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Insulin
RSUD Balangan
dr. Riswanto, SpPD
Diabetes 2003-2025 Epidemiology Projections
An
An increasing
increasing problem
problem worldwide
worldwide
World
2003 = 194 M
2025 = 333 M
NA 72%
EUR
23.0 M
36.2 M 48.4 M
58.6 M EMME
57.0% SEA
21% 19.2 M WP
39.4 M 39.3 M
105% 81.6 M 43.0 M
108% 75.8 M
79%
SACA
AFR
14.2 M
26.2 M 7.1M
15.0 M
85%
111%
3
PANCREATIC ISLET MORPHOLOGY
-Cells
(insulin) -Cells
(glucagon)
NORMAL PANCREAS
Adapted from Rhodes CJ. Science. 2005; 307:380384
Roles of Insulin and Glucagon in Normal Glucose
Homeostasis
+
Insulin* Glucose Glucagon*
(plasma concentration) (plasma concentration) (plasma concentration)
*Insulin and glucagon secretion are also influenced by other nutrients, hormones, and neural input
Adapted from Berne RM, Levy MN, eds. Physiology. St. Louis, Mo: Mosby, Inc; 1998: 822847.
5
PANCREATIC ISLET MORPHOLOGY: STRUCTURAL
DEFECTS ARE EVIDENT IN TYPE 2 DM
Normal T2DM
-Cells Amyloid
(insulin) plaque
-Cells
(glucagon)
50 % DM-2 50 %
Pre-Diabetes
70 - 100 % Gangguan Toleransi Glukosa 50 %
60%
55%
50%
30%
Kontribusi kadar glukosa puasa
15
Postprandial
hyperglycaemia
Blood glucose (mmol/l)
10 Fasting
hyperglycaemia Diabetes profile
5
Healthy profile
0
06:00 12:00 18:00 24:00 06:00
Time of day
Less validated
core therapies Lifestyle
+ Lifestyle
Metformin +
+ Metformin
Pioglitazon +
(No hypogycemia, Pioglitazone
Oedema/ CHF +
Bone loss ) Sulfonilurea
Lifestyle
+ Lifestyle
Metformin +
+ Metformin
GLP-1 agonist
(No hypogycemia, +
Weight loss Basal insulin
Nausea /vomiting)
3 4
Penemuan
insulin
Diabetes
Devices
Pipeline
- past,
Advisory
present
Board
and
Meeting
future 18-19 March-2011
March 2009 Slide no 16
Basal
Insulin Analogs
Advancements
Biphasic
Insulin Analogs
Rapid-acting
Insulin Analogs
2000s
Recombinant
Human
Animal Insulin
Isolation
Insulin
of Insulin
(Banting & Best) Preparations
1990s
1977
1922
Time
( Program Insulin )
dosis =BBx0,5
60%rapid : 40% basal
Menekan Mengendalikan
Hiperglikemi Post Prandial Glukosa darah
Basal
Memacu glikogenesis
Menekan Hepatic
Glucose Production
Diabetes Pipeline Advisory Board Meeting 18-19 March 2009
GD 2j PP titrasi
Fast acting Mulai 4u /hari naikkan 2u sampai
target tercapai tiap
3hari
OAD stop begitu start insulin rapid
Diabetes Pipeline Advisory Board Meeting 18-19 March 2009
Analogue Insulin:
ANALOG INSULIN
for better physiologic, efficacy, safety and flexibility
NovoMix Premix
Analog
Levemir
---- NovoRapid
NovoMix
Human insulin
Period of unwanted
hypoglycemia
Baseline time
inflexibility injection
level
Time (h)
SC injection
Injection Site Rotation
Pen Injection Technique
Injection Techniques
Kriteria Pengendalian DM
*DCCT referenced assays: normal range 46%; **12 hours postprandial; ADA and ADA/EASD guidelines recommend
HbA1c levels as close to normal (<6%) as possible without significant hypoglycaemia 1,5
AACE=American Association of Clinical Endocrinologists; ADA=American Diabetes Association;
EASD=European Association for the Study of Diabetes; IDF=International Diabetes Federation
1. ADA. Diabetes Care 2006;29(suppl 1):S4S42.
2. ADA. Diabetes Care 2006;29(suppl 1):S438.
3. AACE. Endocr Pract 2002;8(suppl 1):4082.
4. IDF. Global Guideline for Type 2 Diabetes. Brussels: International Diabetes Federation, 2005. http://www.idf.org/webdata/docs/IDF
%20GGT2D.pdf.
5. Nathan DM, et al. Diabetologia 2006;49:171121.
Type 2 Diabetes Mellitus Complications
MICROVASCULAR MACROVASCULAR
Retinopathy,
glaucoma or Cerebrovascular
cataracts disease
Cardiomyopathy Coronary
heart
Nephropathy disease
Peripheral
Neuropathy vascular
disease
Erectile dysfunction
Kaki Diabetes
Neuropati
Vaskular Manifestasi Neuropati Diabetik
Infeksi Sangat bervariasi
Kesemutan, baal, kebas, hilang rasa
sering tidak terhiraukan
MERUPAKAN RISIKO TERJADINYA
ULKUS, KARENA SENSASI NYERI
TIDAK ADA
Nyeri (Painful Neuropathy)