INSULIN GLARGINE

HARLI AMIR MAHMUDJI

RSJ. Prof. dr. SOEROYO - Magelang

Insulin in Indonesia
Onset of
Action

Peak of
Action

Duration
of Action

Presentatio
n

30-60 min

120-180
min

5-8 hour

Vial,
Pen/Cartridge

Insulin Lispro (Humalog)

5-15 min

30-90 min

3-5 hour

Pen/Cartridge

Insulin Glulisine (Apidra)

5-15 min

30-90 min

3-5 hour

Pen

Insulin Aspart (Novorapid)

5-15 min

30-90 min

3-5 hour

Pen, Vial

Type of Insulin
Insulin Prandial (Meal-Related)
Insulin Short-Acting
Regular (Actrapid, Humulin
R)
Insulin Analog Rapid-Acting

PERKENI Consensus Guidelines, 2011.

Insulin in Indonesia (Contd)

Onset of
Action

Peak of
Action

Duration
of Action

Presentati
on

2-4 hour

4-10 hour

10-16 hour

Vial,
Pen/Cartridge

Insulin Glargine (Lantus)

2-4 hour

No Peak

20-24 hour

Pen

Insulin Detemir (Levemir)

2-4 hour

No Peak

16-24 hour

Pen

70% NPH 30% Regular

(Mixtard, Humulin 30/70)

30-60 min

Dual

10-16 hour

Pen/Cartridge

70% Insulin Aspart Protamin

30% Insulin Aspart (Novomix
30)

10-20 min

Dual

15-18 hour

Pen

5-15 min

Dual

16-18 hour

Pen/Cartridge

Type of Insulin
Insulin Intermediate-Acting
NPH (Insulatard, Humulin N)
Insulin Long-Acting

Insulin Campuran

75% Insulin Lispro Protamin

25% Insulin Lispro
(HumalogMix 25)
PERKENI Consensus Guidelines, 2011.

glargin
glargin
e
e

Treating fasting hyperglycaemia lowers

the entire
24-hour plasma glucose profile
20

T2DM

300

15
200

Hyperglycaemia due to an increase in fasting glucose

10

100

Normal
0
6

Meal

Meal

10

14

Meal

18

Plasma glucose (mmol/l)

Plasma glucose (mg/dl)

400

0
22

Time of day (hours)

Comparison of 24-hour glucose levels in control subjects vs patients with diabetes
(p<0.001).
Adapted from Polonsky K, et al. N Engl J Med 1988;318:12319.

APAN MEMULAI TERAPI INSULIN?

sedikitnya 3 bulan
terapi GHS + 2 OHO:

A1c >7 % dan

Glukosa Puasa>100

Glukosa Darah

A1c > 9 %
GHS: Gaya Hidup
Sehat
Konsensus Perkeni 2011

PENGHALANG MENGGUNAKAN
INSULIN
Barrier

Intervention

KECANDUAN

Motivasi di coba sebulan dan evaluasi

Aktivitas menjadi
terbatas

Edukasi ttg perjalanan penyakit

diabetes

Membuat Buta

Edukasi komplikasi diabetes

Takut Suntik

Dipilih Flexpen : Pasien bisa

merasakan sakit suntik (karena
pengalamn suntik merupakan yang
terburuk)

Polonsky W et al. Clin Diabetes 2004;22:147-50.

Initiation and Titration of Basal

Insulin
Bedtime or morning long-acting insulin
OR
Bedtime intermediate-acting insulin
Daily dose: 10 U or 0.2 U/kg

Initiate insulin with a single

injection of a basal insulin,
such as insulin glargine

Check
FBG daily
Increase dose by 2 U every 3 days
until FBG is 3.97.2 mmol/L (70130
mg/dL)
If FBG is >10 mmol/L (>180 mg/dL),
increase dose by 4 U every 3 days

Continue regimen and

check HbA1c every 3 months

Nathan DM et al. Diabetes Care 2009;32:193-203.

In the event of hypoglycemia or

FBG level <3.9 mmol/L (<70
mg/dL), reduce bedtime insulin
dose by 4 units, or by 10% if
>60 units

POINT OF INTEREST
Bedti
me

High Alert
Medication

HARM
: HYPO
TINDAKAN MEDIS YANG
DIBERIKAN PERHATIAN
DAN PENGETAHUAN
KHUSUS DENGAN
INDIKATOR
KEDARURATANNYA ATAS
TINDAKAN TERSEBUT

GLICEMI
A

Glargi
ne

Target
GDP

No
Peak

Definitions of Hypoglycemia
Whipples triad:
Symptoms of hypoglycemia
Low PG
Symptom relief with treatment

However
Some patients with diabetes may experience
symptoms of low BG with normal BG results by meter
Not all patients with diabetes experience symptoms of
hypoglycemia even with low BG by meter
PG = Plasma Glucose
BG = Blood Glucose

Classification of
Hypoglycemia
Symptomatic Hypoglycemia
Characterized by a plasma glucose
<70 mg/dL in association with typical
adrenergic symptoms

Asymptomatic Hypoglycemia
Plasma glucose <70 mg/dL not
accompanied by typical adrenergic
symptoms

Classification of
Hypoglycemia
Severe Hypoglycemia
An event requiring the assistance of
another person to actively administer
carbohydrate, glucagon or other
resuscitative action
Relative Hypoglycemia
An event during which the person with
diabetes reports symptoms of hypoglycemia
that improves with ingestion of carbohydrate
but plasma glucose is >70 mg/dL (3.9 mmol/L)

Signs and Symptoms of Hypoglycemia in

the Adult
AUTONOMIC

NEUROGLYCOPENIC

Symptoms

Signs

Symptoms

Signs

Hunger

Pallor

Weakness, fatigue

Cortical -blindness

Sweating

Tachycardia

Dizziness

Hypothermia

Anxiety

Widened
pulse-pressure

Headache

Seizures

Paresthesias

Confusion

Coma

Palpitations

Behavioral changes

Tremulousness

Cognitive- dysfunction
Blurred vision, diplopia

SAMPUN