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Diabetes Mellitus

Type of Diabetes.....
Type 1 diabetes

Results from the body's failure to produce insulin, the hormone


that "unlocks" the cells of the body, allowing glucose to enter and
fuel them.

It is estimated that 5-10% of World populations who are diagnosed


with diabetes have type 1 diabetes.

Type 2 diabetes

Results from insulin resistance (a condition in which the body fails


to properly use insulin), combined with relative insulin deficiency.

Most Americans who are diagnosed with diabetes have type 2


diabetes.

Others Type of
Diabetes....
Gestational diabetes

Diabetes during pregnancy

Immediately after pregnancy, 5% to 10% of women with


gestational diabetes are found to have diabetes, usually, type 2.

Pre-diabetes

Pre-diabetes is a condition that occurs when a person's blood


glucose levels are higher than normal but not high enough for a
diagnosis of type 2 diabetes.

There are 57 million Americans who have pre-diabetes, in addition


to the 23.6 million with diabetes.

Diagnosing
Diabetes....
Classical symtoms : 6P
Fasting Blood Glucose (FBG):
126 mg/dl
Post prandial Blood Glucose :
200 mg/dl
Oral Glucose Tolerance Test (OGTT)
Blood glucose level is measured
fasting and two hours after drinking a
glucose-rich beverage (75 gr) Blood
Glucose 200 mg/dl

Komplikasi dari
diabetes....

Obat-obatan
Diabetes...

Tahapan terapi...

ADA/EASD: Metabolic
Management of Type
2 Diabetes

Which Insulin ?

Basal-bolus insulin treatment: matching


insulin administration to insulin needs
Rapid-acting insulins
100

Basal insulins

U/
ml

80
60

Normal pattern

40
20

0600

0800

1200

1800

2400

0600

Time of day
B = breakfast; L = lunch; D = dinner
Riddle MC. CADRE Core Slide Kit. 2003
Polonsky KS et al. N Engl J Med. 1988;318:1231-1239

Approximate pharmacokinetic
profiles of human insulin and
insulin analogues

N.B. Duration of action will vary widely between and within people
NPH = neutal protamine hagedorn/isophane insulin

Treatment Based on the


Pathophysiology Hyperglycemia in
Type 2 Diabetes

Fasting Hyperglycemia

Basal Insulin

Prandial Hyperglycemia

Prandial Insulin

Prandrial

Basal

Algoritma
penggunaan insulin....

Initiating and Adjusting


Insulin

Hypoglycemia
or FG >3.89 mmol/l (70 mg/dl):
Reduce bedtime dose by 4 units
(or 10% if dose >60 units)

Bedtime intermediate-acting insulin,


or
bedtime or morning long-acting
insulin
Check FG and increase
dose until in target
(initiate with 10 units
or 0.2 units per kg)
range.

If HbA1c 7%...
Continue regimen;
check HbA1c every 3
months

Pre-lunch BG out of range:


add rapid-acting insulin at
breakfast

3.89-7.22 mmol/L
(70-130 mg/dL)

If HbA1c 7%...

If fasting BG in target range, check BG before lunch, dinner, and


bed. Depending on BG results, add second injection
(can usually begin with ~4 units and adjust by 2 units every 3 days until BG in
range)

Pre-dinner BG out of range: add NPH


insulin at breakfast or rapid-acting insulin
at lunch

If HbA1c 7%...
Continue regimen; check
HbA1c every 3 months

Target range:

Pre-bed BG out of range: add


rapid-acting insulin at dinner

If HbA1c 7%...

Recheck pre-meal BG levels and if out of range, may need to add another
injection; if HbA1c continues to be out of range, check 2-hr postprandial
levels and adjust preprandial rapid-acting insulin
Nathan DM et al. Diabetes Care. 2006;29(8):1963-72.

Perbedaan antara
Hiperglikemia dengan
Hipoglycemia....

Supplemental Regular
Insuline Scale
Pre Prandial Glucose
(mg/dl)

Additional Units (regular


Insuline)

< 100
100 140
140 160
160 180
180 200
200 250
250 300
> 300

0
2
3
4
5
6
8
10

Terima kasih.....
Semoga bermanfaat untuk kalian semua.....
Keep in touch yach.......

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