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Pelatihan Penatalaksanaan Diabetes Mellitus Bagi Internis WDF Project bekerjasama dengan PB PERKENI PERKENI Cabang Yogyakarta Maret 2007
Hepatic gluconeogenesis
HYPERGLYCEMIA
The core defect: insulin secretion and insulin resistance Comorbid (hypertension, obesity, dyslipidemia) Data are not sufficient to support a recommendation of one class of glucose-lowering agents, or one combination of medication with regard to effects on complications (Nathan et al., 2006) A1C 7% should serve as a call to action to initiate or change therapy (Nathan et al., 2006)
A1C 7%
TETRATION OF METFORMIN
Begin with low-dose metformin (50 mg) taken one or twice per day with meals (breakfast and/or dinner) After 5-7 days, if GI side effects have not occurred, advance dose to 850 or 1,000 mg before breakfast and dinner If GI side effects appear as doses advanced, can decrease to previous lower dose and try to advance dose at a later time The maximum effective dose is usually 850 mg twice per day, with modestly greater effectiveness with doses up to 3 g per day (Nathan et al., 2006)
SPECIAL CONSIDERATIONS
Severely uncontrolled diabetes with catabolism: FBG >250 mg/dl; random glucose levels consistently >350 mg/dl; or the presence of ketonuria; or as symptomatic diabetes with polyuria, polydipsia, and weight loss
Patent
Diabenese Daonil Glucotrol Diamicron Glurenorm Amaryl NovoNorm Starlix Avandia Actos
Mg/tab
100, 250 2.5; 5 5; 10 80 30 1; 2; 3; 4 0.5; 1; 2 120 4 15; 30
Daily dose
100-500 2.5-15 2.5- 40 80-320 30-120 0.5-6 1.5-6 360 4-8 15-45
Duration (h)
24-36 12-24 12-18 10-20 6-8 24 2-6 24 24 1
Freq.
Time
a.C a.C a.C a.C a.c a.C a.C
Metaboli sm
hepatic
Excretio n
Renal
Renal, intestinal
Glinide
TZD
Ren, Int.
500-850
2503,000
6-8
1-3
Insulin sensitizer: non-TZD (Glitazar, non-glitazar) Intestinal enzyme inhibitor: -amylase inhibitor (Tendamistase) Other specific type: DPP-IV inhibitor, amylin analogues (pramintide) Fixed dose combination type: glucovance, avandaryl
SITE OF ACTION
GLUCOSE INFLUX -glucosidase inhibitor
Insulin secretagogue
HYPERGLYCEMIA
INSULIN SECRETION