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MAKALAH KEPERAWATAN MATERNITAS II
MAKALAH KEPERAWATAN MATERNITAS II
ASUHAN KEPERAWATAN PADA PENYAKIT YANG MENYERTAI
ASUHAN KEPERAWATAN PADA PENYAKIT YANG MENYERTAI
KEHAMILAN : DIABETES MELITUS PADA IBU HAMIL
KEHAMILAN : DIABETES MELITUS PADA IBU HAMIL
FASILITATOR:
FASILITATOR:
Dr. Esti Yunitasari, S.Kp., M.Kes.
Dr. Esti Yunitasari, S.Kp., M.Kes.
ANGGOTA KELOMPOK
ANGGOTA KELOMPOK
SGD 3 A1 !1":
SGD 3 A1 !1":
E#iesa
E#iesa Ra$%&a
Ra$%&a Putri
Putri 131"1
131"1113
1133!!1
3!!1
A'e#ia
A'e#ia D(i
D(i Lai#)*ira
Lai#)*ira Ra&a'%ania
Ra&a'%ania 131"1
131"1113
1133!!+
3!!+
L$ita
L$ita Arti-a
Arti-a Isti
Isti 131"1
131"1113
1133!!
3!!
Ni/&atus% S%#e%a
Ni/&atus% S%#e%a 131"1
131"1113
1133!!0
3!!0
Nuru# i'a)ati
Nuru# i'a)ati 131"1
131"1113
1133!30
3!30
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PROGRAM STUDI PENDIDIKAN NERS
PROGRAM STUDI PENDIDIKAN NERS
FAKULTAS KEPERAWATAN
FAKULTAS KEPERAWATAN
UNIVERSITAS AIRLANGGA
UNIVERSITAS AIRLANGGA
2018
2018
KAT
KATA PE
A PENGAN
NGANT
TAR
AR
Pui s)u-ur -a&i panat-an -e %a'irat A##a% S4T, atas #i&pa%an ra%&at
Pui s)u-ur -a&i panat-an -e %a'irat A##a% S4T, atas #i&pa%an ra%&at
'a
'an
n %i
%i'a
'a)a
)a%n
%n)a
)a pe
penu
nu#i
#is
s 'a
'apa
pat
t &e
&en)
n)e#
e#esa
esai-
i-an
an Ma
Ma-a
-a#a
#a%
% te
tent
ntan
an5
5 6
6 As
Asu%
u%an
an
Kepera(atan Pa'a Pen)a-it Yan5 Men)ertai Ke%a&i#an : Dia7etes Me#itus Pa'a
Kepera(atan Pa'a Pen)a-it Yan5 Men)ertai Ke%a&i#an : Dia7etes Me#itus Pa'a
I7
I7u
u a
a&i
&i#8
#8 Ma
Ma-a
-a#a
#a% in
% ini
i 'i
'isu
susu
sun
n se7
se7a5
a5ai
ai sa#
sa#a%
a% sat
satu
u tu
tu5a
5as
s &a
&ata
ta pe
pe#a
#aa
aran
ran
Ke
Kepe
pera
ra(a
(ata
tan
n Ma
Mate
tern
rnit
itas
as II
II.
. Da
Da#a
#a&
& -e
-ese
se&p
&pat
atan
an in
ini
i -a
-a&i
&i &e
&en5
n5u$
u$ap
ap-a
-an
n
teri&a-asi% )an5 se'a#a&9'a#a&n)a -epa'a Dsen Pe&7i&7in5 'an Re-an9re-an
teri&a-asi% )an5 se'a#a&9'a#a&n)a -epa'a Dsen Pe&7i&7in5 'an Re-an9re-an
satu -e#&p- )an5 te#a% &e&7antu 'a#a&
satu -e#&p- )an5 te#a% &e&7antu 'a#a& pen)usunan Ma-a#a% ini.
pen)usunan Ma-a#a% ini.
Ka
Ka&i
&i &e
&en)
n)a'
a'ar
ari
i 7a
7a%(
%(a
a 'a
'a#a
#a&
& pe
pen)
n)us
usun
unan
an Ma
Ma-a
-a#a
#a%
% in
ini
i a
au%
u% 'a
'ari
ri
se&purna, 7ai- 'ari se5i pen)usunan, 7a%asan, ataupun penu#isann)a. O#e% -arena
se&purna, 7ai- 'ari se5i pen)usunan, 7a%asan, ataupun penu#isann)a. O#e% -arena
itu -a&i &en5%arap-an -riti- 'an saran )an5 siatn)a &e&7an5un, -%ususn)a
itu -a&i &en5%arap-an -riti- 'an saran )an5 siatn)a &e&7an5un, -%ususn)a
'ari Dsen &ata -u#ia% 5una &ena'i a$uan 'a#a& 7e-a# pen5a#a&an 7a5i -a&i
'ari Dsen &ata -u#ia% 5una &ena'i a$uan 'a#a& 7e-a# pen5a#a&an 7a5i -a&i
untu- #e7i%
untu- #e7i% 7ai-
7ai- 'i &asa )an5
'i &asa )an5 a-an 'atan5.
a-an 'atan5.
Sura7a)a, + A5ustus !1
Sura7a)a, + A5ustus !1
Pen)usun
Pen)usun
Ke#&p- 3
Ke#&p- 3
i
i
DAFTAR ISI
DAFTAR ISI
KA
KAT
TA
A PENGANT
PENGANTAR
AR ....................
...........................................
..............................................
..................................................i
...........................i
DAFTAR ISI ....................................................................................................................ii
DAFTAR ISI ....................................................................................................................ii
BAB 1 PENDAHULUAN ................................................................................................1
BAB 1 PENDAHULUAN ................................................................................................1
1.1 Latar ;e#a-an5.........................................................................................................1
1.1 Latar ;e#a-an5.........................................................................................................1
1. Ru&usan Masa#a%....................................................................................................
1. Ru&usan Masa#a%....................................................................................................
1.3 Tuuan ......................................................................................................................
1.3 Tuuan ......................................................................................................................
BAB II TINJ
BAB II TINJAUAN PUSTAKA
AUAN PUSTAKA ......................................................................................3
......................................................................................3
.1
.1 Pen5ertian Dia7etes Me#itus pa'a I7u a&i#
Pen5ertian Dia7etes Me#itus pa'a I7u a&i#.......................................................3
.......................................................3
.
. Eti#5i Dia7etes Me#itus pa'a I7u a&i# ......................................................2
Eti#5i Dia7etes Me#itus pa'a I7u a&i# ......................................................2
.3
.3 K#asii-asi Dia7etes Me#itus pa'a I7u a&i#
K#asii-asi Dia7etes Me#itus pa'a I7u a&i# .......
..............
..............
..................
................................+
.....................+
.2 4O< Dia7etes Me#itus pa'a I7u a&i# ....................................................................
.2 4O< Dia7etes Me#itus pa'a I7u a&i# ....................................................................
.+
.+ Patisi#5i Dia7etes Me#itus pa'a I7u a&i#
Patisi#5i Dia7etes Me#itus pa'a I7u a&i# ................................................1!
................................................1!
."
." Maniestasi K#inis Dia7etes Me#itus pa'a I7u a&i#
Maniestasi K#inis Dia7etes Me#itus pa'a I7u a&i# .......................................11
.......................................11
.=
.= Pen5aru% 'an
Pen5aru% 'an K&p#i-asi
K&p#i-asi Dia7etes Me#itus ter%a'ap
Dia7etes Me#itus ter%a'ap Ke%a&i#an ...............1
Ke%a&i#an ...............1
. Pe&eri-saan Dia5nsti- pa'a Dia7etes Me#itus
. Pe&eri-saan Dia5nsti- pa'a Dia7etes Me#itus .......
..............
..............
................................12
.........................12
.0
.0 Penata#a-sanaan Me'is pa'a Dia7etes Me#itus
Penata#a-sanaan Me'is pa'a Dia7etes Me#itus .......
..............
..............
..................................1+
...........................1+
BAB III
BAB III ASUHAN KEPERA
ASUHAN KEPERAW
WA
AT
TAN...........................
AN.........................................................
.....................................
.............
...........
.....17
17
3.1
3.1 Kasus
Kasus ......................................................................................................................1=
......................................................................................................................1=
3.
3. Asu%an Kepera(atan
Asu%an Kepera(atan.............................................................................................1=
.............................................................................................1=
BAB IV PENUTUP
BAB IV PENUTUP .......................................................................................................0
.......................................................................................................0
2.1 Kesi&pu#an ............................................................................................................0
2.1 Kesi&pu#an ............................................................................................................0
2. Saran ......................................................................................................................3!
2. Saran ......................................................................................................................3!
DAFTAR PUSTAKA......................................................................................................1
DAFTAR PUSTAKA......................................................................................................1
ii
ii
BAB I
BAB I
PENDAHULUAN
PENDAHULUAN
1.1
1.1 L!"!
L!"!# B$
# B$%!&!'
%!&!'(
(
Dia7etes &e#itus )an5 tera'i pa'a i7u %a&i# 'ise7ut 'en5an Dia7etes
Dia7etes &e#itus )an5 tera'i pa'a i7u %a&i# 'ise7ut 'en5an Dia7etes
Me#
Me#it
itus
us Ge
Gesta
stasi
sina
na#
# >D
>DGM
GM?.
?. Sa
Sa#a
#a%
% sat
satu
u pe
pen)
n)a-
a-it
it ti
ti'a
'a-
- &e
&enu
nu#a
#ar
r )a
)an5
n5
ter&asu- 'a#a& -&p#i-asi &e'is pa'a -e%a&i#an. Pen)a-it 'ia7etes &e#itus
ter&asu- 'a#a& -&p#i-asi &e'is pa'a -e%a&i#an. Pen)a-it 'ia7etes &e#itus
5estasina# &erupa-an 5an55uan t#eransi -ar7%i'rat )an5 tera'i pa'a saat
5estasina# &erupa-an 5an55uan t#eransi -ar7%i'rat )an5 tera'i pa'a saat
2
2 &in5
&in55u
5u usia -e%a&i#an
usia -e%a&i#an.
. Pa'a -e%a&i#an tera'i
Pa'a -e%a&i#an tera'i penin
penin5-ata
5-atan
n pr'u
pr'u-si
-si
%r&ne9%r&n anta5nis insu#in, antara #ain pr5estern, estr5en,
%r&ne9%r&n anta5nis insu#in, antara #ain pr5estern, estr5en, human
human
placenta
placenta lactogen
lactogen, 'an -rtis#. Penin-atan %r&ne terse7ut &en)e7a7-an
, 'an -rtis#. Penin-atan %r&ne terse7ut &en)e7a7-an
tera'in)a resistensi insu#in 'an penin5-atan -a'ar 5#u-sa 'ara% >Kusnant,
tera'in)a resistensi insu#in 'an penin5-atan -a'ar 5#u-sa 'ara% >Kusnant,
P. 1000?
P. 1000?
Menur
Menurut A&eri$an
ut A&eri$an Dia7et
Dia7etes Ass$iatin >ADA?
es Ass$iatin >ADA? ta%un !!!,
ta%un !!!, 'ia7e
'ia7etes
tes
&e#
&e#itu
itus
s 5es
5estasi
tasina
na#
# ter
tera'
a'i
i =@
=@ pa'
pa'a
a -e%
-e%a&i
a&i#an
#an set
setiap
iap ta%
ta%unn
unn)a.
)a. Pa'
Pa'a
a i7u
i7u
%a&i# 'en5an ri(a)at -e#uar5a &en'erita 'ia7etes &e#itus , pre*a#ensin)a
%a&i# 'en5an ri(a)at -e#uar5a &en'erita 'ia7etes &e#itus , pre*a#ensin)a
&ena'i +,1 @. Dia7etes &e##itus per#u 'iper%ati-an -arena resi- &r7i'itas
&ena'i +,1 @. Dia7etes &e##itus per#u 'iper%ati-an -arena resi- &r7i'itas
'an &rta#itas pa'a &aterna# 'an perinata# tin55i >u#i-ar, D.,!!0?..
'an &rta#itas pa'a &aterna# 'an perinata# tin55i >u#i-ar, D.,!!0?..
Pa'a pen'erita 'ia7etes &e#itus &asa -e%a&i#an 'i'apati se#a&a &asa
Pa'a pen'erita 'ia7etes &e#itus &asa -e%a&i#an 'i'apati se#a&a &asa
-e%a&i#an trisester -e'ua atau -eti5a. Dia7etes &e#itus pa'a i7u %a&i# 'i atas
-e%a&i#an trisester -e'ua atau -eti5a. Dia7etes &e#itus pa'a i7u %a&i# 'i atas
usia 3! ta%un, pere&puan 'en5an 7e'sitas >IMT B3!?, pere&puan 'en5an
usia 3! ta%un, pere&puan 'en5an 7e'sitas >IMT B3!?, pere&puan 'en5an
ri(
ri(a)
a)at
at 'i
'ia7
a7et
etes
es &e
&e#i
#itu
tus
s pa
pa'a
'a r
ran
an5
5 tu
tua
a at
atau
au ri(
ri(a)
a)at
at 'i
'ia7
a7et
etes
es &e
&e#i
#itu
tus
s
5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i 'en5an 7erat
5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i 'en5an 7erat
#a%ir B 2!!! 5ra& 'an a'an)a 5#u-suria >Su') A4 '--, !!"?. Dia7etes
#a%ir B 2!!! 5ra& 'an a'an)a 5#u-suria >Su') A4 '--, !!"?. Dia7etes
&e
&e#i
#itu
tus
s Gesta
Gestasina
sina#
# &enin
&enin5-at-
5-at-an
an &r7i
&r7i'itas
'itas nen
nenatus,
atus, )aitu
)aitu %ip5
%ip5#i-e&
#i-e&ia,
ia,
i-terus, p#isite&ia, 'an &a-rs&ia
i-terus, p#isite&ia, 'an &a-rs&ia
Dia7e
Dia7etes
tes &e##i
&e##itus
tus 5estasi
5estasina#
na# &ena
&ena'i
'i &asa#a% -ese%atan &as)ara-at
&asa#a% -ese%atan &as)ara-at
se7a7 pen)a-it ini 7er'a&pa- #an5sun5 pa'a -ese%atan i7u 'an anin. Dete-si
se7a7 pen)a-it ini 7er'a&pa- #an5sun5 pa'a -ese%atan i7u 'an anin. Dete-si
'ini pa'a i7u %a&i# 'apat &e&7antu untu- &enin5-at-an -esea%teraan i7u
'ini pa'a i7u %a&i# 'apat &e&7antu untu- &enin5-at-an -esea%teraan i7u
7ai-
7ai- se#a&a
se#a&a -e%a&i#an
-e%a&i#an ataupun
ataupun sesu'a%
sesu'a% &asa
&asa -e%a&i#an.
-e%a&i#an. a#
a# terse7ut
terse7ut 'apat
'apat
&enar
&enarin5
in5 'ia7et
'ia7etes
es &e#it
&e#itus
us 5estasi
5estasina# a5ar
na# a5ar 'apat 'i-e##a
'apat 'i-e##a se7ai-
se7ai-97ai-n
97ai-n)a
)a
teruta&a 'i#a-u-an pa'a i7u 'en5an a$tr resi-. O#e% -arena %a# terse7ut,
teruta&a 'i#a-u-an pa'a i7u 'en5an a$tr resi-. O#e% -arena %a# terse7ut,
-e#&p- -a&i &en)e#esai-an &a-a#a% Kepera(atan Maternitas II 'en5an
-e#&p- -a&i &en)e#esai-an &a-a#a% Kepera(atan Maternitas II 'en5an
1
1
tpi- 6 Asu%an Kepera(atan pa'a Pen)a-it )an5 Men)ertai Ke%a&i#an :
tpi- 6 Asu%an Kepera(atan pa'a Pen)a-it )an5 Men)ertai Ke%a&i#an :
Dia7etes Me#itus Pa'a I7u a&i#8.
Dia7etes Me#itus Pa'a I7u a&i#8.
1.2
1.2 R)*)
R)*)+!' M!
+!' M!+!%!,
+!%!,
1.
1. Apa-a
Apa-a% )an
% )an5 'i&
5 'i&a-su'
a-su' 'en5a
'en5an Dia7
n Dia7etes M
etes Me#itus
e#itus pa'a I
pa'a I7u a
7u a&i#C
&i#C
.
. Apa-a
Apa-a%
% pen)e
pen)e7a7
7a7 i7u
i7u %a&i#
%a&i# 'apat
'apat &en5a
&en5a#a&i
#a&i Dia7et
Dia7etes M
es Me#itus
e#itus C
C
3.
3. ;a5ai
;a5ai&ana
&ana -#asi
-#asii-asi
i-asi Dia7et
Dia7etes Me
es Me#itus
#itus pa'a
pa'a I7u
I7u a&i#C
a&i#C
2.
2. ;a5ai
;a5ai&ana p
&ana pera#an
era#anan pe
an pen)a-i
n)a-it Dia
t Dia7etes
7etes Me#itu
Me#itus I7u
s I7u a&i#
a&i# C
C
+.
+. ;a5ai
;a5ai&ana &
&ana &aniest
aniestasi -#i
asi -#inis pa
nis pa'a Di
'a Dia7etes M
a7etes Me#itu
e#itus pa'a
s pa'a I7u 
I7u a&i#C
a&i#C
".
". Apa-a
Apa-a% pen
% pen5aru% '
5aru% 'an -
an -&p#i-
&p#i-asi Dia7
asi Dia7etes Me#i
etes Me#itus pa'
tus pa'a I7u 
a I7u a&i#C
a&i#C
=.
=. ;a5ai
;a5ai&ana p
&ana pe&eri-
e&eri-saan '
saan 'ia5n
ia5nsti$ )
sti$ )an5 te
an5 tepat pa
pat pa'a i7
'a i7u %a&
u %a&i#C
i#C
.
. ;a5ai
;a5ai&ana pe
&ana penata#a
nata#a-sanaan
-sanaan -#ini
-#inis )an5
s )an5 'apat '
'apat 'i#a-u
i#a-u-an Dia
-an Dia7etes Me
7etes Me#itus
#itus
pa'a I7u a&i#C
pa'a I7u a&i#C
1.
1. T
T)-)!
)-)!'
'
1.
1. Men
Men5et
5eta%u
a%ui Dia7
i Dia7etes M
etes Me#i
e#itus p
tus pa'a I
a'a I7u 
7u a&i
a&i#
#
.
. Mene#
Mene#as-an
as-an pen)e
pen)e7a7
7a7 i7u
i7u %a&i#
%a&i# 'apat
'apat &en5a
&en5a#a&i
#a&i Dia7e
Dia7etes
tes Me#it
Me#itus
us
3.
3. Men5e
Men5eta%ui
ta%ui -#asi
-#asii-asi
i-asi Dia7et
Dia7etes M
es Me#itus
e#itus pa'a
pa'a I7u
I7u a&i#
a&i#
2.
2. Mene#
Mene#as-an
as-an pera#
pera#anan
anan pen)a
pen)a-it
-it Dia7et
Dia7etes
es Me#itu
Me#itus
s I7u
I7u a&i#
a&i#
+.
+. Men5e
Men5eta%ui
ta%ui &ani
&aniestasi -
estasi -#inis
#inis pa'a D
pa'a Dia7ete
ia7etes Me#itu
s Me#itus pa'a
s pa'a I7u 
I7u a&i#
a&i#
".
". Mene#
Mene#as-anp
as-anpen5aru
en5aru% 'an -
% 'an -&p#i
&p#i-asi Di
-asi Dia7etes Me
a7etes Me#itus p
#itus pa'a I7u
a'a I7u a&i#
a&i#
=.
=. Me&7e
Me&7eri-an i
ri-an inr&
nr&asi pe&
asi pe&eri-saa
eri-saan 'ia5n
n 'ia5nsti$ )
sti$ )an5 te
an5 tepat pa'
pat pa'a i7u %
a i7u %a&i#
a&i#
.
. Men5e
Men5eta%ui p
ta%ui penata#a
enata#a-sanaa
-sanaan -#in
n -#inis )an5
is )an5 'apat '
'apat 'i#a-u
i#a-u-an Dia
-an Dia7etes Me
7etes Me#itus
#itus
pa'a I7u a&i#
pa'a I7u a&i#
BAB II
BAB II
TINJAUAN PUSTAKA
TINJAUAN PUSTAKA
2.1 P$'($#"i!' Di!$"$+ M$%i")+
2.1 P$'($#"i!' Di!$"$+ M$%i")+ G$+"!+i/'!%
G$+"!+i/'!%
Dise7u
Dise7ut
t 'ia7e
'ia7etes
tes 5estasi
5estasina# 7i#a
na# 7i#a 5an55
5an55uan t#eransi
uan t#eransi 5#u-
5#u-sa
sa )an5 tera'i
)an5 tera'i
se(a-tu %a&i# -e&7a#i nr&a# 'a#a& " &in55u sete#a% persa#inan. 'ian55ap
se(a-tu %a&i# -e&7a#i nr&a# 'a#a& " &in55u sete#a% persa#inan. 'ian55ap
'ia
'ia7et
7etes
es &e#
&e##it
#itus
us >a'
>a'i
i 7u-
7u-an
an 5es
5estasi
tasi?
? 7i#
7i#a
a 5an
5an55u
55uan
an t#
t#eran
eransi
si 5#u
5#u-s
-sa
a
&en
&enetap
etap sete
sete#a%
#a% per
persa#i
sa#inan
nan.
. Pa'
Pa'a
a 5#
5#n5
n5an
an ini
ini,
, -n
-n'is
'isi
i 'ia
'ia7et
7etes
es 'ia
'ia#a&
#a&i
i
2
2
se&ent
se&entara
ara se#a&a &asa
se#a&a &asa -e%a&
-e%a&i#an. Artin
i#an. Artin)a
)a -n'
-n'isi
isi 'ia7e
'ia7etes
tes atau int#eransi
atau int#eransi
5#
5#u-
u-s
sa
a pe
pert
rta&
a&a
a -a
-a#i
#i 'i
'i'a
'apa
pati
ti se#
se#a&
a&a
a &a
&asa
sa -e
-e%a
%a&i
&i#a
#an,
n, 7i
7iasa
asan)
n)a
a pa
pa'a
'a
tri&ester -e'ua atau -eti5a.
tri&ester -e'ua atau -eti5a.
Dia
Dia7et
7etes
es Me#
Me##it
#itus
us Gest
Gestasi
asina#
na# >DM
>DMG?
G? 'i'
'i'ein
einisi-
isi-an
an se7
se7a5a
a5ai
i 5an
5an55u
55uan
an
t#eransi 5#u-sa 7er7a5ai tin5-at )an5 'i-eta%ui perta&a -a#i saat %a&i#
t#eransi 5#u-sa 7er7a5ai tin5-at )an5 'i-eta%ui perta&a -a#i saat %a&i#
tanpa &e&7e'a-an apa-a% pen'erita per#u&en 'apat insu#in atau ti'a-. Pa'a
tanpa &e&7e'a-an apa-a% pen'erita per#u&en 'apat insu#in atau ti'a-. Pa'a
-e%a&i#an tri&ester perta&a -a'ar 5#u-sa a-an turun antara ++9"+@ 'an %a#
-e%a&i#an tri&ester perta&a -a'ar 5#u-sa a-an turun antara ++9"+@ 'an %a#
in
ini
i &e
&eru
rupa
pa-a
-an
n res
resp
pn
n te
ter%
r%a'
a'ap
ap tr
tran
ansp
sprt
rtasi
asi 5#
5#u-
u-s
sa
a 'a
'ari
ri i7
i7u
u -e
-e a
ani
nin.
n.
Se7
Se7a5i
a5ian
an 7es
7esar
ar DMG
DMG asi
asi&t
&t&ati
&atis
s se%i
se%in55
n55a
a 'ia
'ia5n
5nsis
sis 'it
'itent
entu-a
u-an
n se$a
se$ara
ra
-e7etu#an pa'a saat pe&eri-saan rutin. Dia7etes &e#itus 5estatina# a'a#a%
-e7etu#an pa'a saat pe&eri-saan rutin. Dia7etes &e#itus 5estatina# a'a#a%
-ea'aa
-ea'aan
n int#
int#eransi -ar7%i'r
eransi -ar7%i'rat
at 'ari
'ari seran
seran5
5 (anit
(anita
a )an5 'i-eta%u
)an5 'i-eta%ui
i perta&
perta&a
a
-a#i -eti-a 'ia se'an5 %a&i#. Dia7etes 5estatina# tera'i -arena -e#ainan
-a#i -eti-a 'ia se'an5 %a&i#. Dia7etes 5estatina# tera'i -arena -e#ainan
)an5 'ipi$u
)an5 'ipi$u #e% -e%a&i#an
#e% -e%a&i#an,
, 'iper
'iper-ira-a
-ira-an
n -arena tera'in)
-arena tera'in)a
a peru7
peru7a%an pa'a
a%an pa'a
&eta7#is&e 5#u-sa.
&eta7#is&e 5#u-sa.
Teri )an5 #ain &en5ata-an 7a%(a 'ia7etes tipe  ini 'ise7ut se7a5ai
Teri )an5 #ain &en5ata-an 7a%(a 'ia7etes tipe  ini 'ise7ut se7a5ai
6un&a
6un&as-e'8 atau
s-e'8 atau 7aru 'ite&u-
7aru 'ite&u-an saat
an saat %a&i# 'an patut
%a&i# 'an patut 'i$uri
'i$uri5ai pa'a
5ai pa'a (anita
(anita
)an5 &e&i#i-i $iri 5e&u-, ri(a)at -e#uar5a 'ia7etes, ri(a)at &e#a%ir-an 7a)i
)an5 &e&i#i-i $iri 5e&u-, ri(a)at -e#uar5a 'ia7etes, ri(a)at &e#a%ir-an 7a)i
B 2 -5, ri(a)at 7a)i #a%ir &ati, 'an ri(a)at a7rtus 7eru#an5. An5-a #a%ir
B 2 -5, ri(a)at 7a)i #a%ir &ati, 'an ri(a)at a7rtus 7eru#an5. An5-a #a%ir
&at
&ati
i ter
teruta
uta&a
&a pa'
pa'a
a 'ia
'ia7et
7etes
es )an
)an5
5 ti'
ti'a-
a- ter
ter-en
-en'a#
'a#i
i 'ap
'apat
at ter
tera'i
a'i 1!
1! -a#
-a#i
i
'arinr&a#.
'arinr&a#.
2.2 E"i/%/(i Di!$"$+ M$%i")+ G$+"!+i/'!%
2.2 E"i/%/(i Di!$"$+ M$%i")+ G$+"!+i/'!%
Pa
Pa'a
'a saa
saat
t se
ser
ran
an5
5 (a
(ani
nita
ta %a
%a&i
&i#,
#, pe
peru
ru7a
7a%a
%an
n %
%r&
r&n
n9%
9%r
r&
&n
n 'a
'a#a&
#a&
tu7u%n)a &e&7uat -era insu#in &ena'i ti'a- ee-ti. Karena -era insu#in
tu7u%n)a &e&7uat -era insu#in &ena'i ti'a- ee-ti. Karena -era insu#in
&e&7a
&e&7antu
ntu pen)e
pen)erapan 5#u-sa #e%
rapan 5#u-sa #e% se#9se# tu7u% ti'a-
se#9se# tu7u% ti'a- ee-ti
ee-ti,
, a-i7at
a-i7atn)a
n)a
u&#a% 5#u-sa 'a#a& 'ara% &enin5-at 'an pen)
u&#a% 5#u-sa 'a#a& 'ara% &enin5-at 'an pen)e7a7 #ainn)a a'a#a% :
e7a7 #ainn)a a'a#a% :
1.
1. P
P#a &
#a &a-
a-an
an
3
3
Men5-nsu&si &a-anan )an5 7er#e7i%an )an5 7erarti u&#a% -a#ri
Men5-nsu&si &a-anan )an5 7er#e7i%an )an5 7erarti u&#a% -a#ri
)an5 'i7utu%-an tu7u% u&#a%n)a 7er#e7i%. Apa7i#a -nsu&si &a-anan
)an5 'i7utu%-an tu7u% u&#a%n)a 7er#e7i%. Apa7i#a -nsu&si &a-anan
)an5 7er#e7i%an ti'a- 'ii&7an5i #e% se-resi insu#in 'a#a& u&#a% )an5
)an5 7er#e7i%an ti'a- 'ii&7an5i #e% se-resi insu#in 'a#a& u&#a% )an5
$u-up a-an &en)e7a7-an -a'ar 5u#a 'a#a& 'ara
$u-up a-an &en)e7a7-an -a'ar 5u#a 'a#a& 'ara% &enin5-at
% &enin5-at
.
. Fa-
Fa-tr -e
tr -etur
turuna
unan 
n  Gen
Geneti
eti-
-
Dia7etes &i#itus 'apat 'i(aris-an 'ari ran5 tua -epa'a ana-. Gen
Dia7etes &i#itus 'apat 'i(aris-an 'ari ran5 tua -epa'a ana-. Gen
pen)e7a7
pen)e7a7 'ia7etes
'ia7etes &e#itus
&e#itus a-an
a-an 'i7a(a
'i7a(a #e%
#e% ana-
ana- i-a
i-a ran5
ran5 tuan)a
tuan)a
&en'erita 'ia7etes &e#itus. Pe(aris 5en ini 'apat sa&pai -e $u$un)a
&en'erita 'ia7etes &e#itus. Pe(aris 5en ini 'apat sa&pai -e $u$un)a
7a%-an
7a%-an $i$it
$i$it (a#aupun
(a#aupun resi-n)a
resi-n)a -e$i#.
-e$i#. Se*ara
Se*ara -#inis,
-#inis, pen)a-it
pen)a-it DM
DM
a(a#n)a 'i'&inasi #e% resistensi insu#in )an5 'isertai 'ee$t un5si
a(a#n)a 'i'&inasi #e% resistensi insu#in )an5 'isertai 'ee$t un5si
se-resi. Tetapi, pa'a ta%ap )an5 #e7i% #anut %a# itu 'i'&inasi 'ee$t
se-resi. Tetapi, pa'a ta%ap )an5 #e7i% #anut %a# itu 'i'&inasi 'ee$t
un5si se-resi )an5 'isertai 'en5an resistensi insu#in. Kaitann)a 'en5an
un5si se-resi )an5 'isertai 'en5an resistensi insu#in. Kaitann)a 'en5an
&utasi DNA &it-n'ria )aitu -arena prses pr'u-si %r&n insu#in
&utasi DNA &it-n'ria )aitu -arena prses pr'u-si %r&n insu#in
sa
san5
n5at
at er
erat
at -a
-ait
itan
ann)
n)a
a '
'en
en5
5an
an &e
&e-a
-an
nis
is&
&e
e p
pr
rse
ses
s 
i'
i'at
ati*
i*e
e
p%sp%r)#atin >OPO
p%sp%r)#atin >OPOS? 'i 'a#a& pen-reas.
S? 'i 'a#a& pen-reas.
3.
3. Str
Stres '
es 'an
an &er
&er-
--
-
Ke
Keti
ti-a
-a 'a
'a#a&
#a& -e
-ea'
a'aa
aan
n st
stres
res,
, %
%r&
r&n
n9%
9%r
r&
&n
n str
stres
es 'i
'itu
tu7u
7u%
% a-
a-an
an
&enin5-at %a# ini u5a a-an &e&i$u nai-n)a -a'ar 5u#a
&enin5-at %a# ini u5a a-an &e&i$u nai-n)a -a'ar 5u#a 'i 'a#a& 'ara%.
'i 'a#a& 'ara%.
Se'an5-an &er-- 'apat &e&per7erat 5an55uan sir-u#asi 'ara% 'i
Se'an5-an &er-- 'apat &e&per7erat 5an55uan sir-u#asi 'ara% 'i
'aera% uun59uun5 tu7u% &isa#n)a ari -a-i, se%in55a 'en5a &er--
'aera% uun59uun5 tu7u% &isa#n)a ari -a-i, se%in55a 'en5a &er--
'apat &e&per$epat prses pe&7entu-an 5an5ren.
'apat &e&per$epat prses pe&7entu-an 5an5ren.
2.
2. Ke5e&
Ke5e&u-an  7
u-an  7esitas 7ia
esitas 7iasan)a ter
san)a tera'i pa'a usi
a'i pa'a usia 2! ta%un
a 2! ta%un
Se7enarn)a DM 7isa &ena'i pen)e7a7 'an a-i7at. Se7a5ai pen)e7a7,
Se7enarn)a DM 7isa &ena'i pen)e7a7 'an a-i7at. Se7a5ai pen)e7a7,
7esitas &en)e7a7-an se# 7eta > )an5 &en5se-resi insu#in 'a#a& 'ara%?
7esitas &en)e7a7-an se# 7eta > )an5 &en5se-resi insu#in 'a#a& 'ara%?
pan-reas
pan-reas pen5%asi#
pen5%asi# insu#in
insu#in %ipertrpi
%ipertrpi )an5
)an5 pa'a
pa'a 5i#irann)a
5i#irann)a a-an
a-an
-e#e#a%an 'an e7# se%in55a insu#in &ena'i 7er-uran5 pr'u-sin)a.
-e#e#a%an 'an e7# se%in55a insu#in &ena'i 7er-uran5 pr'u-sin)a.
Se
Se7a
7a5a
5ai
i a-
a-i7
i7at
at pe
pen5
n55u
5una
na in
insu
su#i
#in
n se7
se7a5
a5ai
ai te
tera
rapi
pi 'i
'ia7
a7et
etes
es &e
&e#it
#itus
us
7e#e7i%an
7e#e7i%an &en)e7a7-an
&en)e7a7-an peni&7unan
peni&7unan #e&a-
#e&a- su7-utan
su7-utan )an5
)an5 7er#e7ian
7er#e7ian
pu#a.
pu#a.
+.
+. ;a%an
;a%an -i&ia
-i&ia 'an
'an 7at9
7at97atan
7atan
;a%an -i&ia tertentu 'apat &en5iritasi pa-reas se%in55a &en)e7a7-an
;a%an -i&ia tertentu 'apat &en5iritasi pa-reas se%in55a &en)e7a7-an
ra'
ra'an5
an5 pan
pan-re
-reas.
as. Per
Pera'a
a'an5a
n5an
n pa'
pa'a
a pan
pan-re
-reas
as &en
&en)e7
)e7a7a
a7an
n pan
pan-re
-reas
as
ti'
ti'a-
a- 7er
7erun
un5si
5si se$a
se$ara
ra pt
pti&a
i&a#
# 'a#
'a#a&
a& &en
&ense-r
se-resi-
esi-an
an %r
%r&n
&n )an
)an5
5
'iper#u-an untu- &eta7#is&e tu7u%, ter&asu- %r&n insu#in.
'iper#u-an untu- &eta7#is&e tu7u%, ter&asu- %r&n insu#in.
".
". Men5-
Men5-nsu
nsu&si -ar7
&si -ar7%i'r
%i'rat 7er#e
at 7er#e7i%an
7i%an
4
4
T
Tin55i
in55in)a
n)a -nsu
-nsu&si
&si -ar7
-ar7%i'rat
%i'rat &en)e
&en)e7a7-a
7a7-an
n -nse
-nsentrasi
ntrasi 5#u-
5#u-sa
sa
'a#
'a#a&
a& 'ar
'ara%
a% &en
&enin5
in5-at
-at.
. i-
i-a
a u&
u&#a%
#a% ins
insu#i
u#in
n )an
)an5
5 'ip
'ipr'
r'u-s
u-si
i ti'
ti'a-
a-
'ise-
'ise-resi-an #e% se#9se#
resi-an #e% se#9se# 7eta >
7eta > )an5 &en5se-r
)an5 &en5se-resi insu#in 'a#a&
esi insu#in 'a#a& 'ara%?
'ara%?
pan-reas
pan-reas a-i7at
a-i7at 7e7erapa
7e7erapa 5an55uan
5an55uan 'a#a&
'a#a& tu7u%,
tu7u%, 5#u-sa
5#u-sa 'ara%
'ara% ti'a-
ti'a-
'iu7a% &ena'i ener5i 'an ti'a- 'apat 'iu7a% 'a#a& 7entu- 5#i-5en.
'iu7a% &ena'i ener5i 'an ti'a- 'apat 'iu7a% 'a#a& 7entu- 5#i-5en.
a# ini &en)e7a7-an -a'ar 5#u-sa 'a#a& 'ara% tin55i, >&e#e(ati 7atas
a# ini &en)e7a7-an -a'ar 5#u-sa 'a#a& 'ara% tin55i, >&e#e(ati 7atas
-esan
-esan55up
55upan
an 5ina
5ina#
# untu
untu-
- &en)a
&en)arin5
rin5 5#u-
5#u-sa
sa -arena
-arena -nse
-nsentrasi
ntrasin)a
n)a
ter#a#u tin55i?, 5#u-sa a-an 'i-e#uar-an &e#a#ui urin se%in55a tera'i
ter#a#u tin55i?, 5#u-sa a-an 'i-e#uar-an &e#a#ui urin se%in55a tera'i
5#u-saria >5#u-sa 'a#a& urin H -en$in5 &anis?
5#u-saria >5#u-sa 'a#a& urin H -en$in5 &anis?
=.
=. Ker
Kerusa
usa-an pa
-an pa'a se# pa
'a se# pan-r
n-reas
eas
In
Ine
e-s
-si
i &i
&i-r
-r
r5
r5an
anis
is&e
&e 'a
'an
n *i
*iru
rus
s pa
pa'a
'a pa
pan5
n5-r
-rea
eas
s u
u5a
5a 'a
'apa
pat
t
&en)e7a7-an ra'an5 pan-reas )an5 t&atis a-an &en)e7a7-an un5si
&en)e7a7-an ra'an5 pan-reas )an5 t&atis a-an &en)e7a7-an un5si
pan-reas turun se%in55a ti'a- a'a s
pan-reas turun se%in55a ti'a- a'a se-resi %r&n9%r&n untu- prses
e-resi %r&n9%r&n untu- prses
&eta7#is&e )u7u% ter&asu- insu#in. Pen)a-it seperti -#ester# tin55i
&eta7#is&e )u7u% ter&asu- insu#in. Pen)a-it seperti -#ester# tin55i
'an 'isp#i'e&ia 'apat &enin5-at-an risi- ter-ena 'ia7etes &i#itus.
'an 'isp#i'e&ia 'apat &enin5-at-an risi- ter-ena 'ia7etes &i#itus.
2. K%!+ii&!+i Di!$"$+
2. K%!+ii&!+i Di!$"$+ M$%i")+ G$+"!+i/'!%
M$%i")+ G$+"!+i/'!%
K
K$
$%
%!
!+
+ K
K!
!#
#!
!&
&"
"$
$#
#i
i+
+"
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i&
& I
I*
*
%
%i
i&
&!
!+
+i
i
Int#eransi
Int#eransi
G#u-sa pa'a
G#u-sa pa'a
&asa %a&i#
&asa %a&i#
T
T#eransi 5#u-sa
#eransi 5#u-sa a7nr&a#
a7nr&a#
se#a&a &asa %a&i#, %iper5#i-e&i
se#a&a &asa %a&i#, %iper5#i-e&i
pas$aran'ia# se#a&a &asa %a&i#
pas$aran'ia# se#a&a &asa %a&i#
Dia5nsis se7e#u& usia
Dia5nsis se7e#u& usia
5estasi 3! &in55u pentin5
5estasi 3! &in55u pentin5
untu- &en$e5a%
untu- &en$e5a%
&a-rs&ia.
&a-rs&ia.
T
Tan5ani 'en5at 'iet
an5ani 'en5at 'iet -a#ri
-a#ri
)an5 a'e-uat untu-
)an5 a'e-uat untu-
&en$e5a% penurunan 7erat
&en$e5a% penurunan 7erat
7a'an i7u.
7a'an i7u.
Sasaran )an5 'i$apai:
Sasaran )an5 'i$apai:
5#u-sa 'ara%
5#u-sa 'ara%
pas$apran'ia# 13!&5# 1
pas$apran'ia# 13!&5# 1
a& sete#a% &a-an atau
a& sete#a% &a-an atau
1!+ &5'#  a& sete#a%
1!+ &5'#  a& sete#a%
&a-an. Apa7i#a insu#in
&a-an. Apa7i#a insu#in
5
5
'i7utu%-an, tan5ani seperti
'i7utu%-an, tan5ani seperti
penan5anan -e#as ; 'an <.
penan5anan -e#as ; 'an <.
A
A
Dia7etes Ki&ia(i )an5
Dia7etes Ki&ia(i )an5
'i'ia5nsis se7e#u& &asa %a&i#:
'i'ia5nsis se7e#u& &asa %a&i#:
'iatasi %an)a &e#a#ui upa)a 'iet.
'iatasi %an)a &e#a#ui upa)a 'iet.
Penata#a-sanaan sa&a
Penata#a-sanaan sa&a
'en5an penan5anan
'en5an penan5anan
int#eransi 5#u-sa pa'a
int#eransi 5#u-sa pa'a
-e%a&i#an
-e%a&i#an
;
;
T
Terapi Insu#in
erapi Insu#in )an5 'i#a-u-an
)an5 'i#a-u-an
se7e#u& Masa %a&i#J a(itan pa'a
se7e#u& Masa %a&i#J a(itan pa'a
usia ! ta%un atau #e7i% 'urasi
usia ! ta%un atau #e7i% 'urasi
-uran5 1! ta%un
-uran5 1! ta%un
Se-resi insu#in en'5en
Se-resi insu#in en'5en
'apat &enetap, resi- pa'a
'apat &enetap, resi- pa'a
nenatus 'an anin 'en5an
nenatus 'an anin 'en5an
resi- pa'a -e#as < 'an D
resi- pa'a -e#as < 'an D
7e5itu u5a 'en5an
7e5itu u5a 'en5an
penata#a-sanaann)a.
penata#a-sanaann)a.
<
<
A
A(a# pa'a
(a# pa'a usia 1!9! ta%un, a
usia 1!9! ta%un, atau
tau
'urasi 1!9! ta%un. Dia7etes
'urasi 1!9! ta%un. Dia7etes
-arena -uran5 insu#in
-arena -uran5 insu#in
Dia7etes -arena -uran5
Dia7etes -arena -uran5
insu#in 'en5an a(a# pa'a
insu#in 'en5an a(a# pa'a
&asa ana-9ana-.
&asa ana-9ana-.
D
D
A
A(a# se7e#u&
(a# se7e#u& usia 1!9! ta%un
usia 1!9! ta%un
atau 'urasi 1!9! ta%un
atau 'urasi 1!9! ta%un
Ma-rs&ia anin atau
Ma-rs&ia anin atau
retar'asi pertu&7u%an
retar'asi pertu&7u%an
intrauterine 'apat tera'i,
intrauterine 'apat tera'i,
&i-rr5anis&e retina,
&i-rr5anis&e retina,
't9%e&ra5i, 'an a'e-ut
't9%e&ra5i, 'an a'e-ut
&enin5-at se#a&a &asa
&enin5-at se#a&a &asa
%a&i#, -e&u'ian &enurun
%a&i#, -e&u'ian &enurun
sete#a% &e#a%ir-an
sete#a% &e#a%ir-an
F
F
Nerpati 'ia7eti$ 'isertai 'en5an
Nerpati 'ia7eti$ 'isertai 'en5an
prteinuria
prteinuria
Ane&i 'an %ipertensi
Ane&i 'an %ipertensi
u&u& tera'i, prteinuria
u&u& tera'i, prteinuria
&enin5-at pa'a
&enin5-at pa'a
trise&ester -e 3, #a#u
trise&ester -e 3, #a#u
&enurun -e&7a#i
&enurun -e&7a#i
6
6
2.
2. WO3 Di!$"$+ M$%i")+ !4! I) H!*i%
WO3 Di!$"$+ M$%i")+ !4! I) H!*i%
7
7
Geneti-, *irus, pen5erusa-an insu#in 'ari se7e#u&
Geneti-, *irus, pen5erusa-an insu#in 'ari se7e#u&
-e%a&i#an atau &un$u# pa'a saat -e%a&i#an
-e%a&i#an atau &un$u# pa'a saat -e%a&i#an
Kerusa-an se# 7eta
Kerusa-an se# 7eta
Estr5en, -tis#, PL
Estr5en, -tis#, PL 5
5
Keti'a-sei&7an5an pr'u-si insu#in 'an
Keti'a-sei&7an5an pr'u-si insu#in 'an
-era insu#in ter5an55u 'an 
-era insu#in ter5an55u 'an 
Gu#a 'a#a& 'ara% ti'a- 'apat
Gu#a 'a#a& 'ara% ti'a- 'apat 'i7a(a
'i7a(a
&asu- -e 'a#a& se#
&asu- -e 'a#a& se#
iper5#i-e&i pa'a i7u
iper5#i-e&i pa'a i7u
G#u-sa 'ip#as&a
G#u-sa 'ip#as&a 5
5
 s&#a#itas p#as&a 'an
 s&#a#itas p#as&a 'an
$airan 'a#a& tu7u#us 5ina#
$airan 'a#a& tu7u#us 5ina#
G#u-suria
G#u-suria
Ke%i#an5an -a#ri
Ke%i#an5an -a#ri
G#u-sa &asu- -e
G#u-sa &asu- -e
p#asenta 'an 
p#asenta 'an 
Meran5san5
Meran5san5
%ipta#a&us
%ipta#a&us
Pen5a&7i#an 5#u-sa sir-u#asi p#asenta
Pen5a&7i#an 5#u-sa sir-u#asi p#asenta 5
5
G#u-suria pa'a I7u
G#u-suria pa'a I7u
Ke%i#an5an -a#ri
Ke%i#an5an -a#ri
Se# -e-uran5an 7a%an
Se# -e-uran5an 7a%an
untu- &eta7#is&e
untu- &eta7#is&e
Prtein 'ari #e&a-
Prtein 'ari #e&a-
'i7a-ar
'i7a-ar
;erat 7a'an &enurun
;erat 7a'an &enurun
Ana7#is&e prtein
Ana7#is&e prtein
&enurun
&enurun
Kerusa-an pa'a anti7'i
Kerusa-an pa'a anti7'i
Ke-e7a#an tu7u%
Ke-e7a#an tu7u%
&enurun
&enurun
R$+i&/ i'$&+i
R$+i&/ i'$&+i
8
8
;a)i -e#e7i%an nutrisi
;a)i -e#e7i%an nutrisi
>%iper5#i-e&ia?
>%iper5#i-e&ia?
Pusat #apar 'an
Pusat #apar 'an
%aus
%aus
P#i'ipsia
P#i'ipsia
P#ia5ia
P#ia5ia
K$"i4!&+$i*!'(!'
K$"i4!&+$i*!'(!'
')"#i+i &)#!'( 4!#i
')"#i+i &)#!'( 4!#i
Ma-rs&ia >77 7a)i
Ma-rs&ia >77 7a)i
B 2!!! 5r?
B 2!!! 5r?
Ri+i&/ 6i4$#! -!'i'
Ri+i&/ 6i4$#! -!'i' In'i-asi 'i#a-u-an
In'i-asi 'i#a-u-an
persa#inan S<
persa#inan S<
K$"i4!&+$i*!'(!'
K$"i4!&+$i*!'(!'
')"#i+i &)#!'( 4!#i
')"#i+i &)#!'( 4!#i
&$)"),!' ")),
&$)"),!' ")),
A'+i$"!+
A'+i$"!+
D$i+i" $'($"!,)!'
D$i+i" $'($"!,)!'
K$%$"i,!'
K$%$"i,!'
&$)"),!' ")),
&$)"),!' ")),
2.
2. P!"/i+i/%/(i Di!$"$+ M$%i")+ !4! I) H!*i%
P!"/i+i/%/(i Di!$"$+ M$%i")+ !4! I) H!*i%
Dia7e
Dia7etes
tes &e##it
&e##itus
us 'itan
'itan'ai
'ai 'en5
'en5an
an %iper
%iper5#i-e&
5#i-e&ia
ia >peni
>penin5-at
n5-atan
an 5#u-
5#u-sa
sa
'a
'ara
ra%?
%? 'i
'ia-
a-i7
i7at
at-a
-an
n -a
-are
rena
na pr
pr'
'u-
u-si
si in
insu
su#i
#in
n )a
)an5
n5 ti
ti'a
'a-
- a'
a'e-
e-ua
uat
t at
atau
au
pen55unaan
pen55unaan insu#in
insu#in se$ara
se$ara ti'a-
ti'a- ee-ti
ee-ti pa'a
pa'a tin5-at
tin5-at se#u#er.
se#u#er. Insu#in
Insu#in )an5
)an5
'ip
'ipr'
r'u-s
u-si
i se#9
se#9se#
se# 7et
7eta
a pu#
pu#au
au #an
#an5er
5er%an
%ans
s 'i
'i pra
pran-e
n-eas
as 7er
7ertan
tan55u
55un5
n5 a(
a(a7
a7
&entranspr 5#u-sa -e 'a#a& se#. Apa7i#a insu#in ti'a- $u-up  ti'a- ee-ti,
&entranspr 5#u-sa -e 'a#a& se#. Apa7i#a insu#in ti'a- $u-up  ti'a- ee-ti,
5#
5#u-
u-s
sa
a 7e
7era-
ra-u&
u&u#
u#as
asi
i 'a
'a#a
#a&
& a#
a#ir
iran
an 'a
'ara
ra%
% 'a
'an
n te
tera
ra'i
'i %i
%ipe
per5
r5#i
#i-e
-e&i
&ia.
a.
iper
iper5#i-e&
5#i-e&ia
ia &en)
&en)e7a7-
e7a7-an
an %iper
%ipers&#
s&#aritas
aritas 'a#a&
'a#a& 'ara% )an5
'ara% )an5 &enari
&enari-
-
$air
$airan
an int
intrase
rase#
# -e
-e 'a#
'a#a&
a& sist
siste&
e& *as
*as-u#
-u#ar
ar se%
se%in5
in55a
5a ter
tera'i
a'i 'e%
'e%i'r
i'rasi
asi 'an
'an
penin5-atan *#u&e
penin5-atan *#u&e 'ara%. A-i7atn)a 5ina#
'ara%. A-i7atn)a 5ina# &en)e-resi urine
&en)e-resi urine 'a#a&
'a#a& *#u&e
*#u&e
7esar
7esar >p#iuria?
>p#iuria? se7a5ai
se7a5ai upa)a
upa)a untu-
untu- &en5atur
&en5atur -e#e7i%an
-e#e7i%an *#u&e
*#u&e 'ara%
'ara% 'an
'an
&en)e
&en)e-resi
-resi 5#u-
5#u-sa
sa )an5 ti'a-
)an5 ti'a- 'i5u
'i5una-an >5#iusuri
na-an >5#iusuria?.
a?. De%i'
De%i'rasi
rasi se#u#e
se#u#er,
r,
&eni&7u#-an rasa %aus 7er#e7i%an >p#i'ipsi?. Penurunan 7erat 7a'an a-i7at
&eni&7u#-an rasa %aus 7er#e7i%an >p#i'ipsi?. Penurunan 7erat 7a'an a-i7at
pe&e$a%an
pe&e$a%an #e&a-
#e&a- 'an
'an arin5an
arin5an tt,
tt, pe&e$a%an
pe&e$a%an arin5an
arin5an ini
ini &eni&7u#-an
&eni&7u#-an
rasa
rasa #ap
#apar
ar )an
)an5
5 &e&
&e&7ua
7uat
t in'
in'i*i
i*i'u
'u &a-
&a-an
an se$a
se$ara
ra 7er
7er#e7
#e7i%a
i%an
n >p
>p#ia
#ia#5i
#5ia?.
a?.
Sete#a% an5-a
Sete#a% an5-a (a-tu tertentu,
(a-tu tertentu, 'ia7e
'ia7etes
tes &en)
&en)e7a7-
e7a7-an
an peru7
peru7a%an
a%an *as-u
*as-u#er
#er
)an5 7er&a-na. Peru7a%an ini teruta&a &e&pun5aru%i antun5, &ata 'an
)an5 7er&a-na. Peru7a%an ini teruta&a &e&pun5aru%i antun5, &ata 'an
5in
5ina#
a#.
. K&
K&p#i
p#i-as
-asi
i a-i
a-i7at
7at 'ia
'ia7et
7etes
es &en
&en$a-
$a-up
up ater
aters-
s-#er
#ersi
sis,
s, pre
pre&at
&ature
ure,
,
reti
retinp
npati
ati 'an nerp
'an nerpati
ati.
. Dia
Dia7et
7etes
es tip
tipe
e I
I 'an
'an II
II 7ia
7iasan
san)sa
)sa 'i-
'i-ena
ena#
# se7
se7a5a
a5ai
i
sin'r
sin'r&
& )an5 'ise7a7-
)an5 'ise7a7-an
an #e% a-tr
#e% a-tr 5enet
5eneti-.
i-. Dia7et
Dia7etes
es 7iasan
7iasan)a
)a 'i(ari
'i(aris-an
s-an
se7a
se7a5ai
5ai si
siat
at rese
resesi,
si, teta
tetapi
pi &un
&un$u#
$u# se7
se7a5a
a5ai
i sia
siat
t '&
'&ina
inan
n pa'
pa'a
a 7e7
7e7era
erapa
pa
-e#uar
-e#uar5a.
5a. Pe(ari
Pe(arisan siat
san siat 5eneti
5eneti-
- >5en
>5entip? 'ia7etes
tip? 'ia7etes &e##it
&e##itus
us ti'a- se#a#u
ti'a- se#a#u
7erarti 7a%(a in'i*i'u a-an &en5a#a&i int#eransi 5#u-sa 'ia7eti-
7erarti 7a%(a in'i*i'u a-an &en5a#a&i int#eransi 5#u-sa 'ia7eti- >entip?.
>entip?.
;an)a- in'i*i'u )an5 &e&i#i-i 5entip, ti'a- &e&per#i%at-an
;an)a- in'i*i'u )an5 &e&i#i-i 5entip, ti'a- &e&per#i%at-an satupun 5ea#a
satupun 5ea#a
'ia
'ia7et
7etes
es sa&
sa&pai
pai &er
&ere-a
e-a &en
&en5a#
5a#a&i
a&i satu atau
satu atau #e7
#e7i%
i% stre
stressr atau
ssr atau a-
a-tr
tr
presipitasi.
presipitasi. <nt%
<nt% stressr
stressr terse7ut
terse7ut a'a#a%
a'a#a% penin5-atan
penin5-atan usia,
usia, peri'e
peri'e
per-e&7an5an
per-e&7an5an nr&a#,
nr&a#, peru7a%an
peru7a%an %r&na#
%r&na# )an5
)an5 $epat,
$epat, 7esitas,
7esitas, ine-si,
ine-si,
pe&7e'a%an, -risis e&si 'an tu&r atau ine-si pan5-reas.
pe&7e'a%an, -risis e&si 'an tu&r atau ine-si pan5-reas.
Dia7e
Dia7etes
tes Gestas
Gestasina# >'ia7etes
ina# >'ia7etes -e%a&
-e%a&i#an?
i#an? int#
int#eransi 5#u-sa
eransi 5#u-sa se#a&a
se#a&a
-e
-e%a
%a&i
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, ti
ti'a
'a-
- 'i
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en5a
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n
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i#an &enin
&enin5-ats
5-atse-resi
e-resi %r&
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n pertu&
pertu&7u%an
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9
9
s&at
s&at&a&tr
&a&trpin ><S?.
pin ><S?. r&
r&n
n ini
ini &enin
&enin5-at untu-
5-at untu- &ensu
&ensup#ai
p#ai asa&
asa&
a&in 'an 5#u-sa -e etus. Da#a& -e%a&i#an tera'i peru7a%an &eta7#is&
a&in 'an 5#u-sa -e etus. Da#a& -e%a&i#an tera'i peru7a%an &eta7#is&
en'-rin 'an -ar7%i'rat )an5 &enunan5 pe&as-an &a-anan 7a5i anin
en'-rin 'an -ar7%i'rat )an5 &enunan5 pe&as-an &a-anan 7a5i anin
serta persiapan untu- &en)usui. G#u-sa 'apat 7er'iusi se$ara tetap &e#a#ui
serta persiapan untu- &en)usui. G#u-sa 'apat 7er'iusi se$ara tetap &e#a#ui
p#asenta
p#asenta -epa'a
-epa'a anin
anin se%in55a
se%in55a -a'arn)a
-a'arn)a 'a#a&
'a#a& 'ara%
'ara% anin
anin %a&pir
%a&pir
&en)e
&en)erupai -a'ar 'ara%
rupai -a'ar 'ara% i7u. Insu#in i7u ta-
i7u. Insu#in i7u ta- 'apat &en$apa
'apat &en$apai
i anin, se%in5
anin, se%in55a
5a
-a'ar 5u#a i7u )an5 &e&pen5aru%i -a'ar pa'a anin. Pen5en'a#ian -a'ar
-a'ar 5u#a i7u )an5 &e&pen5aru%i -a'ar pa'a anin. Pen5en'a#ian -a'ar
5u#a teruta&a
5u#a teruta&a 'ipen
'ipen5aru%
5aru%i
i #e% insu#in,
#e% insu#in, 'isa&p
'isa&pin5 7e7erapa
in5 7e7erapa %r&
%r&n
n #ain
#ain
seperti estr5en, steri'
seperti estr5en, steri' 'an p#asenta
'an p#asenta #a-t
#a-t5en. A-i7
5en. A-i7at
at #a&7a
#a&7atn)a
tn)a resrp
resrpsi
si
&a-
&a-ana
anan
n &a-
&a-a
a ter
tera'
a'i
i %ip
%iper
er5#i
5#i-e&
-e&ia
ia )an
)an5
5 re#
re#ati
ati
 #a&
#a&a
a 'an
'an ini
ini &en
&enunt
untut
ut
-e7utu%an insu#in. Mene#an5 ater& -e7utu%an insu#in &enin5-at se%in55a
-e7utu%an insu#in. Mene#an5 ater& -e7utu%an insu#in &enin5-at se%in55a
&e
&en$
n$ap
apai
ai 3
3 -a
-a#i
#i 'a
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ri -e
-ea'
a'aa
aan
n n
nr&
r&a#
a#.
. a
a#
# in
ini
i 'i
'ise
se7u
7ut
t se7
se7a5
a5ai
ai te
te-a
-ana
nan
n
'ia7eteni- 'a#a& -e%a&i#an. Se$ara isi#5i- te#a% tera'i resistensi insu#in
'ia7eteni- 'a#a& -e%a&i#an. Se$ara isi#5i- te#a% tera'i resistensi insu#in
)ai
)aitu
tu 7i#
7i#a
a ia
ia 'it
'ita&7
a&7a%
a% 'en
'en5an insu#i
5an insu#in
n e-s
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n ia
ia ti'
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i
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n tet
tetapi
api,
, 7i#
7i#a
a i7u
i7u ti'
ti'a-
a- &a&
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pu &en
&enin5
in5-at
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si
insu#i
insu#in,
n, se%in5
se%in55a
5a ia
ia re#ati*
re#ati*e
e %ip
%ipinsu#i
insu#in
n )an5 &en)e7a7-
)an5 &en)e7a7-an
an %iper
%iper5#i-e&
5#i-e&ia
ia
atau
atau 'ia7e
'ia7etes
tes -e%a&
-e%a&i#an.
i#an.Pa'a
Pa'a DMG,
DMG, se#ain
se#ain peru7
peru7a%an9
a%an9peru7
peru7a%an
a%an isi#
isi#5i
5i
terse7u
terse7ut, a-an
t, a-an tera'
tera'i
i suatu -ea'aan 'i &ana
suatu -ea'aan 'i &ana u&#a
u&#a%
% 
 un5
un5si insu#in &ena'i
si insu#in &ena'i
ti'a- pti&a#. Tera'i peru7a%an -ineti-a insu#in 'an resistensi ter%a'ap ee-
ti'a- pti&a#. Tera'i peru7a%an -ineti-a insu#in 'an resistensi ter%a'ap ee-
insu#in. A-i7atn)a, -&psisi su&7er ener5i 'a#a& p#as&a i7u 7erta&7a%
insu#in. A-i7atn)a, -&psisi su&7er ener5i 'a#a& p#as&a i7u 7erta&7a%
>-a'ar 5u#a 'ara% tin55i, -a'ar insu#in tetap tin55i?. Me#a#ui 'iusi terasi#itasi
>-a'ar 5u#a 'ara% tin55i, -a'ar insu#in tetap tin55i?. Me#a#ui 'iusi terasi#itasi
'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin
'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a i-ut
u5a i-ut tera'i -&psi
tera'i -&psisi
si
su&
su&7er
7er ene
ener5
r5i
i a7n
a7nr&
r&a#
a# >&e
>&en)e
n)e7a7
7a7-an
-an -e&
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un5-in
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an ter
tera'
a'i
i 7er
7er7a5
7a5ai
ai
-&
-&p#i
p#i-as
-asi?.
i?. Se#
Se#ain
ain itu
itu ter
tera'
a'i
i u5
u5a
a %ip
%iperin
erinsu#
su#ine
ine&ia
&ia se%i
se%in55
n55a
a an
anin
in u5
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a
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n5a#
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a&i
i 5a
5an5
n55u
5uan
an &e
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ta7
7#i
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>%ip
ip5
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a, %i
%ip
p&a
&a5n
5nes
ese&
e&ia
ia,
,
%ip-a#se&ia, %iper7i#iru7ine&ia, 'an se7a5ain)a.
%ip-a#se&ia, %iper7i#iru7ine&ia, 'an se7a5ain)a.
2. M!'i$+"!+i K%i'i+ Di!$"$+ M$%i")+ G$+"!+i/'!%
2. M!'i$+"!+i K%i'i+ Di!$"$+ M$%i")+ G$+"!+i/'!%
;eri-ut Maniestasi K#inis DM Gestasina# :
;eri-ut Maniestasi K#inis DM Gestasina# :
9
9 P
P#)
#)ur
uria > 7
ia > 7an
an)a
)a- 7e
- 7er-
r-e&
e&i%
i%?,
?,
9
9 P
P#)
#)'i
'ips
psia >
ia > 7a
7an)
n)a- &
a- &in
inu&
u&?,
?,
9
9 Pe
Penu
nuru
runa
nan 7e
n 7era
rat 7a
t 7a'a
'an,
n,
9
9 P
P#)
#)p%
p%a5
a5ia >
ia >7a
7an)
n)a- &
a- &a-
a-an
an?,
?,
10
10
9
9 Le
Leti
ti%,
%, #e
#esu
su,
, Le
Le&a
&a%
% 7a
7a'a
'an,
n,
9
9 G
Ga
at
ta
a#
#,
,
9
9 pa
pan'
n'an
an5a
5an
n -a
-a7u
7ur
r,
,
9
9 'a
'an pr
n prur
urit
itus *
us *u#
u#*a
*ae pa'
e pa'a(
a(an
anit
ita,
a,
9
9 P
Pu
us
si
in
n5
5,
,
9
9 M
Mu
ua
a#
#,
,
9
9 '
'an
an &u
&u'a
'a% i
% in
ne
e-
-si
si.
.
2.7 P$'(!#), 4!' K/
2.7 P$'(!#), 4!' K/*%i&!+i
*%i&!+i Di!$"$+ M$%i"
Di!$"$+ M$%i")+ "$#,!4! K$,!*i%!
)+ "$#,!4! K$,!*i%!'
'
Dia7etes &e#itus 5estasina# 'apat &erupa-an -e#ainan 5eneti- 'en5an
Dia7etes &e#itus 5estasina# 'apat &erupa-an -e#ainan 5eneti- 'en5an
$a
$ara
ra in
insu
sui
isi
sien
ensi
si at
atau
au 7e
7er-
r-ur
uran
an5n
5n)a
)a in
insu
su#i
#in
n 'a
'a#a
#a&
& si
sir-
r-u#
u#as
asi
i 'a
'ara
ra%,
%,
7er-uran5n)a 5#i-5enesis, 'an -nsentrasi 5u#a 'ara% tin55i. Dia7etes 'a#a&
7er-uran5n)a 5#i-5enesis, 'an -nsentrasi 5u#a 'ara% tin55i. Dia7etes 'a#a&
-e%a&i#an &eni&7u#-an 7an)a- -esu#itan. Pen)a-it ini a-an &en)e7a7-an
-e%a&i#an &eni&7u#-an 7an)a- -esu#itan. Pen)a-it ini a-an &en)e7a7-an
peru7a%an9peru7a%an
peru7a%an9peru7a%an &eta7#i-
&eta7#i- 'an
'an %r&na#
%r&na# pa'a
pa'a pen'erita.
pen'erita. ;e7erapa
;e7erapa
%r&n tertentu &en5a#a&i penin5-atan u&#a%, &isa#n)a %r&n -rtis#,
%r&n tertentu &en5a#a&i penin5-atan u&#a%, &isa#n)a %r&n -rtis#,
estr5en, 'an %u&an p#a$enta# #a$t5en >PL?. Penin5-atan u&#a% se&ua
estr5en, 'an %u&an p#a$enta# #a$t5en >PL?. Penin5-atan u&#a% se&ua
%r&n terse7ut saat %a&i# tern)ata &e&pun)ai pen5aru% ter%a'ap un5si
%r&n terse7ut saat %a&i# tern)ata &e&pun)ai pen5aru% ter%a'ap un5si
insu#in 'a#a& &en5atur -a'ar 5u#a 'ara%. Kn'isi ini &en)e7a7-an suatu
insu#in 'a#a& &en5atur -a'ar 5u#a 'ara%. Kn'isi ini &en)e7a7-an suatu
-n'isi )an5 -e7a# ter%a'ap insu#in )an5 'ise7ut se7a5ai resisten insu#in.
-n'isi )an5 -e7a# ter%a'ap insu#in )an5 'ise7ut se7a5ai resisten insu#in.
Se%in55a &eni&7u#-an 'a&pa- penin5-atan -a'ar 5#u-sa pa'a i7u %a&i#
Se%in55a &eni&7u#-an 'a&pa- penin5-atan -a'ar 5#u-sa pa'a i7u %a&i#
>Ra%a)u, !1"?.
>Ra%a)u, !1"?.
Pa'a
Pa'a 'ia7e
'ia7etes
tes &e#itu
&e#itus
s 5estasi
5estasina#,
na#, se#ain
se#ain peru7
peru7a%an9p
a%an9peru7a%
eru7a%an
an isi#
isi#5i
5i
terse7ut, a-an tera'i suatu -ea'aan 'i &ana un5si insu#in &ena'i ti'a-
terse7ut, a-an tera'i suatu -ea'aan 'i &ana un5si insu#in &ena'i ti'a-
pt
pti&a
i&a#.
#. T
Ter
era'i
a'i per
peru7a
u7a%an
%an -in
-ineti
eti-a
-a ins
insu#i
u#in
n 'an
'an resi
resisten
stensi
si ter
ter%a'
%a'ap
ap ee
ee-
-
insu#in, a-i7atn)a -an'un5an 5#u-sa 'a#a& p#as&a i7u 7erta&7a%, -a'ar
insu#in, a-i7atn)a -an'un5an 5#u-sa 'a#a& p#as&a i7u 7erta&7a%, -a'ar
5u#a 'ara%
5u#a 'ara% tin55
tin55i,
i, tetapi -a'ar insu#in tetap
tetapi -a'ar insu#in tetap tin55
tin55i.
i. Me#a#u
Me#a#ui
i 'iusi terasi#it
'iusi terasi#itasi
asi
'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a
'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a i-ut tera'i -an'un5
i-ut tera'i -an'un5an
an
5#u
5#u-s
-sa
a a7n
a7nr&
r&a#.
a#. Pen
Penin5
in5-at
-atan
an tin
tin5-a
5-at
t seru
seru&
& &et
&eta7
a7#it
#it pa'
pa'a
a i7u
i7u )an
)an5
5
&en5a
&en5a#a&i
#a&i 'ia7e
'ia7etes
tes >&isa#n
>&isa#n)a5#u
)a5#u-sa, asa&
-sa, asa& #e&a- 7e7as,
#e&a- 7e7as, sen)a(
sen)a(a
a -etn
-etn
'a#a& tu7u%, tri5#iseri'a, 'an asa&asa& a&in? a-an &e&i$u penin5-atan
'a#a& tu7u%, tri5#iseri'a, 'an asa&asa& a&in? a-an &e&i$u penin5-atan
tra
trans
nse
er
r nu
nutr
trie
ien
n pa
pa'a
'a a
ani
nin
n )a
)an5
n5 pa
pa'a
'a 5i
5i#i
#ira
rann
nn)a
)a a-
a-an
an &e
&eni
ni&7
&7u#
u#-a
-an
n
%iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eru7a% pertu&7u%an
%iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eru7a% pertu&7u%an
'an -&psisi tu7u% anin >Ra%a)u, !1"?.
'an -&psisi tu7u% anin >Ra%a)u, !1"?.
Ke&u'ian pa'a tri&ester -e'ua -e%a&i#an, pan-reas anin 'en5an i7u
Ke&u'ian pa'a tri&ester -e'ua -e%a&i#an, pan-reas anin 'en5an i7u
'ia7etes &e##itus 5estasina# a-an 7era'aptasi 'en5an %iper5#i-e&i- 'a#a&
'ia7etes &e##itus 5estasina# a-an 7era'aptasi 'en5an %iper5#i-e&i- 'a#a&
11
11
#i
#in5
n5-u
-un5
n5an
an u
ute
teru
rus
s '
'en
en5a
5an
n &e
&eni
nin
n5-
5-at
at-a
-an
n p
pr
r'u
'u-
-si
si in
insu
su#i
#in
n,
, )a
)an
n5
5
&en5a-i7at-an %iperinsu#ine&ia pa'a anin. Titi- -u#&inasi 'ari peristi(a
&en5a-i7at-an %iperinsu#ine&ia pa'a anin. Titi- -u#&inasi 'ari peristi(a
&eta7#i- )an5 tera'i 'i 'a#a& uterus ini a-an &en5a-i7at-an %ip5#i-e&ia,
&eta7#i- )an5 tera'i 'i 'a#a& uterus ini a-an &en5a-i7at-an %ip5#i-e&ia,
p#isite&ia,
p#isite&ia, %iper7i#iru7ine&ia,
%iper7i#iru7ine&ia, -&p#i-asi
-&p#i-asi 5a(at
5a(at naas
naas >respiratr)
>respiratr) 'istress
'istress
s)
s)n'
n'r
r&e
&e?,
?, 'a
'an
n pe
pert
rtu&
u&7u
7u%a
%an
n e
etu
tus
s )a
)an5
n5 7e
7era
ratn
tn)a
)a 7e
7er#
r#e7
e7i%
i%an
an at
atau
au
&a-rs&ia >Ra%a)u, !1"?.
&a-rs&ia >Ra%a)u, !1"?.
Ma-
Ma-rs
rs&i
&ia,
a, )an
)an5
5 'i'
'i'ei
einis
nisi-a
i-an
n se7
se7a5a
a5ai
i 7er
7erat
at #a%
#a%irB
irB 2.!
2.!!!
!! 5,
5, ter
tera'i
a'i
pa'a
pa'a !93!@
!93!@ 7a)i
7a)i )an5
)an5 i7un)a
i7un)a &en'erita
&en'erita Dia7etes
Dia7etes Mi#itus
Mi#itus Gestasina#.
Gestasina#.
Fa
Fa-t
-tr
r9
9a-
a-t
tr
r #a
#ain
in )a
)an5
n5 'a
'apa
pat
t 'i
'ipe
per#
r#i%
i%at
at pa
pa'a
'a i7
i7u
u )a
)an5
n5 &e
&e&i
&i$u
$u-a
-an
n
penin5-atan
penin5-atan insi'en
insi'en -e#a%iran
-e#a%iran anin
anin &a-rs&ia
&a-rs&ia ter&asu-
ter&asu- %iper5#i-e&ia,
%iper5#i-e&ia,
;') Mass In'e >;MI? tin55i, usia )an5 #e7i% tua, &u#tiparitas. Den5an ini,
;') Mass In'e >;MI? tin55i, usia )an5 #e7i% tua, &u#tiparitas. Den5an ini,
-asus &a-rs&ia 'apat
-asus &a-rs&ia 'apat &en)
&en)e7a7-
e7a7-an
an untu- &r7i'it
untu- &r7i'itas
as anin &enin5-at
anin &enin5-at
se(a-tu 'i#a%ir-an, seperti 'istsia 7a%u, 'an &enin5-at-an risi- -e#a%iran
se(a-tu 'i#a%ir-an, seperti 'istsia 7a%u, 'an &enin5-at-an risi- -e#a%iran
se$ara sa$ti $aesaria. ip5#i-e&ia nenata# 'apat tera'i 'a#a& 7e7erapa
se$ara sa$ti $aesaria. ip5#i-e&ia nenata# 'apat tera'i 'a#a& 7e7erapa
a&
a& sete#a%
sete#a% 'i#a%ir-an.
'i#a%ir-an. a#
a# ini
ini a'a#a%
a'a#a% -arena
-arena i7u
i7u )an5
)an5 %iper5#i-e&ia
%iper5#i-e&ia 'apat
'apat
&en)e7a7-an anin %iperinsu#ine&ia.
&en)e7a7-an anin %iperinsu#ine&ia.
K&p#i-asi an5-a p
K&p#i-asi an5-a panan5 pa'a anin
anan5 pa'a anin 'en5an i7u
'en5an i7u ter&asu- penin5-atan
ter&asu- penin5-atan
risi- int#eransi 5#u-sa, 'ia7etes, 'an 7esitas. K&p#i-asi pa'a i7u GDM
risi- int#eransi 5#u-sa, 'ia7etes, 'an 7esitas. K&p#i-asi pa'a i7u GDM
&e#iputi %ipertensi, pree-#a&psia, 'an penin5-atan risi- -e#a%iran se$ara
&e#iputi %ipertensi, pree-#a&psia, 'an penin5-atan risi- -e#a%iran se$ara
sa$ti $aesaria. ipertensi ini &un5-in ter-ait 'en5an resistensi insu#in. O#e%
sa$ti $aesaria. ipertensi ini &un5-in ter-ait 'en5an resistensi insu#in. O#e%
-arena itu,
-arena itu, inter*
inter*ensi
ensi )an5 &enunu-
)an5 &enunu--an
-an penin
penin5-at-
5-at-an
an sensit
sensiti*itas
i*itas insu#i
insu#in
n
'apat &e&7antu &en$e5a% -&p#i-asi ini. Ti'a- %an)a itu, (anita 'en5an
'apat &e&7antu &en$e5a% -&p#i-asi ini. Ti'a- %an)a itu, (anita 'en5an
ri(a)a
ri(a)at Dia7etes Mi#itus Gestasi
t Dia7etes Mi#itus Gestasina#
na# &e&i#i
&e&i#i-i penin5-
-i penin5-atan risi- 'ia7
atan risi- 'ia7etes
etes
se
sete
te#a
#a%
% -e
-e%a
%a&i
&i#a
#an
n se
se7e
7esa
sar
r 21
21,3
,3@
@ &e
&en'
n'er
erit
ita
a DM
DMG
G pa
pa'a
'a -e
-e%a
%a&i
&i#a
#an
n
7eri-utn)a,
7eri-utn)a, se'an5-an
se'an5-an pa'a
pa'a (anita
(anita )an5
)an5 ti'a-
ti'a- &e&i#i-i
&e&i#i-i ri(a)at
ri(a)at DMG
DMG
se7
se7e#
e#u&
u&n)
n)a
a %a
%an)
n)a
a 2,
2,@
@.0
.0 Ri
Risi
si-
- &e
&en'
n'eri
erita
ta 'i
'ia7
a7et
etes
es +
+ ta
ta%u
%un
n set
sete#
e#a%
a%
ter'
ter'ia5
ia5ns
nsis
is DMG
DMG a'a
a'a#a%
#a% ",0
",0@
@ 'an
'an sete
sete#a%
#a% 1!
1! ta%
ta%un
un &en
&ena'
a'i
i 1,
1,1@.
1@.1!
1!
Dia
Dia7et
7etes
es 5es
5estasi
tasina
na#
# )an
)an5
5 'it
'iterap
erapi
i a-a
a-an
n &en
&en5ur
5uran5
an5i
i risi
risi-
- &a-
&a-rs
rs&i
&ia,
a,
'istsia 7a%u, 'an %ipertensi 5estasina# >Lin5, !1"?.
'istsia 7a%u, 'an %ipertensi 5estasina# >Lin5, !1"?.
2.8 P$*$#i&+!!' Di!('/+"i& Di!$"$+ Mi%i")+
2.8 P$*$#i&+!!' Di!('/+"i& Di!$"$+ Mi%i")+ G$+"!+i/'!%
G$+"!+i/'!%
12
12
Men
Menuru
urut
t Li
Lin5
n5 >!
>!1"?
1"? pe&
pe&eri-
eri-saan
saan 'ia
'ia5n
5nsti-
sti- DMG
DMG 'ap
'apat
at 'i#
'i#a-u
a-u-an
-an
'en5an sa#a% satu 'ari 'ua strate5i 7eri-ut :
'en5an sa#a% satu 'ari 'ua strate5i 7eri-ut :
1. 6
1. 6One-step
One-step8 =+ 5ra& TTGO
8 =+ 5ra& TTGO
Strate5i
Strate5i One-Step
One-Step a'a#a% tes t#eransi 5#u-sa ra# 'en5an =+ 5ra&
a'a#a% tes t#eransi 5#u-sa ra# 'en5an =+ 5ra&
5#u
5#u-s
-sa.
a. Pen
Pen5u-
5u-ura
uran
n 5#u
5#u-s
-sa
a p#a
p#as&a
s&a 'i#
'i#a-u
a-u-an
-an saat
saat pasi
pasien
en 'a#
'a#a&
a&
-ea'aan puasa, 1 a&, 'an  a& sete#a% tes t#eransi 5#u-sa. Tes
-ea'aan puasa, 1 a&, 'an  a& sete#a% tes t#eransi 5#u-sa. Tes
'i#a-
'i#a-u-an pa'a
u-an pa'a usia -e%a&i#an 29 &in55u pa'a
usia -e%a&i#an 29 &in55u pa'a (anit
(anita
a %a&i# )an5
%a&i# )an5
se7e#u&n)a 7e#u& perna% ter'ia5nsis 'ia7etes &e#itus. Tes t#eransi
se7e#u&n)a 7e#u& perna% ter'ia5nsis 'ia7etes &e#itus. Tes t#eransi
5#u-sa ra# %arus 'i#a-u-an pa'a pa5i %ari sete#a% puasa se&a#a&an
5#u-sa ra# %arus 'i#a-u-an pa'a pa5i %ari sete#a% puasa se&a#a&an
set
seti'a
i'a-n)
-n)a
a se#a
se#a&a
&a 
 a&
a&.
. Dia
Dia5n
5nsis
sis DMG
DMG 'it
'ite5a
e5a--a
--an
n apa
apa7i#
7i#a
a %asi
%asi#
#
-a'ar 5#u-sa p#as&a ni#ain)a &e&enu%i seti'a-n)a satu -riteria 'i
-a'ar 5#u-sa p#as&a ni#ain)a &e&enu%i seti'a-n)a satu -riteria 'i
7a(a% ini:
7a(a% ini:
Pua
Puasa
sa 0
0 &5
&5'L
'L >+,
>+,1
1 &&
&&#L
#L?
?
atau #e7i% tin55i
atau #e7i% tin55i
1
1 
a
a&
& 1
1
!
! &
&5
5
'
'L
L >
>1
1!
! &
&&
&
#
#
L
L?
?
atau #e7i% tin55i
atau #e7i% tin55i

 
a
a&
& 1
1+
++
+ &
&5
5
'
'L
L >
>
,
,+
+ &
&&
&
#
#
L
L?
?
atau #e7i% tin55i
atau #e7i% tin55i
.
. 6
6Two-step
Two-step8
8 app
appra
ra$%
$% &en
&en55u
55una-
na-an
an +!
+! 5ra
5ra&
& 5#u
5#u-s
-sa
a >ta
>tanpa
npa pua
puasa?
sa?
'ii-uti 'en5an tes t#eransi 5#u-sa ra# >TTGO? &en55una-an 1!!
'ii-uti 'en5an tes t#eransi 5#u-sa ra# >TTGO? &en55una-an 1!!
5ra
5ra&
& 5#u
5#u-s
-sa
a i-
i-a
a s-r
s-rini
inin5
n5 a(a
a(a#
# &e&
&e&7er
7eri-a
i-an
n %as
%asi#
i# p
psiti
siti.
. Str
Strate5
ate5i
i
T(9Steps:
T(9Steps:

 Step 1
Step 1
La-
La-u-a
u-an
n tes
tes pe&
pe&7e7
7e7ana
anan
n 5#u
5#u-
-sa
sa +!
+! 5ra
5ra&
& >ta
>tanpa
npa pua
puasa?,
sa?,
-a'ar 5#u-sa p#as&a 'iu-ur 1 a& sete#a% pe&7e7anan 5#u-sa,
-a'ar 5#u-sa p#as&a 'iu-ur 1 a& sete#a% pe&7e7anan 5#u-sa,
'i#a-
'i#a-u-an pa'a
u-an pa'a (anit
(anita
a 'en5a
'en5an
n usia -e%a&i#an 29
usia -e%a&i#an 29 &in5
&in55u
5u
)an
)an5
5 7e#
7e#u&
u& per
perna%
na% ter
ter'ia
'ia5n
5nsis
sis 'ia
'ia7et
7etes
es &e#
&e#itu
itus.
s. i-
i-a
a -a'
-a'ar
ar
5#
5#u-
u-s
sa
a p#
p#as&
as&a
a 1
1 a
a&
& set
sete#
e#a%
a% pe
pe&7
&7e7
e7an
anan
an 5#
5#u-
u-s
sa
a B1
B12!
2!
&5'L >=, &&#L?, 'i#anut-an 'en5an tes t#eransi 5#u-sa
&5'L >=, &&#L?, 'i#anut-an 'en5an tes t#eransi 5#u-sa
ra# 'en5an 1!! 5ra& 5#u-sa.
ra# 'en5an 1!! 5ra& 5#u-sa.

 Step 
Step 
13
13
T
Tes
es t
t#e
#era
rans
nsi
i 5#
5#u-
u-s
sa
a r
ra#
a# 'e
'en5
n5an
an 1!
1!!
! 5r
5ra&
a& 5#
5#u-
u-s
sa
a
'i#a-u-an pa'a pasien 'a#a& -ea'aan puasa. Dua 'ari e&pat
'i#a-u-an pa'a pasien 'a#a& -ea'aan puasa. Dua 'ari e&pat
%asi# pen5u-uran 5#u-sa p#as&a &e&enu%i -riteria 7eri-ut:
%asi# pen5u-uran 5#u-sa p#as&a &e&enu%i -riteria 7eri-ut:
2.9 P$'!"!%!&+!'!!' M$4i+
2.9 P$'!"!%!&+!'!!' M$4i+ Di!$"$+ G$+"!+i/'!%
Di!$"$+ G$+"!+i/'!%
Terapi untu- pasien 'ia7etes &e##itus 5estasina# 'apat 'i#a-u-an 'en5an
Terapi untu- pasien 'ia7etes &e##itus 5estasina# 'apat 'i#a-u-an 'en5an
'ua $ara )aitu 'en5an terapi nn ar&a-#5i 'an terapi ar&a-#5i :
'ua $ara )aitu 'en5an terapi nn ar&a-#5i 'an terapi ar&a-#5i :
1.
1. T
Terap
erapi
i Far&
Far&a-
a-#5
#5is
is
1
1?
? I
In
ns
su
u#
#i
in
n
Insu#in a'a#a% %r&ne p#ipepti'a )an5 ter'iri 'ari +1 asa&
Insu#in a'a#a% %r&ne p#ipepti'a )an5 ter'iri 'ari +1 asa&
a&in )an5 tersusun 'a#a&  rantai, rantai A ter'iri 'ari 1 asa&
a&in )an5 tersusun 'a#a&  rantai, rantai A ter'iri 'ari 1 asa&
a&in 'an rantai ; &e&i#i-i 3! asa& a&in. Tuuan 'ari terapi
a&in 'an rantai ; &e&i#i-i 3! asa& a&in. Tuuan 'ari terapi
insu#in )aitu untu- &en5atur -a'ar 5#u-sa 'ara% 'en5an tar5et
insu#in )aitu untu- &en5atur -a'ar 5#u-sa 'ara% 'en5an tar5et
r
r5an
5an uta
uta&a
&a a'a
a'a#a%
#a% %ep
%epar
ar,
, t
tt,
t, 'an
'an ari
arin5a
n5an
n a'i
a'ips
psa.
a. Pre
Prepar
parat
at
insu#i
insu#in
n 'apat 'i7e'a-
'apat 'i7e'a-an 7er'asar-an #a&a
an 7er'asar-an #a&a -era )aitu
-era )aitu insu#i
insu#in
n -era
-era
$epat, se'an5, 'an panan5 >Tanu, !!=?. Me-anis&e -era 'ari
$epat, se'an5, 'an panan5 >Tanu, !!=?. Me-anis&e -era 'ari
i
in
ns
su
u#
#i
in
n )
)ai
ait
tu
u &
&en
enu
uru
run
n-
-a
an
n -
-a
a'
'a
ar
r 5
5#
#u
u-
-
sa
sa '
'a
ara
ra%
% '
'e
en
n5
5a
an
n
&e
&ens
nsti
ti&u
&u#as
#asi
i pe
pen5
n5a&
a&7i
7i#a
#an
n 5#
5#u-
u-s
sa
a pe
peri
rier
er 'a
'an
n &e
&en5
n5%a
%a&7
&7at
at
pr'u-si 5#u-sa %epati-.
pr'u-si 5#u-sa %epati-.
?
? O7
O7at 
at ip
ip5
5#i
#i-e
-e&i
&i- Or
- Ora# >
a# >O
OO?
O?
O7at %ip5#i-e&i- ra# 7iasa 'i5una-an untu- pasien DM a'a
O7at %ip5#i-e&i- ra# 7iasa 'i5una-an untu- pasien DM a'a
+ 5#n5an )aitu su#ni#urea, 7i5uani', &e5#itini', pen5%a&7at 
+ 5#n5an )aitu su#ni#urea, 7i5uani', &e5#itini', pen5%a&7at 
5#i-si'ase, 'an tia#i'ine'ine. Na&un, 7at %ip5#i-e&i- ra#
5#i-si'ase, 'an tia#i'ine'ine. Na&un, 7at %ip5#i-e&i- ra#
)an5 a&an 'an 'apat 'i7eri-an pa'a pasien DM 5estasina# %an)a
)an5 a&an 'an 'apat 'i7eri-an pa'a pasien DM 5estasina# %an)a
5#i7u
5#i7uri'5
ri'5#i7en-
#i7en-#a&i'
#a&i' >su#
>su#ni#ure
ni#urea?,
a?, &etr
&etr&in
&in >7i5u
>7i5uani'?
ani'?,
, 'an
'an
14
14
<arpenter<ustan NDDG
<arpenter<ustan NDDG
P
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ua
as
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NDDG,
NDDG, National Diabetes Data Gr
National Diabetes Data Group
oup
a-a
a-ar7
r7se
se >pe
>pen5%
n5%a&7
a&7at
at 95
95#i-
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si'ase?
ase? >T%
>T%a$-
a$-er
er Q
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,
!!0?.
!!0?.
G#i
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i'5#i
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i' >su
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a? 7e-
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an5san5 se
san5 se-re
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si insu#in 'a
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ri 5ranu# se#9
u# se#9se#
se# 7e
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ta #an
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5er%an
%ans
s
pan-reas.
pan-reas. Metr&in
Metr&in >7i5uani'?
>7i5uani'? 7e-era
7e-era 'en5an
'en5an &enurun-an
&enurun-an
pr'u-si
pr'u-si 5#u-sa
5#u-sa 'i
'i %epar
%epar 'an
'an &enin5-at-an
&enin5-at-an sensiti*itas
sensiti*itas arin5an
arin5an
tt 'an arin5an a'ipsa ter%a'ap insu#in. A-ar7se >pen5%a&7at
tt 'an arin5an a'ipsa ter%a'ap insu#in. A-ar7se >pen5%a&7at
9
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5#i-
i-s
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i'as
ase?
e? 7e
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& 9
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5#i-si'ase 'i 7rus% 7r'er intestine se%in55a 'apat &e&per#a&7at
5#i-si'ase 'i 7rus% 7r'er intestine se%in55a 'apat &e&per#a&7at
a7srpsi p#isa-ari'a, 'e-strin, 'an 'isa-ari'a 'i intestine >Tanu,
a7srpsi p#isa-ari'a, 'e-strin, 'an 'isa-ari'a 'i intestine >Tanu,
!!=?.
!!=?.
.
. T
Ter
erap
api N
i Nn F
n Far
ar&a
&a-
-#
#5i
5is
s
1
1?
? D
Di
ie
et
t D
DM
M 
 M
MN
NT
T >
>Medical Nutrition Therapy
Medical Nutrition Therapy?
?
Dietterapi nutrisi &erupa-an pen57atan stan'ar untu- se&ua
Dietterapi nutrisi &erupa-an pen57atan stan'ar untu- se&ua
pasien
pasien 'ia7etes
'ia7etes &e##itus
&e##itus 5estasina#
5estasina# 'en5an
'en5an tuuan
tuuan &enin5-at-an
&enin5-at-an
nut
nutrisi
risi unt
untu-
u- i7u
i7u 'an
'an an
anin,
in, &en
&enin5
in5-at
-at-an
-an asu
asupan
pan -a#
-a#ri
ri 7a5
7a5i
i
tu&7u% -e&7an5 anin, pen5aturan nr&5#i-e&ia, 'an &en$e5a%
tu&7u% -e&7an5 anin, pen5aturan nr&5#i-e&ia, 'an &en$e5a%
-etsis >Seti
-etsis >Seti et al.
et al., !!+?.
, !!+?.
?
? Self Monitoring of Blood Glucose
Self Monitoring of Blood Glucose >SM;G?
>SM;G?
merican
merican Diabetes
Diabetes ssociation
ssociation >ADA?
>ADA? &ere-
&ere-&en'
&en'asi-an
asi-an
&nitrin5 5#u-sa 'ara% >SM;G? 'apat 'i#a-u-an se7an)a- 3
&nitrin5 5#u-sa 'ara% >SM;G? 'apat 'i#a-u-an se7an)a- 3
atau #e7i% se%ari untu- pasien )an5 &en55una-an ine-si insu#in
atau #e7i% se%ari untu- pasien )an5 &en55una-an ine-si insu#in
atau terapi p&pa insu#in.
atau terapi p&pa insu#in.
BAB III
BAB III
ASUHAN KEPERAWATAN
ASUHAN KEPERAWATAN
.1 K!+)+
.1 K!+)+
N)
N).
. 
 3+
3+ ta%un,
ta%un, G2
G2 P3A!,
P3A!, usia
usia -e%a&i#an
-e%a&i#an 3!
3! &in55u,
&in55u, 'i
'i ra(at
ra(at 'i
'i RS
RS
'en5an -e#u%an sea- 3 %ari )an5 #a#u &en)ata-an &u'a% #e#a%, ti'a- nasu
'en5an -e#u%an sea- 3 %ari )an5 #a#u &en)ata-an &u'a% #e#a%, ti'a- nasu
&a-an, &ua# &unta% B " -a#i, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi#
&a-an, &ua# &unta% B " -a#i, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi#
pe&eri-saan ;; +-5, T; 1"! $&, T; : !! 5ra&, %asi# #a7ratriu& GDS
pe&eri-saan ;; +-5, T; 1"! $&, T; : !! 5ra&, %asi# #a7ratriu& GDS
: +! &5'#, ri(a)at -e#uar5a 'en5an DM, ri(a)at &e#a%ir-an ana- -eti5a
: +! &5'#, ri(a)at -e#uar5a 'en5an DM, ri(a)at &e#a%ir-an ana- -eti5a
'en
'en5an
5an ;;L 2!!
;;L 2!! 5r
5r.
. O#e
O#e%
% '-
'-ter
ter N)
N).
. 
 'in
'in)at
)ata-a
a-an
n &en
&en5i'
5i'ap
ap Dia
Dia7et
7etes
es
15
15
Gest
Gestasi
asina#
na# -e&
-e&u'i
u'ian
an 'i7
'i7eri-
eri-an
an %u&
%u&u#i
u#in
n 3!
3!=!
=! +
+ I
I 3!
3! &nt a.$.,
&nt a.$., N)
N).
. 

$e
$e&
&as
as pe
pe&7
&7er
eria
ian
n in
insu
su#i
#in
n a-
a-an
an &e
&en)
n)e7
e7a7
a7-
-an
an -e
-ete
ter
r5
5an
antu
tun
n5a
5an
n '
'an
an
&en)e7a7-an 5an55uan per-e&7an5an aninn)a. Se#a&a
&en)e7a7-an 5an55uan per-e&7an5an aninn)a. Se#a&a 'i RS, N).  aran5
'i RS, N).  aran5
'itun55u -e#uar5an)a -arena sua&i
'itun55u -e#uar5an)a -arena sua&i N)
N).  %arus
.  %arus 7e-era, 'an ran5
7e-era, 'an ran5 tua N). 
tua N). 
u5a &era(at ana- N)
u5a &era(at ana- N). . >Sa# Si&u#asi K;S KOM Ners 12
. . >Sa# Si&u#asi K;S KOM Ners 12?.
?.
.2 A+),!' K$$#!!"!'
.2 A+),!' K$$#!!"!'
P$'(&!-i!':
P$'(&!-i!':
1.
1. I'
I'en
enti
tita
tas
s
a?
a? Na
Na&a
&a: N)
: N). 
. 
7?
7? sia: 3+ ta%un
sia: 3+ ta%un
$?
$? ;;
;;: 
: + -
+ -5
5
'?
'? T;
T;: 1
: 1"!
"! $&
$&
e?
e? a
a&i
&i# an
# ana- -
a- -e: 2
e: 2
?
? Pa
Part
rtus
us: 3 -
: 3 -a#
a#i
i
.
. Ke
Ke#u
#u%a
%an t
n ta&
a&a
a
Mu'a% #e#a%, ti'a- nasu &a-an, &ua# &unta%, #e&as, &erasa %aus,
Mu'a% #e#a%, ti'a- nasu &a-an, &ua# &unta%, #e&as, &erasa %aus,
7an)a- -en$in5.
7an)a- -en$in5.
3.
3. Ri(a)
Ri(a)at
at Pen)a
Pen)a-it
-it Ke#ua
Ke#uar5a
r5a
Ke#uar5a &e&pun)ai ri(a)at Dia7etes &e##itus
Ke#uar5a &e&pun)ai ri(a)at Dia7etes &e##itus
2.
2. Ri(
Ri(a)a
a)at Ke%a&
t Ke%a&i#an Se-
i#an Se-aran
aran5
5
a
a&i
&i#
# tu
tua
a us
usia
ia 3!
3! &i
&in5
n55u
5u 'e
'en5
n5an
an -e
-e#u
#u%a
%an
n se
sea-
a- 3
3 %a
%ari
ri )a
)an5
n5 #a#
#a#u
u
&en)ata-an &u'a% #e#a%, ti'a- nasu &a-an, &ua# &unta% B " -a#i,
&en)ata-an &u'a% #e#a%, ti'a- nasu &a-an, &ua# &unta% B " -a#i,
#e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# pe&eri-saan ;; +-5,
#e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# pe&eri-saan ;; +-5,
T; 1"! $&.
T; 1"! $&.
+.
+. P#
P#a A-ti
a A-ti*it
*itas
as Se%
Se%ari
ari9%ar
9%ari
i
a?
a? P#a Nut
P#a Nutrisi: -#ie
risi: -#ien ti'a- na
n ti'a- nasu &a-an &u
su &a-an &u#a, &erasa %au
#a, &erasa %aus
s
7?
7? P#a E#i&inasi: -#ien serin5 -en$in5.
P#a E#i&inasi: -#ien serin5 -en$in5.
".
". Asp
Aspe-
e- psi
psi-#
-#5i
5is
s
N)
N).
. 
 &erasa
&erasa $e&as
$e&as pe&7erian
pe&7erian insu#in
insu#in a-an
a-an &en)e7a7-an
&en)e7a7-an
-eter5antun5an 'an &en)e7a7-an 5an55uan per-e&7an5an aninn)a.
-eter5antun5an 'an &en)e7a7-an 5an55uan per-e&7an5an aninn)a.
=.
=. As
Aspe
pe- S
- Ss
sia
ia#
#
N)
N).
. 
 aran5
aran5 'itun55u -e#uar5an)a
'itun55u -e#uar5an)a -arena
-arena sua&i
sua&i N)
N).
. 
 %arus
%arus 7e-era,
7e-era,
'an ran5 tua
'an ran5 tua N)
N).  u5a
.  u5a &era(at ana-
&era(at ana- N)
N). .
. .
.
. Da
Data O
ta O7
7e-
e-ti
ti

a?
a? Pe
Pe&e
&eri
ri-s
-saan &
aan &u&
u&


K
Ke
ea
a'
'a
aa
an
n u
u&
&u
u&
& :
: 7
7a
ai
i-
-
16
16

 K
Ke
es
sa
a'
'a
ar
ra
an
n :
: $
$
&
&p
p
s
s&
&e
en
nt
ti
is
s

 S
St
ta
at
tu
us e
s e&
&
s
si
i
n
na
a#
# : s
: st
ta
a7
7i
i#
#

 ;;: + K5
;;: + K5

 T;: 1"! $&
T;: 1"! $&
7?
7? Pe&eri-saan Fisi-
Pe&eri-saan Fisi-

 Ke
Kepa
pa#a
#a : &
: &ess
ess$
$ep
epa#
a#. T
. Ti'
i'a-
a- a'
a'a 7
a 7en
en
#an
#an, 7
, 7er
ersi%
si%, t
, ti'
i'a-
a-
7er-et&7e
7er-et&7e

 4
4aa%
aa% :
: si&etris,
si&etris, ti'a-
ti'a- a'a
a'a 'e&a,
'e&a,

 T
Te#in5a
e#in5a :
: si&etris,
si&etris, ter'apat
ter'apat #u7an5
#u7an5 te#in5a
te#in5a

 Mat
Mata
a :
: si&
si&etri
etris,
s, -n
-nun
un5ti
5ti*a
*a &er
&era%
a% &u'
&u'a,
a, s$#e
s$#era
ra put
puti%
i%

 i'u&5
i'u&5 : si&etris, ti'a-
: si&etris, ti'a- p#ip, ti'a-
p#ip, ti'a- a'a se-ret
a'a se-ret

 Mu#ut
Mu#ut :
: si&etri
si&etris,
s, ti'a-
ti'a- #a7i
#a7is-isisp
s-isispa#ats-
a#ats-isis,
isis, ti'a-
ti'a- -aries
-aries 5i5i
5i5i

 Le%er
Le%er :
: ti'a-
ti'a- a'a
a'a p&7es
p&7esaran
aran *ena
*ena u5u#
u5u#aris,
aris, -e#en
-e#enar
ar
partis#i&e
partis#i&e

 Da'
Da'a
a :
: si&
si&etri
etris,
s, ti'
ti'a-
a- retr
retra-s
a-si
i 'in
'in'in
'in5
5 'a'
'a'a.
a.

 P
Pa
a)
)u
u'
'a
ar
ra:
a: si
si&
&e
et
tri
ris
s,
, p
pu
ut
tt
ti
in
n5
5 &
&e
en
n
n
n

#
#,
, $
$
#
#u
ust
str
ru
u&
&>
>9?
9?,
,
%)perpi5&entasi
%)perpi5&entasi
0.
0. Da
Data pe
ta penu
nun
nan
an5
5

 GDS: +! &5'#
GDS: +! &5'#

 %u&u#in 3!=! + I 3! &nt a.$
%u&u#in 3!=! + I 3! &nt a.$
Analisa Data:
Analisa Data:
N
N Data
Data Eti#5i
Eti#5i Masa#a% -epera(atan
Masa#a% -epera(atan
1
1.
. D
DS
S:
:

 K#ien &en5e#u% ti'a-
K#ien &en5e#u% ti'a-
naasu &a-an
naasu &a-an

 K#ien &en5e#u%
K#ien &en5e#u%
&ua#, &unta%
&ua#, &unta%
DO: 9
DO: 9
Ke%a&i#an
Ke%a&i#an
Penin5-atan %r&n <G
Penin5-atan %r&n <G
Mua#, &unta%, ti'a- nasu &a-an
Mua#, &unta%, ti'a- nasu &a-an
Keti'a- sei&7an5an nutrisi -uran5
Keti'a- sei&7an5an nutrisi -uran5
'ari -e7utu%an tu7u%
'ari -e7utu%an tu7u%
Keti'a- sei&7an5an
Keti'a- sei&7an5an
nutrisi -uran5 'ari
nutrisi -uran5 'ari
-e7utu%an tu7u%
-e7utu%an tu7u%

.
. D
DS
S:
:

 K#ien &en5e#u%
K#ien &en5e#u%
&ua#, &unta%.
&ua#, &unta%.

 K#ien &erasa %aus
K#ien &erasa %aus
DO: 9
DO: 9
Ke%a&i#an
Ke%a&i#an
Penin5-atan %r&n <G
Penin5-atan %r&n <G
Mua#, &unta%, ti'a- nasu &a-an
Mua#, &unta%, ti'a- nasu &a-an
Ke-uran5an *#u&e $airan
Ke-uran5an *#u&e $airan
Ke-uran5an *#u&e
Ke-uran5an *#u&e
$airan
$airan
17
17
3
3.
. D
DS
S:
:

 K#ien &en)ata-an
K#ien &en)ata-an
&u'a% #e#a%
&u'a% #e#a%

 K#ien &n5e#u% #e&as
K#ien &n5e#u% #e&as
DO: 9
DO: 9
Ke%a&i#an
Ke%a&i#an
Peru7a%an %r&na# 'an &eta7#is&e
Peru7a%an %r&na# 'an &eta7#is&e
Penin5-atan %&n -rtis#, estr5en
Penin5-atan %&n -rtis#, estr5en
'an PL
'an PL
Resistensi insu#in
Resistensi insu#in
Se#9se# -e#aparan
Se#9se# -e#aparan
Pr'u-si ener5i 'i se#9se# tt
Pr'u-si ener5i 'i se#9se# tt
7er-uran5
7er-uran5
Le&as, &u'a% #e#a%
Le&as, &u'a% #e#a%
Ke#eti%an
Ke#eti%an
Ke#eti%an
Ke#eti%an
Di!('/+! K$$#!!"!'
Di!('/+! K$$#!!"!'
1.
1. Keti'a
Keti'a- sei&7
- sei&7an5an n
an5an nutris
utrisi -uran
i -uran5 'ari -e
5 'ari -e7utu%
7utu%an tu7u
an tu7u% 7.' -e
% 7.' -eti'a-&
ti'a-&a&puan
a&puan
untu- &en$erna &a-anan.
untu- &en$erna &a-anan.
.
. Ke-ur
Ke-uran5an
an5an *#u&
*#u&e $ai
e $airan
ran 7.'
7.' -e%i#a
-e%i#an5an
n5an $aira
$airan a-
n a-ti.
ti.
3.
3. Ke
Ke#e
#eti
ti%a
%an 7
n 7.'
.' -e
-e%a
%a&i
&i#an
#an.
.
R$'6!'! I'"$#;$'+i
R$'6!'! I'"$#;$'+i
D
Di
i!
!(
('
'/
/+
+!
! N
NO
O3
3 N
NI
I3
3
1.
1. Ket
Keti'a
i'a-
- sei
sei&7a
&7an5a
n5an
n
nutrisi -uran5 'ari
nutrisi -uran5 'ari
-e7utu%an tu7u% 7.'
-e7utu%an tu7u% 7.'
-eti'a-&a&puan
-eti'a-&a&puan
untu- &en$erna
untu- &en$erna
&a-anan.
&a-anan.
Deinisi:
Deinisi:
Asupan nutrisi ti'a-
Asupan nutrisi ti'a-
$u-up untu- &e&enu%i
$u-up untu- &e&enu%i
-e7utu%an &eta7#i-
-e7utu%an &eta7#i-
>D&ain . Nutrisi,
>D&ain . Nutrisi,
-e#as 1. Ma-an, -'e
-e#as 1. Ma-an, -'e
!!!!?
!!!!?
Sete#a% 'i#a-u-an asu%an
Sete#a% 'i#a-u-an asu%an
-epera(atan se#a&a 32 a&
-epera(atan se#a&a 32 a&
'i%arapa-an pe&enu%an
'i%arapa-an pe&enu%an
-e7utu%an nutrisi -#ien
-e7utu%an nutrisi -#ien
terpenu%i, 'en5an -riteria
terpenu%i, 'en5an -riteria
%asi#:
%asi#:
S"!")+ N)"#i+i: A+)!'
S"!")+ N)"#i+i: A+)!'
M!&!'!' 4!' 6!i#!' <1008=
M!&!'!' 4!' 6!i#!' <1008=

 Asupan &a-anan
Asupan &a-anan
se$ara ra# terpenu%i
se$ara ra# terpenu%i

 Asu%an $airan se$ara
Asu%an $airan se$ara
ra# terpenu%i
ra# terpenu%i

 Asupan nutrisi
Asupan nutrisi
parentera# terpenu%i
parentera# terpenu%i
S"!")+ N)"#i+i: A+)!'
S"!")+ N)"#i+i: A+)!'
M!'!-$*$' N)"#i+i
M!'!-$*$' N)"#i+i

 T
Tentu-an u&#a%
entu-an u&#a% -a#ri
-a#ri
'an enis nutrisi )an5
'an enis nutrisi )an5
'i7utu%-an untu-
'i7utu%-an untu-
&e&enu%i pers)aratan
&e&enu%i pers)aratan
5ii.
5ii.
R!+i/'!%:
R!+i/'!%:Me&7antu
Me&7antu
'a#a& &en5i'entii-asi
'a#a& &en5i'entii-asi
&a#nutris prtein9
&a#nutris prtein9
prtein.
prtein.

 Atur 'iet )an5
Atur 'iet )an5
'iper#u-an )aitu 'en5an
'iper#u-an )aitu 'en5an
&enin5-at-an asupan
&enin5-at-an asupan
prtein 'an *ita&in.
prtein 'an *ita&in.
R!+i/'!%:
R!+i/'!%:untu-
untu-
&enin5-at-an -ese%atan
&enin5-at-an -ese%atan
i7u 'an anin.
i7u 'an anin.

 Anur-an -#ien untu-
Anur-an -#ien untu-
18
18
N)"#i+i <1009=
N)"#i+i <1009=

 Asupan -a#ri
Asupan -a#ri
terpenu%i
terpenu%i

 Asupan prtein
Asupan prtein
terpenu%i
terpenu%i


Asupan -ar7%i'rat
Asupan -ar7%i'rat
terpenu%i
terpenu%i

 Asupan *ita&in
Asupan *ita&in
terpenu%i
terpenu%i

 Asupan &inera#
Asupan &inera#
terpenu%i
terpenu%i

 Asupan at 7esi
Asupan at 7esi
terpenu%i
terpenu%i
&e&antau -a#ri 'an
&e&antau -a#ri 'an
inta-e &a-anan 'en5an
inta-e &a-anan 'en5an
&e&7uat $atatan
&e&7uat $atatan
&a-anan %arian.
&a-anan %arian.
R!+i/'!%:
R!+i/'!%: ntu-
ntu-
&en5eta%ui -a#ri 'an
&en5eta%ui -a#ri 'an
nutrisi pasien terpenu%i
nutrisi pasien terpenu%i
atau ti'a-
atau ti'a-
M/'i"/#i'( N)"#i+i
M/'i"/#i'( N)"#i+i

 Ti&7an5 7erat 7a'an
Ti&7an5 7erat 7a'an
-#ien
-#ien
R!+i/'!%:
R!+i/'!%: Pena&7a%an
Pena&7a%an
7erat 7a'an a'a#a%
7erat 7a'an a'a#a%
-un$i petunu- untu-
-un$i petunu- untu-
&e&utus-an
&e&utus-an
pen)esuaian -e7utu%an
pen)esuaian -e7utu%an
-a#ri
-a#ri

 Mnitr a'an)a &ua#
Mnitr a'an)a &ua#
'an &unta%
'an &unta%
R!+i/'!%:
R!+i/'!%: Mua# 'an
Mua# 'an
&unta% 'apat
&unta% 'apat
&en5a-i7at-an
&en5a-i7at-an
'eisiensi -ar7%i'rat
'eisiensi -ar7%i'rat
)an5 'apat
)an5 'apat
&en5a-i7at-an
&en5a-i7at-an
&eta7#is&e #e&a- 'an
&eta7#is&e #e&a- 'an
tera'in)a -etsis.
tera'in)a -etsis.

 La-u-an pe&eri-san
La-u-an pe&eri-san
#a7ratriu&, &nitr
#a7ratriu&, &nitr
%asi#n)a: -a'ar a#7u&in,
%asi#n)a: -a'ar a#7u&in,
tta# prtein, 7 'an
tta# prtein, 7 'an
-a'ar t.
-a'ar t.
R!+i/'!%:
R!+i/'!%: untu-
untu-
&en5eta%ui -a'ar
&en5eta%ui -a'ar
a#7u&in, tta# prtein,
a#7u&in, tta# prtein,
7 'an -a'ar t.
7 'an -a'ar t.
19
19
. Ke-uran5an *#u&e
. Ke-uran5an *#u&e
$airan 7.' -e%i#an5an
$airan 7.' -e%i#an5an
$airan a-ti.
$airan a-ti.
Deinisi:
Deinisi:
Penurunan $airan
Penurunan $airan
intra*as$u#ar,
intra*as$u#ar,
interstisia#, 'anatau
interstisia#, 'anatau
intrase#u#ar. Ini
intrase#u#ar. Ini
&en5a$u pa'a
&en5a$u pa'a
'e%i'rasi, -e%i#an5an
'e%i'rasi, -e%i#an5an
$airan saa tanpa
$airan saa tanpa
peru7a%an -a'ar
peru7a%an -a'ar
nattriu&.
nattriu&.
>D&ain . Nutrisi,
>D&ain . Nutrisi,
-e#as +. i'rasi, -'e
-e#as +. i'rasi, -'e
!!!=?
!!!=?
Se
Sete#
te#a%
a% 'i
'i#a
#a-u
-u-a
-an
n tin
tin'a
'a-a
-an
n
-epera(atan se#a&a 12 a&
-epera(atan se#a&a 12 a&
'
'i
i%
%a
ar
ra
ap
p-
-a
an
n -
-e
e-
-u
ur
ra
an
n5
5a
an
n
*
*#u
#u&e
&e $a
$air
iran
an -#
-#ie
ien
n 'a
'apa
pat
t
teratasi, 'en5an -riteria %asi#:
teratasi, 'en5an -riteria %asi#:
K$+$i*!'(!' 3!i#!' <001=
K$+$i*!'(!' 3!i#!' <001=

 ;erat 7a'an sta7i#.
;erat 7a'an sta7i#.

 Ke
Kese
sei&
i&7a
7an5
n5an
an inta!e
inta!e
'
'a
an
n output
output 'a#
'a#a& 2
a& 2
a& a'e-uat.
a& a'e-uat.
Hi4#!+i <002=
Hi4#!+i <002=

 Tur5r -u#it nr&a#.
Tur5r -u#it nr&a#.

 M
Me
e&
&7
7r
ra
an
n &
&u
u-
-
s
sa
a
#e&7a7.
#e&7a7.
K
K$
$
!
!#
#!
!,
,!
!'
' M
M)
)!
!%
% 4
4!
!'
'
M)'"!, <2107=
M)'"!, <2107=

 T
Ti'
i'a-
a- a'
a'a
a r
re-
e-ue
uens
nsi
i
&ua#.
&ua#.

 T
Ti'
i'a-
a- a'
a'a
a r
re-
e-ue
uens
nsi
i
&unta%.
&unta%.
M!'!-$*$' 3!i#!' <120=
M!'!-$*$' 3!i#!' <120=

 Ti&7an5 7erat 7a'an
Ti&7an5 7erat 7a'an
setiap %ari 'an &nitr
setiap %ari 'an &nitr
status pasien.
status pasien.
R!+i/'!%:
R!+i/'!%:
ntu- &en5eta%ui 7erat
ntu- &en5eta%ui 7erat
7a'an -#ien apa7i#a
7a'an -#ien apa7i#a
tera'i peru7a%an 7erat
tera'i peru7a%an 7erat
7a'an -arena
7a'an -arena
-e-uran5an $airan.
-e-uran5an $airan.

 a5a
a5a inta!e
inta!e asupan
 asupan
)an5 a-urat 'an $atat
)an5 a-urat 'an $atat
output
output -#ien.
-#ien.
R!+i/'!%:
R!+i/'!%:
A5ar pe&asu-an $airan
A5ar pe&asu-an $airan
-#ien tepat 'an 'apat
-#ien tepat 'an 'apat
&en5eta%ui
&en5eta%ui
per-e&7an5an status
per-e&7an5an status
$airan -#ien.
$airan -#ien.

 ;eri-an terapi I seperti
;eri-an terapi I seperti
)an5 'itentu-an.
)an5 'itentu-an.
R!+i/'!%:
R!+i/'!%:
A5ar pe&enu%an $airan
A5ar pe&enu%an $airan
tepat sesuai 'en5an
tepat sesuai 'en5an
terapi )an5 'i7eri-an.
terapi )an5 'i7eri-an.
M/'i"/# 3!i#!' <10=
M/'i"/# 3!i#!' <10=

 Mnitr &e&7ran
Mnitr &e&7ran
&u-sa, tur5r -u#it,
&u-sa, tur5r -u#it,
'an respn %aus.
'an respn %aus.
R!+i/'!%:
R!+i/'!%:
ntu- &en5eta%ui
ntu- &en5eta%ui
&enunu--an
&enunu--an
-e%i#an5an $airan
-e%i#an5an $airan
7er#e7i% 'e%i'rasi.
7er#e7i% 'e%i'rasi.
M!'!-$*$' M)'"!, <170=
M!'!-$*$' M)'"!, <170=

 Aar-an pen55unaan
Aar-an pen55unaan
te-ni- nnar&a-#5i
te-ni- nnar&a-#5i
untu- &en5e##a &unta%
untu- &en5e##a &unta%
20
20
T
T!'4!>T!'4! Vi"!% <
!'4!>T!'4! Vi"!% <0802=
0802=

 Su%u tu7u% nr&a#
Su%u tu7u% nr&a#

 De
Den
n)u
)ut
t na
na'
'i
i ra
ra'
'ia
ia#
#
nr&a#
nr&a#

 T
Tin5
in5-a
-at
t pe
pern
rnap
apasa
asan
n
nr&a#
nr&a#

 Te-anan 'ara% sist#i-
Te-anan 'ara% sist#i-
nr&a#
nr&a#

 T
Te
e-
-a
an
na
an
n '
'a
ar
ra
a%
%
'iast#i- nr&a#
'iast#i- nr&a#
Se
Sete#
te#a%
a% 'i
'i#a
#a-u
-u-a
-an
n tin
tin'a
'a-a
-an
n
-epera(atan se#a&a 12 a&
-epera(atan se#a&a 12 a&
'i
'i%a
%ara
rap-
p-an
an -e
-e#et
#eti%
i%an
an -#
-#ie
ien
n
'apa
'apat
t terat
teratasi,
asi, 'en5a
'en5an
n -rite
-riteria
ria
>&isa#n)a, %ipnsis,
>&isa#n)a, %ipnsis,
re#a-sasi, a-upresur?.
re#a-sasi, a-upresur?.
M/'i"/#
M/'i"/# T
T!'4!>T!'4! Vi"!%
!'4!>T!'4! Vi"!%
<80=
<80=

 Mnitr te-anan 'ara%,
Mnitr te-anan 'ara%,
na'i, su%u, 'an status
na'i, su%u, 'an status
pernaasan 'en5an tepat.
pernaasan 'en5an tepat.
R!+i/'!%:
R!+i/'!%:
ntu- &en5eta%ui
ntu- &en5eta%ui
a'an)a peru7a%an
a'an)a peru7a%an
tan'a9tan'a *ita# atau
tan'a9tan'a *ita# atau
per-e&7an5an status
per-e&7an5an status
-ese%atan -#ien.
-ese%atan -#ien.
M!'!-$*$' E'$#(i <0180=
M!'!-$*$' E'$#(i <0180=

 M
Mni
nit
tr
r inta!e
inta!e
 as
asup
upan
an
n
nu
ut
tr
ri
is
si
i u
un
nt
tu
u-
-
&
&e
en
n5
5e
eta
ta%
%u
ui
i s
su
u&
&7
7e
er
r
ener5i )an5 a'e-uat.
ener5i )an5 a'e-uat.
R!+i/'!%:
R!+i/'!%:

n
nt
tu
u-
- &
&e
e&
&
n
ni
it
t
r
r
a
as
su
up
pa
an
n n
nu
ut
tr
ris
isi
i a
a5
5a
ar
r
s
su
u&
&7
7e
er
r e
en
ne
er
r5
5i
i )
)a
an
n5
5
'i'apat-an a'e-uat a5ar
'i'apat-an a'e-uat a5ar
ti'a- #e&a%, #e&as, 'an
ti'a- #e&a%, #e&as, 'an
#eti%.
#eti%.

 Kn
Knsu#
su#-an
-an 'en
'en5an
5an a%#
a%#i
i
5
5i
i
i
i &
&e
en
n5
5e
en
na
ai
i $
$a
ar
ra
a
&e
&eni
nin5
n5-a
-at-
t-an
an as
asup
upan
an
ener5i 'ari &a-anan.
ener5i 'ari &a-anan.
R!+i/'!%:
R!+i/'!%:
M
Me
e&
&7
7a
an
nt
tu
u -
-#
#i
ie
en
n
&e
&en5
n5et
eta%
a%ui
ui &a
&a-a
-ana
nan
n
)a
)an5
n5 tep
tepat
at )a
)an5
n5 'a
'apa
pat
t
&e
&eni
nin5
n5-a
-at-
t-an
an en
ener
er5i
5i
-
-#
#i
ie
en
n a
a5
5a
ar
r t
ti
i'
'a
a-
-
-e#eti%an.
-e#eti%an.

 ;
;a
an
nt
tu
u -
-#
#i
ie
en
n u
un
nt
tu
u-
-
21
21
3. Ke#eti%an 7.'
3. Ke#eti%an 7.'
-e%a&i#an
-e%a&i#an
Deinisi:
Deinisi:
Ke#eti%an terus9&enerus
Ke#eti%an terus9&enerus
'
'a
an
n p
pe
en
nu
ur
ru
un
na
an
n
-a
-apa
pasi
sitas
tas un
untu
tu-
- -e
-era
ra
i
isi
si-
- 'a
'an
n &e
&ent
nta#
a# pa
pa'a
'a
tin5-at )an5 #ai&.
tin5-at )an5 #ai&.
>D&ain 2. A-ti*itas
>D&ain 2. A-ti*itas
Istira%at, -e#as 3
Istira%at, -e#as 3
Kesei&7an5an Ener5i,
Kesei&7an5an Ener5i,
-'e !!!03?
-'e !!!03?
%asi#:
%asi#:
K/'+$#;!+i $'$#(i <0002=
K/'+$#;!+i $'$#(i <0002=

 Me&perta%an-an
Me&perta%an-an
i
in
nt
ta
a!
!e
e nu
nutr
tris
isi
i )a
)an5
n5
$u-up.
$u-up.

 Men
Men55u
55una-
na-an
an te-
te-ni-
ni-
-nser*asi ener5i.
-nser*asi ener5i.
Men5atur a-ti*itas untu-
Men5atur a-ti*itas untu-
-nser*asi ener5i.
-nser*asi ener5i.
&
&e
e&
&a
a%
%a
a&
&i
i p
pr
ri
in
ns
si
ip
p
-
-
n
ns
se
er
r*
*a
as
si
i e
en
ne
er
r5
5i
i
>&
>&isa
isa#n
#n)a
)a,
, -e
-e7u
7utu
tu%a
%an
n
u
un
nt
tu
u-
- &
&e
e&
&7
7a
at
ta
as
si
i
a
a-
-t
ti
i*
*i
it
ta
as
s '
'a
an
n t
ti
ir
ra
a%
%
7arin5?.
7arin5?.
R!+i/'!%:
R!+i/'!%:
A
A5
5a
ar
r -
-#
#i
ie
en
n '
'a
ap
pa
at
t
&en5ntr# a-t*itas 'an
&en5ntr# a-t*itas 'an
t
ti
ir
ra
a%
% 7
7a
ar
ri
in
n5
5 u
un
nt
tu
u-
-
&en
&en5ur
5uran5
an5i
i ras
rasa
a #et
#eti%,
i%,
#e#a% 'an #e&as.
#e#a% 'an #e&as.

 ;antu
;antu -#ien
-#ien i'enti
i'entii-asi
i-asi
pi#i%an
pi#i%an a-ti*itas9
a-ti*itas9
a
a-
-t
ti
i*
*i
it
ta
as
s )
)a
an
n5
5 a
a-
-a
an
n
'i#a-u-an.
'i#a-u-an.
R
R!
!+
+i
i/
/'
'!
!%
%:
: ntu-
ntu-
&
&e
e&
&7
7a
an
nt
tu
u -
-#
#i
ie
en
n
&e&
&e&i#i%
i#i% a-t
a-ti*i
i*itas
tas )an
)an5
5
ti'a- &e&7uat -e#eti%an
ti'a- &e&7uat -e#eti%an
'an &e&7uan5 ener5i.
'an &e&7uan5 ener5i.
Implementas
Implementasi
i dan Evaluasi
dan Evaluasi
aritan55a#s%i
aritan55a#s%i
t
t
N
N
.
.
D
D
K
K

a
a&
& I
I&
&p
p#
#e
e&
&e
en
nt
ta
as
si
i p
pa
ar
ra
a
 
a
a&
& E
E*
*a
a#
#u
ua
as
si
i
>SOAP?
>SOAP?
para
para
Senin=
Senin=
A5ustus !1
A5ustus !1
pa5i
pa5i
1
1.
. !
!0
0.
.!
!!
! 
 Menentu-an u&#a%
Menentu-an u&#a%
-a#ri 'an enis
-a#ri 'an enis
nutrisi )an5
nutrisi )an5
'i7utu%-an untu-
'i7utu%-an untu-
&e&enu%i
&e&enu%i
pers)aratan 5ii.
pers)aratan 5ii.

 Men5atur 'iet )an5
Men5atur 'iet )an5
'iper#u-an )aitu
'iper#u-an )aitu
'en5an
'en5an
&enin5-at-an
&enin5-at-an
asupan prtein 'an
asupan prtein 'an
*ita&in
*ita&in

 Men5anur-an -#ien
Men5anur-an -#ien
1
1!
!.
.3
3!
! S
S:
:

 K#ien
K#ien
&en5ata-an
&en5ata-an
nasu &a-an
nasu &a-an
n)a
n)a
&e&7ai-
&e&7ai-

 K#ien
K#ien
&en5ata-an
&en5ata-an
&ua#
&ua#
&unta%n)a
&unta%n)a
7er-uran
7er-uran
22
22
Senin =
Senin =
A5ustus !1
A5ustus !1
Pa5i
Pa5i

.
. !
!0
0.
.3
3!
!
untu- &e&antau
untu- &e&antau
-a#ri 'an inta-e
-a#ri 'an inta-e
&a-anan 'en5an
&a-anan 'en5an
&e&7uat $atatan
&e&7uat $atatan
&a-anan %arian.
&a-anan %arian.

 Meni&7an5 7erat
Meni&7an5 7erat
7a'an -#ien
7a'an -#ien

 Me&nitr a'an)a
Me&nitr a'an)a
&ua# 'an &unta%
&ua# 'an &unta%

 Me#a-u-an
Me#a-u-an
pe&eri-san
pe&eri-san
#a7ratriu&,
#a7ratriu&,
&nitr %asi#n)a:
&nitr %asi#n)a:
-a'ar a#7u&in, tta#
-a'ar a#7u&in, tta#
prtein, 7 'an
prtein, 7 'an
-a'ar t.
-a'ar t.

 Meni&7an5 7erat
Meni&7an5 7erat
7a'an setiap %ari
7a'an setiap %ari
'an &nitr status
'an &nitr status
pasien.
pasien.

 Mena5a
Mena5a inta!e
inta!e

asupan )an5 a-urat
asupan )an5 a-urat
'an &en$atat
'an &en$atat
output
output -#ien.
-#ien.

 Me&7eri-an terapi
Me&7eri-an terapi
I seperti )an5
I seperti )an5
'itentu-an.
'itentu-an.

 Me&nitr
Me&nitr
&e&7ran &u-sa,
&e&7ran &u-sa,
tur5r -u#it, 'an
tur5r -u#it, 'an
respn %aus.
respn %aus.

 Men5aar-an
Men5aar-an
pen55unaan te-ni-
pen55unaan te-ni-
nnar&a-#5i
nnar&a-#5i
untu- &en5e##a
untu- &en5e##a
&unta% >&isa#n)a,
&unta% >&isa#n)a,
%ipnsis, re#a-sasi,
%ipnsis, re#a-sasi,
11.!!
11.!!
O:
O:

 Prsi &a-an
Prsi &a-an
-#ien
-#ien
&enin5-at
&enin5-at

 Fre-uensi
Fre-uensi
&ua# &unta%
&ua# &unta%
-#ien
-#ien
7er-uran5
7er-uran5
A: &asa#a%
A: &asa#a%
Keti'a-
Keti'a-
sei&7an5an
sei&7an5an
nutrisi -uran5
nutrisi -uran5
'ari -e7utu%an
'ari -e7utu%an
tu7u% terastasi
tu7u% terastasi
se7a5ian
se7a5ian
P: Inter*ensi
P: Inter*ensi
'i#anut-an
'i#anut-an
S :
S :

 K#ien
K#ien
&en5ata-an
&en5ata-an
su'a% ti'a-
su'a% ti'a-
a'a &ua# 'an
a'a &ua# 'an
&unta%
&unta%

 K#ien
K#ien
&en5ata-an
&en5ata-an
su'a% ti'a-
su'a% ti'a-
&u'a% %aus.
&u'a% %aus.
O :
O :

 ;erat 7a'an
;erat 7a'an
-#ien sta7i#.
-#ien sta7i#.

 "nta!e
"nta!e 'an
'an
output
output -#ien
-#ien
nr&a#
nr&a#
sei&7an5.
sei&7an5.

 Me&7ran
Me&7ran
&u-sa
&u-sa
#e&7a7, tur5r
#e&7a7, tur5r
23
23
Senin =
Senin =
A5ustus !1
A5ustus !1
Pa5i
Pa5i
3.
3. 1!.!!
1!.!!
a-upresur?.
a-upresur?.

 Me&nitr te-anan
Me&nitr te-anan
'ara%, na'i, su%u,
'ara%, na'i, su%u,
'an status
'an status
pernaasan 'en5an
pernaasan 'en5an
tepat.
tepat.

 Me&nitr
Me&nitr inta!e
inta!e

asupan nutrisi untu-
asupan nutrisi untu-
&en5eta%ui su&7er
&en5eta%ui su&7er
ener5i )an5
ener5i )an5
a'e-uat.
a'e-uat.

 Men)aran-an -#ien
Men)aran-an -#ien
untu- 7er-nsu#tasi
untu- 7er-nsu#tasi
'en5an a%#i 5ii
'en5an a%#i 5ii
&en5enai $ara
&en5enai $ara
&enin5-at-an
&enin5-at-an
asupan ener5i 'ari
asupan ener5i 'ari
&a-anan.
&a-anan.

 Me&7antu -#ien
Me&7antu -#ien
untu- &e&a%a&i
untu- &e&a%a&i
prinsip -nser*asi
prinsip -nser*asi
ener5i >&isa#n)a,
ener5i >&isa#n)a,
-e7utu%an untu-
-e7utu%an untu-
&e&7atasi a-ti*itas
&e&7atasi a-ti*itas
'an tira% 7arin5?.
'an tira% 7arin5?.

 Me&7antu -#ien
Me&7antu -#ien
&en5i'entii-asi
&en5i'entii-asi
11.3!
11.3!
-u#it nr&a# ,
-u#it nr&a# ,
 'eti-, respn
 'eti-, respn
%aus
%aus
7er-uran5
7er-uran5
su'a% ti'a-
su'a% ti'a-
&u'a% %aus.
&u'a% %aus.


Dapat
Dapat
&en5e##a
&en5e##a
&ua# 'an
&ua# 'an
&unta%
&unta%
'en5an
'en5an
7e7erapa
7e7erapa
te-ni-
te-ni-
nnar&a-#
nnar&a-#
5.
5.

 Tan'a9tan'a
Tan'a9tan'a
*ita# nr&a#.
*ita# nr&a#.
A
A :
:
Masa#a%
Masa#a%
-e-uran5an
-e-uran5an
*#u&e $airan
*#u&e $airan
tu7u% teratasi.
tu7u% teratasi.
P :
P :
Inter*ensi
Inter*ensi
'i%enti-an.
'i%enti-an.
S :
S :

 K#ien
K#ien
&en5ata-an
&en5ata-an
su'a% ti'a-
su'a% ti'a-
&erasa #e#a%
&erasa #e#a%
'an #e&as.
'an #e&as.

 K#ien
K#ien
&en5ata-an
&en5ata-an
su'a% ti'a-
su'a% ti'a-
&en5a#a&i
&en5a#a&i
-e#eti%an.
-e#eti%an.
O :
O :


Ma-anan )an5
Ma-anan )an5
24
24
pi#i%an a-ti*itas9
pi#i%an a-ti*itas9
a-ti*itas )an5 a-an
a-ti*itas )an5 a-an
'i#a-u-an.
'i#a-u-an.
'i&a-an -#ien
'i&a-an -#ien
&en5an'un5
&en5an'un5
asupan ener5i
asupan ener5i
)an5 a'e-uat.
)an5 a'e-uat.

 K#ien
K#ien
&e&a%a&i
&e&a%a&i
prinsip
prinsip
-nser*asi
-nser*asi
ener5i.
ener5i.

 K#ien &a&pu
K#ien &a&pu
&en5i'entii-
&en5i'entii-
asi a-ti*itas9
asi a-ti*itas9
a-ti*itas )an5
a-ti*itas )an5
a-an
a-an
'i#a-u-an
'i#a-u-an
sesuai
sesuai
-e&a&puan
-e&a&puan
-#ien.
-#ien.
A
A :
:
Masa#a%
Masa#a%
-e#eti%an
-e#eti%an
teratasi.
teratasi.
P :
P :
Inter*ensi
Inter*ensi
'i%enti-an
'i%enti-an
25
25
BAB IV
BAB IV
PENUTUP
PENUTUP
.1
.1 K$
K$+i*
+i*)%
)%!'
!'
a.
a. Dia
Dia7et
7etes &e#itu
es &e#itus
s pa'
pa'a
a -e%
-e%a&i
a&i#an >'ia7
#an >'ia7ete
etes
s &e#
&e#itu
itus
s 5es
5estati
tatina
na#D
#DMG?
MG?
a'a
a'a#a%
#a% -e%
-e%a&i
a&i#an
#an nr
nr&a#
&a# )an
)an5
5 'is
'isert
ertai
ai 'en
'en5an
5an pen
penin5
in5-at
-atan
an insulin
insulin
resistance
resistance >i7u %a&i# 5a5a# &e&perta%an-an
>i7u %a&i# 5a5a# &e&perta%an-an euglycemia
euglycemia? pa'a &in55u
? pa'a &in55u
-e 2 sa&pai -e  &asa -e%a&i#an.
-e 2 sa&pai -e  &asa -e%a&i#an.
7.
7. Dia7etes &e#itus
Dia7etes &e#itus 5estasina# 'apat
5estasina# 'apat tera'i pa'a
tera'i pa'a i7u )an5 %a&i#
i7u )an5 %a&i# 'i atas
'i atas
usi
usia
a 3!
3! ta%
ta%un,
un, per
pere&p
e&puan
uan 'en
'en5an
5an 7e
7esit
sitas
as >IM
>IMT
T B3!
B3!?,
?, per
pere&p
e&puan
uan
'en5a
'en5an
n ri(a)a
ri(a)at
t 'ia7e
'ia7etes &e#itus
tes &e#itus pa'a ran5 tua
pa'a ran5 tua atau ri(a)at 'ia7etes
atau ri(a)at 'ia7etes
&e#itus 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i
&e#itus 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i
'en5an 7erat #a%ir B2!!! 5ra& 'an a'an)a 5#u-suria.
'en5an 7erat #a%ir B2!!! 5ra& 'an a'an)a 5#u-suria.
$.
$. Pen
Pen)a-
)a-it ini &en)
it ini &en)e7a
e7a7-a
7-an peru7
n peru7a%a
a%an &eta7
n &eta7#i$ 'an %
#i$ 'an %r&
r&na# )an
na# )an5
5
7erpen5aru%
7erpen5aru% pa'a
pa'a un5si
un5si insu#in
insu#in 'an
'an &en5a-i7at-an
&en5a-i7at-an -n'isi
-n'isi -e7a#
-e7a#
ter%a'
ter%a'ap insu#in.
ap insu#in. Se%in
Se%in55a &eni&7
55a &eni&7u#-an 'a&pa- peni
u#-an 'a&pa- penin5-at
n5-atan -a'ar
an -a'ar
5#u-sa pa'a i7u %a&i#.
5#u-sa pa'a i7u %a&i#.
'.
'. Det
Dete-s
e-si
i 'in
'ini san5a
i san5at
t 'ip
'iper#
er#u-a
u-an untu- &en
n untu- &enari
arin5 DM Gestas
n5 DM Gestasin
ina# a5ar
a# a5ar
'ap
'apat
at 'i-
'i-e#
e##a
#a se7
se7ai-
ai-97ai
97ai-n)
-n)a
a teru
teruta&
ta&a
a 'i#
'i#a-u
a-u-an
-an pa'
pa'a
a i7u
i7u 'en
'en5an
5an
a-tr risi-.
a-tr risi-.
e.
e. Ka'
Ka'ar 5u#a 'ar
ar 5u#a 'ara% i7u a-a
a% i7u a-an &e&p
n &e&pen5
en5aru
aru%i 5u#a 'ar
%i 5u#a 'ara% ani
a% anin se%in
n se%in55a
55a
5u
5u#a
#a '
'ar
ara%
a% a
an
nin
in u
u5
5a
a &e
&en
nin
in5
5-a
-at
t '
'an
an p
pa'
a'a
a 5
5i#
i#ir
iran
ann)
n)a
a a-
a-an
an
&eni&7u#-an %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat
&eni&7u#-an %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat
&eru7
&eru7a%
a% pertu&
pertu&7u%an 'an
7u%an 'an -&p
-&psisi
sisi tu7u% anin.Da&
tu7u% anin.Da&pa-n)
pa-n)a
a 7a)i
7a)i
)an5 #a%ir 'ari i7u )an5 &en5a#a&i 'ia7etes &e#itus 5estasina# ini
)an5 #a%ir 'ari i7u )an5 &en5a#a&i 'ia7etes &e#itus 5estasina# ini
7erisi- tin55i untu- ter-ena &a-rs&ia.
7erisi- tin55i untu- ter-ena &a-rs&ia.
26
26
.
.2
2 S!
S!#!
#!'
'
1.
1. Pe
Pera
rana
nan
n pe
pera
ra(a
(at
t 'a
'a#a
#a&
& &e
&e&7
&7er
eri-
i-an
an ar
ara%
a%an
an 'a
'an
n e'
e'u-
u-asi pa'
asi pa'a
a i7
i7u
u
%a&i# untu- a-ti &e#a-u-an pe&eri-saan rutin untu- &en$e5a% resi-
%a&i# untu- a-ti &e#a-u-an pe&eri-saan rutin untu- &en$e5a% resi-
tera'in)a 'ia7etes 5estasina# 'an &en5e##a se7ai-97ai-n)a ter%a'ap
tera'in)a 'ia7etes 5estasina# 'an &en5e##a se7ai-97ai-n)a ter%a'ap
i7u 'en5an a$tr resi-.
i7u 'en5an a$tr resi-.
.
. Pen'i
Pen'i'i-an -
'i-an -ese%ata
ese%atan i7u %
n i7u %a&i# &e
a&i# &en5ena
n5enai 'ia7et
i 'ia7etes &e#it
es &e#itus 5esta
us 5estasina#
sina#
'iper#u-an untu- &asa -e%a&i#an.
'iper#u-an untu- &asa -e%a&i#an.
27
27
Askep DM ibu hamil[1].pdf
Askep DM ibu hamil[1].pdf
Askep DM ibu hamil[1].pdf

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Askep DM ibu hamil[1].pdf

  • 1. MAKALAH KEPERAWATAN MATERNITAS II MAKALAH KEPERAWATAN MATERNITAS II ASUHAN KEPERAWATAN PADA PENYAKIT YANG MENYERTAI ASUHAN KEPERAWATAN PADA PENYAKIT YANG MENYERTAI KEHAMILAN : DIABETES MELITUS PADA IBU HAMIL KEHAMILAN : DIABETES MELITUS PADA IBU HAMIL FASILITATOR: FASILITATOR: Dr. Esti Yunitasari, S.Kp., M.Kes. Dr. Esti Yunitasari, S.Kp., M.Kes. ANGGOTA KELOMPOK ANGGOTA KELOMPOK SGD 3 A1 !1": SGD 3 A1 !1": E#iesa E#iesa Ra$%&a Ra$%&a Putri Putri 131"1 131"1113 1133!!1 3!!1 A'e#ia A'e#ia D(i D(i Lai#)*ira Lai#)*ira Ra&a'%ania Ra&a'%ania 131"1 131"1113 1133!!+ 3!!+ L$ita L$ita Arti-a Arti-a Isti Isti 131"1 131"1113 1133!! 3!! Ni/&atus% S%#e%a Ni/&atus% S%#e%a 131"1 131"1113 1133!!0 3!!0 Nuru# i'a)ati Nuru# i'a)ati 131"1 131"1113 1133!30 3!30 K Ku us sn nu u# # O O- -t ta an ni ia a 1 13 31 1" "1 11 11 13 33 3! !2 23 3 S Se ep pt ti in n S Sr ri i& &e en nt ta ar ri i L Le e# #) ) D Da ar r& &a a 1 13 31 1" "1 11 11 13 33 3! !2 2" " PROGRAM STUDI PENDIDIKAN NERS PROGRAM STUDI PENDIDIKAN NERS FAKULTAS KEPERAWATAN FAKULTAS KEPERAWATAN UNIVERSITAS AIRLANGGA UNIVERSITAS AIRLANGGA 2018 2018
  • 2. KAT KATA PE A PENGAN NGANT TAR AR Pui s)u-ur -a&i panat-an -e %a'irat A##a% S4T, atas #i&pa%an ra%&at Pui s)u-ur -a&i panat-an -e %a'irat A##a% S4T, atas #i&pa%an ra%&at 'a 'an n %i %i'a 'a)a )a%n %n)a )a pe penu nu#i #is s 'a 'apa pat t &e &en) n)e# e#esa esai- i-an an Ma Ma-a -a#a #a% % te tent ntan an5 5 6 6 As Asu% u%an an Kepera(atan Pa'a Pen)a-it Yan5 Men)ertai Ke%a&i#an : Dia7etes Me#itus Pa'a Kepera(atan Pa'a Pen)a-it Yan5 Men)ertai Ke%a&i#an : Dia7etes Me#itus Pa'a I7 I7u u a a&i &i#8 #8 Ma Ma-a -a#a #a% in % ini i 'i 'isu susu sun n se7 se7a5 a5ai ai sa# sa#a% a% sat satu u tu tu5a 5as s &a &ata ta pe pe#a #aa aran ran Ke Kepe pera ra(a (ata tan n Ma Mate tern rnit itas as II II. . Da Da#a #a& & -e -ese se&p &pat atan an in ini i -a -a&i &i &e &en5 n5u$ u$ap ap-a -an n teri&a-asi% )an5 se'a#a&9'a#a&n)a -epa'a Dsen Pe&7i&7in5 'an Re-an9re-an teri&a-asi% )an5 se'a#a&9'a#a&n)a -epa'a Dsen Pe&7i&7in5 'an Re-an9re-an satu -e#&p- )an5 te#a% &e&7antu 'a#a& satu -e#&p- )an5 te#a% &e&7antu 'a#a& pen)usunan Ma-a#a% ini. pen)usunan Ma-a#a% ini. Ka Ka&i &i &e &en) n)a' a'ar ari i 7a 7a%( %(a a 'a 'a#a #a& & pe pen) n)us usun unan an Ma Ma-a -a#a #a% % in ini i a au% u% 'a 'ari ri se&purna, 7ai- 'ari se5i pen)usunan, 7a%asan, ataupun penu#isann)a. O#e% -arena se&purna, 7ai- 'ari se5i pen)usunan, 7a%asan, ataupun penu#isann)a. O#e% -arena itu -a&i &en5%arap-an -riti- 'an saran )an5 siatn)a &e&7an5un, -%ususn)a itu -a&i &en5%arap-an -riti- 'an saran )an5 siatn)a &e&7an5un, -%ususn)a 'ari Dsen &ata -u#ia% 5una &ena'i a$uan 'a#a& 7e-a# pen5a#a&an 7a5i -a&i 'ari Dsen &ata -u#ia% 5una &ena'i a$uan 'a#a& 7e-a# pen5a#a&an 7a5i -a&i untu- #e7i% untu- #e7i% 7ai- 7ai- 'i &asa )an5 'i &asa )an5 a-an 'atan5. a-an 'atan5. Sura7a)a, + A5ustus !1 Sura7a)a, + A5ustus !1 Pen)usun Pen)usun Ke#&p- 3 Ke#&p- 3 i i
  • 3. DAFTAR ISI DAFTAR ISI KA KAT TA A PENGANT PENGANTAR AR .................... ........................................... .............................................. ..................................................i ...........................i DAFTAR ISI ....................................................................................................................ii DAFTAR ISI ....................................................................................................................ii BAB 1 PENDAHULUAN ................................................................................................1 BAB 1 PENDAHULUAN ................................................................................................1 1.1 Latar ;e#a-an5.........................................................................................................1 1.1 Latar ;e#a-an5.........................................................................................................1 1. Ru&usan Masa#a%.................................................................................................... 1. Ru&usan Masa#a%.................................................................................................... 1.3 Tuuan ...................................................................................................................... 1.3 Tuuan ...................................................................................................................... BAB II TINJ BAB II TINJAUAN PUSTAKA AUAN PUSTAKA ......................................................................................3 ......................................................................................3 .1 .1 Pen5ertian Dia7etes Me#itus pa'a I7u a&i# Pen5ertian Dia7etes Me#itus pa'a I7u a&i#.......................................................3 .......................................................3 . . Eti#5i Dia7etes Me#itus pa'a I7u a&i# ......................................................2 Eti#5i Dia7etes Me#itus pa'a I7u a&i# ......................................................2 .3 .3 K#asii-asi Dia7etes Me#itus pa'a I7u a&i# K#asii-asi Dia7etes Me#itus pa'a I7u a&i# ....... .............. .............. .................. ................................+ .....................+ .2 4O< Dia7etes Me#itus pa'a I7u a&i# .................................................................... .2 4O< Dia7etes Me#itus pa'a I7u a&i# .................................................................... .+ .+ Patisi#5i Dia7etes Me#itus pa'a I7u a&i# Patisi#5i Dia7etes Me#itus pa'a I7u a&i# ................................................1! ................................................1! ." ." Maniestasi K#inis Dia7etes Me#itus pa'a I7u a&i# Maniestasi K#inis Dia7etes Me#itus pa'a I7u a&i# .......................................11 .......................................11 .= .= Pen5aru% 'an Pen5aru% 'an K&p#i-asi K&p#i-asi Dia7etes Me#itus ter%a'ap Dia7etes Me#itus ter%a'ap Ke%a&i#an ...............1 Ke%a&i#an ...............1 . Pe&eri-saan Dia5nsti- pa'a Dia7etes Me#itus . Pe&eri-saan Dia5nsti- pa'a Dia7etes Me#itus ....... .............. .............. ................................12 .........................12 .0 .0 Penata#a-sanaan Me'is pa'a Dia7etes Me#itus Penata#a-sanaan Me'is pa'a Dia7etes Me#itus ....... .............. .............. ..................................1+ ...........................1+ BAB III BAB III ASUHAN KEPERA ASUHAN KEPERAW WA AT TAN........................... AN......................................................... ..................................... ............. ........... .....17 17 3.1 3.1 Kasus Kasus ......................................................................................................................1= ......................................................................................................................1= 3. 3. Asu%an Kepera(atan Asu%an Kepera(atan.............................................................................................1= .............................................................................................1= BAB IV PENUTUP BAB IV PENUTUP .......................................................................................................0 .......................................................................................................0 2.1 Kesi&pu#an ............................................................................................................0 2.1 Kesi&pu#an ............................................................................................................0 2. Saran ......................................................................................................................3! 2. Saran ......................................................................................................................3! DAFTAR PUSTAKA......................................................................................................1 DAFTAR PUSTAKA......................................................................................................1 ii ii
  • 4. BAB I BAB I PENDAHULUAN PENDAHULUAN 1.1 1.1 L!"! L!"!# B$ # B$%!&!' %!&!'( ( Dia7etes &e#itus )an5 tera'i pa'a i7u %a&i# 'ise7ut 'en5an Dia7etes Dia7etes &e#itus )an5 tera'i pa'a i7u %a&i# 'ise7ut 'en5an Dia7etes Me# Me#it itus us Ge Gesta stasi sina na# # >D >DGM GM?. ?. Sa Sa#a #a% % sat satu u pe pen) n)a- a-it it ti ti'a 'a- - &e &enu nu#a #ar r )a )an5 n5 ter&asu- 'a#a& -&p#i-asi &e'is pa'a -e%a&i#an. Pen)a-it 'ia7etes &e#itus ter&asu- 'a#a& -&p#i-asi &e'is pa'a -e%a&i#an. Pen)a-it 'ia7etes &e#itus 5estasina# &erupa-an 5an55uan t#eransi -ar7%i'rat )an5 tera'i pa'a saat 5estasina# &erupa-an 5an55uan t#eransi -ar7%i'rat )an5 tera'i pa'a saat 2 2 &in5 &in55u 5u usia -e%a&i#an usia -e%a&i#an. . Pa'a -e%a&i#an tera'i Pa'a -e%a&i#an tera'i penin penin5-ata 5-atan n pr'u pr'u-si -si %r&ne9%r&n anta5nis insu#in, antara #ain pr5estern, estr5en, %r&ne9%r&n anta5nis insu#in, antara #ain pr5estern, estr5en, human human placenta placenta lactogen lactogen, 'an -rtis#. Penin-atan %r&ne terse7ut &en)e7a7-an , 'an -rtis#. Penin-atan %r&ne terse7ut &en)e7a7-an tera'in)a resistensi insu#in 'an penin5-atan -a'ar 5#u-sa 'ara% >Kusnant, tera'in)a resistensi insu#in 'an penin5-atan -a'ar 5#u-sa 'ara% >Kusnant, P. 1000? P. 1000? Menur Menurut A&eri$an ut A&eri$an Dia7et Dia7etes Ass$iatin >ADA? es Ass$iatin >ADA? ta%un !!!, ta%un !!!, 'ia7e 'ia7etes tes &e# &e#itu itus s 5es 5estasi tasina na# # ter tera' a'i i =@ =@ pa' pa'a a -e% -e%a&i a&i#an #an set setiap iap ta% ta%unn unn)a. )a. Pa' Pa'a a i7u i7u %a&i# 'en5an ri(a)at -e#uar5a &en'erita 'ia7etes &e#itus , pre*a#ensin)a %a&i# 'en5an ri(a)at -e#uar5a &en'erita 'ia7etes &e#itus , pre*a#ensin)a &ena'i +,1 @. Dia7etes &e##itus per#u 'iper%ati-an -arena resi- &r7i'itas &ena'i +,1 @. Dia7etes &e##itus per#u 'iper%ati-an -arena resi- &r7i'itas 'an &rta#itas pa'a &aterna# 'an perinata# tin55i >u#i-ar, D.,!!0?.. 'an &rta#itas pa'a &aterna# 'an perinata# tin55i >u#i-ar, D.,!!0?.. Pa'a pen'erita 'ia7etes &e#itus &asa -e%a&i#an 'i'apati se#a&a &asa Pa'a pen'erita 'ia7etes &e#itus &asa -e%a&i#an 'i'apati se#a&a &asa -e%a&i#an trisester -e'ua atau -eti5a. Dia7etes &e#itus pa'a i7u %a&i# 'i atas -e%a&i#an trisester -e'ua atau -eti5a. Dia7etes &e#itus pa'a i7u %a&i# 'i atas usia 3! ta%un, pere&puan 'en5an 7e'sitas >IMT B3!?, pere&puan 'en5an usia 3! ta%un, pere&puan 'en5an 7e'sitas >IMT B3!?, pere&puan 'en5an ri( ri(a) a)at at 'i 'ia7 a7et etes es &e &e#i #itu tus s pa pa'a 'a r ran an5 5 tu tua a at atau au ri( ri(a) a)at at 'i 'ia7 a7et etes es &e &e#i #itu tus s 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i 'en5an 7erat 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i 'en5an 7erat #a%ir B 2!!! 5ra& 'an a'an)a 5#u-suria >Su') A4 '--, !!"?. Dia7etes #a%ir B 2!!! 5ra& 'an a'an)a 5#u-suria >Su') A4 '--, !!"?. Dia7etes &e &e#i #itu tus s Gesta Gestasina sina# # &enin &enin5-at- 5-at-an an &r7i &r7i'itas 'itas nen nenatus, atus, )aitu )aitu %ip5 %ip5#i-e& #i-e&ia, ia, i-terus, p#isite&ia, 'an &a-rs&ia i-terus, p#isite&ia, 'an &a-rs&ia Dia7e Dia7etes tes &e##i &e##itus tus 5estasi 5estasina# na# &ena &ena'i 'i &asa#a% -ese%atan &as)ara-at &asa#a% -ese%atan &as)ara-at se7a7 pen)a-it ini 7er'a&pa- #an5sun5 pa'a -ese%atan i7u 'an anin. Dete-si se7a7 pen)a-it ini 7er'a&pa- #an5sun5 pa'a -ese%atan i7u 'an anin. Dete-si 'ini pa'a i7u %a&i# 'apat &e&7antu untu- &enin5-at-an -esea%teraan i7u 'ini pa'a i7u %a&i# 'apat &e&7antu untu- &enin5-at-an -esea%teraan i7u 7ai- 7ai- se#a&a se#a&a -e%a&i#an -e%a&i#an ataupun ataupun sesu'a% sesu'a% &asa &asa -e%a&i#an. -e%a&i#an. a# a# terse7ut terse7ut 'apat 'apat &enar &enarin5 in5 'ia7et 'ia7etes es &e#it &e#itus us 5estasi 5estasina# a5ar na# a5ar 'apat 'i-e##a 'apat 'i-e##a se7ai- se7ai-97ai-n 97ai-n)a )a teruta&a 'i#a-u-an pa'a i7u 'en5an a$tr resi-. O#e% -arena %a# terse7ut, teruta&a 'i#a-u-an pa'a i7u 'en5an a$tr resi-. O#e% -arena %a# terse7ut, -e#&p- -a&i &en)e#esai-an &a-a#a% Kepera(atan Maternitas II 'en5an -e#&p- -a&i &en)e#esai-an &a-a#a% Kepera(atan Maternitas II 'en5an 1 1
  • 5. tpi- 6 Asu%an Kepera(atan pa'a Pen)a-it )an5 Men)ertai Ke%a&i#an : tpi- 6 Asu%an Kepera(atan pa'a Pen)a-it )an5 Men)ertai Ke%a&i#an : Dia7etes Me#itus Pa'a I7u a&i#8. Dia7etes Me#itus Pa'a I7u a&i#8. 1.2 1.2 R)*) R)*)+!' M! +!' M!+!%!, +!%!, 1. 1. Apa-a Apa-a% )an % )an5 'i& 5 'i&a-su' a-su' 'en5a 'en5an Dia7 n Dia7etes M etes Me#itus e#itus pa'a I pa'a I7u a 7u a&i#C &i#C . . Apa-a Apa-a% % pen)e pen)e7a7 7a7 i7u i7u %a&i# %a&i# 'apat 'apat &en5a &en5a#a&i #a&i Dia7et Dia7etes M es Me#itus e#itus C C 3. 3. ;a5ai ;a5ai&ana &ana -#asi -#asii-asi i-asi Dia7et Dia7etes Me es Me#itus #itus pa'a pa'a I7u I7u a&i#C a&i#C 2. 2. ;a5ai ;a5ai&ana p &ana pera#an era#anan pe an pen)a-i n)a-it Dia t Dia7etes 7etes Me#itu Me#itus I7u s I7u a&i# a&i# C C +. +. ;a5ai ;a5ai&ana & &ana &aniest aniestasi -#i asi -#inis pa nis pa'a Di 'a Dia7etes M a7etes Me#itu e#itus pa'a s pa'a I7u  I7u a&i#C a&i#C ". ". Apa-a Apa-a% pen % pen5aru% ' 5aru% 'an - an -&p#i- &p#i-asi Dia7 asi Dia7etes Me#i etes Me#itus pa' tus pa'a I7u  a I7u a&i#C a&i#C =. =. ;a5ai ;a5ai&ana p &ana pe&eri- e&eri-saan ' saan 'ia5n ia5nsti$ ) sti$ )an5 te an5 tepat pa pat pa'a i7 'a i7u %a& u %a&i#C i#C . . ;a5ai ;a5ai&ana pe &ana penata#a nata#a-sanaan -sanaan -#ini -#inis )an5 s )an5 'apat ' 'apat 'i#a-u i#a-u-an Dia -an Dia7etes Me 7etes Me#itus #itus pa'a I7u a&i#C pa'a I7u a&i#C 1. 1. T T)-)! )-)!' ' 1. 1. Men Men5et 5eta%u a%ui Dia7 i Dia7etes M etes Me#i e#itus p tus pa'a I a'a I7u  7u a&i a&i# # . . Mene# Mene#as-an as-an pen)e pen)e7a7 7a7 i7u i7u %a&i# %a&i# 'apat 'apat &en5a &en5a#a&i #a&i Dia7e Dia7etes tes Me#it Me#itus us 3. 3. Men5e Men5eta%ui ta%ui -#asi -#asii-asi i-asi Dia7et Dia7etes M es Me#itus e#itus pa'a pa'a I7u I7u a&i# a&i# 2. 2. Mene# Mene#as-an as-an pera# pera#anan anan pen)a pen)a-it -it Dia7et Dia7etes es Me#itu Me#itus s I7u I7u a&i# a&i# +. +. Men5e Men5eta%ui ta%ui &ani &aniestasi - estasi -#inis #inis pa'a D pa'a Dia7ete ia7etes Me#itu s Me#itus pa'a s pa'a I7u  I7u a&i# a&i# ". ". Mene# Mene#as-anp as-anpen5aru en5aru% 'an - % 'an -&p#i &p#i-asi Di -asi Dia7etes Me a7etes Me#itus p #itus pa'a I7u a'a I7u a&i# a&i# =. =. Me&7e Me&7eri-an i ri-an inr& nr&asi pe& asi pe&eri-saa eri-saan 'ia5n n 'ia5nsti$ ) sti$ )an5 te an5 tepat pa' pat pa'a i7u % a i7u %a&i# a&i# . . Men5e Men5eta%ui p ta%ui penata#a enata#a-sanaa -sanaan -#in n -#inis )an5 is )an5 'apat ' 'apat 'i#a-u i#a-u-an Dia -an Dia7etes Me 7etes Me#itus #itus pa'a I7u a&i# pa'a I7u a&i# BAB II BAB II TINJAUAN PUSTAKA TINJAUAN PUSTAKA 2.1 P$'($#"i!' Di!$"$+ M$%i")+ 2.1 P$'($#"i!' Di!$"$+ M$%i")+ G$+"!+i/'!% G$+"!+i/'!% Dise7u Dise7ut t 'ia7e 'ia7etes tes 5estasi 5estasina# 7i#a na# 7i#a 5an55 5an55uan t#eransi uan t#eransi 5#u- 5#u-sa sa )an5 tera'i )an5 tera'i se(a-tu %a&i# -e&7a#i nr&a# 'a#a& " &in55u sete#a% persa#inan. 'ian55ap se(a-tu %a&i# -e&7a#i nr&a# 'a#a& " &in55u sete#a% persa#inan. 'ian55ap 'ia 'ia7et 7etes es &e# &e##it #itus us >a' >a'i i 7u- 7u-an an 5es 5estasi tasi? ? 7i# 7i#a a 5an 5an55u 55uan an t# t#eran eransi si 5#u 5#u-s -sa a &en &enetap etap sete sete#a% #a% per persa#i sa#inan nan. . Pa' Pa'a a 5# 5#n5 n5an an ini ini, , -n -n'is 'isi i 'ia 'ia7et 7etes es 'ia 'ia#a& #a&i i 2 2
  • 6. se&ent se&entara ara se#a&a &asa se#a&a &asa -e%a& -e%a&i#an. Artin i#an. Artin)a )a -n' -n'isi isi 'ia7e 'ia7etes tes atau int#eransi atau int#eransi 5# 5#u- u-s sa a pe pert rta& a&a a -a -a#i #i 'i 'i'a 'apa pati ti se# se#a& a&a a &a &asa sa -e -e%a %a&i &i#a #an, n, 7i 7iasa asan) n)a a pa pa'a 'a tri&ester -e'ua atau -eti5a. tri&ester -e'ua atau -eti5a. Dia Dia7et 7etes es Me# Me##it #itus us Gest Gestasi asina# na# >DM >DMG? G? 'i' 'i'ein einisi- isi-an an se7 se7a5a a5ai i 5an 5an55u 55uan an t#eransi 5#u-sa 7er7a5ai tin5-at )an5 'i-eta%ui perta&a -a#i saat %a&i# t#eransi 5#u-sa 7er7a5ai tin5-at )an5 'i-eta%ui perta&a -a#i saat %a&i# tanpa &e&7e'a-an apa-a% pen'erita per#u&en 'apat insu#in atau ti'a-. Pa'a tanpa &e&7e'a-an apa-a% pen'erita per#u&en 'apat insu#in atau ti'a-. Pa'a -e%a&i#an tri&ester perta&a -a'ar 5#u-sa a-an turun antara ++9"+@ 'an %a# -e%a&i#an tri&ester perta&a -a'ar 5#u-sa a-an turun antara ++9"+@ 'an %a# in ini i &e &eru rupa pa-a -an n res resp pn n te ter% r%a' a'ap ap tr tran ansp sprt rtasi asi 5# 5#u- u-s sa a 'a 'ari ri i7 i7u u -e -e a ani nin. n. Se7 Se7a5i a5ian an 7es 7esar ar DMG DMG asi asi&t &t&ati &atis s se%i se%in55 n55a a 'ia 'ia5n 5nsis sis 'it 'itent entu-a u-an n se$a se$ara ra -e7etu#an pa'a saat pe&eri-saan rutin. Dia7etes &e#itus 5estatina# a'a#a% -e7etu#an pa'a saat pe&eri-saan rutin. Dia7etes &e#itus 5estatina# a'a#a% -ea'aa -ea'aan n int# int#eransi -ar7%i'r eransi -ar7%i'rat at 'ari 'ari seran seran5 5 (anit (anita a )an5 'i-eta%u )an5 'i-eta%ui i perta& perta&a a -a#i -eti-a 'ia se'an5 %a&i#. Dia7etes 5estatina# tera'i -arena -e#ainan -a#i -eti-a 'ia se'an5 %a&i#. Dia7etes 5estatina# tera'i -arena -e#ainan )an5 'ipi$u )an5 'ipi$u #e% -e%a&i#an #e% -e%a&i#an, , 'iper 'iper-ira-a -ira-an n -arena tera'in) -arena tera'in)a a peru7 peru7a%an pa'a a%an pa'a &eta7#is&e 5#u-sa. &eta7#is&e 5#u-sa. Teri )an5 #ain &en5ata-an 7a%(a 'ia7etes tipe  ini 'ise7ut se7a5ai Teri )an5 #ain &en5ata-an 7a%(a 'ia7etes tipe  ini 'ise7ut se7a5ai 6un&a 6un&as-e'8 atau s-e'8 atau 7aru 'ite&u- 7aru 'ite&u-an saat an saat %a&i# 'an patut %a&i# 'an patut 'i$uri 'i$uri5ai pa'a 5ai pa'a (anita (anita )an5 &e&i#i-i $iri 5e&u-, ri(a)at -e#uar5a 'ia7etes, ri(a)at &e#a%ir-an 7a)i )an5 &e&i#i-i $iri 5e&u-, ri(a)at -e#uar5a 'ia7etes, ri(a)at &e#a%ir-an 7a)i B 2 -5, ri(a)at 7a)i #a%ir &ati, 'an ri(a)at a7rtus 7eru#an5. An5-a #a%ir B 2 -5, ri(a)at 7a)i #a%ir &ati, 'an ri(a)at a7rtus 7eru#an5. An5-a #a%ir &at &ati i ter teruta uta&a &a pa' pa'a a 'ia 'ia7et 7etes es )an )an5 5 ti' ti'a- a- ter ter-en -en'a# 'a#i i 'ap 'apat at ter tera'i a'i 1! 1! -a# -a#i i 'arinr&a#. 'arinr&a#. 2.2 E"i/%/(i Di!$"$+ M$%i")+ G$+"!+i/'!% 2.2 E"i/%/(i Di!$"$+ M$%i")+ G$+"!+i/'!% Pa Pa'a 'a saa saat t se ser ran an5 5 (a (ani nita ta %a %a&i &i#, #, pe peru ru7a 7a%a %an n % %r& r&n n9% 9%r r& &n n 'a 'a#a& #a& tu7u%n)a &e&7uat -era insu#in &ena'i ti'a- ee-ti. Karena -era insu#in tu7u%n)a &e&7uat -era insu#in &ena'i ti'a- ee-ti. Karena -era insu#in &e&7a &e&7antu ntu pen)e pen)erapan 5#u-sa #e% rapan 5#u-sa #e% se#9se# tu7u% ti'a- se#9se# tu7u% ti'a- ee-ti ee-ti, , a-i7at a-i7atn)a n)a u&#a% 5#u-sa 'a#a& 'ara% &enin5-at 'an pen) u&#a% 5#u-sa 'a#a& 'ara% &enin5-at 'an pen)e7a7 #ainn)a a'a#a% : e7a7 #ainn)a a'a#a% : 1. 1. P P#a & #a &a- a-an an 3 3
  • 7. Men5-nsu&si &a-anan )an5 7er#e7i%an )an5 7erarti u&#a% -a#ri Men5-nsu&si &a-anan )an5 7er#e7i%an )an5 7erarti u&#a% -a#ri )an5 'i7utu%-an tu7u% u&#a%n)a 7er#e7i%. Apa7i#a -nsu&si &a-anan )an5 'i7utu%-an tu7u% u&#a%n)a 7er#e7i%. Apa7i#a -nsu&si &a-anan )an5 7er#e7i%an ti'a- 'ii&7an5i #e% se-resi insu#in 'a#a& u&#a% )an5 )an5 7er#e7i%an ti'a- 'ii&7an5i #e% se-resi insu#in 'a#a& u&#a% )an5 $u-up a-an &en)e7a7-an -a'ar 5u#a 'a#a& 'ara $u-up a-an &en)e7a7-an -a'ar 5u#a 'a#a& 'ara% &enin5-at % &enin5-at . . Fa- Fa-tr -e tr -etur turuna unan  n  Gen Geneti eti- - Dia7etes &i#itus 'apat 'i(aris-an 'ari ran5 tua -epa'a ana-. Gen Dia7etes &i#itus 'apat 'i(aris-an 'ari ran5 tua -epa'a ana-. Gen pen)e7a7 pen)e7a7 'ia7etes 'ia7etes &e#itus &e#itus a-an a-an 'i7a(a 'i7a(a #e% #e% ana- ana- i-a i-a ran5 ran5 tuan)a tuan)a &en'erita 'ia7etes &e#itus. Pe(aris 5en ini 'apat sa&pai -e $u$un)a &en'erita 'ia7etes &e#itus. Pe(aris 5en ini 'apat sa&pai -e $u$un)a 7a%-an 7a%-an $i$it $i$it (a#aupun (a#aupun resi-n)a resi-n)a -e$i#. -e$i#. Se*ara Se*ara -#inis, -#inis, pen)a-it pen)a-it DM DM a(a#n)a 'i'&inasi #e% resistensi insu#in )an5 'isertai 'ee$t un5si a(a#n)a 'i'&inasi #e% resistensi insu#in )an5 'isertai 'ee$t un5si se-resi. Tetapi, pa'a ta%ap )an5 #e7i% #anut %a# itu 'i'&inasi 'ee$t se-resi. Tetapi, pa'a ta%ap )an5 #e7i% #anut %a# itu 'i'&inasi 'ee$t un5si se-resi )an5 'isertai 'en5an resistensi insu#in. Kaitann)a 'en5an un5si se-resi )an5 'isertai 'en5an resistensi insu#in. Kaitann)a 'en5an &utasi DNA &it-n'ria )aitu -arena prses pr'u-si %r&n insu#in &utasi DNA &it-n'ria )aitu -arena prses pr'u-si %r&n insu#in sa san5 n5at at er erat at -a -ait itan ann) n)a a ' 'en en5 5an an &e &e-a -an nis is& &e e p pr rse ses s  i' i'at ati* i*e e p%sp%r)#atin >OPO p%sp%r)#atin >OPOS? 'i 'a#a& pen-reas. S? 'i 'a#a& pen-reas. 3. 3. Str Stres ' es 'an an &er &er- -- - Ke Keti ti-a -a 'a 'a#a& #a& -e -ea' a'aa aan n st stres res, , % %r& r&n n9% 9%r r& &n n str stres es 'i 'itu tu7u 7u% % a- a-an an &enin5-at %a# ini u5a a-an &e&i$u nai-n)a -a'ar 5u#a &enin5-at %a# ini u5a a-an &e&i$u nai-n)a -a'ar 5u#a 'i 'a#a& 'ara%. 'i 'a#a& 'ara%. Se'an5-an &er-- 'apat &e&per7erat 5an55uan sir-u#asi 'ara% 'i Se'an5-an &er-- 'apat &e&per7erat 5an55uan sir-u#asi 'ara% 'i 'aera% uun59uun5 tu7u% &isa#n)a ari -a-i, se%in55a 'en5a &er-- 'aera% uun59uun5 tu7u% &isa#n)a ari -a-i, se%in55a 'en5a &er-- 'apat &e&per$epat prses pe&7entu-an 5an5ren. 'apat &e&per$epat prses pe&7entu-an 5an5ren. 2. 2. Ke5e& Ke5e&u-an  7 u-an  7esitas 7ia esitas 7iasan)a ter san)a tera'i pa'a usi a'i pa'a usia 2! ta%un a 2! ta%un Se7enarn)a DM 7isa &ena'i pen)e7a7 'an a-i7at. Se7a5ai pen)e7a7, Se7enarn)a DM 7isa &ena'i pen)e7a7 'an a-i7at. Se7a5ai pen)e7a7, 7esitas &en)e7a7-an se# 7eta > )an5 &en5se-resi insu#in 'a#a& 'ara%? 7esitas &en)e7a7-an se# 7eta > )an5 &en5se-resi insu#in 'a#a& 'ara%? pan-reas pan-reas pen5%asi# pen5%asi# insu#in insu#in %ipertrpi %ipertrpi )an5 )an5 pa'a pa'a 5i#irann)a 5i#irann)a a-an a-an -e#e#a%an 'an e7# se%in55a insu#in &ena'i 7er-uran5 pr'u-sin)a. -e#e#a%an 'an e7# se%in55a insu#in &ena'i 7er-uran5 pr'u-sin)a. Se Se7a 7a5a 5ai i a- a-i7 i7at at pe pen5 n55u 5una na in insu su#i #in n se7 se7a5 a5ai ai te tera rapi pi 'i 'ia7 a7et etes es &e &e#it #itus us 7e#e7i%an 7e#e7i%an &en)e7a7-an &en)e7a7-an peni&7unan peni&7unan #e&a- #e&a- su7-utan su7-utan )an5 )an5 7er#e7ian 7er#e7ian pu#a. pu#a. +. +. ;a%an ;a%an -i&ia -i&ia 'an 'an 7at9 7at97atan 7atan ;a%an -i&ia tertentu 'apat &en5iritasi pa-reas se%in55a &en)e7a7-an ;a%an -i&ia tertentu 'apat &en5iritasi pa-reas se%in55a &en)e7a7-an ra' ra'an5 an5 pan pan-re -reas. as. Per Pera'a a'an5a n5an n pa' pa'a a pan pan-re -reas as &en &en)e7 )e7a7a a7an n pan pan-re -reas as ti' ti'a- a- 7er 7erun un5si 5si se$a se$ara ra pt pti&a i&a# # 'a# 'a#a& a& &en &ense-r se-resi- esi-an an %r %r&n &n )an )an5 5 'iper#u-an untu- &eta7#is&e tu7u%, ter&asu- %r&n insu#in. 'iper#u-an untu- &eta7#is&e tu7u%, ter&asu- %r&n insu#in. ". ". Men5- Men5-nsu nsu&si -ar7 &si -ar7%i'r %i'rat 7er#e at 7er#e7i%an 7i%an 4 4
  • 8. T Tin55i in55in)a n)a -nsu -nsu&si &si -ar7 -ar7%i'rat %i'rat &en)e &en)e7a7-a 7a7-an n -nse -nsentrasi ntrasi 5#u- 5#u-sa sa 'a# 'a#a& a& 'ar 'ara% a% &en &enin5 in5-at -at. . i- i-a a u& u&#a% #a% ins insu#i u#in n )an )an5 5 'ip 'ipr' r'u-s u-si i ti' ti'a- a- 'ise- 'ise-resi-an #e% se#9se# resi-an #e% se#9se# 7eta > 7eta > )an5 &en5se-r )an5 &en5se-resi insu#in 'a#a& esi insu#in 'a#a& 'ara%? 'ara%? pan-reas pan-reas a-i7at a-i7at 7e7erapa 7e7erapa 5an55uan 5an55uan 'a#a& 'a#a& tu7u%, tu7u%, 5#u-sa 5#u-sa 'ara% 'ara% ti'a- ti'a- 'iu7a% &ena'i ener5i 'an ti'a- 'apat 'iu7a% 'a#a& 7entu- 5#i-5en. 'iu7a% &ena'i ener5i 'an ti'a- 'apat 'iu7a% 'a#a& 7entu- 5#i-5en. a# ini &en)e7a7-an -a'ar 5#u-sa 'a#a& 'ara% tin55i, >&e#e(ati 7atas a# ini &en)e7a7-an -a'ar 5#u-sa 'a#a& 'ara% tin55i, >&e#e(ati 7atas -esan -esan55up 55upan an 5ina 5ina# # untu untu- - &en)a &en)arin5 rin5 5#u- 5#u-sa sa -arena -arena -nse -nsentrasi ntrasin)a n)a ter#a#u tin55i?, 5#u-sa a-an 'i-e#uar-an &e#a#ui urin se%in55a tera'i ter#a#u tin55i?, 5#u-sa a-an 'i-e#uar-an &e#a#ui urin se%in55a tera'i 5#u-saria >5#u-sa 'a#a& urin H -en$in5 &anis? 5#u-saria >5#u-sa 'a#a& urin H -en$in5 &anis? =. =. Ker Kerusa usa-an pa -an pa'a se# pa 'a se# pan-r n-reas eas In Ine e-s -si i &i &i-r -r r5 r5an anis is&e &e 'a 'an n *i *iru rus s pa pa'a 'a pa pan5 n5-r -rea eas s u u5a 5a 'a 'apa pat t &en)e7a7-an ra'an5 pan-reas )an5 t&atis a-an &en)e7a7-an un5si &en)e7a7-an ra'an5 pan-reas )an5 t&atis a-an &en)e7a7-an un5si pan-reas turun se%in55a ti'a- a'a s pan-reas turun se%in55a ti'a- a'a se-resi %r&n9%r&n untu- prses e-resi %r&n9%r&n untu- prses &eta7#is&e )u7u% ter&asu- insu#in. Pen)a-it seperti -#ester# tin55i &eta7#is&e )u7u% ter&asu- insu#in. Pen)a-it seperti -#ester# tin55i 'an 'isp#i'e&ia 'apat &enin5-at-an risi- ter-ena 'ia7etes &i#itus. 'an 'isp#i'e&ia 'apat &enin5-at-an risi- ter-ena 'ia7etes &i#itus. 2. K%!+ii&!+i Di!$"$+ 2. K%!+ii&!+i Di!$"$+ M$%i")+ G$+"!+i/'!% M$%i")+ G$+"!+i/'!% K K$ $% %! !+ + K K! !# #! !& &" "$ $# #i i+ +" "i i& & I I* * % %i i& &! !+ +i i Int#eransi Int#eransi G#u-sa pa'a G#u-sa pa'a &asa %a&i# &asa %a&i# T T#eransi 5#u-sa #eransi 5#u-sa a7nr&a# a7nr&a# se#a&a &asa %a&i#, %iper5#i-e&i se#a&a &asa %a&i#, %iper5#i-e&i pas$aran'ia# se#a&a &asa %a&i# pas$aran'ia# se#a&a &asa %a&i# Dia5nsis se7e#u& usia Dia5nsis se7e#u& usia 5estasi 3! &in55u pentin5 5estasi 3! &in55u pentin5 untu- &en$e5a% untu- &en$e5a% &a-rs&ia. &a-rs&ia. T Tan5ani 'en5at 'iet an5ani 'en5at 'iet -a#ri -a#ri )an5 a'e-uat untu- )an5 a'e-uat untu- &en$e5a% penurunan 7erat &en$e5a% penurunan 7erat 7a'an i7u. 7a'an i7u. Sasaran )an5 'i$apai: Sasaran )an5 'i$apai: 5#u-sa 'ara% 5#u-sa 'ara% pas$apran'ia# 13!&5# 1 pas$apran'ia# 13!&5# 1 a& sete#a% &a-an atau a& sete#a% &a-an atau 1!+ &5'#  a& sete#a% 1!+ &5'#  a& sete#a% &a-an. Apa7i#a insu#in &a-an. Apa7i#a insu#in 5 5
  • 9. 'i7utu%-an, tan5ani seperti 'i7utu%-an, tan5ani seperti penan5anan -e#as ; 'an <. penan5anan -e#as ; 'an <. A A Dia7etes Ki&ia(i )an5 Dia7etes Ki&ia(i )an5 'i'ia5nsis se7e#u& &asa %a&i#: 'i'ia5nsis se7e#u& &asa %a&i#: 'iatasi %an)a &e#a#ui upa)a 'iet. 'iatasi %an)a &e#a#ui upa)a 'iet. Penata#a-sanaan sa&a Penata#a-sanaan sa&a 'en5an penan5anan 'en5an penan5anan int#eransi 5#u-sa pa'a int#eransi 5#u-sa pa'a -e%a&i#an -e%a&i#an ; ; T Terapi Insu#in erapi Insu#in )an5 'i#a-u-an )an5 'i#a-u-an se7e#u& Masa %a&i#J a(itan pa'a se7e#u& Masa %a&i#J a(itan pa'a usia ! ta%un atau #e7i% 'urasi usia ! ta%un atau #e7i% 'urasi -uran5 1! ta%un -uran5 1! ta%un Se-resi insu#in en'5en Se-resi insu#in en'5en 'apat &enetap, resi- pa'a 'apat &enetap, resi- pa'a nenatus 'an anin 'en5an nenatus 'an anin 'en5an resi- pa'a -e#as < 'an D resi- pa'a -e#as < 'an D 7e5itu u5a 'en5an 7e5itu u5a 'en5an penata#a-sanaann)a. penata#a-sanaann)a. < < A A(a# pa'a (a# pa'a usia 1!9! ta%un, a usia 1!9! ta%un, atau tau 'urasi 1!9! ta%un. Dia7etes 'urasi 1!9! ta%un. Dia7etes -arena -uran5 insu#in -arena -uran5 insu#in Dia7etes -arena -uran5 Dia7etes -arena -uran5 insu#in 'en5an a(a# pa'a insu#in 'en5an a(a# pa'a &asa ana-9ana-. &asa ana-9ana-. D D A A(a# se7e#u& (a# se7e#u& usia 1!9! ta%un usia 1!9! ta%un atau 'urasi 1!9! ta%un atau 'urasi 1!9! ta%un Ma-rs&ia anin atau Ma-rs&ia anin atau retar'asi pertu&7u%an retar'asi pertu&7u%an intrauterine 'apat tera'i, intrauterine 'apat tera'i, &i-rr5anis&e retina, &i-rr5anis&e retina, 't9%e&ra5i, 'an a'e-ut 't9%e&ra5i, 'an a'e-ut &enin5-at se#a&a &asa &enin5-at se#a&a &asa %a&i#, -e&u'ian &enurun %a&i#, -e&u'ian &enurun sete#a% &e#a%ir-an sete#a% &e#a%ir-an F F Nerpati 'ia7eti$ 'isertai 'en5an Nerpati 'ia7eti$ 'isertai 'en5an prteinuria prteinuria Ane&i 'an %ipertensi Ane&i 'an %ipertensi u&u& tera'i, prteinuria u&u& tera'i, prteinuria &enin5-at pa'a &enin5-at pa'a trise&ester -e 3, #a#u trise&ester -e 3, #a#u &enurun -e&7a#i &enurun -e&7a#i 6 6
  • 10. 2. 2. WO3 Di!$"$+ M$%i")+ !4! I) H!*i% WO3 Di!$"$+ M$%i")+ !4! I) H!*i% 7 7 Geneti-, *irus, pen5erusa-an insu#in 'ari se7e#u& Geneti-, *irus, pen5erusa-an insu#in 'ari se7e#u& -e%a&i#an atau &un$u# pa'a saat -e%a&i#an -e%a&i#an atau &un$u# pa'a saat -e%a&i#an Kerusa-an se# 7eta Kerusa-an se# 7eta Estr5en, -tis#, PL Estr5en, -tis#, PL 5 5 Keti'a-sei&7an5an pr'u-si insu#in 'an Keti'a-sei&7an5an pr'u-si insu#in 'an -era insu#in ter5an55u 'an  -era insu#in ter5an55u 'an  Gu#a 'a#a& 'ara% ti'a- 'apat Gu#a 'a#a& 'ara% ti'a- 'apat 'i7a(a 'i7a(a &asu- -e 'a#a& se# &asu- -e 'a#a& se# iper5#i-e&i pa'a i7u iper5#i-e&i pa'a i7u G#u-sa 'ip#as&a G#u-sa 'ip#as&a 5 5  s&#a#itas p#as&a 'an  s&#a#itas p#as&a 'an $airan 'a#a& tu7u#us 5ina# $airan 'a#a& tu7u#us 5ina# G#u-suria G#u-suria Ke%i#an5an -a#ri Ke%i#an5an -a#ri G#u-sa &asu- -e G#u-sa &asu- -e p#asenta 'an  p#asenta 'an  Meran5san5 Meran5san5 %ipta#a&us %ipta#a&us Pen5a&7i#an 5#u-sa sir-u#asi p#asenta Pen5a&7i#an 5#u-sa sir-u#asi p#asenta 5 5 G#u-suria pa'a I7u G#u-suria pa'a I7u Ke%i#an5an -a#ri Ke%i#an5an -a#ri Se# -e-uran5an 7a%an Se# -e-uran5an 7a%an untu- &eta7#is&e untu- &eta7#is&e Prtein 'ari #e&a- Prtein 'ari #e&a- 'i7a-ar 'i7a-ar ;erat 7a'an &enurun ;erat 7a'an &enurun Ana7#is&e prtein Ana7#is&e prtein &enurun &enurun Kerusa-an pa'a anti7'i Kerusa-an pa'a anti7'i Ke-e7a#an tu7u% Ke-e7a#an tu7u% &enurun &enurun R$+i&/ i'$&+i R$+i&/ i'$&+i 8 8 ;a)i -e#e7i%an nutrisi ;a)i -e#e7i%an nutrisi >%iper5#i-e&ia? >%iper5#i-e&ia? Pusat #apar 'an Pusat #apar 'an %aus %aus P#i'ipsia P#i'ipsia P#ia5ia P#ia5ia K$"i4!&+$i*!'(!' K$"i4!&+$i*!'(!' ')"#i+i &)#!'( 4!#i ')"#i+i &)#!'( 4!#i Ma-rs&ia >77 7a)i Ma-rs&ia >77 7a)i B 2!!! 5r? B 2!!! 5r? Ri+i&/ 6i4$#! -!'i' Ri+i&/ 6i4$#! -!'i' In'i-asi 'i#a-u-an In'i-asi 'i#a-u-an persa#inan S< persa#inan S< K$"i4!&+$i*!'(!' K$"i4!&+$i*!'(!' ')"#i+i &)#!'( 4!#i ')"#i+i &)#!'( 4!#i &$)"),!' ")), &$)"),!' ")), A'+i$"!+ A'+i$"!+ D$i+i" $'($"!,)!' D$i+i" $'($"!,)!' K$%$"i,!' K$%$"i,!'
  • 11. &$)"),!' ")), &$)"),!' ")), 2. 2. P!"/i+i/%/(i Di!$"$+ M$%i")+ !4! I) H!*i% P!"/i+i/%/(i Di!$"$+ M$%i")+ !4! I) H!*i% Dia7e Dia7etes tes &e##it &e##itus us 'itan 'itan'ai 'ai 'en5 'en5an an %iper %iper5#i-e& 5#i-e&ia ia >peni >penin5-at n5-atan an 5#u- 5#u-sa sa 'a 'ara ra%? %? 'i 'ia- a-i7 i7at at-a -an n -a -are rena na pr pr' 'u- u-si si in insu su#i #in n )a )an5 n5 ti ti'a 'a- - a' a'e- e-ua uat t at atau au pen55unaan pen55unaan insu#in insu#in se$ara se$ara ti'a- ti'a- ee-ti ee-ti pa'a pa'a tin5-at tin5-at se#u#er. se#u#er. Insu#in Insu#in )an5 )an5 'ip 'ipr' r'u-s u-si i se#9 se#9se# se# 7et 7eta a pu# pu#au au #an #an5er 5er%an %ans s 'i 'i pra pran-e n-eas as 7er 7ertan tan55u 55un5 n5 a( a(a7 a7 &entranspr 5#u-sa -e 'a#a& se#. Apa7i#a insu#in ti'a- $u-up  ti'a- ee-ti, &entranspr 5#u-sa -e 'a#a& se#. Apa7i#a insu#in ti'a- $u-up  ti'a- ee-ti, 5# 5#u- u-s sa a 7e 7era- ra-u& u&u# u#as asi i 'a 'a#a #a& & a# a#ir iran an 'a 'ara ra% % 'a 'an n te tera ra'i 'i %i %ipe per5 r5#i #i-e -e&i &ia. a. iper iper5#i-e& 5#i-e&ia ia &en) &en)e7a7- e7a7-an an %iper %ipers&# s&#aritas aritas 'a#a& 'a#a& 'ara% )an5 'ara% )an5 &enari &enari- - $air $airan an int intrase rase# # -e -e 'a# 'a#a& a& sist siste& e& *as *as-u# -u#ar ar se% se%in5 in55a 5a ter tera'i a'i 'e% 'e%i'r i'rasi asi 'an 'an penin5-atan *#u&e penin5-atan *#u&e 'ara%. A-i7atn)a 5ina# 'ara%. A-i7atn)a 5ina# &en)e-resi urine &en)e-resi urine 'a#a& 'a#a& *#u&e *#u&e 7esar 7esar >p#iuria? >p#iuria? se7a5ai se7a5ai upa)a upa)a untu- untu- &en5atur &en5atur -e#e7i%an -e#e7i%an *#u&e *#u&e 'ara% 'ara% 'an 'an &en)e &en)e-resi -resi 5#u- 5#u-sa sa )an5 ti'a- )an5 ti'a- 'i5u 'i5una-an >5#iusuri na-an >5#iusuria?. a?. De%i' De%i'rasi rasi se#u#e se#u#er, r, &eni&7u#-an rasa %aus 7er#e7i%an >p#i'ipsi?. Penurunan 7erat 7a'an a-i7at &eni&7u#-an rasa %aus 7er#e7i%an >p#i'ipsi?. Penurunan 7erat 7a'an a-i7at pe&e$a%an pe&e$a%an #e&a- #e&a- 'an 'an arin5an arin5an tt, tt, pe&e$a%an pe&e$a%an arin5an arin5an ini ini &eni&7u#-an &eni&7u#-an rasa rasa #ap #apar ar )an )an5 5 &e& &e&7ua 7uat t in' in'i*i i*i'u 'u &a- &a-an an se$a se$ara ra 7er 7er#e7 #e7i%a i%an n >p >p#ia #ia#5i #5ia?. a?. Sete#a% an5-a Sete#a% an5-a (a-tu tertentu, (a-tu tertentu, 'ia7e 'ia7etes tes &en) &en)e7a7- e7a7-an an peru7 peru7a%an a%an *as-u *as-u#er #er )an5 7er&a-na. Peru7a%an ini teruta&a &e&pun5aru%i antun5, &ata 'an )an5 7er&a-na. Peru7a%an ini teruta&a &e&pun5aru%i antun5, &ata 'an 5in 5ina# a#. . K& K&p#i p#i-as -asi i a-i a-i7at 7at 'ia 'ia7et 7etes es &en &en$a- $a-up up ater aters- s-#er #ersi sis, s, pre pre&at &ature ure, , reti retinp npati ati 'an nerp 'an nerpati ati. . Dia Dia7et 7etes es tip tipe e I I 'an 'an II II 7ia 7iasan san)sa )sa 'i- 'i-ena ena# # se7 se7a5a a5ai i sin'r sin'r& & )an5 'ise7a7- )an5 'ise7a7-an an #e% a-tr #e% a-tr 5enet 5eneti-. i-. Dia7et Dia7etes es 7iasan 7iasan)a )a 'i(ari 'i(aris-an s-an se7a se7a5ai 5ai si siat at rese resesi, si, teta tetapi pi &un &un$u# $u# se7 se7a5a a5ai i sia siat t '& '&ina inan n pa' pa'a a 7e7 7e7era erapa pa -e#uar -e#uar5a. 5a. Pe(ari Pe(arisan siat san siat 5eneti 5eneti- - >5en >5entip? 'ia7etes tip? 'ia7etes &e##it &e##itus us ti'a- se#a#u ti'a- se#a#u 7erarti 7a%(a in'i*i'u a-an &en5a#a&i int#eransi 5#u-sa 'ia7eti- 7erarti 7a%(a in'i*i'u a-an &en5a#a&i int#eransi 5#u-sa 'ia7eti- >entip?. >entip?. ;an)a- in'i*i'u )an5 &e&i#i-i 5entip, ti'a- &e&per#i%at-an ;an)a- in'i*i'u )an5 &e&i#i-i 5entip, ti'a- &e&per#i%at-an satupun 5ea#a satupun 5ea#a 'ia 'ia7et 7etes es sa& sa&pai pai &er &ere-a e-a &en &en5a# 5a#a&i a&i satu atau satu atau #e7 #e7i% i% stre stressr atau ssr atau a- a-tr tr presipitasi. presipitasi. <nt% <nt% stressr stressr terse7ut terse7ut a'a#a% a'a#a% penin5-atan penin5-atan usia, usia, peri'e peri'e per-e&7an5an per-e&7an5an nr&a#, nr&a#, peru7a%an peru7a%an %r&na# %r&na# )an5 )an5 $epat, $epat, 7esitas, 7esitas, ine-si, ine-si, pe&7e'a%an, -risis e&si 'an tu&r atau ine-si pan5-reas. pe&7e'a%an, -risis e&si 'an tu&r atau ine-si pan5-reas. Dia7e Dia7etes tes Gestas Gestasina# >'ia7etes ina# >'ia7etes -e%a& -e%a&i#an? i#an? int# int#eransi 5#u-sa eransi 5#u-sa se#a&a se#a&a -e -e%a %a&i &i#an #an, , ti ti'a 'a- - 'i 'i-e -e# #&p &p- --a -an n -e -e'a 'a#a #a& & NI NIDD DDM M pa pa'a 'a pe pert rten en5a 5a%a %an n -e%a& -e%a&i#an i#an &enin &enin5-ats 5-atse-resi e-resi %r& %r&n n pertu& pertu&7u%an 7u%an 'an 'an %r& %r&n n $%ri $%rini- ni- 9 9
  • 12. s&at s&at&a&tr &a&trpin ><S?. pin ><S?. r& r&n n ini ini &enin &enin5-at untu- 5-at untu- &ensu &ensup#ai p#ai asa& asa& a&in 'an 5#u-sa -e etus. Da#a& -e%a&i#an tera'i peru7a%an &eta7#is& a&in 'an 5#u-sa -e etus. Da#a& -e%a&i#an tera'i peru7a%an &eta7#is& en'-rin 'an -ar7%i'rat )an5 &enunan5 pe&as-an &a-anan 7a5i anin en'-rin 'an -ar7%i'rat )an5 &enunan5 pe&as-an &a-anan 7a5i anin serta persiapan untu- &en)usui. G#u-sa 'apat 7er'iusi se$ara tetap &e#a#ui serta persiapan untu- &en)usui. G#u-sa 'apat 7er'iusi se$ara tetap &e#a#ui p#asenta p#asenta -epa'a -epa'a anin anin se%in55a se%in55a -a'arn)a -a'arn)a 'a#a& 'a#a& 'ara% 'ara% anin anin %a&pir %a&pir &en)e &en)erupai -a'ar 'ara% rupai -a'ar 'ara% i7u. Insu#in i7u ta- i7u. Insu#in i7u ta- 'apat &en$apa 'apat &en$apai i anin, se%in5 anin, se%in55a 5a -a'ar 5u#a i7u )an5 &e&pen5aru%i -a'ar pa'a anin. Pen5en'a#ian -a'ar -a'ar 5u#a i7u )an5 &e&pen5aru%i -a'ar pa'a anin. Pen5en'a#ian -a'ar 5u#a teruta&a 5u#a teruta&a 'ipen 'ipen5aru% 5aru%i i #e% insu#in, #e% insu#in, 'isa&p 'isa&pin5 7e7erapa in5 7e7erapa %r& %r&n n #ain #ain seperti estr5en, steri' seperti estr5en, steri' 'an p#asenta 'an p#asenta #a-t #a-t5en. A-i7 5en. A-i7at at #a&7a #a&7atn)a tn)a resrp resrpsi si &a- &a-ana anan n &a- &a-a a ter tera' a'i i %ip %iper er5#i 5#i-e& -e&ia ia )an )an5 5 re# re#ati ati  #a& #a&a a 'an 'an ini ini &en &enunt untut ut -e7utu%an insu#in. Mene#an5 ater& -e7utu%an insu#in &enin5-at se%in55a -e7utu%an insu#in. Mene#an5 ater& -e7utu%an insu#in &enin5-at se%in55a &e &en$ n$ap apai ai 3 3 -a -a#i #i 'a 'ari ri -e -ea' a'aa aan n n nr& r&a# a#. . a a# # in ini i 'i 'ise se7u 7ut t se7 se7a5 a5ai ai te te-a -ana nan n 'ia7eteni- 'a#a& -e%a&i#an. Se$ara isi#5i- te#a% tera'i resistensi insu#in 'ia7eteni- 'a#a& -e%a&i#an. Se$ara isi#5i- te#a% tera'i resistensi insu#in )ai )aitu tu 7i# 7i#a a ia ia 'it 'ita&7 a&7a% a% 'en 'en5an insu#i 5an insu#in n e-s e-s5e 5en n ia ia ti' ti'a- a- &u' &u'a% a% &en &ena' a'i i %ip %ip5# 5#i-e i-e&i. &i. A-a A-an n tet tetapi api, , 7i# 7i#a a i7u i7u ti' ti'a- a- &a& &a&pu pu &en &enin5 in5-at -at-an -an pr pr'u- 'u-si si insu#i insu#in, n, se%in5 se%in55a 5a ia ia re#ati* re#ati*e e %ip %ipinsu#i insu#in n )an5 &en)e7a7- )an5 &en)e7a7-an an %iper %iper5#i-e& 5#i-e&ia ia atau atau 'ia7e 'ia7etes tes -e%a& -e%a&i#an. i#an.Pa'a Pa'a DMG, DMG, se#ain se#ain peru7 peru7a%an9 a%an9peru7 peru7a%an a%an isi# isi#5i 5i terse7u terse7ut, a-an t, a-an tera' tera'i i suatu -ea'aan 'i &ana suatu -ea'aan 'i &ana u&#a u&#a% %   un5 un5si insu#in &ena'i si insu#in &ena'i ti'a- pti&a#. Tera'i peru7a%an -ineti-a insu#in 'an resistensi ter%a'ap ee- ti'a- pti&a#. Tera'i peru7a%an -ineti-a insu#in 'an resistensi ter%a'ap ee- insu#in. A-i7atn)a, -&psisi su&7er ener5i 'a#a& p#as&a i7u 7erta&7a% insu#in. A-i7atn)a, -&psisi su&7er ener5i 'a#a& p#as&a i7u 7erta&7a% >-a'ar 5u#a 'ara% tin55i, -a'ar insu#in tetap tin55i?. Me#a#ui 'iusi terasi#itasi >-a'ar 5u#a 'ara% tin55i, -a'ar insu#in tetap tin55i?. Me#a#ui 'iusi terasi#itasi 'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin 'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a i-ut u5a i-ut tera'i -&psi tera'i -&psisi si su& su&7er 7er ene ener5 r5i i a7n a7nr& r&a# a# >&e >&en)e n)e7a7 7a7-an -an -e& -e&un5 un5-in -inan an ter tera' a'i i 7er 7er7a5 7a5ai ai -& -&p#i p#i-as -asi?. i?. Se# Se#ain ain itu itu ter tera' a'i i u5 u5a a %ip %iperin erinsu# su#ine ine&ia &ia se%i se%in55 n55a a an anin in u5 u5a a &e &en5 n5a# a#a& a&i i 5a 5an5 n55u 5uan an &e &eta ta7 7#i #i- - >% >%ip ip5 5#i #i-e -e&i &ia, a, %i %ip p&a &a5n 5nes ese& e&ia ia, , %ip-a#se&ia, %iper7i#iru7ine&ia, 'an se7a5ain)a. %ip-a#se&ia, %iper7i#iru7ine&ia, 'an se7a5ain)a. 2. M!'i$+"!+i K%i'i+ Di!$"$+ M$%i")+ G$+"!+i/'!% 2. M!'i$+"!+i K%i'i+ Di!$"$+ M$%i")+ G$+"!+i/'!% ;eri-ut Maniestasi K#inis DM Gestasina# : ;eri-ut Maniestasi K#inis DM Gestasina# : 9 9 P P#) #)ur uria > 7 ia > 7an an)a )a- 7e - 7er- r-e& e&i% i%?, ?, 9 9 P P#) #)'i 'ips psia > ia > 7a 7an) n)a- & a- &in inu& u&?, ?, 9 9 Pe Penu nuru runa nan 7e n 7era rat 7a t 7a'a 'an, n, 9 9 P P#) #)p% p%a5 a5ia > ia >7a 7an) n)a- & a- &a- a-an an?, ?, 10 10
  • 13. 9 9 Le Leti ti%, %, #e #esu su, , Le Le&a &a% % 7a 7a'a 'an, n, 9 9 G Ga at ta a# #, , 9 9 pa pan' n'an an5a 5an n -a -a7u 7ur r, , 9 9 'a 'an pr n prur urit itus * us *u# u#*a *ae pa' e pa'a( a(an anit ita, a, 9 9 P Pu us si in n5 5, , 9 9 M Mu ua a# #, , 9 9 ' 'an an &u &u'a 'a% i % in ne e- -si si. . 2.7 P$'(!#), 4!' K/ 2.7 P$'(!#), 4!' K/*%i&!+i *%i&!+i Di!$"$+ M$%i" Di!$"$+ M$%i")+ "$#,!4! K$,!*i%! )+ "$#,!4! K$,!*i%!' ' Dia7etes &e#itus 5estasina# 'apat &erupa-an -e#ainan 5eneti- 'en5an Dia7etes &e#itus 5estasina# 'apat &erupa-an -e#ainan 5eneti- 'en5an $a $ara ra in insu sui isi sien ensi si at atau au 7e 7er- r-ur uran an5n 5n)a )a in insu su#i #in n 'a 'a#a #a& & si sir- r-u# u#as asi i 'a 'ara ra%, %, 7er-uran5n)a 5#i-5enesis, 'an -nsentrasi 5u#a 'ara% tin55i. Dia7etes 'a#a& 7er-uran5n)a 5#i-5enesis, 'an -nsentrasi 5u#a 'ara% tin55i. Dia7etes 'a#a& -e%a&i#an &eni&7u#-an 7an)a- -esu#itan. Pen)a-it ini a-an &en)e7a7-an -e%a&i#an &eni&7u#-an 7an)a- -esu#itan. Pen)a-it ini a-an &en)e7a7-an peru7a%an9peru7a%an peru7a%an9peru7a%an &eta7#i- &eta7#i- 'an 'an %r&na# %r&na# pa'a pa'a pen'erita. pen'erita. ;e7erapa ;e7erapa %r&n tertentu &en5a#a&i penin5-atan u&#a%, &isa#n)a %r&n -rtis#, %r&n tertentu &en5a#a&i penin5-atan u&#a%, &isa#n)a %r&n -rtis#, estr5en, 'an %u&an p#a$enta# #a$t5en >PL?. Penin5-atan u&#a% se&ua estr5en, 'an %u&an p#a$enta# #a$t5en >PL?. Penin5-atan u&#a% se&ua %r&n terse7ut saat %a&i# tern)ata &e&pun)ai pen5aru% ter%a'ap un5si %r&n terse7ut saat %a&i# tern)ata &e&pun)ai pen5aru% ter%a'ap un5si insu#in 'a#a& &en5atur -a'ar 5u#a 'ara%. Kn'isi ini &en)e7a7-an suatu insu#in 'a#a& &en5atur -a'ar 5u#a 'ara%. Kn'isi ini &en)e7a7-an suatu -n'isi )an5 -e7a# ter%a'ap insu#in )an5 'ise7ut se7a5ai resisten insu#in. -n'isi )an5 -e7a# ter%a'ap insu#in )an5 'ise7ut se7a5ai resisten insu#in. Se%in55a &eni&7u#-an 'a&pa- penin5-atan -a'ar 5#u-sa pa'a i7u %a&i# Se%in55a &eni&7u#-an 'a&pa- penin5-atan -a'ar 5#u-sa pa'a i7u %a&i# >Ra%a)u, !1"?. >Ra%a)u, !1"?. Pa'a Pa'a 'ia7e 'ia7etes tes &e#itu &e#itus s 5estasi 5estasina#, na#, se#ain se#ain peru7 peru7a%an9p a%an9peru7a% eru7a%an an isi# isi#5i 5i terse7ut, a-an tera'i suatu -ea'aan 'i &ana un5si insu#in &ena'i ti'a- terse7ut, a-an tera'i suatu -ea'aan 'i &ana un5si insu#in &ena'i ti'a- pt pti&a i&a#. #. T Ter era'i a'i per peru7a u7a%an %an -in -ineti eti-a -a ins insu#i u#in n 'an 'an resi resisten stensi si ter ter%a' %a'ap ap ee ee- - insu#in, a-i7atn)a -an'un5an 5#u-sa 'a#a& p#as&a i7u 7erta&7a%, -a'ar insu#in, a-i7atn)a -an'un5an 5#u-sa 'a#a& p#as&a i7u 7erta&7a%, -a'ar 5u#a 'ara% 5u#a 'ara% tin55 tin55i, i, tetapi -a'ar insu#in tetap tetapi -a'ar insu#in tetap tin55 tin55i. i. Me#a#u Me#a#ui i 'iusi terasi#it 'iusi terasi#itasi asi 'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a 'a#a& &e&7ran p#asenta, 'i&ana sir-u#asi anin u5a i-ut tera'i -an'un5 i-ut tera'i -an'un5an an 5#u 5#u-s -sa a a7n a7nr& r&a#. a#. Pen Penin5 in5-at -atan an tin tin5-a 5-at t seru seru& & &et &eta7 a7#it #it pa' pa'a a i7u i7u )an )an5 5 &en5a &en5a#a&i #a&i 'ia7e 'ia7etes tes >&isa#n >&isa#n)a5#u )a5#u-sa, asa& -sa, asa& #e&a- 7e7as, #e&a- 7e7as, sen)a( sen)a(a a -etn -etn 'a#a& tu7u%, tri5#iseri'a, 'an asa&asa& a&in? a-an &e&i$u penin5-atan 'a#a& tu7u%, tri5#iseri'a, 'an asa&asa& a&in? a-an &e&i$u penin5-atan tra trans nse er r nu nutr trie ien n pa pa'a 'a a ani nin n )a )an5 n5 pa pa'a 'a 5i 5i#i #ira rann nn)a )a a- a-an an &e &eni ni&7 &7u# u#-a -an n %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eru7a% pertu&7u%an %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eru7a% pertu&7u%an 'an -&psisi tu7u% anin >Ra%a)u, !1"?. 'an -&psisi tu7u% anin >Ra%a)u, !1"?. Ke&u'ian pa'a tri&ester -e'ua -e%a&i#an, pan-reas anin 'en5an i7u Ke&u'ian pa'a tri&ester -e'ua -e%a&i#an, pan-reas anin 'en5an i7u 'ia7etes &e##itus 5estasina# a-an 7era'aptasi 'en5an %iper5#i-e&i- 'a#a& 'ia7etes &e##itus 5estasina# a-an 7era'aptasi 'en5an %iper5#i-e&i- 'a#a& 11 11
  • 14. #i #in5 n5-u -un5 n5an an u ute teru rus s ' 'en en5a 5an n &e &eni nin n5- 5-at at-a -an n p pr r'u 'u- -si si in insu su#i #in n, , )a )an n5 5 &en5a-i7at-an %iperinsu#ine&ia pa'a anin. Titi- -u#&inasi 'ari peristi(a &en5a-i7at-an %iperinsu#ine&ia pa'a anin. Titi- -u#&inasi 'ari peristi(a &eta7#i- )an5 tera'i 'i 'a#a& uterus ini a-an &en5a-i7at-an %ip5#i-e&ia, &eta7#i- )an5 tera'i 'i 'a#a& uterus ini a-an &en5a-i7at-an %ip5#i-e&ia, p#isite&ia, p#isite&ia, %iper7i#iru7ine&ia, %iper7i#iru7ine&ia, -&p#i-asi -&p#i-asi 5a(at 5a(at naas naas >respiratr) >respiratr) 'istress 'istress s) s)n' n'r r&e &e?, ?, 'a 'an n pe pert rtu& u&7u 7u%a %an n e etu tus s )a )an5 n5 7e 7era ratn tn)a )a 7e 7er# r#e7 e7i% i%an an at atau au &a-rs&ia >Ra%a)u, !1"?. &a-rs&ia >Ra%a)u, !1"?. Ma- Ma-rs rs&i &ia, a, )an )an5 5 'i' 'i'ei einis nisi-a i-an n se7 se7a5a a5ai i 7er 7erat at #a% #a%irB irB 2.! 2.!!! !! 5, 5, ter tera'i a'i pa'a pa'a !93!@ !93!@ 7a)i 7a)i )an5 )an5 i7un)a i7un)a &en'erita &en'erita Dia7etes Dia7etes Mi#itus Mi#itus Gestasina#. Gestasina#. Fa Fa-t -tr r9 9a- a-t tr r #a #ain in )a )an5 n5 'a 'apa pat t 'i 'ipe per# r#i% i%at at pa pa'a 'a i7 i7u u )a )an5 n5 &e &e&i &i$u $u-a -an n penin5-atan penin5-atan insi'en insi'en -e#a%iran -e#a%iran anin anin &a-rs&ia &a-rs&ia ter&asu- ter&asu- %iper5#i-e&ia, %iper5#i-e&ia, ;') Mass In'e >;MI? tin55i, usia )an5 #e7i% tua, &u#tiparitas. Den5an ini, ;') Mass In'e >;MI? tin55i, usia )an5 #e7i% tua, &u#tiparitas. Den5an ini, -asus &a-rs&ia 'apat -asus &a-rs&ia 'apat &en) &en)e7a7- e7a7-an an untu- &r7i'it untu- &r7i'itas as anin &enin5-at anin &enin5-at se(a-tu 'i#a%ir-an, seperti 'istsia 7a%u, 'an &enin5-at-an risi- -e#a%iran se(a-tu 'i#a%ir-an, seperti 'istsia 7a%u, 'an &enin5-at-an risi- -e#a%iran se$ara sa$ti $aesaria. ip5#i-e&ia nenata# 'apat tera'i 'a#a& 7e7erapa se$ara sa$ti $aesaria. ip5#i-e&ia nenata# 'apat tera'i 'a#a& 7e7erapa a& a& sete#a% sete#a% 'i#a%ir-an. 'i#a%ir-an. a# a# ini ini a'a#a% a'a#a% -arena -arena i7u i7u )an5 )an5 %iper5#i-e&ia %iper5#i-e&ia 'apat 'apat &en)e7a7-an anin %iperinsu#ine&ia. &en)e7a7-an anin %iperinsu#ine&ia. K&p#i-asi an5-a p K&p#i-asi an5-a panan5 pa'a anin anan5 pa'a anin 'en5an i7u 'en5an i7u ter&asu- penin5-atan ter&asu- penin5-atan risi- int#eransi 5#u-sa, 'ia7etes, 'an 7esitas. K&p#i-asi pa'a i7u GDM risi- int#eransi 5#u-sa, 'ia7etes, 'an 7esitas. K&p#i-asi pa'a i7u GDM &e#iputi %ipertensi, pree-#a&psia, 'an penin5-atan risi- -e#a%iran se$ara &e#iputi %ipertensi, pree-#a&psia, 'an penin5-atan risi- -e#a%iran se$ara sa$ti $aesaria. ipertensi ini &un5-in ter-ait 'en5an resistensi insu#in. O#e% sa$ti $aesaria. ipertensi ini &un5-in ter-ait 'en5an resistensi insu#in. O#e% -arena itu, -arena itu, inter* inter*ensi ensi )an5 &enunu- )an5 &enunu--an -an penin penin5-at- 5-at-an an sensit sensiti*itas i*itas insu#i insu#in n 'apat &e&7antu &en$e5a% -&p#i-asi ini. Ti'a- %an)a itu, (anita 'en5an 'apat &e&7antu &en$e5a% -&p#i-asi ini. Ti'a- %an)a itu, (anita 'en5an ri(a)a ri(a)at Dia7etes Mi#itus Gestasi t Dia7etes Mi#itus Gestasina# na# &e&i#i &e&i#i-i penin5- -i penin5-atan risi- 'ia7 atan risi- 'ia7etes etes se sete te#a #a% % -e -e%a %a&i &i#a #an n se se7e 7esa sar r 21 21,3 ,3@ @ &e &en' n'er erit ita a DM DMG G pa pa'a 'a -e -e%a %a&i &i#a #an n 7eri-utn)a, 7eri-utn)a, se'an5-an se'an5-an pa'a pa'a (anita (anita )an5 )an5 ti'a- ti'a- &e&i#i-i &e&i#i-i ri(a)at ri(a)at DMG DMG se7 se7e# e#u& u&n) n)a a %a %an) n)a a 2, 2,@ @.0 .0 Ri Risi si- - &e &en' n'eri erita ta 'i 'ia7 a7et etes es + + ta ta%u %un n set sete# e#a% a% ter' ter'ia5 ia5ns nsis is DMG DMG a'a a'a#a% #a% ",0 ",0@ @ 'an 'an sete sete#a% #a% 1! 1! ta% ta%un un &en &ena' a'i i 1, 1,1@. 1@.1! 1! Dia Dia7et 7etes es 5es 5estasi tasina na# # )an )an5 5 'it 'iterap erapi i a-a a-an n &en &en5ur 5uran5 an5i i risi risi- - &a- &a-rs rs&i &ia, a, 'istsia 7a%u, 'an %ipertensi 5estasina# >Lin5, !1"?. 'istsia 7a%u, 'an %ipertensi 5estasina# >Lin5, !1"?. 2.8 P$*$#i&+!!' Di!('/+"i& Di!$"$+ Mi%i")+ 2.8 P$*$#i&+!!' Di!('/+"i& Di!$"$+ Mi%i")+ G$+"!+i/'!% G$+"!+i/'!% 12 12
  • 15. Men Menuru urut t Li Lin5 n5 >! >!1"? 1"? pe& pe&eri- eri-saan saan 'ia 'ia5n 5nsti- sti- DMG DMG 'ap 'apat at 'i# 'i#a-u a-u-an -an 'en5an sa#a% satu 'ari 'ua strate5i 7eri-ut : 'en5an sa#a% satu 'ari 'ua strate5i 7eri-ut : 1. 6 1. 6One-step One-step8 =+ 5ra& TTGO 8 =+ 5ra& TTGO Strate5i Strate5i One-Step One-Step a'a#a% tes t#eransi 5#u-sa ra# 'en5an =+ 5ra& a'a#a% tes t#eransi 5#u-sa ra# 'en5an =+ 5ra& 5#u 5#u-s -sa. a. Pen Pen5u- 5u-ura uran n 5#u 5#u-s -sa a p#a p#as&a s&a 'i# 'i#a-u a-u-an -an saat saat pasi pasien en 'a# 'a#a& a& -ea'aan puasa, 1 a&, 'an  a& sete#a% tes t#eransi 5#u-sa. Tes -ea'aan puasa, 1 a&, 'an  a& sete#a% tes t#eransi 5#u-sa. Tes 'i#a- 'i#a-u-an pa'a u-an pa'a usia -e%a&i#an 29 &in55u pa'a usia -e%a&i#an 29 &in55u pa'a (anit (anita a %a&i# )an5 %a&i# )an5 se7e#u&n)a 7e#u& perna% ter'ia5nsis 'ia7etes &e#itus. Tes t#eransi se7e#u&n)a 7e#u& perna% ter'ia5nsis 'ia7etes &e#itus. Tes t#eransi 5#u-sa ra# %arus 'i#a-u-an pa'a pa5i %ari sete#a% puasa se&a#a&an 5#u-sa ra# %arus 'i#a-u-an pa'a pa5i %ari sete#a% puasa se&a#a&an set seti'a i'a-n) -n)a a se#a se#a&a &a   a& a&. . Dia Dia5n 5nsis sis DMG DMG 'it 'ite5a e5a--a --an n apa apa7i# 7i#a a %asi %asi# # -a'ar 5#u-sa p#as&a ni#ain)a &e&enu%i seti'a-n)a satu -riteria 'i -a'ar 5#u-sa p#as&a ni#ain)a &e&enu%i seti'a-n)a satu -riteria 'i 7a(a% ini: 7a(a% ini: Pua Puasa sa 0 0 &5 &5'L 'L >+, >+,1 1 && &&#L #L? ? atau #e7i% tin55i atau #e7i% tin55i 1 1  a a& & 1 1 ! ! & &5 5 ' 'L L > >1 1! ! & && & # # L L? ? atau #e7i% tin55i atau #e7i% tin55i    a a& & 1 1+ ++ + & &5 5 ' 'L L > > , ,+ + & && & # # L L? ? atau #e7i% tin55i atau #e7i% tin55i . . 6 6Two-step Two-step8 8 app appra ra$% $% &en &en55u 55una- na-an an +! +! 5ra 5ra& & 5#u 5#u-s -sa a >ta >tanpa npa pua puasa? sa? 'ii-uti 'en5an tes t#eransi 5#u-sa ra# >TTGO? &en55una-an 1!! 'ii-uti 'en5an tes t#eransi 5#u-sa ra# >TTGO? &en55una-an 1!! 5ra 5ra& & 5#u 5#u-s -sa a i- i-a a s-r s-rini inin5 n5 a(a a(a# # &e& &e&7er 7eri-a i-an n %as %asi# i# p psiti siti. . Str Strate5 ate5i i T(9Steps: T(9Steps:   Step 1 Step 1 La- La-u-a u-an n tes tes pe& pe&7e7 7e7ana anan n 5#u 5#u- -sa sa +! +! 5ra 5ra& & >ta >tanpa npa pua puasa?, sa?, -a'ar 5#u-sa p#as&a 'iu-ur 1 a& sete#a% pe&7e7anan 5#u-sa, -a'ar 5#u-sa p#as&a 'iu-ur 1 a& sete#a% pe&7e7anan 5#u-sa, 'i#a- 'i#a-u-an pa'a u-an pa'a (anit (anita a 'en5a 'en5an n usia -e%a&i#an 29 usia -e%a&i#an 29 &in5 &in55u 5u )an )an5 5 7e# 7e#u& u& per perna% na% ter ter'ia 'ia5n 5nsis sis 'ia 'ia7et 7etes es &e# &e#itu itus. s. i- i-a a -a' -a'ar ar 5# 5#u- u-s sa a p# p#as& as&a a 1 1 a a& & set sete# e#a% a% pe pe&7 &7e7 e7an anan an 5# 5#u- u-s sa a B1 B12! 2! &5'L >=, &&#L?, 'i#anut-an 'en5an tes t#eransi 5#u-sa &5'L >=, &&#L?, 'i#anut-an 'en5an tes t#eransi 5#u-sa ra# 'en5an 1!! 5ra& 5#u-sa. ra# 'en5an 1!! 5ra& 5#u-sa.   Step  Step  13 13
  • 16. T Tes es t t#e #era rans nsi i 5# 5#u- u-s sa a r ra# a# 'e 'en5 n5an an 1! 1!! ! 5r 5ra& a& 5# 5#u- u-s sa a 'i#a-u-an pa'a pasien 'a#a& -ea'aan puasa. Dua 'ari e&pat 'i#a-u-an pa'a pasien 'a#a& -ea'aan puasa. Dua 'ari e&pat %asi# pen5u-uran 5#u-sa p#as&a &e&enu%i -riteria 7eri-ut: %asi# pen5u-uran 5#u-sa p#as&a &e&enu%i -riteria 7eri-ut: 2.9 P$'!"!%!&+!'!!' M$4i+ 2.9 P$'!"!%!&+!'!!' M$4i+ Di!$"$+ G$+"!+i/'!% Di!$"$+ G$+"!+i/'!% Terapi untu- pasien 'ia7etes &e##itus 5estasina# 'apat 'i#a-u-an 'en5an Terapi untu- pasien 'ia7etes &e##itus 5estasina# 'apat 'i#a-u-an 'en5an 'ua $ara )aitu 'en5an terapi nn ar&a-#5i 'an terapi ar&a-#5i : 'ua $ara )aitu 'en5an terapi nn ar&a-#5i 'an terapi ar&a-#5i : 1. 1. T Terap erapi i Far& Far&a- a-#5 #5is is 1 1? ? I In ns su u# #i in n Insu#in a'a#a% %r&ne p#ipepti'a )an5 ter'iri 'ari +1 asa& Insu#in a'a#a% %r&ne p#ipepti'a )an5 ter'iri 'ari +1 asa& a&in )an5 tersusun 'a#a&  rantai, rantai A ter'iri 'ari 1 asa& a&in )an5 tersusun 'a#a&  rantai, rantai A ter'iri 'ari 1 asa& a&in 'an rantai ; &e&i#i-i 3! asa& a&in. Tuuan 'ari terapi a&in 'an rantai ; &e&i#i-i 3! asa& a&in. Tuuan 'ari terapi insu#in )aitu untu- &en5atur -a'ar 5#u-sa 'ara% 'en5an tar5et insu#in )aitu untu- &en5atur -a'ar 5#u-sa 'ara% 'en5an tar5et r r5an 5an uta uta&a &a a'a a'a#a% #a% %ep %epar ar, , t tt, t, 'an 'an ari arin5a n5an n a'i a'ips psa. a. Pre Prepar parat at insu#i insu#in n 'apat 'i7e'a- 'apat 'i7e'a-an 7er'asar-an #a&a an 7er'asar-an #a&a -era )aitu -era )aitu insu#i insu#in n -era -era $epat, se'an5, 'an panan5 >Tanu, !!=?. Me-anis&e -era 'ari $epat, se'an5, 'an panan5 >Tanu, !!=?. Me-anis&e -era 'ari i in ns su u# #i in n ) )ai ait tu u & &en enu uru run n- -a an n - -a a' 'a ar r 5 5# #u u- - sa sa ' 'a ara ra% % ' 'e en n5 5a an n &e &ens nsti ti&u &u#as #asi i pe pen5 n5a& a&7i 7i#a #an n 5# 5#u- u-s sa a pe peri rier er 'a 'an n &e &en5 n5%a %a&7 &7at at pr'u-si 5#u-sa %epati-. pr'u-si 5#u-sa %epati-. ? ? O7 O7at  at ip ip5 5#i #i-e -e&i &i- Or - Ora# > a# >O OO? O? O7at %ip5#i-e&i- ra# 7iasa 'i5una-an untu- pasien DM a'a O7at %ip5#i-e&i- ra# 7iasa 'i5una-an untu- pasien DM a'a + 5#n5an )aitu su#ni#urea, 7i5uani', &e5#itini', pen5%a&7at  + 5#n5an )aitu su#ni#urea, 7i5uani', &e5#itini', pen5%a&7at  5#i-si'ase, 'an tia#i'ine'ine. Na&un, 7at %ip5#i-e&i- ra# 5#i-si'ase, 'an tia#i'ine'ine. Na&un, 7at %ip5#i-e&i- ra# )an5 a&an 'an 'apat 'i7eri-an pa'a pasien DM 5estasina# %an)a )an5 a&an 'an 'apat 'i7eri-an pa'a pasien DM 5estasina# %an)a 5#i7u 5#i7uri'5 ri'5#i7en- #i7en-#a&i' #a&i' >su# >su#ni#ure ni#urea?, a?, &etr &etr&in &in >7i5u >7i5uani'? ani'?, , 'an 'an 14 14 <arpenter<ustan NDDG <arpenter<ustan NDDG P Pu ua as sa a 0 0+ + & &5 5 ' 'L L > >+ +, ,3 3& && & # # L L? ? B B1 1! !+ + & &5 5 ' 'L L > >+ +, ,  &&#L? &&#L? 1 1  a a& & 1 1 ! ! & &5 5 ' 'L L > >1 1! ! & && & # # L L? ? B B1 10 0! ! & &5 5 ' 'L L > >1 1! !, ," " &&#L? &&#L?    a a& & 1 1+ ++ + & &5 5 ' 'L L > > , ," " & && & # # L L? ? B B1 1" "+ + & &5 5 ' 'L L > >0 0, ,  &&#L? &&#L? 3 3  a a& & 1 12 2! ! & &5 5 ' 'L L > >= =, ,  & && & # # L L? ? B B1 12 2+ + & &5 5 ' 'L L > >  & && & # # L L? ? NDDG, NDDG, National Diabetes Data Gr National Diabetes Data Group oup
  • 17. a-a a-ar7 r7se se >pe >pen5% n5%a&7 a&7at at 95 95#i- #i-si' si'ase? ase? >T% >T%a$- a$-er er Q Q Pet Pet-e( -e(i$ i$, , !!0?. !!0?. G#i G#i7ur 7uri' i'5#i 5#i7en 7en-#a& -#a&i' i' >su >su# #ni# ni#ure urea? a? 7e- 7e-era era 'en 'en5an 5an &er &eran5 an5san5 se san5 se-re -resi insu si insu#in 'a #in 'ari 5ran ri 5ranu# se#9 u# se#9se# se# 7e 7eta ta #an #an5er 5er%an %ans s pan-reas. pan-reas. Metr&in Metr&in >7i5uani'? >7i5uani'? 7e-era 7e-era 'en5an 'en5an &enurun-an &enurun-an pr'u-si pr'u-si 5#u-sa 5#u-sa 'i 'i %epar %epar 'an 'an &enin5-at-an &enin5-at-an sensiti*itas sensiti*itas arin5an arin5an tt 'an arin5an a'ipsa ter%a'ap insu#in. A-ar7se >pen5%a&7at tt 'an arin5an a'ipsa ter%a'ap insu#in. A-ar7se >pen5%a&7at 9 95# 5#i- i-s si' i'as ase? e? 7e 7e-e -er ra a 'e 'en5 n5an an &e &en5 n5%a %a&7 &7at at -e -era ra en eni i& & 9 9 5#i-si'ase 'i 7rus% 7r'er intestine se%in55a 'apat &e&per#a&7at 5#i-si'ase 'i 7rus% 7r'er intestine se%in55a 'apat &e&per#a&7at a7srpsi p#isa-ari'a, 'e-strin, 'an 'isa-ari'a 'i intestine >Tanu, a7srpsi p#isa-ari'a, 'e-strin, 'an 'isa-ari'a 'i intestine >Tanu, !!=?. !!=?. . . T Ter erap api N i Nn F n Far ar&a &a- -# #5i 5is s 1 1? ? D Di ie et t D DM M   M MN NT T > >Medical Nutrition Therapy Medical Nutrition Therapy? ? Dietterapi nutrisi &erupa-an pen57atan stan'ar untu- se&ua Dietterapi nutrisi &erupa-an pen57atan stan'ar untu- se&ua pasien pasien 'ia7etes 'ia7etes &e##itus &e##itus 5estasina# 5estasina# 'en5an 'en5an tuuan tuuan &enin5-at-an &enin5-at-an nut nutrisi risi unt untu- u- i7u i7u 'an 'an an anin, in, &en &enin5 in5-at -at-an -an asu asupan pan -a# -a#ri ri 7a5 7a5i i tu&7u% -e&7an5 anin, pen5aturan nr&5#i-e&ia, 'an &en$e5a% tu&7u% -e&7an5 anin, pen5aturan nr&5#i-e&ia, 'an &en$e5a% -etsis >Seti -etsis >Seti et al. et al., !!+?. , !!+?. ? ? Self Monitoring of Blood Glucose Self Monitoring of Blood Glucose >SM;G? >SM;G? merican merican Diabetes Diabetes ssociation ssociation >ADA? >ADA? &ere- &ere-&en' &en'asi-an asi-an &nitrin5 5#u-sa 'ara% >SM;G? 'apat 'i#a-u-an se7an)a- 3 &nitrin5 5#u-sa 'ara% >SM;G? 'apat 'i#a-u-an se7an)a- 3 atau #e7i% se%ari untu- pasien )an5 &en55una-an ine-si insu#in atau #e7i% se%ari untu- pasien )an5 &en55una-an ine-si insu#in atau terapi p&pa insu#in. atau terapi p&pa insu#in. BAB III BAB III ASUHAN KEPERAWATAN ASUHAN KEPERAWATAN .1 K!+)+ .1 K!+)+ N) N). .   3+ 3+ ta%un, ta%un, G2 G2 P3A!, P3A!, usia usia -e%a&i#an -e%a&i#an 3! 3! &in55u, &in55u, 'i 'i ra(at ra(at 'i 'i RS RS 'en5an -e#u%an sea- 3 %ari )an5 #a#u &en)ata-an &u'a% #e#a%, ti'a- nasu 'en5an -e#u%an sea- 3 %ari )an5 #a#u &en)ata-an &u'a% #e#a%, ti'a- nasu &a-an, &ua# &unta% B " -a#i, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# &a-an, &ua# &unta% B " -a#i, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# pe&eri-saan ;; +-5, T; 1"! $&, T; : !! 5ra&, %asi# #a7ratriu& GDS pe&eri-saan ;; +-5, T; 1"! $&, T; : !! 5ra&, %asi# #a7ratriu& GDS : +! &5'#, ri(a)at -e#uar5a 'en5an DM, ri(a)at &e#a%ir-an ana- -eti5a : +! &5'#, ri(a)at -e#uar5a 'en5an DM, ri(a)at &e#a%ir-an ana- -eti5a 'en 'en5an 5an ;;L 2!! ;;L 2!! 5r 5r. . O#e O#e% % '- '-ter ter N) N). .   'in 'in)at )ata-a a-an n &en &en5i' 5i'ap ap Dia Dia7et 7etes es 15 15
  • 18. Gest Gestasi asina# na# -e& -e&u'i u'ian an 'i7 'i7eri- eri-an an %u& %u&u#i u#in n 3! 3!=! =! + + I I 3! 3! &nt a.$., &nt a.$., N) N). .   $e $e& &as as pe pe&7 &7er eria ian n in insu su#i #in n a- a-an an &e &en) n)e7 e7a7 a7- -an an -e -ete ter r5 5an antu tun n5a 5an n ' 'an an &en)e7a7-an 5an55uan per-e&7an5an aninn)a. Se#a&a &en)e7a7-an 5an55uan per-e&7an5an aninn)a. Se#a&a 'i RS, N).  aran5 'i RS, N).  aran5 'itun55u -e#uar5an)a -arena sua&i 'itun55u -e#uar5an)a -arena sua&i N) N).  %arus .  %arus 7e-era, 'an ran5 7e-era, 'an ran5 tua N).  tua N).  u5a &era(at ana- N) u5a &era(at ana- N). . >Sa# Si&u#asi K;S KOM Ners 12 . . >Sa# Si&u#asi K;S KOM Ners 12?. ?. .2 A+),!' K$$#!!"!' .2 A+),!' K$$#!!"!' P$'(&!-i!': P$'(&!-i!': 1. 1. I' I'en enti tita tas s a? a? Na Na&a &a: N) : N).  .  7? 7? sia: 3+ ta%un sia: 3+ ta%un $? $? ;; ;;:  : + - + -5 5 '? '? T; T;: 1 : 1"! "! $& $& e? e? a a&i &i# an # ana- - a- -e: 2 e: 2 ? ? Pa Part rtus us: 3 - : 3 -a# a#i i . . Ke Ke#u #u%a %an t n ta& a&a a Mu'a% #e#a%, ti'a- nasu &a-an, &ua# &unta%, #e&as, &erasa %aus, Mu'a% #e#a%, ti'a- nasu &a-an, &ua# &unta%, #e&as, &erasa %aus, 7an)a- -en$in5. 7an)a- -en$in5. 3. 3. Ri(a) Ri(a)at at Pen)a Pen)a-it -it Ke#ua Ke#uar5a r5a Ke#uar5a &e&pun)ai ri(a)at Dia7etes &e##itus Ke#uar5a &e&pun)ai ri(a)at Dia7etes &e##itus 2. 2. Ri( Ri(a)a a)at Ke%a& t Ke%a&i#an Se- i#an Se-aran aran5 5 a a&i &i# # tu tua a us usia ia 3! 3! &i &in5 n55u 5u 'e 'en5 n5an an -e -e#u #u%a %an n se sea- a- 3 3 %a %ari ri )a )an5 n5 #a# #a#u u &en)ata-an &u'a% #e#a%, ti'a- nasu &a-an, &ua# &unta% B " -a#i, &en)ata-an &u'a% #e#a%, ti'a- nasu &a-an, &ua# &unta% B " -a#i, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# pe&eri-saan ;; +-5, #e&es, &erasa %aus, 7an)a- -en$in5. Dari %asi# pe&eri-saan ;; +-5, T; 1"! $&. T; 1"! $&. +. +. P# P#a A-ti a A-ti*it *itas as Se% Se%ari ari9%ar 9%ari i a? a? P#a Nut P#a Nutrisi: -#ie risi: -#ien ti'a- na n ti'a- nasu &a-an &u su &a-an &u#a, &erasa %au #a, &erasa %aus s 7? 7? P#a E#i&inasi: -#ien serin5 -en$in5. P#a E#i&inasi: -#ien serin5 -en$in5. ". ". Asp Aspe- e- psi psi-# -#5i 5is s N) N). .   &erasa &erasa $e&as $e&as pe&7erian pe&7erian insu#in insu#in a-an a-an &en)e7a7-an &en)e7a7-an -eter5antun5an 'an &en)e7a7-an 5an55uan per-e&7an5an aninn)a. -eter5antun5an 'an &en)e7a7-an 5an55uan per-e&7an5an aninn)a. =. =. As Aspe pe- S - Ss sia ia# # N) N). .   aran5 aran5 'itun55u -e#uar5an)a 'itun55u -e#uar5an)a -arena -arena sua&i sua&i N) N). .   %arus %arus 7e-era, 7e-era, 'an ran5 tua 'an ran5 tua N) N).  u5a .  u5a &era(at ana- &era(at ana- N) N). . . . . . Da Data O ta O7 7e- e-ti ti  a? a? Pe Pe&e &eri ri-s -saan & aan &u& u&   K Ke ea a' 'a aa an n u u& &u u& & : : 7 7a ai i- - 16 16
  • 19.   K Ke es sa a' 'a ar ra an n : : $ $ & &p p s s& &e en nt ti is s   S St ta at tu us e s e& & s si i n na a# # : s : st ta a7 7i i# #   ;;: + K5 ;;: + K5   T;: 1"! $& T;: 1"! $& 7? 7? Pe&eri-saan Fisi- Pe&eri-saan Fisi-   Ke Kepa pa#a #a : & : &ess ess$ $ep epa# a#. T . Ti' i'a- a- a' a'a 7 a 7en en #an #an, 7 , 7er ersi% si%, t , ti' i'a- a- 7er-et&7e 7er-et&7e   4 4aa% aa% : : si&etris, si&etris, ti'a- ti'a- a'a a'a 'e&a, 'e&a,   T Te#in5a e#in5a : : si&etris, si&etris, ter'apat ter'apat #u7an5 #u7an5 te#in5a te#in5a   Mat Mata a : : si& si&etri etris, s, -n -nun un5ti 5ti*a *a &er &era% a% &u' &u'a, a, s$#e s$#era ra put puti% i%   i'u&5 i'u&5 : si&etris, ti'a- : si&etris, ti'a- p#ip, ti'a- p#ip, ti'a- a'a se-ret a'a se-ret   Mu#ut Mu#ut : : si&etri si&etris, s, ti'a- ti'a- #a7i #a7is-isisp s-isispa#ats- a#ats-isis, isis, ti'a- ti'a- -aries -aries 5i5i 5i5i   Le%er Le%er : : ti'a- ti'a- a'a a'a p&7es p&7esaran aran *ena *ena u5u# u5u#aris, aris, -e#en -e#enar ar partis#i&e partis#i&e   Da' Da'a a : : si& si&etri etris, s, ti' ti'a- a- retr retra-s a-si i 'in 'in'in 'in5 5 'a' 'a'a. a.   P Pa a) )u u' 'a ar ra: a: si si& &e et tri ris s, , p pu ut tt ti in n5 5 & &e en n n n  # #, , $ $ # #u ust str ru u& &> >9? 9?, , %)perpi5&entasi %)perpi5&entasi 0. 0. Da Data pe ta penu nun nan an5 5   GDS: +! &5'# GDS: +! &5'#   %u&u#in 3!=! + I 3! &nt a.$ %u&u#in 3!=! + I 3! &nt a.$ Analisa Data: Analisa Data: N N Data Data Eti#5i Eti#5i Masa#a% -epera(atan Masa#a% -epera(atan 1 1. . D DS S: :   K#ien &en5e#u% ti'a- K#ien &en5e#u% ti'a- naasu &a-an naasu &a-an   K#ien &en5e#u% K#ien &en5e#u% &ua#, &unta% &ua#, &unta% DO: 9 DO: 9 Ke%a&i#an Ke%a&i#an Penin5-atan %r&n <G Penin5-atan %r&n <G Mua#, &unta%, ti'a- nasu &a-an Mua#, &unta%, ti'a- nasu &a-an Keti'a- sei&7an5an nutrisi -uran5 Keti'a- sei&7an5an nutrisi -uran5 'ari -e7utu%an tu7u% 'ari -e7utu%an tu7u% Keti'a- sei&7an5an Keti'a- sei&7an5an nutrisi -uran5 'ari nutrisi -uran5 'ari -e7utu%an tu7u% -e7utu%an tu7u%  . . D DS S: :   K#ien &en5e#u% K#ien &en5e#u% &ua#, &unta%. &ua#, &unta%.   K#ien &erasa %aus K#ien &erasa %aus DO: 9 DO: 9 Ke%a&i#an Ke%a&i#an Penin5-atan %r&n <G Penin5-atan %r&n <G Mua#, &unta%, ti'a- nasu &a-an Mua#, &unta%, ti'a- nasu &a-an Ke-uran5an *#u&e $airan Ke-uran5an *#u&e $airan Ke-uran5an *#u&e Ke-uran5an *#u&e $airan $airan 17 17
  • 20. 3 3. . D DS S: :   K#ien &en)ata-an K#ien &en)ata-an &u'a% #e#a% &u'a% #e#a%   K#ien &n5e#u% #e&as K#ien &n5e#u% #e&as DO: 9 DO: 9 Ke%a&i#an Ke%a&i#an Peru7a%an %r&na# 'an &eta7#is&e Peru7a%an %r&na# 'an &eta7#is&e Penin5-atan %&n -rtis#, estr5en Penin5-atan %&n -rtis#, estr5en 'an PL 'an PL Resistensi insu#in Resistensi insu#in Se#9se# -e#aparan Se#9se# -e#aparan Pr'u-si ener5i 'i se#9se# tt Pr'u-si ener5i 'i se#9se# tt 7er-uran5 7er-uran5 Le&as, &u'a% #e#a% Le&as, &u'a% #e#a% Ke#eti%an Ke#eti%an Ke#eti%an Ke#eti%an Di!('/+! K$$#!!"!' Di!('/+! K$$#!!"!' 1. 1. Keti'a Keti'a- sei&7 - sei&7an5an n an5an nutris utrisi -uran i -uran5 'ari -e 5 'ari -e7utu% 7utu%an tu7u an tu7u% 7.' -e % 7.' -eti'a-& ti'a-&a&puan a&puan untu- &en$erna &a-anan. untu- &en$erna &a-anan. . . Ke-ur Ke-uran5an an5an *#u& *#u&e $ai e $airan ran 7.' 7.' -e%i#a -e%i#an5an n5an $aira $airan a- n a-ti. ti. 3. 3. Ke Ke#e #eti ti%a %an 7 n 7.' .' -e -e%a %a&i &i#an #an. . R$'6!'! I'"$#;$'+i R$'6!'! I'"$#;$'+i D Di i! !( (' '/ /+ +! ! N NO O3 3 N NI I3 3 1. 1. Ket Keti'a i'a- - sei sei&7a &7an5a n5an n nutrisi -uran5 'ari nutrisi -uran5 'ari -e7utu%an tu7u% 7.' -e7utu%an tu7u% 7.' -eti'a-&a&puan -eti'a-&a&puan untu- &en$erna untu- &en$erna &a-anan. &a-anan. Deinisi: Deinisi: Asupan nutrisi ti'a- Asupan nutrisi ti'a- $u-up untu- &e&enu%i $u-up untu- &e&enu%i -e7utu%an &eta7#i- -e7utu%an &eta7#i- >D&ain . Nutrisi, >D&ain . Nutrisi, -e#as 1. Ma-an, -'e -e#as 1. Ma-an, -'e !!!!? !!!!? Sete#a% 'i#a-u-an asu%an Sete#a% 'i#a-u-an asu%an -epera(atan se#a&a 32 a& -epera(atan se#a&a 32 a& 'i%arapa-an pe&enu%an 'i%arapa-an pe&enu%an -e7utu%an nutrisi -#ien -e7utu%an nutrisi -#ien terpenu%i, 'en5an -riteria terpenu%i, 'en5an -riteria %asi#: %asi#: S"!")+ N)"#i+i: A+)!' S"!")+ N)"#i+i: A+)!' M!&!'!' 4!' 6!i#!' <1008= M!&!'!' 4!' 6!i#!' <1008=   Asupan &a-anan Asupan &a-anan se$ara ra# terpenu%i se$ara ra# terpenu%i   Asu%an $airan se$ara Asu%an $airan se$ara ra# terpenu%i ra# terpenu%i   Asupan nutrisi Asupan nutrisi parentera# terpenu%i parentera# terpenu%i S"!")+ N)"#i+i: A+)!' S"!")+ N)"#i+i: A+)!' M!'!-$*$' N)"#i+i M!'!-$*$' N)"#i+i   T Tentu-an u&#a% entu-an u&#a% -a#ri -a#ri 'an enis nutrisi )an5 'an enis nutrisi )an5 'i7utu%-an untu- 'i7utu%-an untu- &e&enu%i pers)aratan &e&enu%i pers)aratan 5ii. 5ii. R!+i/'!%: R!+i/'!%:Me&7antu Me&7antu 'a#a& &en5i'entii-asi 'a#a& &en5i'entii-asi &a#nutris prtein9 &a#nutris prtein9 prtein. prtein.   Atur 'iet )an5 Atur 'iet )an5 'iper#u-an )aitu 'en5an 'iper#u-an )aitu 'en5an &enin5-at-an asupan &enin5-at-an asupan prtein 'an *ita&in. prtein 'an *ita&in. R!+i/'!%: R!+i/'!%:untu- untu- &enin5-at-an -ese%atan &enin5-at-an -ese%atan i7u 'an anin. i7u 'an anin.   Anur-an -#ien untu- Anur-an -#ien untu- 18 18
  • 21. N)"#i+i <1009= N)"#i+i <1009=   Asupan -a#ri Asupan -a#ri terpenu%i terpenu%i   Asupan prtein Asupan prtein terpenu%i terpenu%i   Asupan -ar7%i'rat Asupan -ar7%i'rat terpenu%i terpenu%i   Asupan *ita&in Asupan *ita&in terpenu%i terpenu%i   Asupan &inera# Asupan &inera# terpenu%i terpenu%i   Asupan at 7esi Asupan at 7esi terpenu%i terpenu%i &e&antau -a#ri 'an &e&antau -a#ri 'an inta-e &a-anan 'en5an inta-e &a-anan 'en5an &e&7uat $atatan &e&7uat $atatan &a-anan %arian. &a-anan %arian. R!+i/'!%: R!+i/'!%: ntu- ntu- &en5eta%ui -a#ri 'an &en5eta%ui -a#ri 'an nutrisi pasien terpenu%i nutrisi pasien terpenu%i atau ti'a- atau ti'a- M/'i"/#i'( N)"#i+i M/'i"/#i'( N)"#i+i   Ti&7an5 7erat 7a'an Ti&7an5 7erat 7a'an -#ien -#ien R!+i/'!%: R!+i/'!%: Pena&7a%an Pena&7a%an 7erat 7a'an a'a#a% 7erat 7a'an a'a#a% -un$i petunu- untu- -un$i petunu- untu- &e&utus-an &e&utus-an pen)esuaian -e7utu%an pen)esuaian -e7utu%an -a#ri -a#ri   Mnitr a'an)a &ua# Mnitr a'an)a &ua# 'an &unta% 'an &unta% R!+i/'!%: R!+i/'!%: Mua# 'an Mua# 'an &unta% 'apat &unta% 'apat &en5a-i7at-an &en5a-i7at-an 'eisiensi -ar7%i'rat 'eisiensi -ar7%i'rat )an5 'apat )an5 'apat &en5a-i7at-an &en5a-i7at-an &eta7#is&e #e&a- 'an &eta7#is&e #e&a- 'an tera'in)a -etsis. tera'in)a -etsis.   La-u-an pe&eri-san La-u-an pe&eri-san #a7ratriu&, &nitr #a7ratriu&, &nitr %asi#n)a: -a'ar a#7u&in, %asi#n)a: -a'ar a#7u&in, tta# prtein, 7 'an tta# prtein, 7 'an -a'ar t. -a'ar t. R!+i/'!%: R!+i/'!%: untu- untu- &en5eta%ui -a'ar &en5eta%ui -a'ar a#7u&in, tta# prtein, a#7u&in, tta# prtein, 7 'an -a'ar t. 7 'an -a'ar t. 19 19
  • 22. . Ke-uran5an *#u&e . Ke-uran5an *#u&e $airan 7.' -e%i#an5an $airan 7.' -e%i#an5an $airan a-ti. $airan a-ti. Deinisi: Deinisi: Penurunan $airan Penurunan $airan intra*as$u#ar, intra*as$u#ar, interstisia#, 'anatau interstisia#, 'anatau intrase#u#ar. Ini intrase#u#ar. Ini &en5a$u pa'a &en5a$u pa'a 'e%i'rasi, -e%i#an5an 'e%i'rasi, -e%i#an5an $airan saa tanpa $airan saa tanpa peru7a%an -a'ar peru7a%an -a'ar nattriu&. nattriu&. >D&ain . Nutrisi, >D&ain . Nutrisi, -e#as +. i'rasi, -'e -e#as +. i'rasi, -'e !!!=? !!!=? Se Sete# te#a% a% 'i 'i#a #a-u -u-a -an n tin tin'a 'a-a -an n -epera(atan se#a&a 12 a& -epera(atan se#a&a 12 a& ' 'i i% %a ar ra ap p- -a an n - -e e- -u ur ra an n5 5a an n * *#u #u&e &e $a $air iran an -# -#ie ien n 'a 'apa pat t teratasi, 'en5an -riteria %asi#: teratasi, 'en5an -riteria %asi#: K$+$i*!'(!' 3!i#!' <001= K$+$i*!'(!' 3!i#!' <001=   ;erat 7a'an sta7i#. ;erat 7a'an sta7i#.   Ke Kese sei& i&7a 7an5 n5an an inta!e inta!e ' 'a an n output output 'a# 'a#a& 2 a& 2 a& a'e-uat. a& a'e-uat. Hi4#!+i <002= Hi4#!+i <002=   Tur5r -u#it nr&a#. Tur5r -u#it nr&a#.   M Me e& &7 7r ra an n & &u u- - s sa a #e&7a7. #e&7a7. K K$ $ ! !# #! !, ,! !' ' M M) )! !% % 4 4! !' ' M)'"!, <2107= M)'"!, <2107=   T Ti' i'a- a- a' a'a a r re- e-ue uens nsi i &ua#. &ua#.   T Ti' i'a- a- a' a'a a r re- e-ue uens nsi i &unta%. &unta%. M!'!-$*$' 3!i#!' <120= M!'!-$*$' 3!i#!' <120=   Ti&7an5 7erat 7a'an Ti&7an5 7erat 7a'an setiap %ari 'an &nitr setiap %ari 'an &nitr status pasien. status pasien. R!+i/'!%: R!+i/'!%: ntu- &en5eta%ui 7erat ntu- &en5eta%ui 7erat 7a'an -#ien apa7i#a 7a'an -#ien apa7i#a tera'i peru7a%an 7erat tera'i peru7a%an 7erat 7a'an -arena 7a'an -arena -e-uran5an $airan. -e-uran5an $airan.   a5a a5a inta!e inta!e asupan  asupan )an5 a-urat 'an $atat )an5 a-urat 'an $atat output output -#ien. -#ien. R!+i/'!%: R!+i/'!%: A5ar pe&asu-an $airan A5ar pe&asu-an $airan -#ien tepat 'an 'apat -#ien tepat 'an 'apat &en5eta%ui &en5eta%ui per-e&7an5an status per-e&7an5an status $airan -#ien. $airan -#ien.   ;eri-an terapi I seperti ;eri-an terapi I seperti )an5 'itentu-an. )an5 'itentu-an. R!+i/'!%: R!+i/'!%: A5ar pe&enu%an $airan A5ar pe&enu%an $airan tepat sesuai 'en5an tepat sesuai 'en5an terapi )an5 'i7eri-an. terapi )an5 'i7eri-an. M/'i"/# 3!i#!' <10= M/'i"/# 3!i#!' <10=   Mnitr &e&7ran Mnitr &e&7ran &u-sa, tur5r -u#it, &u-sa, tur5r -u#it, 'an respn %aus. 'an respn %aus. R!+i/'!%: R!+i/'!%: ntu- &en5eta%ui ntu- &en5eta%ui &enunu--an &enunu--an -e%i#an5an $airan -e%i#an5an $airan 7er#e7i% 'e%i'rasi. 7er#e7i% 'e%i'rasi. M!'!-$*$' M)'"!, <170= M!'!-$*$' M)'"!, <170=   Aar-an pen55unaan Aar-an pen55unaan te-ni- nnar&a-#5i te-ni- nnar&a-#5i untu- &en5e##a &unta% untu- &en5e##a &unta% 20 20
  • 23. T T!'4!>T!'4! Vi"!% < !'4!>T!'4! Vi"!% <0802= 0802=   Su%u tu7u% nr&a# Su%u tu7u% nr&a#   De Den n)u )ut t na na' 'i i ra ra' 'ia ia# # nr&a# nr&a#   T Tin5 in5-a -at t pe pern rnap apasa asan n nr&a# nr&a#   Te-anan 'ara% sist#i- Te-anan 'ara% sist#i- nr&a# nr&a#   T Te e- -a an na an n ' 'a ar ra a% % 'iast#i- nr&a# 'iast#i- nr&a# Se Sete# te#a% a% 'i 'i#a #a-u -u-a -an n tin tin'a 'a-a -an n -epera(atan se#a&a 12 a& -epera(atan se#a&a 12 a& 'i 'i%a %ara rap- p-an an -e -e#et #eti% i%an an -# -#ie ien n 'apa 'apat t terat teratasi, asi, 'en5a 'en5an n -rite -riteria ria >&isa#n)a, %ipnsis, >&isa#n)a, %ipnsis, re#a-sasi, a-upresur?. re#a-sasi, a-upresur?. M/'i"/# M/'i"/# T T!'4!>T!'4! Vi"!% !'4!>T!'4! Vi"!% <80= <80=   Mnitr te-anan 'ara%, Mnitr te-anan 'ara%, na'i, su%u, 'an status na'i, su%u, 'an status pernaasan 'en5an tepat. pernaasan 'en5an tepat. R!+i/'!%: R!+i/'!%: ntu- &en5eta%ui ntu- &en5eta%ui a'an)a peru7a%an a'an)a peru7a%an tan'a9tan'a *ita# atau tan'a9tan'a *ita# atau per-e&7an5an status per-e&7an5an status -ese%atan -#ien. -ese%atan -#ien. M!'!-$*$' E'$#(i <0180= M!'!-$*$' E'$#(i <0180=   M Mni nit tr r inta!e inta!e  as asup upan an n nu ut tr ri is si i u un nt tu u- - & &e en n5 5e eta ta% %u ui i s su u& &7 7e er r ener5i )an5 a'e-uat. ener5i )an5 a'e-uat. R!+i/'!%: R!+i/'!%:  n nt tu u- - & &e e& & n ni it t r r a as su up pa an n n nu ut tr ris isi i a a5 5a ar r s su u& &7 7e er r e en ne er r5 5i i ) )a an n5 5 'i'apat-an a'e-uat a5ar 'i'apat-an a'e-uat a5ar ti'a- #e&a%, #e&as, 'an ti'a- #e&a%, #e&as, 'an #eti%. #eti%.   Kn Knsu# su#-an -an 'en 'en5an 5an a%# a%#i i 5 5i i i i & &e en n5 5e en na ai i $ $a ar ra a &e &eni nin5 n5-a -at- t-an an as asup upan an ener5i 'ari &a-anan. ener5i 'ari &a-anan. R!+i/'!%: R!+i/'!%: M Me e& &7 7a an nt tu u - -# #i ie en n &e &en5 n5et eta% a%ui ui &a &a-a -ana nan n )a )an5 n5 tep tepat at )a )an5 n5 'a 'apa pat t &e &eni nin5 n5-a -at- t-an an en ener er5i 5i - -# #i ie en n a a5 5a ar r t ti i' 'a a- - -e#eti%an. -e#eti%an.   ; ;a an nt tu u - -# #i ie en n u un nt tu u- - 21 21
  • 24. 3. Ke#eti%an 7.' 3. Ke#eti%an 7.' -e%a&i#an -e%a&i#an Deinisi: Deinisi: Ke#eti%an terus9&enerus Ke#eti%an terus9&enerus ' 'a an n p pe en nu ur ru un na an n -a -apa pasi sitas tas un untu tu- - -e -era ra i isi si- - 'a 'an n &e &ent nta# a# pa pa'a 'a tin5-at )an5 #ai&. tin5-at )an5 #ai&. >D&ain 2. A-ti*itas >D&ain 2. A-ti*itas Istira%at, -e#as 3 Istira%at, -e#as 3 Kesei&7an5an Ener5i, Kesei&7an5an Ener5i, -'e !!!03? -'e !!!03? %asi#: %asi#: K/'+$#;!+i $'$#(i <0002= K/'+$#;!+i $'$#(i <0002=   Me&perta%an-an Me&perta%an-an i in nt ta a! !e e nu nutr tris isi i )a )an5 n5 $u-up. $u-up.   Men Men55u 55una- na-an an te- te-ni- ni- -nser*asi ener5i. -nser*asi ener5i. Men5atur a-ti*itas untu- Men5atur a-ti*itas untu- -nser*asi ener5i. -nser*asi ener5i. & &e e& &a a% %a a& &i i p pr ri in ns si ip p - - n ns se er r* *a as si i e en ne er r5 5i i >& >&isa isa#n #n)a )a, , -e -e7u 7utu tu%a %an n u un nt tu u- - & &e e& &7 7a at ta as si i a a- -t ti i* *i it ta as s ' 'a an n t ti ir ra a% % 7arin5?. 7arin5?. R!+i/'!%: R!+i/'!%: A A5 5a ar r - -# #i ie en n ' 'a ap pa at t &en5ntr# a-t*itas 'an &en5ntr# a-t*itas 'an t ti ir ra a% % 7 7a ar ri in n5 5 u un nt tu u- - &en &en5ur 5uran5 an5i i ras rasa a #et #eti%, i%, #e#a% 'an #e&as. #e#a% 'an #e&as.   ;antu ;antu -#ien -#ien i'enti i'entii-asi i-asi pi#i%an pi#i%an a-ti*itas9 a-ti*itas9 a a- -t ti i* *i it ta as s ) )a an n5 5 a a- -a an n 'i#a-u-an. 'i#a-u-an. R R! !+ +i i/ /' '! !% %: : ntu- ntu- & &e e& &7 7a an nt tu u - -# #i ie en n &e& &e&i#i% i#i% a-t a-ti*i i*itas tas )an )an5 5 ti'a- &e&7uat -e#eti%an ti'a- &e&7uat -e#eti%an 'an &e&7uan5 ener5i. 'an &e&7uan5 ener5i. Implementas Implementasi i dan Evaluasi dan Evaluasi aritan55a#s%i aritan55a#s%i t t N N . . D D K K  a a& & I I& &p p# #e e& &e en nt ta as si i p pa ar ra a   a a& & E E* *a a# #u ua as si i >SOAP? >SOAP? para para Senin= Senin= A5ustus !1 A5ustus !1 pa5i pa5i 1 1. . ! !0 0. .! !! !   Menentu-an u&#a% Menentu-an u&#a% -a#ri 'an enis -a#ri 'an enis nutrisi )an5 nutrisi )an5 'i7utu%-an untu- 'i7utu%-an untu- &e&enu%i &e&enu%i pers)aratan 5ii. pers)aratan 5ii.   Men5atur 'iet )an5 Men5atur 'iet )an5 'iper#u-an )aitu 'iper#u-an )aitu 'en5an 'en5an &enin5-at-an &enin5-at-an asupan prtein 'an asupan prtein 'an *ita&in *ita&in   Men5anur-an -#ien Men5anur-an -#ien 1 1! !. .3 3! ! S S: :   K#ien K#ien &en5ata-an &en5ata-an nasu &a-an nasu &a-an n)a n)a &e&7ai- &e&7ai-   K#ien K#ien &en5ata-an &en5ata-an &ua# &ua# &unta%n)a &unta%n)a 7er-uran 7er-uran 22 22
  • 25. Senin = Senin = A5ustus !1 A5ustus !1 Pa5i Pa5i  . . ! !0 0. .3 3! ! untu- &e&antau untu- &e&antau -a#ri 'an inta-e -a#ri 'an inta-e &a-anan 'en5an &a-anan 'en5an &e&7uat $atatan &e&7uat $atatan &a-anan %arian. &a-anan %arian.   Meni&7an5 7erat Meni&7an5 7erat 7a'an -#ien 7a'an -#ien   Me&nitr a'an)a Me&nitr a'an)a &ua# 'an &unta% &ua# 'an &unta%   Me#a-u-an Me#a-u-an pe&eri-san pe&eri-san #a7ratriu&, #a7ratriu&, &nitr %asi#n)a: &nitr %asi#n)a: -a'ar a#7u&in, tta# -a'ar a#7u&in, tta# prtein, 7 'an prtein, 7 'an -a'ar t. -a'ar t.   Meni&7an5 7erat Meni&7an5 7erat 7a'an setiap %ari 7a'an setiap %ari 'an &nitr status 'an &nitr status pasien. pasien.   Mena5a Mena5a inta!e inta!e  asupan )an5 a-urat asupan )an5 a-urat 'an &en$atat 'an &en$atat output output -#ien. -#ien.   Me&7eri-an terapi Me&7eri-an terapi I seperti )an5 I seperti )an5 'itentu-an. 'itentu-an.   Me&nitr Me&nitr &e&7ran &u-sa, &e&7ran &u-sa, tur5r -u#it, 'an tur5r -u#it, 'an respn %aus. respn %aus.   Men5aar-an Men5aar-an pen55unaan te-ni- pen55unaan te-ni- nnar&a-#5i nnar&a-#5i untu- &en5e##a untu- &en5e##a &unta% >&isa#n)a, &unta% >&isa#n)a, %ipnsis, re#a-sasi, %ipnsis, re#a-sasi, 11.!! 11.!! O: O:   Prsi &a-an Prsi &a-an -#ien -#ien &enin5-at &enin5-at   Fre-uensi Fre-uensi &ua# &unta% &ua# &unta% -#ien -#ien 7er-uran5 7er-uran5 A: &asa#a% A: &asa#a% Keti'a- Keti'a- sei&7an5an sei&7an5an nutrisi -uran5 nutrisi -uran5 'ari -e7utu%an 'ari -e7utu%an tu7u% terastasi tu7u% terastasi se7a5ian se7a5ian P: Inter*ensi P: Inter*ensi 'i#anut-an 'i#anut-an S : S :   K#ien K#ien &en5ata-an &en5ata-an su'a% ti'a- su'a% ti'a- a'a &ua# 'an a'a &ua# 'an &unta% &unta%   K#ien K#ien &en5ata-an &en5ata-an su'a% ti'a- su'a% ti'a- &u'a% %aus. &u'a% %aus. O : O :   ;erat 7a'an ;erat 7a'an -#ien sta7i#. -#ien sta7i#.   "nta!e "nta!e 'an 'an output output -#ien -#ien nr&a# nr&a# sei&7an5. sei&7an5.   Me&7ran Me&7ran &u-sa &u-sa #e&7a7, tur5r #e&7a7, tur5r 23 23
  • 26. Senin = Senin = A5ustus !1 A5ustus !1 Pa5i Pa5i 3. 3. 1!.!! 1!.!! a-upresur?. a-upresur?.   Me&nitr te-anan Me&nitr te-anan 'ara%, na'i, su%u, 'ara%, na'i, su%u, 'an status 'an status pernaasan 'en5an pernaasan 'en5an tepat. tepat.   Me&nitr Me&nitr inta!e inta!e  asupan nutrisi untu- asupan nutrisi untu- &en5eta%ui su&7er &en5eta%ui su&7er ener5i )an5 ener5i )an5 a'e-uat. a'e-uat.   Men)aran-an -#ien Men)aran-an -#ien untu- 7er-nsu#tasi untu- 7er-nsu#tasi 'en5an a%#i 5ii 'en5an a%#i 5ii &en5enai $ara &en5enai $ara &enin5-at-an &enin5-at-an asupan ener5i 'ari asupan ener5i 'ari &a-anan. &a-anan.   Me&7antu -#ien Me&7antu -#ien untu- &e&a%a&i untu- &e&a%a&i prinsip -nser*asi prinsip -nser*asi ener5i >&isa#n)a, ener5i >&isa#n)a, -e7utu%an untu- -e7utu%an untu- &e&7atasi a-ti*itas &e&7atasi a-ti*itas 'an tira% 7arin5?. 'an tira% 7arin5?.   Me&7antu -#ien Me&7antu -#ien &en5i'entii-asi &en5i'entii-asi 11.3! 11.3! -u#it nr&a# , -u#it nr&a# ,  'eti-, respn  'eti-, respn %aus %aus 7er-uran5 7er-uran5 su'a% ti'a- su'a% ti'a- &u'a% %aus. &u'a% %aus.   Dapat Dapat &en5e##a &en5e##a &ua# 'an &ua# 'an &unta% &unta% 'en5an 'en5an 7e7erapa 7e7erapa te-ni- te-ni- nnar&a-# nnar&a-# 5. 5.   Tan'a9tan'a Tan'a9tan'a *ita# nr&a#. *ita# nr&a#. A A : : Masa#a% Masa#a% -e-uran5an -e-uran5an *#u&e $airan *#u&e $airan tu7u% teratasi. tu7u% teratasi. P : P : Inter*ensi Inter*ensi 'i%enti-an. 'i%enti-an. S : S :   K#ien K#ien &en5ata-an &en5ata-an su'a% ti'a- su'a% ti'a- &erasa #e#a% &erasa #e#a% 'an #e&as. 'an #e&as.   K#ien K#ien &en5ata-an &en5ata-an su'a% ti'a- su'a% ti'a- &en5a#a&i &en5a#a&i -e#eti%an. -e#eti%an. O : O :   Ma-anan )an5 Ma-anan )an5 24 24
  • 27. pi#i%an a-ti*itas9 pi#i%an a-ti*itas9 a-ti*itas )an5 a-an a-ti*itas )an5 a-an 'i#a-u-an. 'i#a-u-an. 'i&a-an -#ien 'i&a-an -#ien &en5an'un5 &en5an'un5 asupan ener5i asupan ener5i )an5 a'e-uat. )an5 a'e-uat.   K#ien K#ien &e&a%a&i &e&a%a&i prinsip prinsip -nser*asi -nser*asi ener5i. ener5i.   K#ien &a&pu K#ien &a&pu &en5i'entii- &en5i'entii- asi a-ti*itas9 asi a-ti*itas9 a-ti*itas )an5 a-ti*itas )an5 a-an a-an 'i#a-u-an 'i#a-u-an sesuai sesuai -e&a&puan -e&a&puan -#ien. -#ien. A A : : Masa#a% Masa#a% -e#eti%an -e#eti%an teratasi. teratasi. P : P : Inter*ensi Inter*ensi 'i%enti-an 'i%enti-an 25 25
  • 28. BAB IV BAB IV PENUTUP PENUTUP .1 .1 K$ K$+i* +i*)% )%!' !' a. a. Dia Dia7et 7etes &e#itu es &e#itus s pa' pa'a a -e% -e%a&i a&i#an >'ia7 #an >'ia7ete etes s &e# &e#itu itus s 5es 5estati tatina na#D #DMG? MG? a'a a'a#a% #a% -e% -e%a&i a&i#an #an nr nr&a# &a# )an )an5 5 'is 'isert ertai ai 'en 'en5an 5an pen penin5 in5-at -atan an insulin insulin resistance resistance >i7u %a&i# 5a5a# &e&perta%an-an >i7u %a&i# 5a5a# &e&perta%an-an euglycemia euglycemia? pa'a &in55u ? pa'a &in55u -e 2 sa&pai -e  &asa -e%a&i#an. -e 2 sa&pai -e  &asa -e%a&i#an. 7. 7. Dia7etes &e#itus Dia7etes &e#itus 5estasina# 'apat 5estasina# 'apat tera'i pa'a tera'i pa'a i7u )an5 %a&i# i7u )an5 %a&i# 'i atas 'i atas usi usia a 3! 3! ta% ta%un, un, per pere&p e&puan uan 'en 'en5an 5an 7e 7esit sitas as >IM >IMT T B3! B3!?, ?, per pere&p e&puan uan 'en5a 'en5an n ri(a)a ri(a)at t 'ia7e 'ia7etes &e#itus tes &e#itus pa'a ran5 tua pa'a ran5 tua atau ri(a)at 'ia7etes atau ri(a)at 'ia7etes &e#itus 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i &e#itus 5estasina# pa'a -e%a&i#an se7e#u&n)a 'an &e#a%ir-an 7a)i 'en5an 7erat #a%ir B2!!! 5ra& 'an a'an)a 5#u-suria. 'en5an 7erat #a%ir B2!!! 5ra& 'an a'an)a 5#u-suria. $. $. Pen Pen)a- )a-it ini &en) it ini &en)e7a e7a7-a 7-an peru7 n peru7a%a a%an &eta7 n &eta7#i$ 'an % #i$ 'an %r& r&na# )an na# )an5 5 7erpen5aru% 7erpen5aru% pa'a pa'a un5si un5si insu#in insu#in 'an 'an &en5a-i7at-an &en5a-i7at-an -n'isi -n'isi -e7a# -e7a# ter%a' ter%a'ap insu#in. ap insu#in. Se%in Se%in55a &eni&7 55a &eni&7u#-an 'a&pa- peni u#-an 'a&pa- penin5-at n5-atan -a'ar an -a'ar 5#u-sa pa'a i7u %a&i#. 5#u-sa pa'a i7u %a&i#. '. '. Det Dete-s e-si i 'in 'ini san5a i san5at t 'ip 'iper# er#u-a u-an untu- &en n untu- &enari arin5 DM Gestas n5 DM Gestasin ina# a5ar a# a5ar 'ap 'apat at 'i- 'i-e# e##a #a se7 se7ai- ai-97ai 97ai-n) -n)a a teru teruta& ta&a a 'i# 'i#a-u a-u-an -an pa' pa'a a i7u i7u 'en 'en5an 5an a-tr risi-. a-tr risi-. e. e. Ka' Ka'ar 5u#a 'ar ar 5u#a 'ara% i7u a-a a% i7u a-an &e&p n &e&pen5 en5aru aru%i 5u#a 'ar %i 5u#a 'ara% ani a% anin se%in n se%in55a 55a 5u 5u#a #a ' 'ar ara% a% a an nin in u u5 5a a &e &en nin in5 5-a -at t ' 'an an p pa' a'a a 5 5i# i#ir iran ann) n)a a a- a-an an &eni&7u#-an %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eni&7u#-an %iper5#i-e&i- 'a#a& #in5-un5an uterus se%in55a 'apat &eru7 &eru7a% a% pertu& pertu&7u%an 'an 7u%an 'an -&p -&psisi sisi tu7u% anin.Da& tu7u% anin.Da&pa-n) pa-n)a a 7a)i 7a)i )an5 #a%ir 'ari i7u )an5 &en5a#a&i 'ia7etes &e#itus 5estasina# ini )an5 #a%ir 'ari i7u )an5 &en5a#a&i 'ia7etes &e#itus 5estasina# ini 7erisi- tin55i untu- ter-ena &a-rs&ia. 7erisi- tin55i untu- ter-ena &a-rs&ia. 26 26
  • 29. . .2 2 S! S!#! #!' ' 1. 1. Pe Pera rana nan n pe pera ra(a (at t 'a 'a#a #a& & &e &e&7 &7er eri- i-an an ar ara% a%an an 'a 'an n e' e'u- u-asi pa' asi pa'a a i7 i7u u %a&i# untu- a-ti &e#a-u-an pe&eri-saan rutin untu- &en$e5a% resi- %a&i# untu- a-ti &e#a-u-an pe&eri-saan rutin untu- &en$e5a% resi- tera'in)a 'ia7etes 5estasina# 'an &en5e##a se7ai-97ai-n)a ter%a'ap tera'in)a 'ia7etes 5estasina# 'an &en5e##a se7ai-97ai-n)a ter%a'ap i7u 'en5an a$tr resi-. i7u 'en5an a$tr resi-. . . Pen'i Pen'i'i-an - 'i-an -ese%ata ese%atan i7u % n i7u %a&i# &e a&i# &en5ena n5enai 'ia7et i 'ia7etes &e#it es &e#itus 5esta us 5estasina# sina# 'iper#u-an untu- &asa -e%a&i#an. 'iper#u-an untu- &asa -e%a&i#an. 27 27