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Insulin in Indonesia

PERKENI Consensus Guidelines, 2011.

Type of InsulinOnset ofAction

Peak ofAction

Durationof Action

Presentation

Insulin Prandial (Meal-Related

Insulin S!ort-A"ting

Regular (A"tra#id$% Hu&ulin$R

'-) &in*+-*,

&in-, !our

ial%

Pen/0artridge

Insulin Analog Ra#id-A"ting

Insulin Lis#ro (Hu&alog$ -* &in '-1 &in '- !our Pen/0artridge

Insulin 2lulisine (A#idra$ -* &in '-1 &in '- !our Pen

Insulin As#art (3o4ora#id$ -* &in '-1 &in '- !our Pen% ial

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Insulin in Indonesia (0ont5d

Type of InsulinOnset ofAction

Peak ofAction

Durationof Action

Presentation

Insulin Inter&ediate-A"ting

3PH (Insulatard$% Hu&ulin$ 3 +-6 !our 6-* !our *-*) !ourial%

Pen/0artridge

Insulin Long-Acting

Insulin Glargine (Lantus®) 2-4 hour No Peak 20-24 hour Pen

Insulin Detemir (Levemir®) 2-4 hour No Peak !-24 hour Pen

Insulin 0auran

78 3PH '8 Regular

(Mi9tard$% Hu&ulin$ '/7

'-) &in Dual *-*) !our Pen/0artridge

78 Insulin As#art Prota&in'8 Insulin As#art (3o4o&i9$'

*-+ &in Dual *-*, !our Pen

78 Insulin Lis#ro Prota&in+8 Insulin Lis#ro(Hu&alogMi9$ +

-* &in Dual *)-*, !our Pen/0artridge

PERKENI Consensus Guidelines, 2011.

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0oarison of +6-!our glu"ose le4els in "ontrol su:;e"ts 4s #atients ? @% et al. 3 Engl J Med *1,,'*,B*+'*C1.

 i&e of da? (!ours

400

300

200

100

0

6 610 14 18 22 2

   P

   l  a  s  m  a  g   l  u  c  o  s  e   (  m  g   /   d   l   )

Normal

Meal Meal Meal

20

15

10

 5

  0

Plasma

glucose(mmo

l/l)

Treating fasting hyperglycaeia lo!ersthe entire

"#$hour plasa glucose pro%le

Hyperglycaemia due to an increase in fasting glucose

  T2DM

     g       l     a     r     g       i     n

     e

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lukosa Darah

se&ikitnya ' (ulanterapi G)S * " O)O+

• A,c -. / &anGlukosa Puasa-,00

 A,c - 1 /

@onsensus Per>eni +**

 2HSB 2a?a Hidu#Se!at

PAN 3E3ULAI TERAPI INSULIN4

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PE32HALA32 ME322U3A@A3I3SULI3

Polonsky W et al . Clin Diabetes 2004;22:147-0.

Barrier Intervention

“KECANDUAN” !o"i#$si di %o&$ se&ul$n d$n e#$lu$si

“Aktivitas menjaditerbatas”

Eduk$si ""' (e)*$l$n$n (eny$ki"di$&e"es

“Membuat Buta” Eduk$si ko+(lik$si di$&e"es

“Takut Suntik”i(ili le/(en : P$sien &is$

+e)$s$k$n s$ki" sun"ik k$)en$(en'$l$+n sun"ik +e)u($k$n y$n'

"e)&u)uk

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Initiation and itration of asalInsulin

Bedtime or morning ong!a"ting insuin

#$

Bedtime intermediate!a"ting insuin

Dai% dose& '( U or ()* U+kg

In"rease dose b% * U ever% , da%s

unti -B. is ,)/01)* mmo+2 31(0',(

mg+d24

I5 -B. is 6'( mmo+2 36'7( mg+d248in"rease dose b% 9 U ever% , da%s

Continue regimen and

":e"k ;bA'" ever% , mont:s

In t:e event o5 :%9 units8 or b% '(? i5

6@( units

 C:e"k

 -B. dai%

N$"$n ! et al . Diabetes Care 200;32:13-203)

Initiate insuin it: a singe inje"tion o5 a basa insuin8

 su": as insuin gargine

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POI3 OF I3ERES

2largine

edti&e

3oPea>

 arget2DP

)AR3+ )5POGLI6E3I

A

)igh Alert3e&ication

TINDA2AN 3EDIS 5ANGDI7ERI2AN PER)ATIAN

DAN PENGETA)UAN2)USUS DENGAN

INDI2ATOR2EDARURATANN5A ATAS

TINDA2AN TERSE7UT

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DeGnitions of H?#ogl?"e&ia

• "hi##le$s tria% B

  S?to&s of !?#ogl?"e&ia

  Lo< P2

  S?to& relief

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0lassiG"ation ofH?#ogl?"e&ia

• Syptoatic )ypoglyceia  0!ara"teried :? a #las&a glu"ose

=7 &g/dL in asso"iation

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0lassiG"ation ofH?#ogl?"e&ia

• Se8ere )ypoglyceia  An e4ent reKuiring t!e assistan"e of

anot!er #erson to a"ti4el? ad&inister

"ar:o!?drate% glu"agon or ot!erresus"itati4e a"tion

• Relati8e )ypoglyceia

  An e4ent during

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Signs and S%m

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SAMPU3