M5L5: Diabetes, CVDs and lifestyle disorders

Almost 2/3^rd of NCDs in India can be attributed to alcohol consumption, drug abuse, tobacco, unhealthy eating habits combined with lack of physical activity leading to obesity and diabetes.

First let us start with diabetes. To understand this, I would like to ask one question. What is the major component of urine? Urea or Uric acid right?

Now, say if the body is unable to reject urea, then what? Urea starts accumulating in the body and causes Gout

Let us jump to the other side

What are those substances that increase the flow of urine? Tea, coffee, caffeine, alcohol and cocoa. They are called as di-uretics.

If they are di-uretics, is there anything that opposes them? We have a hormone that is called as anti-diuretic. It is known as vasopressin. The substances that increase the flow of urine are called as di-uretics and anti-diuretic hormone act against the them. It restricts the flow of urine.

But how does it work? The ADH hormone or anti-diuretic hormone is released from the pituitary gland. When the kidney receives this hormone, it starts restricting the flow of urine and returns the water back to the body. This prevents the body from dehydration.

Sometimes, the pituitary gland is unable to release this hormone. This can be due to some kind of accident that hit the brain or other reasons like tumor, trauma or inflammation of the pituitary or hypothalamus (that produces ADH). However, this is not the subject of discussion here. (Remember UPSC says, General Science that does not require subject specialization)

Or say, in the worst-case scenario, the kidney is not responsive to ADH hormone. In both the cases, the ADH hormone is unable to manifest itself and therefore, unable to stop the flow of urine. In this case, the urine flows continuously and the body gets dehydrated very fast. This kind of diabetes is called as Diabetes insipidus wherein the body requires a lot of water to compensate the loss in urine. A person in this case naturally feels thirstier.

Body builders consume diets containing more proteins. It is the responsibility of liver to metabolise them and convert them into simpler molecules. These molecules are usually ammonia or urea. Excessive urea in blood can also cause breakdown of muscles or weightless

The other type of diabetes is called as diabetes mellitus. It is defined by too much amount of glucose in the blood

The responsibility to process excess sugar lies on liver. But the liver does it through insulin that is released from Pancreas. When pancreas release insulin, the liver converts excess glucose to glycogen. If the proportion of glycogen increases too much, the liver converts it into glucose. Excess glucose levels in the body then forms fatty acids + glycerol through a process known as glycolysis.

Triglycerides are the ester derived from glycerol and three fatty acids (tri + glyceride). They are the main constituent of body fat in humans and animals, as well as vegetable fat. When a person suffering from diabetes goes to the pathology lab to check his blood sugar levels, you must have noticed the report also shows the levels of triglycerides. Both of them are important and they are used as biomarkers. Biosensors are devices used to detect the presence or concentration of a biomolecule. It can contain protein, peptide, enzymes, antibodies and/or nucleic acids. They are also known as biomarkers. For e.g. in order to check the level of jaundice, Bilirubin is used as a biomarker. In order to check pregnancy, the levels of HCG hormone are used to check if pregnancy exists or not. To check the levels of dengue, we use platelet counts as a biomarker. We will take few examples to understand this.

Do you know? Scientists at NASA have constructed a bio-capsule that effectively encapsulates insulin-secreting (insulinoma) cells. The capsule, which is made of a microfabricated silicon membrane that has nanometer-scale pores and is bound to a polymer well, has potential as an implantable system for steady and continuous insulin production and delivery into the bloodstream. Such nano-capsules that can be used to deliver some enzyme or nutrient or pharmaceutical drug are also known as liposomes A major challenge in the development of this bio delivery device is protecting the transplanted cells from attack by the body’s immune system while allowing the passage of needed nutrients. The 24.5-nm pores are believed to be small enough to block the entrance of antibodies and other immune components. .

So, in case of Diabetes Mellitus, we find that the levels of Blood sugar increases.

On that basis, it can be classified into two types

Type 1 diabetes: One in which, pancreas is unable to produce insulin in required quantities

In this case, the insulin can be directed externally

Type 2 diabetes: One in which the liver becomes unresponsive to insulin. India has patients that mostly suffer from Diabetes Type II

The Center for Molecular Biology in Hyderabad has discovered that Indians are more susceptible to diabetes because of our genetic evolution

Now, since India is becoming the diabetes capital of the world, it was found that Indians are losing a lot of money to get treated. The Triglycerides mentioned earlier get deposited in our body in the form of cholesterol plaques. The resulting situation is called as atherosclerosis

So, what is the solution to this problem? In order to detect these blockages, the doctors first go for angiography

Angio means blood vessels. Graph means study. So, in this case, the interior of the blood vessels are checked. In case a blockage is visible, they suggest Angioplasty to the patient. In Angioplasty, stents are used. Recently, the government of India has put a price cap on stents to reduce the Out of Pocket expenditure of the patients.

AYUSH ministry has come out with a new herbal tablet BGR 34 for diabetes patients.

Now, it has been found that this cholesterol plaques can also build up in Coronary arteries. To, treat this problem, off course it is not possible to use stents. In that case scenario, the doctors prescribe CABG surgery (also known as Coronary Artery Bypass Surgery)

Now, these methods are curative. Isnt it better to focus on preventive side? To do this, we first need to understand what makes this cholesterol

There are actually two types of cholesterol

1.    HDL (High Density Lipoprotein or good cholesterol). This helps transport triglycerides to the liver for excretion

2.    LDL (Low Density Lipoprotein or bad cholesterol). This causes blockage in arteries. It can be made up of either trans-fats and saturated fats.

The word Cis means belong to the same line or generation or family. Trans means the generation or family or chain is broken

Where do we find these Cis fats and Trans fats? When certain food items are deep fried, heating and re-heating cycles turn the oil from cis fat to trans fats. This means, that the hawker, frying bhajiyas and vadapav near your place, is actually frying the food item in trans fats that tends to contribute more cholesterol in your body.

That was about cis fats and trans fats. What about saturated and unsaturated fats?

Normally, you must have seen Dalda ghee used by people who make Mithai. This Dalda ghee is partially saturated fat. Sunflower oil, olive oil etc. are considered to be healthy for the hearts since they contain unsaturated fats.

Saturated fats tend to become grease like when allowed to stay at room temperature

	Unsaturated Fats		Saturated Fats
Type of bonds	Consist of at least 1 double bond		Consist of single bond
Health Effects	Unsaturated fats are considered good to eat if you are watching your cholesterol. Also high in antioxidants.		Excessive consumption is not good because of their association with atherosclerosis and heart diseases.
Cholesterol	Unsaturated fats increase High-Density Lipoprotein (HDL or good cholesterol).		Saturated fats increase Low Density Lipoproteins (LDL or bad cholesterol).
Sources	Sources of HDL include onions & Omega-3 fatty acids like flax oil, fish, foods rich in fiber (grains)		Sources of bad cholesterol are foods rich in trans-fatty acids, refined carbohydrates such as white sugar & flour.
Commonly found in	Avocado, soybean oil, canola oil and olive oil, sunflower oil, fish oils walnuts, flax, & red meats		Butter, coconut oil, whole milk, meat, peanut, butter, margarine, cheese, vegetable oil, fried foods, & frozen dinners
Shelf Life	These spoil quickly		These are long lasting and do not spoil quickly
Physical state at room temp.	Liquid (Monounsaturated & Polyunsaturated Fats- Omega 3's & 9's)		Solid (Trans Fats & Saturated Fats)
Examples	Olive Oil, linoleic acid, alpha-linolenic acid		Hydrogenated Oils, Butter, Processed Meats

Now, these conditions like hypertension, atherosclerosis and some other blood problems can lead to the development of blood clots. When the clot blocks the blood flow to the heart or the brain, a heart attack or an Ischemic stroke can follow

In India, at least 28% (0.4 million) out of 1.3 million cardiovascular deaths in the age group from 30 to 69 years are caused by stroke, according to a recent Lancet Global Health report.

Recently, scientists at CSIR-Institute of Microbial Technology (CSIR-IMTECH) have  developed a new clot-buster, PEGylated Streptokinase. IMTECH has signed an agreement with Epygen Biotech Private Limited, Mumbai, which will be the first company in India with exclusive license to develop this patented PEGylated Streptokinase for treatment of ischemic stroke.

Currently tissue plasminogen activator (tPA) is considered the best treatment available for patients of stroke. However, a dose of tPA costs at least ₹ 40,000 and has to be administered within three hours of stroke, after which it becomes counter-productive.