Genetic disorder like diabetes mellitus

1. R AT I O N A L T H E R A P Y O F
G E N E T I C D I S O R D E R L I K E
D I A B E T E S M E L L I T U S
PATIENT OF GENETIC DISORDER

2. INSULIN

3. 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.

4. PATIENT HISTORY
• Name: X
• Sex: Male
• Age: 60
• Height: 5.6”
• Weight: 70 kg
• Blood sugar level: 25 mmol/dL
• Has been suffering from diabetes for 25 years. He is suffering
from type-II diabetes.

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).

7. HOW DOES INSULIN
REGULATE GLUCOSE LEVEL
• The importance of insulin for maintaining blood glucose levels
is mainly due to this effect on liver storage and release.
• The uptake of glucose by cells can take place without insulin -
the hormone simply accelerates this uptake through recruitment
of glucose transporter molecules to the cell membrane.
If there is a lack of insulin in the liver, the liver releases glucose
into the bloodstream faster than tissues can metabolize it.

8. TREATMENT PROTOCOL
•1st we have started with soluble insulin. We gave it 2
times a day.
•2nd we used zinc insulin to prolong the time duration.
• 3rd Life style change
• 4th Food habit control
• 5th Exercise
• 6th Oral Medication

9. ZINC INSULIN
• In the beta-cells of the pancreas, insulin is combined with a little
zinc.
• This leads to the formation of hexamers (groups of 6) of insulin,
which results in better water solubility and tighter packaging of
the insulin.
• However, when adding more and more zinc, insulin first
crystallizes and then forms insoluble insulin-zinc salts.
• Upon s.c. injection, these act as a depot from which insulin is
slowly released.

11. DOSE CALCULATION
According to the case history a patient age and weight 70kg.
So, elimination half life of Lispro of this patient approximate (61± 51)min.
Normal elimination half life of Lispro t1/2=60min.
The elimination half life of the Lispro is 112min. Normal dose of the Lispro is 0.5-1U/kg day divided
into two doses .
So,
C∞
ave = 1.44DN (t1/2 )N / τN VN = 1.44Dₒ (t1/2 )ₒ / τₒ Vₒ
or DN (t1/2 )N / τN = Dₒ (t1/2 )ₒ / τₒ
Keeping the dose constant ,
DN =Dₒ
Where DN is the new dose and Dₒ is the old dose

12. So that
τₒ / τN = (t1/2 )ₒ / (t1/2 )N
Or τₒ =12×(112÷60)
=22.4hr
Therefore, the same dose of the Lispro may be administered every
22.4hr without affecting the average steady-state level of the
Lispro .

13. • Insulin of Lispro:
Usual daily range 0.6-1.2u/kg day dividing dose
We know that my patient weight is 70kg.
So,
For 1kg body weight is required 1U/day dividing dose
And 70kg body weight is required (1.2×70)=84U/day dividing dose
Let ,
For 24hrs insulin is required 70U
and for 1hr insulin is required (84÷24)=3.5U/hr.
We know that the patient blood glucose level is 450mg/dl or 25mmol/dl
If reduce the blood glucose level 25 to 10mmol/dl
That time

14. • Correction dose =
Difference between actual and target blood glucose
(270mg/dl)
÷ correction factor (84) = 3.21 units of rapid acting insulin.
Where ,
Blood sugar target is 180mg/dl
Actual blood sugar after lunch is 450mg/dl
Correction factor is 84

15. To continue those medication after 7days the patient blood glucose level reduce
450mg/dl to 10mg/dl
After than suggest the patient to take zinc insulin , where 75% of zinc and 25% of
Lispro insulin .
75% zinc (0.75) and zinc insulin100% bioavailable(F=1) after infusion .
Dₒ / τ= C∞
ave ClT /SF
The dose rate Dₒ / τ (3.5U/hr) is calculated on the basis of zinc insulin .
So,
Zinc insulin dose rate = SFDₒ / τ

16. LIFE STYLE OF PATIENT
• 1. Eat healthy.
• 2. Exercise.
• 3. Get checkups.
• 4. Manage stress.
• 5. Stop smoking.
• 6. Watch your alcohol

17. FOOD HABIT

19. 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.