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70 Cardio Diabetes Medicine 2017

The Applied Biochemical and Metabolic

Aspects of Diabetes and Heart

Dr. Siva Somana Rajasekar, MD., (Biochemistry),
Affiliation Laboratory Consultant, SAH Hospitals, Thoothukudi.

Abstract defects may occur includingresistance to exogenous
insulin. The mechanism for this includes the develop-
Diabetes mellitus is a chronic metabolic disease-
causing hyperglycemia resulting in microvascular mentof anti-insulin antibodies andinsulin resistance
(4)
and macrovascular complications contributing to the because of genetic and morphological factors .
increased morbidity and mortality and thereby to Type 2 Diabetes mellitus: Hyperglycaemia is due to
the disease burden in India. β-Cell destruction and elevated hepatic glucoseoutput and, to a lesser ex-
Insulin resistance results in hyperglycemia. In Insulin tent, failure of skeletal muscle totake up glucose and
resistance, Insulin fails to produce an increased store it as glycogen due to defective Insulin action.
peripheral glucose utilisation and to inhibit lipolysis Although manyfactors are believed to contribute to
resulting in dyslipidaemia characterised by elevated these two defects,they can broadly be categorized
triglycerides, reduced high-density lipoprotein (HDL), into three groups: β-Celldeficiency/dysfunction, insu-
and increased small dense low-density lipoprotein lin resistance and abnormalitiesof non-insulin-medi-
(LDL) particles. Insulin’s inhibition of platelet aggre- ated glucose disposal .
(4)
gation and fibrinolytic action due to modulation of
plasminogen activator inhibitor-1 (PAI-1) levels is de- Insulin resistance: Insulin resistance is ‘a state in
fective in Insulin resistance. New therapeutic targets which greater than normal amounts of insulin are
from the pathogenetic mechanisms of diabetes and required to elicit a quantitatively normal [glucose] re-
(4)
atherosclerosis may help to further improve their sponse’ ie.an impaired biologic response to insulin
prognosis. (either exogenous or endogenous). It is manifested
by decreased insulin-stimulated glucose transport
The applied biochemical and metabolic and metabolism in adipocytes and skeletal muscle
and by impaired suppression of hepatic glucose
aspects of Diabetes and Heart Background: output. Insulin sensitivity is influenced by a number
Diabetes mellitus is a chronic disease which occurs of factors including age, weight, ethnicity, body fat
when the pancreas is not able to produce enough (especially abdominal), physical activity, and medica-
Insulin (Type1) or when the body cannot utilise Insulin tions. There is also a strong influence of environmen-
effectively(Type2). Raised blood sugar levels in diabe- tal factors on the genetic predisposition to insulin
tes over time results in serious damage to nerves and resistance and therefore to diabetes (5)
blood vessels contributing to the increased morbidity
and mortality and thereby to the disease burden in
India. Among the 422million diabetics in the world,
60million people belong to India as per data till 2015
and this is projected to rise to 109 million diabetics
(1,2)
in India by 2035 .The epidemic of diabetes is at-
tributed to the changes in dietary patterns, decreased
physical activity, population aging, and urbanization (3)

Biochemical Basis of Diabetes Mellitus
Type 1 Diabetes mellitus: β-Cell destruction is the
cause of type 1 diabetesmellitus, secondary metabolic

GCDC 2017