*#%naln m%nham)a$ '%&#%' n'"ln *an m%#an'an l&(%n(l''. P%nn&a$an &a*a# h(#m(n% n !%#l" *!%#h$"n&an *alam $%#a! n'" n'"l ln. n.
Sal Sal' 'la la$$
m%nn %nn& &a$ a$&a &an n
'%&# '%&#%' %'
n'" n'"l ln/ n/
m"n& "n&n n
m%n m%n%) %)a) a)&a &an n
h!(l&%ma. H!(l&%ma %n*%#"n $%#a* !a*a !a'%n *%nan !%nham)a$ a*#%n('%!$(# a&)a$ !%nham)a$an %+%& &a$%&(lamn !a*a l"&(n%(%n%'' *an l&(%n(l''/ ()a$ n "a m%n&a)"#&an $a&&a#* a&)a$ h!(l&%ma. P($%n' %+%& h!(l&%ma n'"ln $%#a* *%nan !%nham)a$ MA;/ '$%#(* ana)(l *an +%n+l"#amn ,FK UI/200>. OBAT ANTIDIABETIK ORAL A*a 5 (l(nan an$*a)%$& (#al , AD; an *a!a$ *"na&an "n$"& DM *an
$%lah *!a'a#&an * In*(n%'a a&n (l(nan7 '"l+(nl"#%a/ m%l$n*/ )"an*/ !%nham)a$ G-l&('*a'%/ *an $a@(l*n%'(n. K%lma (lnan n *a!a$
16
*)%#&an !a*a DM $!% II an $*a& *a!a$ *&(n$#(l hana *%nan *%$ *an la$han +'& 'aa.
7olon,an S)lonil)rea S)lonil)rea D&%nal 2 %n%#a' '"l+(nl"#%a/ %n%#a' 1 $%#*# *a# $(l)"$am*/ a'%$(h%&'m*
*an &l(!#(!am*. %n%#a' II an !($%n' h!(l&%m& l%)h )%'a# an$a#a lan l)"#* , l)%n&lam*/ l!@*/ l&a@* *an lm%!#*. Mekani*me ker-a (l(nan ()a$ n *'%)"$ '%)aa n'"ln '%#%$a(%"'/ &%#ana m%#an'an '%&#%' n'"ln *a# #an"l '%l ? '%l Lan%#han' !an&#%a'. Ran'anan m%lal" n$%#a&'na *%nan ATP- '%n'$% K hann%l !a*a m%m)#an% '%l ? '%l an m%nm)"l&an *%!(la#'a' m%m)#an% *an &%a*aan n a&an m%m)"&a &anal a. D%nan D%nan $%#)"&an $%#)"&ana a &anal &anal a ma&a ma&a (n a a&an ma'"& '%l / m%#an'an #an"la an )%#' n'"ln *an a&an $%#a* '%&#%' n'"ln *%nan "mlah an %&"al%n *%nan !%!$*% . &%"al $"/ '"l+(#l"#%a *a!a$ m%n"#an &l#%n n'"ln * h%!a#. Pa*a Pa*a !%n" !%n"naa naan n an&a an&a !anan !anan a$a" a$a" *('' *('' an an )%'a# )%'a# *a!a$ *a!a$ m%n%) m%n%)a)& a)&an an h!(l&%ma. Eek *ampin, In'*%n In'*%n %+%& 'am!n %n%#a' I '%&$a# 8 :/ n'*%n'na n'*%n'na l%)h #%n*ah la "n$"& %n%#a' II. H!(l&%ma/ )ah&an 'am!a &(ma $%n$" *a!a$ $m)"l. R%a&' n '%#n $%#a* !a*a !a'%n "'a lan"$ *%nan an"an +"n' h%!a# *an nal/ $%#"$ama an m%n"na&an '%*aan *%nan ma'a &%#a !anan. E+%& 'am!n lan/ #%a&' al%# al%# a#an '%&al $%#a* / m"al/m"n$ah m"al/m"n$ah// *a#%/ %ala h%ma$(l(/ '"'"nan 'a#a+ !"'a$/ ma$a/ *an '%)aana. Interak*i ;)a$ ;)a$ an an *a!a *a!a$$ m%n m%nn n&a &a$& $&an an #'& #'&( ( h!( h!(l l& &%m %maa '%a '%a&$ &$" " !%n !%n" "na naan an '"l+(nl"#%a a*alah n'"ln/ al(h(l/ +%n+(#mn/ '"l+(nam*%/ 'al'la$ *('' )%'a#/ +%n)"$a@(n/ (&'+%n)"$a@(n/ !#()%n%@*/ *&"ma#(l/ &l(#am+%n&(l/ !%nham)a$ MA;/ "an%$*n/ ana)(l '$%#(*/ +%n+l"#amn *an &l(+)#a$. P#(!#a P#(!#an(l n(l(l (l *an !%nha !%nham)a m)a$$ a*#%n( a*#%n(#%'% #%'%!$( !$(## lann lannaa m%nha m%nham)a m)a$$ #%a&' #%a&' $a&& $a&&a#* a#*a/ a/ )%#& )%#&%# %#n na a$$ *an *an $#%m( $#%m(## !a*a !a*a h!( h!(l l& &%m %ma a (l%h (l%h )%#) )%#)a aa a '%)a) '%)a) $%#ma $%#ma'" '"& & (l%h (l%h AD;/ D;/ '%h '%hn na a &%a* &%a*aan aan h!( h!(l l& &%m %ma a m%n m%na* a* h%)a h%)a$$ $an! $an!aa *&%$ah *&%$ah". ". S"l+(n S"l+(nl l"#%a "#%a $%#"$ama $%#"$ama &l(#!# &l(#!#(!a (!am* m* *a!a$ *a!a$ m%n"#" m%n"#"n&a n&an n $(l%#an $(l%#an' ' $%#ha*a! al(h(l/ hal n *$"n"&&an *%nan &%m%#ahan $%#"$ama *m"&a *an l%h%#. 1>
Me,litini% R%!aln* *an na$%ln* m%#"!a&an (l(nan m%l$n*/ m%l$n*/ m%&an'm% &%#ana
'ama *%nan *%nan '"l+(nl"# '"l+(nl"#%a %a $%$a! '$#"&$"# &mana 'ana$ )%#)%*a. )%#)%*a. (l(nan (l(nan A;D n m%#an'an n'"ln *%nan m%n"$"! &anal K an ATP- n*%!%n*%n$ * '%l !an&#%a'. Pa*a !%m)%#an (#al a)'(#!'na %!a$ *an &a*a# !"na&na *a!a *alam &"#"n a&$" 1 am. Ma'a !a#"hna 1 am/ &a#%nana ha#"' *)%#&an )%)%#a!a &al '%ha#/ '%ha#/ '%)%l"m '%)%l"m ma&an. ma&an. M%$a)( M%$a)(l'm l'm "$ama "$amaaa * h%!a# h%!a# *an m%$a)(l m%$a)(l$n $na a $*a& $*a& a&$+. S%&$a# 10 : *m%$a)(l'm% * nal. Pa*a !a'%n *%nan an"an +"n' ha$ ha$ a$a" a$a" n nal al ha#" ha#"'' *)% *)%#& #&an an '%a# '%a#aa ha$ ha$ ? ha$ ha$.. E+%& E+%& 'am! 'am!n n "$am "$aman anaa h!(l&%ma *an an"an 'al"#an %#na. R%a&' al%# "a !%#nah *la!(#&an. Bi,)ani% S%)%na#na *&%nal 3 %n' AD; *a (l(nan )"an*7 +%n+(#mn/ )"+(#mn/ *an
m%$+( m%$+(#m #mn n// $%$a! $%$a! an an !%#$ !%#$am amaa $%lah $%lah *$a# *$a#& & *a# *a# !%#%* !%#%*a#a a#an n &a#%n &a#%naa '%#n '%#n m%n%)a)&an a'*('' la&$a$. S%&aan an )ana& *"na&an a*alah m%$+(#mn. Mekani*me ker-a B"an* B"an* '%)%na#na '%)%na#na )"&an )"&an ()a$ h!(l&%m h!(l&%ma/ a/ $%$a! an$h!%#l an$h!%#l&%ma &%ma// $*a& m%n%)a m%n%)a)&a )&an n #an'a #an'ana nan n '%&#%' '%&#%' n'"l n'"ln n *an "m"mn "m"mnaa $*a& $*a& m%n%) m%n%)a)& a)&an an h!( h!(l l& &%m %ma a..
M%$+ M%$+(# (#m mn n m%n" m%n"#" #"n& n&an an !#(* !#(*"& "&' ' l"& l"&(' ('aa * h%!a h%!a## *an *an
m%nn&a$&an '%n'$a' a#nan ($($ *an a*!('% $%#ha*a! n'"ln. Eek *ampin, Ham!# Ham!# 20: !a'%n !a'%n *%nan *%nan m%$+(#m m%$+(#mn n m%nal m%nalam am m"al/ m"al/ m"n$ah m"n$ah// *a#% *a#% '%#$a '%#$a &%a! l(am/ $%$a! *%nan m%n"#"n&an *('' &%l"han ? &%l"han $%#'%)"$ *a!a$ hlan hlan.. Pa*a Pa*a )%)%#a! )%)%#a!aa !a'%n !a'%n an an m"$la& m"$la& )%#an )%#an$"n $"n !a*a !a*a n'"l n'"ln n %&'(% %&'(%n/ n/ &a*an ? &a*an )"an* m%nm)"l&an &%$('' an $*a& *'%#$a h!%#l&%ma. Hal n ha#"' *)%*a&an *%nan &%$('' &a#%na *%+'%n' n'"ln. Pa*a Pa*a !a'% !a'%n n *%n *%nan an an an" "an an +"n +"n' ' n nal al a$a" a$a" ''$% ''$%m m &a#* &a#*( (a a'& '&"l "l%# %#// !%m)%#an )"an* *a!a$ m%nm)"l&an !%nn&a$an &a*a# a'am la&$a$ *alam *a#ah/ '%hna hal n 'a!a$ m%nan" &%'%m)anan %l%&$#(l$ *alam a#an $")"h. 7olon,an Tia1oli%ine%ion Tia1oli%ine%ion Makani*me ker-a %an eek meta/oli( T%lah *$%#an&an *a$a'/ n'"ln m%#an'an !%m)%n$"&an *an $#an'l(&a' LUT
&% m%m)#an% '%l (#an !%#+%#. In $%#a* &a#%na n'"ln m%#an'an Peroxisome m%#an'an Peroxisome proliferators-activated reseptor-γ reseptor-γ ,PPAR ,PPAR * n$ '%l *an m%na&$a' m%na&$a' insulinresponsive genes/ genes/ %n an )%#!%#an *alam m%$a)(l'm &a#)(h*#a$ *an l%ma&. 19
PPA PPAR $%#*a! $%#*a!a$ a$ * $a#%$ $a#%$ n'"l n'"ln/ n/ a&n a&n * a#na a#nan n a*!(' a*!('%/ %/ !an&#% !an&#%a'/ a'/ h%!a#/ h%!a#/ &%)%#a*aanna * ($($ '&%l%$ ma'h m%#a"&an. Ta@( Ta@(l* l*n% n%*( *(n n m%#"!a m%#"!a&an &an a(n' a(n'$$ !($%n$ !($%n$ *an '%l%&$ '%l%&$++ PPA PPAR m%m)%n m%m)%n$"& $"& &(m!l%&' PPAR-RR *an $%#)%n$"&lah LUT )a#". D a#nan a*!('% PPAR m%n"# m%n"#an an &%l"a#n &%l"a#naa a'am l%ma& l%ma& &% ($($/ ($($/ *an &a#%nan &a#%nana a *a!a$ *a!a$ m%n"# m%n"#an an #%''$%n' n'"ln. E+%& 'am!n an$a#a lan/ !%nn&a$&an !%nn&a$&an )%#a$ )a*an / %*%ma/ m%nam)ah m%nam)ah (l"m% (l"m% !la'ma *an m%m!%#)"#"& aal an$"n &(n%'+. E*%ma '%#n $%#a* !a*a !%n"naanna )%#'ama n'"ln. K%"al h%a!/ $*a& *an"#&an !a*a aal nal &%la' 3 *an 8 m%n"#"$ New York H!(l&% &%ma ma !a*a !a*a York Heart Association. Association. H!(l !%n"naan m(n($%#a! a#an $%#a*.
Pen,0am/at En1im 897liko*i%a*e ;)a$ (l(nan !%nham)a$ %n@m G-l&('*a'% n *a!a$ m%m!%#lam)a$ a)'(#!'
!(l'a&a#*a/ *%&'$#n/ *an *'a&a#*a * n$%'$n%. D%nan m%nham)a$ &%#a %n@m %n@m G-l& G-l&(' ('*a'% *a'% * )#"'h )#"'h )(#*%# )(#*%# n$%'$ n$%'$n%/ n%/ *a!a$ *a!a$ m%n% m%n%ah ah !%nn !%nn&a$ &a$an an l"&('a !la'ma !a*a (#an n(#mal *an !a'%n DM. Ka#% Ka#%na na &%# &%#an an a $*a $*a& & m%m! m%m!%n %na a#" #"h h '%&# '%&#%' %' n'" n'"l ln/ n/ ma&a ma&a $*a $*a& & a&an a&an m%n%)a)&an m%n%)a)&an %+%& 'am!n 'am!n h!(l&%ma h!(l&%ma.. A&a#)('% A&a#)('% *a!a$ *"na&an *"na&an '%)aa '%)aa m(n($%#a! !a*a DM "'a $!% lan"$ a$a" DM an l"&('a !('$!#an*alna 'ana$ $n. D &ln& '%#n *"na&an *"na&an )%#'ama )%#'ama an$*a)%$& an$*a)%$& (#al lan *an a$a" n'"ln. ;)a$ (l(nan n *)%#&an !a*a a&$" m"la ma&an *an a)'(#'!' )"#"&. A&a#)('% m%#"!a&an (l('a&a*a an )%#a'al *a# m&#()a/ *an m$(l '"a$" *%#a$% *%'(&'n(#m'n/ '%a#a &(m!%$$+ "a m%nham)a$ l"&(amla'% *an '"&#a'%/ $%$a! %+%&na !a*a G-amla'% !an&#%a' l%mah. E+%& 'am!n an )%#'+a$ *('%- *%!%n*%n$ an$a#a lan mala)'(#)'/ +la$"l%n/ *a#%/ *an a)*(mnal )l(a$n. Un$"& m%n"#an %+%& 'am!n n '%)a&na *('' *$$#a' ,FK UI/200>.
OBAT HERBAL ANTIDIABETIK 1. )a$a )a$an n )#($ )#($( (al al 4 inos inospor porae ae caulis ,m%na ,m%nan*" n*"n n al&al( al&al(* * / @a$ !ah$/ !ah$/
$n('!(#*n%/ )%#%+%& m%n"#"n&an &a*a# "la *a#ah
1=
2. )"ah )"ah !a#% !a#%44 !omordicae fructus ,m%nan*"n ,m%nan*"n al&al(* al&al(* m(m(#*n m(m(#*n )%#%+%& m%n"#"n&an &*a# "la *a#ah *an $%&anan *a#ah 3. Da"n 'am)l($ 'am)l($( ( 4 Andrographii Andrographii folium ,m%nan*"n an*#(#a!h(l*% )%#%+%& m%n"#"n&an "la *a#ah/ $%&anan *a#ah/ m%nn&a$&an '$amna
20
BAB III HASIL IDENTITAS PASIEN Nama Um"# J%n' K%lamn S$a$"' P%#&anan Alama$ Aama S"&" Ban'a P%n**&an P%&%#aan
7 N T(a'ah T(a'ah 7 86 $ah"n 7 P%#%m!"an 7 Kan 7 S"#a*a* - T%al 7 I'lam 7 Jaa 7 7
RESUME PEN:AKIT DAN PENATALAKSANAAN PENATALAKSANAAN :AN7 :AN7 SUDAH SUD AH DILAKUKAN Anamne*i*
Pa'%n *a$an "n$"& &(n$#(l "la *a#ah Riwa+at Pen+akit Sekaran, Pa'%n *a$an *%nan "la *a#ah '%a&$" 280 m4*l Riwa+at Pen+akit Da0)l) Raa$ $%&anan *a#ah $n *'an&al • Raa$ &%nn man' '%a& > $ah"n an lal"/ &(n$#(l $%#a$"# • Raa$ 'a&$ &"nn *'an&al • Raa$ 'a&$ an$"n *'an&al • Raa$ a'ma *'an&al • Riwa+at Pen+akit Kel)ar,a Raa$ &%l"a#a 'a&$ *'an&al • Raa$ &%l"a#a 'a&$ *a#ah $n/ a'ma/ 'a&$ &"nn/ *an an$"n •
*'an&al Pemerik*aan 4i*ik K%a*aan "m"n 7 )a& • K%'a*a#an 7 )a& • Tan*a $al7 • T%n'7 1204>0 mmH Na*7 >0 4m%n$ F#%&"%n' na+a'7 32 4m%n$ S"h"7 36/1 *%#aa$ %l"' a&'la ,&%$a& S$a$"' @7 • BB7 58 & TB7 160 m BMI7 21/1 K%'an 7 n(#mal Dia,no*i* Ker-a
21
Da)%$%' M%l$"' $!% 2 Penatalak*aan 4armakolo,i • l)%n&lam* a#a &%#a m%nn&a$&an '%&#%' n'"ln M%$+(#mn a#a &%#a m%n%&an !#(*"&' l"&('a ha$ • Nonarmakolo,i D%$ *a$"#7 &"#an man' ? man' *an )a$a' ma&anan an
)ana& &a#)(h*#a$. ;lah#aa $%#a$"# 3 ? 8 &al '%mn" &"#an l%)h 30 m%n$ ,
alan 'an$a/ '%!%*a 'an$a/ (n/ )%#%nan P%mahaman $%n$an !%na&$ DM/ h!(l&%ma/ ma&na *an !%#l"na !%n%n*alan *an !%man$a"an DM.
BAB I; PEMBAHASAN
In$% In$%#a #a& &'
*&la &la' '+ +&a &a' '& &an
)%#* %#*a'a# a'a#&a &an n
&%$% &%$%#l #l) )a$ a$an an
*alam alam
!#('% #('%''
+a#ma&(&n%$& ma"!"n +a#ma&(*nam&. In$%#a&' +a#ma&(&n%$& *$an*a *%nan !%#")ahan &a*a# !la'ma ()a$/ a#%a * )aah &"#a ,AU/ (n'%$ a&'/ a&$" !a#( *'). In$%#a&' +a#ma&(&n%$& +a#ma&(&n%$& *a&)a$&an (l%h !%#")ahan !%#")ahan la" a$a" $n&a$ a)'(#!'/ a)'(#!'/ *'$ *'$# #)" )"' '//
m%$a m%$a)( )(l l'm 'm%%
*an *an
%&'& %&'&#% #%' '..
In$% In$%#a #a&' &'
+a#m +a#ma& a&(* (*n nam am& &
)a' )a'an an a
*h")"n&an *%nan &%mam!"an '"a$" ()a$ "n$"& m%n")ah %+%& ()a$ lan $an!a m%n")ah m%n")ah '+a$-'+a$ '+a$-'+a$ +a#ma&(&n%$ +a#ma&(&n%$&n &na. a. In$%#a&' In$%#a&' +a#ma&(*nam +a#ma&(*nam& & m%l!"$ m%l!"$ a*$+ ,%+%& ()a$ A 1/ %+%& ()a$ B 1/ %+%& &(m)na' &%*"ana 2/ !($%n'a' ,%+%& A 0/ %+%& B 1/ %+%& &(m)na &(m)na' ' AB 2/ 'n%# 'n%#'m% 'm% ,%+%& A 1/ %+%& B 1/ %+%& &(m)na' AB 3 *an an$a(n'm% ,%+%& A 1/ %+%& B 1/ %+%& &(m)na' AB 0. M%&an'm% an $%#l)a$ *alam n$%#a&' +a#ma&(*nam& +a#ma&(*nam& a*alah !%#")ahan !%#")ahan %+%& !a*a a#nan a$a" #%'%!$(#. Interak*i armakokinetik armakokinetik
22
6 A/*orp*i
;)a$-()a$ an *"na&an '%a#a (#al )'aana *'%#a! *a# 'al"#an %#na &% *alam *alam ''$%m ''$%m '#&"la '#&"la'. '. A*a A*a )ana )ana& & &%m"n &%m"n&n &nan an $%#a* $%#a* n$%#a n$%#a&' &' '%lama '%lama ()a$ ()a$ m%l%a$ 'al"#an %#na. A)'(#!' ()a$ *a!a$ $%#a* m%lal" $#an'!(#$ !a'+ ma"!"n a&$+/ * mana '%)aan )%'a# ()a$ *a)'(#!' '%a#a !a'+. P#('%' n m%l)a$&an *+"' ()a$ *a# *a%#ah *%nan &a*a# $n &% *a%#ah *%nan &a*a# ()a$ an l%)h #%n*ah. Pa*a $#an'!(#$ a&$+ $%#a* !%#!n*ahan ()a$ m%laan #a*%n &(n'%n$#a' ,(n$(hna (n-(n *an m(l%&"l an la#"$ a# *an !#('%' n m%m)"$"h&an %n%#. A)'(#!' ()a$ '%a#a $#an'!(#$ a&$+ l%)h %!a$ *a# !a*a '%a#a $an'!(#$ !a'+. ;)a$ *alam )%n$"& $a&-$%#(n la#"$ l%ma& *an m"*ah )%#*+"' m%l%a$ m%m)#an '%l/ '%*an&an ()a$ *alam )%n$"& $%#(n $*a& la#"$ l%ma& *an $*a& *a!a$ )%#*+"'. D )aah &(n*' +'(l( +'(l( n(#ma n(#mall a)'(#! a)'(#!'n 'na a aa& aa& $%#$"n $%#$"n*a *a $%$a! $%$a! $n&a $n&a$$ a)'(#! a)'(#!'n 'naa )a'an )a'anaa '%m!"#na. Bla &%%!a$an a)'(#!' )%#")ah/ n$%#a&' ()a$ '%a#a 'n+&an a&an l%)h m"*ah $%#a*/ $%#"$ama ()a$ *%nan a&$" !a#( an !%n*%& a$a" )la *)"$"h&an &a*a# &a*a# !"na& !"na& !la'ma !la'ma an an %!a$ %!a$ "n$"& "n$"& m%n*a! m%n*a!a$&a a$&an n %+%&. %+%&. M%&an M%&an'm% 'm% n$%#a& n$%#a&' ' a&)a$ an"an a)'(#!' an$a#a lan 7 a. In$%#a&' lan'"n In$%#a& In$%#a&' ' '%a#a '%a#a +'&4& +'&4&m ma a an$a# an$a# ()a$ ()a$ *alam *alam l"m%n l"m%n 'al"#an 'al"#an %#na %#na '%)%l" '%)%l"m m a)'(#!' a)'(#!' *a!a$ m%nan" m%nan" !#('%' a)'(#!'. In$%#a&' n *a!a$ *hn*a#&an *hn*a#&an a$a" 'ana$ *&"an )la ()a$ an )%#n$%#a&' *)%#&an *alam an&a a&$" mnmal 2 am. ). !%#")ahan ). !%#")ahan !H 'al"#an %#na a#a a#an n 'al"# 'al"#an an %#na %#na an al&a al&al l'/ '/ m'al m'aln naa a&) a&)a$ a$ a*an a*ana a an$a an$a' '*/ */ a&an a&an m%nn&a$&an &%la#"$an ()a$ an )%#'+a$ a'am an '"&a# la#"$ *alam 'al"#an %#na/ m'alna a'!#n. D%nan *%m&an *!%#%!a$na *'(l"' a'!#n (l%h )a'a a&an m%m!%#%!a$ a)'(#!'na. A&an $%$a!/ '"a'ana al&al' * 'al"#an %#na a&an m%n"# m%n"#an an &%la#" &%la#"$an $an )%)%#a! )%)%#a!aa ()a$ ()a$ an an )%#'+a )%#'+a$$ )a'a )a'a ,m'aln ,m'alna a $%$#a' $%$#a'&l &ln n *alam a#an 'al"#an 'al"#an %#na/ '%hna m%n"#an m%n"#an a)'(#!'na. a)'(#!'na. B%#&"#anna B%#&"#anna
23
&%a'aman lam)"n (l%h an$a'*a a&an m%n"#an !%n#"'a&an ()a$ an $*a& $ahan a'am '%hna m%nn&a$&an )(aala)l$a'na. K%$( K%$(&( &(na na@( @(ll an an *m *mn" n"m m !%# !%# (#al (#al m%m) m%m)"$ "$"h "h&a &an n m%* m%*"m "m a'am a'am "n$" "n$"& & m%la#"$&an '%"mlah an *)"$"h&an '%hna $*a& m%m"n&n&an *)%#&an )%#'ama an$a'*a/ ()a$ an$&(ln%#&/ !%nham)a$an H 2/ a$a" nh)$(# !(m!a !#($(n ,m'alna (m%!#a@(l. J&a m%man *)"$"h&an/ '%)a&na a)a$-()a$ n *)%#&an '%*&$na 2 am '%$%lah !%m)%#an &%$(&(na@(l. . !%m)%n$"&an . !%m)%n$"&an '%naa &(m!l%&' $a& la#"$ a$a" &h%la$/ *an a*'(#' In$%#a&' In$%#a&' an$a#a an$)($& an$)($& (l(nan (l(nan +l"(#(&n(l +l"(#(&n(l(n (n ,'!#(+l(&'a ,'!#(+l(&'a'n/ 'n/ %n(&'a'n/ %n(&'a'n/ l%(+l(&'a'n/ l(m%+l(&'a'n/ n(#+l(&'a'n/ (+l(&'a'n *an '!a#+l(&'a'n *an (n(n *al%n$ *an $#al%n$ ,m'alna (n a 2 / M2 *an Al3 *a# an$a'*a *an ()a$ lan *a!a$ m%n%)a)&a m%n%)a)&an n !%n"#"nan !%n"#"nan an 'n+&an 'n+&an *a# a)'(#!' a)'(#!' 'al"#an %#na/ )(aala)l$a' *an %+%& $%#a!%$&/ &a#%na $%#)%n$"&na '%naa &(m!l%&'. In$%#a&' n "a 'ana$ m%n"#"n&an a&$$a' an$)($& +l"(#(&"n(l(n. E+%& n$%#a& n$%#a&' ' n *a!a$ *a!a$ '%a#a '%a#a 'n+ 'n+&a &an n *&"#a *&"#an n *%nan *%nan m%m)%# m%m)%#&a &an n an$a'* an$a'*aa )%)%#a!a am '%)%l"m a$a" '%$%lah !%m)%#an +l"(#(&"n(l(n. J&a an$a'*a )%na# )%na# *)"$"h&an/ !%n%'"aan $%#a!/ m'alna !%nan$an *%nan ()a$-!)a$ an$a(n' #%'%!$(# H2 a$a" nh)$(# !(m!a !#($(n *a!a$ *la&"&an. B%)%#a!a ()a$ an$*a#% ,an m%nan*"n a$a!"l$ m%n%#a! ()a$-()a$ lan/ '%hn '%hnaa m%n"#" m%n"#"n&a n&an n a)'(#!' a)'(#!'. .
Anali*i* ka*)*
P%n*%#$a )%#nama N T(a'ah/ )%#"m"# 86 $ah"n m%n*%#$a *a)%$%' $!% 2 '%a& > $ah"n an lal". P%n*%#$a '%lal" #"$n &(n$#(l !%n()a$an *a)%$%' m%ll$"' *an #"$n m%la&"&an %& &a*a# "la *a#ah. P%n*%#$a ma&an $%#a$"# *%nan m%n"#an ma&anan an man' ? man' '%'"a !%$"n"& *(&$%# "n$"& m%naa &a*a# "la *a#ahna. Un$"& "la/ !%n*%#$a )a'a m%n"na&an "la #%n*ah &al(#. P%nala&'aan +a#ma&(l( an *)%#&an &%!a*a !%n*%#$a a*alah l)%n&lam* *an m%$+(#mn.
Interak*i o/at ,li/enklami% %an metormin Metormin
M%&an'm% &%#a m%$+(#mn m%n"#"n&an l"&('a *a#ah m%lal" !%na#"hna $%#ha*a! &%#a n'"ln !a*a $n&a$ '%l"la#/ *'$al #%'%!$(# n'"ln *an m%n"#"n&an !#(*"&' l"&('a ha$. M%$+(#mn m%nn&a$&an !%ma&aan l"&('a (l%h '%l "'"' '%hna m%n"#"n&an l"&('a *a#ah *an "a **"a m%nham)a$ a)'(#)' l"&('a * "'"' '%'"*ah a'"!an ma&an. S%$%lah *)%&an (#al/ m%$+(#mn a&an m%na!a &a*a# $%#$n *alam *a#ah '%$%lah 2 am *an *%&'&#%'&an l%a$ "#n *alam &%a*aan "$"h *anan a&$" !a#"h 2/5 am. M%$+(#mn *a!a$ m%n"#"n&an l"&('a *a#ah $%$a! $*a& a&an m%n%)a)&an h!(l&%ma '%hna $*a& *ana! '%)aa ()a$ h!(l&%ma. Pa*a !%ma&aan &(m) &(m)n na' a' *%n *%nan an '"l+ '"l+(n (nl" l"#% #%a/ a/ h!( h!(l l& &%m %maa
*a!a *a!a$$
$%#a $%#a* * a&) a&)a$ a$ !%n !%na" a"h h
'"l+(nll"#%a '"l+(nll"#%ana. na. Pa*a !%ma&aan !%ma&aan $"nal $"nal m%$+(#mn m%$+(#mn *a!a$ m%n"#"n&an m%n"#"n&an l"&('a *a#ah 'am!a 20 : *an &(n'%n$#a' n'"ln !la'ma !a*a &%a*aan )a'al "a $"#"n. M%$+ M%$+(#m (#mn n $*a $*a& & m%n m%n%) %)a) a)&a &an n &%na &%na& &an an )%#a )%#a$$ )a*a )a*an n '%!%# '%!%#$ $ !a*a !a*a !%ma !%ma&a &aa an n '"l+(nl"#%a.
25
7li/lenklami%
M%&an M%&an'm% 'm% &%#a &%#a l)%n l)%n&la &lam* m* a*alah a*alah *%nan *%nan m%#an' m%#an'an an &anal &anal K an an $%#an$"n !a*a ATP *a# '%l )%$a !an&#%a'. Bla 'l+(nl"#%a $%#&a$ #%'%!$(# &anal $%#'%)"$ ma&a a&an $%#a* !%n"$"!an. K%a*aan n a&an m%n%)a)&an $%#a*na !%n"#"nan !%#m%a)l$a' K !a*a m%m)#an% '%l )%$a/ $%#a* *%!(la#'a' m%m)#an% *an m%m)"& m%m)"&aa &anal &anal a $%#an $%#an$"n $"n (l$a'% (l$a'%// *an m%n% m%n%)a) )a)&an &an !%nn !%nn&a$ &a$an an a n$#a'%l. I(n a a&an $%#&a$ !a*a alm(*"ln/ *an m%n%)a)&an %&'('$('' #an"l an m%nan*"n n'"ln. ;)a$ ;)a$ n )%&%#a )%&%#a *%nan *%nan m%#an m%#an'an 'an '%l )%$a )%$a !an&#% !an&#%a' a' "n$"& "n$"& m%l%!a m%l%!a'&a '&an n n'"ln an $%#'m!an. P%n"naan P%n"naan *alam &ln&. &ln&. Pa*a !%ma&aan '"l+(nl"#%a/ '"l+(nl"#%a/ "m"mna "m"mna '%lal" *m"la *%nan *('' #%n*ah/ "n$"& m%nhn*a# &%m"n&nan h!(l&%ma. Pa*a &%a*aan $%#$%n$" * mana &a*a# l"&('a *a#ah 'ana$ $n/ *a!a$ *"na&an *alam *('' )%'a#. K(m)na' l)%n&lam* *an m%$+(#mn 'aa$ n m%#"!a&an &(m)na' an #a'( #a'(nal nal &a#% &a#%na na m%m! m%m!"n "na a a#a a#a &%#a &%#a 'n%# 'n%# '' '%hn '%hn aa &(m) &(m)n na' a' n n *a!a *a!a$$ m%n"#"n&an m%n"#"n&an l"&('a l"&('a *a#ah l%)h l%)h )ana& *a#!a*a *a#!a*a
!%n()a$an !%n()a$an $"nal $"nal ma'n ?
ma'n/ ma'n/ )a& !a*a *('' ma&'mal &%*"ana &%*"ana ma"!"n ma"!"n !a*a *('' #%n*ah. #%n*ah. K(m)na' K(m)na' *%nan *('' ma&'mal *a!a$ m%n"#"n&an l"&('a *a#ah an l%)h )ana&. K(m)na' m%$+(#mn *%nan n'"ln "a *a!a$ *!%#$m)an&an !a*a !'%n %m"& *%nan l&%m an '"&a# *&%n*al&an. K(m)na' l)l%n&lam* *%nan m%$+(#mn l%)h )a& *a#!a*a &(m)na' m%$+(#mn *%nan n'"ln. K(m)n K(m)na' a' l)l%n l)l%n&la &lam* m* *%nan *%nan n'"l n'"ln n **a'a# **a'a#&an &an )aha )aha #%#a$a #%#a$a &a*a# &a*a# l"&('a *a#ah '%!anan ha# $%#"$ama *$%n$"&an (l%h &a*a# l"&('a *a#ah !"a'ana. Um"mna &%na&an &a*a# l"&('a *a#ah '%'"*ah ma&an &"#an l%)h 'ama/ $*a& $%#an$"n *a# &a*a# l"&('a *a#ah !a*a &%a*aan !"a'a. D%nan m%m)%#&an n'"ln &%a '%*an !a*a malam ha#/ !#(*"&' l"&('a ha$ malam ha# *a!a$ *&"#an
26
'%hna &a*a# l"&('a *a#ah !"a'a *a!a$ $"#"n. S%lan"$na &a*a# l"&('a *a#ah 'an ha# *a$"# *%nan !%m)%#an '"l+(nl"#%a '%!%#$ )a'ana. K(m)na' '"+(nl"#%a *an n'"ln $%#na$a l%)h )a& *a#!a*a n'"ln '%n*# *an *('' n'"ln an *!%#l"&an $%#na$a l%)h #%n*ah. Dan a#a &(m)na' n l%)h *a!a$ *$%#ma !a'%n *a#!a*a !%n"naan n'"ln m"l$!l%.
BAB ; PENUTUP
A6 Simp)lan Da)%$%' M%ll$"' a*alah &%lanan an )%#'+a$ &#(n& an *$an*a (l%h
an"an m%$a)(l'm &a#)(h*#a$/ !#($%n/ *an l%ma& an *&"$ (l%h &(m!l&a' m&#(a'&"l%# ma"!"n ma&#(a'&"l%#/ *an $%lah *&%$ah" )%#&a$an *%nan +aa&$(# %n% %n%$ $& & *%n *%nan an %al %alaa &ln &ln& & an an !al !aln n "$am "$amaa a*al a*alah ah n$( n$(l%# l%#an an' ' l"& l"&(' ('aa ,<l'(n/2000. Da) Da)%$% %$%'' M%ll M%ll$" $"'' $!% $!% 2 $%#* $%#*# # *a# *a# )%#) )%#)a aa a maam maam &%la &%lana nan n *%n *%nan an &a#a&$%#'$& an 'ama a$" n'"+'%n' &%#a n'"ln "n$"& m%m!%#$ahan&an &a*a# l"&('a *a#ah *alam )a$a' n(#mal. In'"+'%n' &%#a n'"ln m%#"!a&an &(m)na' *a# #%''$%n' n'"ln *an '%&#%' n'"ln an a)n(#mal ,Da#m(n(/2000. In$% In$%#a #a& &' *&la &la' '+ +&a &a' '& &an )%#* %#*a'a# a'a#&a &an n &%$% &%$%#l #l) )a$ a$an an *alam alam
!#('% #('%''
+a#ma&(&n%$& ma"!"n +a#ma&(*nam&. In$%#a&' +a#ma&(&n%$& *$an*a *%nan !%#")ahan &a*a# !la'ma ()a$/ a#%a * )aah &"#a ,AU/ (n'%$ a&'/ a&$" !a#( *'). In$%#a&' +a#ma&(&n%$& +a#ma&(&n%$& *a&)a$&an (l%h !%#")ahan !%#")ahan la" a$a" $n&a$ a)'(#!'/ a)'(#!'/ *'$ *'$# #)" )"' '//
m%$a m%$a)( )(l l'm 'm%%
*an *an
%&'& %&'&#% #%' '..
In$% In$%#a #a&' &'
+a#m +a#ma& a&(* (*n nam am& &
)a' )a'an an a 2>
*h")"n&an *%nan &%mam!"an '"a$" ()a$ "n$"& m%n")ah %+%& ()a$ lan $an!a m%n")ah '+a$-'+a$ +a#ma&(&n%$&na K(m)na' l)%n&lam* *an m%$+(#mn 'aa$ n m%#"!a&an &(m)na' an #a'( #a'(nal nal &a#% &a#%na na m%m! m%m!"n "na a a#a a#a &%#a &%#a 'n%# 'n%# '' '%hn '%hn aa &(m) &(m)n na' a' n n *a!a *a!a$$ m%n"#"n&an m%n"#"n&an l"&('a l"&('a *a#ah l%)h l%)h )ana& *a#!a*a *a#!a*a
!%n()a$an !%n()a$an $"nal $"nal ma'n ?
ma'n/ ma'n/ )a& !a*a *('' ma&'mal &%*"ana &%*"ana ma"!"n ma"!"n !a*a *('' #%n*ah. #%n*ah. K(m)na' K(m)na' *%nan *('' ma&'mal *a!a$ m%n"#"n&an l"&('a *a#ah an l%)h )ana&. T%#a* %#a* n$%#a n$%#a&' &' 'n%# 'n%#' ' an$a#a an$a#a ()a$ ()a$ *a)%$ *a)%$%' %' (#al (#al a$" a$" l)l% l)l%&la &lam* m* *an m%$+(#mn.
B6 Saran
1. P%n*%#$a '%lal" #"$n "n$"& &(n$#(l "la *a#ah. 2. P%n*%# P%n*%#$a $a m%n&( m%n&(n'" n'"m' m' ()a$ ()a$ an$ an$ *a)%$ *a)%$& & (#al (#al '%'"a '%'"a an"#a an"#an n *(&$%# *(&$%# '%hna '%hna *a!a$ $%#a* n$%#a&' an 'n%#' an$a# ()a$ an$ *a)%$& *a)%$& (#al '%hna $*a& $%#a* h!(l&%ma. 3. P%n*%#$a m%naa !(la ma&an '%hna **a!a$&an %+%& n$%#a&' ()a$ *an *an ma&a ma&ana nan n an an 'al 'aln n 'n% 'n%# #' ' '%h '%hn na a $*a $*a& & $%# $%#a* a* $%# $%#a* a* h!(l&%ma.
29
DA4TAR PUSTAKA Da#m(n(.1==1.S%# K"lah %n*(&#n(l(-m%$a)(l&.FK UNDIP. UNDIP.
Ha#$a$ Ha#$a$/S# /S#.2 .2002 002.M% .M%na na!a !a *a)%$ *a)%$%' %' )ana& )ana& m%na& m%na&)a )a$&a $&an n &%#"'a &%#"'a&an &an (#an (#an $")"h $")"h *an )aamana &%a*anna.S%ma#an7Bala P%n%#)$ FK UNDIP. UNDIP. Sla.1==5.Pa$(+'(l( K(n'%! Kln' P#('%' ? P#('%' P%na&$.Ja&a#$a7E. FK UI.200>.Fa#ma&(l( Dan T%#a!.Ja&a#$a7FKUI. T%#a!.Ja&a#$a7FKUI.
2=
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