DIABETES MELLITUS

NOOR CAHAYA,M.Sc.,Apt.
PS FARMASI FMIPA UNLAM
EPIDEMIOLOGY
Global Report on Diabetes

Diabetes caused 1.5 million deaths in

2012

In 2014, 422 million people in the world

had diabetes – a prevalence of 8.5%

people with diabetes will more than

double over the next 20 years, to reach
a total of 366 million by 2030 among the
adult population
PREVALENCE
PREVALENSI DM DI INDONESIA
Jumlah penderita
diabetes terttinggi
ditemukan pada
kelompok usia 40-
59 tahun (166 juta
jiwa) dan hampir
setara dengan
penderita berusia
60-79 tahun (164
juta jiwa)
PREVALENSI DM DI INDONESIA
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Type 1

previously known as insulin-dependent, juvenile or childhood-

onset diabetes.

is characterized by deficient insulin production in the body

People with type 1 diabetes require daily administration of

insulin to regulate the amount of glucose in their blood.

The cause of type 1 diabetes is not known and it is currently

not preventable.
 Type 2
formerly called non-insulin-dependent or adult-onset diabetes

formerly called non-insulin-dependent or adult-onset

diabetes

results from the body’s ineffective use of insulin

Symptoms may be similar to those of type 1 diabetes, but

are often less marked or absent.
Impaired glucose tolerance & impaired fasting glycaemia

intermediate conditions in the

transition between normal blood
glucose levels and diabetes
(especially type 2), though the
transition is not inevitable

People with IGT or IFG are at

increased risk of heart attacks and
strokes
Gestational Diabetes (DM)

a temporary condition that occurs in pregnancy

and carries long-term risk of type 2 diabetes

The condition is present when blood glucose

values are above normal but still below those
diagnostic of diabetes

Women with gestational diabetes are at

increased risk of some complications during
pregnancy and delivery, as are their infants
 POLIFAGI

DIABETES
MELLITUS
POLIURI
POLIDIPSI

TANDA & GEJALA

OTHERS ....
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 The prevalence of diabetes was 2.8 times greater for
Māori, and 4.1 times greater for Pacific compared with
Europeans.
DIAGNOSIS DM
TERAPI INSULIN
 DM tipe 2 dengan
kontrol glukosa darah
yang tdkbaik meskipun
sudah diberikan obat
oral

INSULIN

Pasien DM dengan
komplikasi
Terapi insulin pada pasien DM tipe 2 dapat dimulai dengan
pertimbangan berikut:

Pasien gagal terapi oral

Kendali kadar glukosa darah yg buruk (A1c<7,5% atau

kadar glukosa darah puasa > 250 mg/dL)

Riwayat pankreatektomi atau disfungsi pankreas

Riwayat fluktuasi kadar glukosa darah yang lebar

Riwayat ketoasidosis

Riwayat penggunaan insulin lebih dari 5 tahun

Penderita DM lebih dari 10 tahun

 Kapan
DM Tipe I memulai
insulin ???
• diberikan segera setelah diagnosis ditegakkan

DM Tipe 2
• Setiap pusat pelayanan memiliki alur terapi dan mula awal terapi insulin
yang berbeda
• Bisa menggunakan acuan dari konsensus ADA-EASD atau PERKENI
• jika kadar glukosa darah tidak terkontrol dengan baik (A1C > 6.5%) dalam
jangka waktu 3 bulan dengan 2 obat oral, maka sudah ada indikasi untuk
memulai terapi kombinasi obat antidiabetik oral dan insulin
 Pemberian insulin juga dapat diberikan pada

Kondisi Kendala glikemik amat buruk & disertai kondisi

tertentu katabolisme (kadar glukosa darah puasa > 250
mg/dL, kadar glukosa darah acak menetap > 300
mg/dL, A1c >10%

Ditemukan ketonuria

Memiliki gejala nyata ex:

poliuria,polidipsia,polifagia & penurunan BB
 Cara memulai terapi insulin injeksi harian multipel
pada pasien DM tipe I

Hitung insulin harian

total (IHT)=0.5 unit x BB
(kg) atau (penjumlahan
dosis terakhir) ex: BB 60
kg,IHT = 30 unit

Insulin prandial total

Insulin basal total
(lispro,aspart atau
(NPH,glargine,ultralente)
reguler) = 60% dari IHT
= 40% dari IHT ex: 40% x
ex: 60% x 30unit= 18
30 unit-12 unit
unit

Dosis makan siang = 1/3 Dosis makan malam = Dosis sebelum tidur =
Dosis sarapan = 1/3 dari
dari IPT ex: 1/3 x 18 = 6 1/3 dari IPT ex: 1/3 x 18 IBT ex: 40% x 30 unit =
IPT ex: 1/3 x 18 = 6 unit
unit = 6 unit 12 unit
Regimen terapi insulin injeksi multipel harian berdasarkan
Cheng & Zinman

Sebelum Sebelum Sebelum Sebelum tidur

makan pagi makan siang makan malam
IP IP IP IB

IP + IB IP IP IB

IP + IB Tanpa insulin IP IB

IP + IB IP + IB IP+IB Tanpa insulin

IP = insulin prandial (reguler, lispro, aspart, glulisine)

IB = insulin basal (NPH, glargine, detemir)
MANFAAT INSULIN

Pada pasien hiperglikemia

mampu memperbaiki luaran
klinis

Memperbaiki status metabolik

dengan cepat, khususnya
kadar glukosa darah

Perbaikan inflamasi
 EBM insulin
The effect of use of insulin in type 2 diabetes from
the time of diagnosis has been evaluated in clinical
trials :
• the UK Prospective Diabetes Study (UKPDS) and
Outcome Reduction With Initial Glargine
Intervention (ORIGIN)
• UKPDS showed that early and continued glucose
control can reduce microvascular complications
and, in the long-term, improve cardiovascular
prognosis
• The beneficial effect of insulin therapy is
further supported by studies in type 1
diabetes where it is apparent that if insulin
therapy is used effectively to induce early
glycemic control, both micro- and
macrovascular protection is achieved
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 Terima
kasih.....