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Kelenjar Pankreas
Homeostasis Glukosa

TIPE DIABETES MELLITUS
INSULIN


BIOSINTESIS INSULIN

SEKRESI INSULIN
DEGRADASI INSULIN

Efek Insulin

Efek Insulin pada Kelenjar
Target
SEDIAAN INSULIN

Durasi berbagai Sediaan Insulin
Struktur Insulin Lispro,
Aspart, dan Gluilisine




Tempat Penyuntikan Insulin

KOMPLIKASI INSULIN
Hypoglycemic
Hypoglycemic reactions are the most common complication
of insulin therapy. They may result from a delay in taking a
meal, inadequate carbohydrate consumed, unusual physical
exertion, or a dose of insulin that is too large for immediate
needs.
Rapid development of hypoglycemia in individuals with intact
hypoglycemic awareness causes signs of autonomic
hyperactivity, both sympathetic (tachycardia, palpitations,
sweating, tremulousness) and parasympathetic (nausea,
hunger) and may progress to convulsions and coma if
untreated.
In patients with persistent, untreated hypoglycemia, the
manifestations of insulin excess may developconfusion,
weakness, bizarre behavior, coma, seizures
Treatment Hypoglycemia
All the manifestations of hypoglycemia are
relieved by glucose administration.
To treat mild hypoglycemia in a patient who
is conscious and able to swallow, dextrose
tablets, glucose gel, or any sugar-containing
beverage or food may be given.
If more severe hypoglycemia has produced
unconsciousness or stupor, the treatment of
choice is to give 2050 mL of 50% glucose
solution by intravenous infusion over a period
of 23 minutes.
ORAL ANTIDIABETIC AGENT
Insulin Secretagogue
Biguanide
Thiazolidindione
-Glucosidase Inhibitor
MK :
1. Merangsang sekresi
insulin dari kelenjar
pankreas
2. Menurunkan
konsentrasi serum
glukagon
INSULIN SECRETAGOGUE - SULFONILUREA
INSULIN SECRETAGOGUE - SULFONILUREA

INSULIN SECRETAGOGUE - MEGLITINIDE

INSULIN SECRETAGOGUE(D-PHENYLALANINE DERIVATES)
Nateglinide, a D-phenylalanine derivative, is the latest
insulin secretagogue to become clinically available.
Nateglinide stimulates very rapid and transient release of
insulin from B cells through closure of the ATP-sensitive
K
+
channel. It also partially restores initial insulin release
in response to an intravenous glucose tolerance test. This
may be a significant advantage of the drug because type
2 diabetes is associated with loss of this initial insulin
response.
Nateglinide is ingested just before meals. It is absorbed
within 20 minutes after oral administration with a time to
peak concentration of less than 1 hour and is hepatically
metabolized by CYP2C9 and CYP3A4 with a half-life of
1.5 hours. The overall duration of action is less than 4
hours.

BIGUANIDES (METFORMIN)
MK : Bekerja langsung pada hepar, menurunkan produksi
glukosa hati. Tidak merangsang sekresi insulin oleh
kelenjar pankreas.
ES : gastrointestinal (anorexia, nausea, vomiting,
abdominal discomfort, diarrhea) and occur in up to 20%
of patients.
Penggunaan : bersama makan
Sediaan : Diabex, Glucophage, Gludepatic.
Fixed Dose Combination : Glucovance (metformin +
Glyburid), metaglip (metformin + glipizid), avandamet
(metformin + rosiglitazone)

THIAZOLIDINDION
MK : Meningkatkan kepekaan tubuh terhadap insulin,
dengan jalan berikatan dg PPARY (peroxisome
protiferator activated receptor-gamma) di otot, jaringan
lemak, dan hati untuk menurunkan resistensi insulin.
TZD juga menurunkan kecepatan glikoneogenesis.
GOLONGAN -Glucosidase Inhibitor
MK : menghambat enzim -glukosidase (maltase,
isomaltase, glukomaltase, sukrose) mengurangi
pencernaan karbohidrat kompleks dan absorbsinya
mengurangi kadar glukosa post prandial. Diberikan pada
suapan pertama setelah makan
Sediaan : Glucobay