This document outlines a treatment plan for a 60-year-old male patient with type 2 diabetes and a blood glucose level of 25 mmol/dl. The plan includes administering humulin insulin twice daily along with oral medications like metformin and sulfonylurea. A diet and exercise regimen is also prescribed to help control blood sugar levels and reduce risks of diabetes complications. Lifestyle changes are emphasized along with monitoring the effects of exercise on blood glucose levels.

1. Rational therapy of genetic disorder like
Diabetes mellitus
Patient of genetic disorder

2. Problem
 On a case history of a patient having a blood glucose level of 25 mmol/dl,
70 kg weight of 60 years old of age.
 To keep everyday food requirement as normal person design a proper
normal therapy and food intake.

3. Patient History
 Name: X
 Sex: Male
 Age: 60
 Height: 5.6”
 Weight: 70 kg
 Blood sugar level: 25 mmol/dL
 He has ben suffering from diabtes for 25 years .He is suffering
from type-II diabetes.

4. Insulin

5. Mode of Insulin
• Insulin has two modes of action on the body - an excitatory one and
an inhibitory one:
• Insulin stimulates glucose uptake and lipid synthesis
• It inhibits the breakdown of lipids, proteins and glycogen, and
inhibits the glucose pathway (gluconeogenesis) and production of
ketone bodies (ketogenesis).

6. How insulin works ?
Insulin works like a key, unlocking the doors of the cells in our body

7. Treatment Protocol
 1st we have started with humulin insulin .We gave it 2 times a day
 2nd Oral medication- Biguanides and Sulfonylurea. We are using a
combination of Vildagliptin and Metformin hydrochloride.
 3rd Diet
 4th Exercise
 5th life style change

8. M/A of Sulfonylureas:
solfonylureas bind to sulfonylurea of beta cells of pancreas
the efflux/explusion of K+ from inside the cell is reduced
so, there will be depolarization and Ca+ channel will be opened
this will cause degranulation and relkease of insulin from
beta cells of pancreas
So, insulin secretion is increased

9. How does NPH insulin work in the body?
 It is an intermediate-acting insulin (isophane).
 Insulin isophane works by helping blood sugar (glucose) get into cells so your
body can use it for energy
 Given to help control blood sugar levels in people with diabetes.
 It is used by injection under the skin once to twice a day.
 Onset of effects is typically in 90 minutes and they last for 24 hours

10. Uses
• Combination isophane/regular insulin is used with a proper diet and exercise
program to control high blood sugar in people with diabetes.
• Controlling high blood sugar helps prevent kidney damage,
• blindness,
• nerve problems,
• loss of limbs,
• and sexual function problems.
• Proper control of diabetes may also lessen your risk of a heart attack or stroke

11.  Twice daily regimens
Intermediate acting insulin(NPH) and short acting (regular) insulin
2/3 of insulin- morning(ratio 1:2)
1/3 of insulin -evening

12. Dose calculation
Insulin of humulin :
Usual daily range 0.6-1.2 U/kg/day
We know that my patient weight is 70kg.
So,
For 1 kg body weight is required 1.2U/day
And 70 kg body weight is required (1.2×70)=84 U/day
Let ,
For 24 hours insulin is required 84 U
and for 1 hour insulin is required (84÷24) = 3.5 U/hr.
We know that the patient blood glucose level is 450 mg/dl or 25 mmol/dl
If reduce the blood glucose level 25 to 9 mmol/dl

14. Life style of patient

15. Exercise
 When we exercise, our muscles become more sensitive to insulin and absorb more
glucose from the blood.
 However, like many aspects of type 2 diabetes, the response can be highly
personal. Exercise can sometimes boost blood sugar.
 At first, you'll need to test our blood sugar before, after, and sometimes during
exercise, to see how our body responds).
 Exercise also helps lower blood pressure an important benefit since high blood
pressure can contribute to heart attacks, strokes, eye problems, kidney failure, and
other type 2 diabetes complications.

16. Exercise: Generally, aerobic exercise, strength training and flexibility training
should be combined to form a comprehensive exercise routine.