Depresi yang diinduksi insulin dan nyeri kronis pada pasien neuropati diabetik dengan paraparesis tipe lower motor neuron: sebuah laporan kasus
Authors: Sega Petrus Agustinus Seda , Indrayani Ida Ayu Sri , Wahyuni Anak Ayu Sri 
Published: November 2023

Background: Indonesia ranks 4th in terms of the number of people with diabetes mellitus in the world, and chronic complications in DM include disorders of the nerves (neuropathy). Paraparesis causes disturbances in mobility and disturbances to the person, namely the perception of his disability which can lead to reactions of disappointment, low self-esteem and ends in despair and depression. This case report aims to describe insulin-induced depression and chronic pain in diabetic neuropathy patient with lower motor neuron paraparesis.
Case Presentation: A 36-year-old Balinese woman could not walk, she had been complaining of sadness for a long time, since she was told she had diabetes, thus limiting her daily activities. The patient has a history of diabetic disease since childhood and was definitely diagnosed at the age of 15 around 18 years ago, and started a history of back pain since December 2021 and worsened with cramps and weakness in both legs since January 2022. Vital signs were good, on waist is attached plate metal as high as vertebrae L3–L4, extremities: edema +/- warm +/+, cruris dextra: edema (+), clinical neurology: lower motor neuron type paraparesis, motor weakness, atrophy of musculus gastrocnemius dextra et sinistra and musculus tibialis dextra et sinistra paresthesia of the glove and stocking type. Psychiatric status: reasonable appearance of consciousness: clear, affective. Mood affect: sad/depressive/ appropriate. Thought process: logical realist/coherent/preoccupation with back pain and weak legs. Mixed-type insomnia exists; history of raptus and hypobulia is present. Impulse control: poor.
Conclusion: Patients with diabetes on insulin treatment were associated with the prevalence of depressive syndromes.
 
Latar belakang: Indonesia menempati urutan ke-4 terbesar dalam jumlah penderita diabetes melitus di dunia, dan komplikasi kronis pada diabetes antara lain kelainan pada saraf (neuropati). Paraparese menyebabkan gangguan dalam mobilitas serta gangguan terhadap pribadinya yaitu persepsi kecacatannya yang dapat menimbulkan reaksi kecewa, rendah diri dan berakhir pada keadaan putus asa dan depresi. Laporan kasus ini bertujuan mendeskripsikan depresi yang diinduksi insulin dan nyeri kronis pada pasien neuropati diabetik dengan paraparesis tipe lower motor neuron.
Presentasi Kasus:  Perempuan 36 tahun suku Bali, tidak bisa berjalan, keluhan sedih sudah lama, semenjak dikatakan mempunyai penyakit diabetes, sehingga membatasi aktivitasnya sehari hari. Pasien memiliki riwayat penyakit diabetes dari kecil dan terdiagnosis pasti pada umur 15 tahun sekitar 18 tahun yang lalu, dan mulai riwayat nyeri punggung sejak bulan desember 2021 dan memberat dengan kram dan lemah pada kedua kaki sejak Januari 2022.  Tanda vital baik, pada pinggang terpasang: plat logam setinggi vertebra L3–L4, ekstremitas: edema +/- hangat +/+, kruris dekstra: edema (+). Klinis neurologis: paraparesis tipe lower motor neuron, kelemahan motorik, atrofi musculus gastrocnemius dekstra et sinistra dan musculus tibialis dekstra et sinistra, parestesia tipe gloves and stocking. Status psikiatri: penampilan wajar kesadaran: jernih. Mood afek: sedih/depresif/appropriate. Proses pikir: logis realis/koheren/preokupasi nyeri punggung dan lemah kaki. Insomnia tipe campuran ada; raptus ada riwayat dan hipobulia ada. Pengendalian impuls: kurang baik.
Simpulan: Diabetes pada pengobatan insulin dikaitkan dengan prevalensi sindrom depresi, menunjukkan hubungan yang permanen dan signifikan.