TERAPI INSULIN

THE ROLE OF INSULIN

• Increased glycogen synthesis
(gluconeogenesis) stimulate storage of
glucose in liver (and muscle) cells in the form
of glycogen;

lowered levels of insulin cause liver cells to

convert glycogen to glucose and excrete it
into the blood (glycogenolisis)

• Increased glycogen synthesis – insulin forces

storage of glucose in liver (and muscle) cells
in the form of glycogen; lowered levels of
insulin cause liver cells to convert glycogen
 THE ROLE OF INSULIN
• Decreased lipolysis – forces reduction in
conversion of fat cell lipid stores into blood fatty
acids
• Decreased proteinolysis – forces reduction of
protein degradation; lack of nsulin increases protein
degradation
• Arterial muscle tone – forces arterial wall muscle to
relax, increasing blood flow, especially in micro
arteries; lack of insulin reduces flow by allowing
these muscles to contract = hypertension
• Increased amino acid uptake – forces cells to
absorb circulating amino acids; lack of insulin
inhibits absorption
 THE ROLE OF INSULIN
• Increased potassium uptake – forces cells
to absorb serum potassium; lack of insulin
inhibits absorption = hyperkalemia
Medicine Update 2010 Vol 20
 Glycemic Recommendations for
Nonpregnant Adults with Diabetes (1)

A1C <7.0%*

Preprandial capillary plasma 70–130 mg/dL* (3.9–

glucose 7.2 mmol/L)

Peak postprandial capillary <180 mg/dL* (<10.0

plasma glucose† mmol/L)

*Individualize goals based on these values.

†Postprandial glucose measurements should be made 1–2 h after the beginning of the meal, generally peak levels in
patients with diabetes.

ADA. V. Diabetes Care. Diabetes Care 2013;36(suppl 1):S21; Table 9.

ADA / EASD STATEMENT OF
MANAGEMENT OF DM TYPE 2
 INSULIN ANALOG
(rapid acting)
• Lispro, Aspart, Glulisine
• ASPART : cepat terdisosiasi shg cepat
diabsorpsi, OA 5 mnt puncak 1 jam
• LISPRO : mencegah insulin berikatan dg
antibodi shg aman untuk px yg alergi dg insulin
• Ada ‘pronounced peak’
• Kadar gula turun 2 jam stlh makan
 RAPID-Acting Insulin Analogs
Lispro and Aspart Plasma Insulin Profiles

400 500
Plasma insulin (pmol/L)

Plasma insulin (pmol/L)

350 Regular 450 Regular
Lispro 400 Aspart
300
350
250 300
200 250
150 200
150
100
100
50 50
0 0
0 30 60 90 120 150 180 210 240 0 50 100 150 200 250 300
Time (min) Time (min)
Meal Meal
SC injection SC injection

Heinemann, et al. Diabet Med. 1996;13:625–629; Mudaliar, et al. Diabetes Care.

1999;22:1501–1506.
 INSULIN REGULER
(short acting)
• OA lbh lama, 30-60 menit, puncak 2-4 jam,
durasi 6-9 jam.

• Efek insulin kurang dpt diprediksi, efek lebih

lama

• Kombinasi dg insulin rapid acting untuk

mengatasi kebutuhan insulin bila jarak waktu
makan cukup panjang

• dpt berperan sbg insulin basal

 SHORT
ACTING
INSULIN
 INSULIN KOMBINASI
• Insulin kerja menengah dg insulin kerja cepat

• Mengendalikan gula darah prandial dan basal

 INSULIN LONG ACTING
• Lantus, levemir

• Masa kerja 24 jam

• Kontrol gula darah puasa lebih baik dp ins
kombinasi

• Resiko nocturnal hypoglycemia rendah

• Tidak ada ‘peak’

• F.kinetik menyerupai human insulin
 Glargine vs NPH Insulin in Type 1 Diabetes
Action Profiles by Glucose Clamp

5 NPH
Glargine
Glucose utilization rate

2
(mg/kg/h)

0
0 10 20 30
Time (h) after SC injection
End of observation period

Lepore, et al. Diabetes. 1999;48(suppl 1):A97.

 Long acting dose
• Initial dose : 10 Units/day

• Lantus titration

Mean FBG x 2 days Unit/day change

≥ 180 mg/dl + 8 unit
140-179 mg/dl + 6 unit
120-139 mg/dl + 4 unit
100-119 mf/dl + 2 unit

Mean FBG x 2 days Mean FBG x 2 days

• Levemir
> 110 mg/dl titration increase 3 units
< 80 mg/dl decrease 3 units
 BASAL INSULIN
TITRATION (Perkeni)

Fasting Plasma Insulin basal dose< 70

Glucose Level
< 70 decrease 2 unit
70 - 130 maintain dose
> 130 incrase dose 2 unit every 3 days
> 180 increase dose 4 unit every 3 days
THANK YOU