Resistance to insulin can be due to : – Antibodies to insulin receptor – Antibodies to insulin – Insulin receptor defects – Post-insulin receptor defects – Counter insulin hormones * Corticosteroids * Growth Hormone * Glucagon * Catecholamines – Defects in glucose transporters SYNDROME X

Resistance to insulin can be due to :

– Antibodies to insulin receptor

– Antibodies to insulin

– Insulin receptor defects

– Post-insulin receptor defects

– Counter insulin hormones

* Corticosteroids

* Growth Hormone

* Glucagon

* Catecholamines

– Defects in glucose transporters

Diagnostic Tests : OGTT / IVGTT Plasma insulin (fasting) Waist–hip ratio Triglycerides Euglycemic – hyperinsulinemic clamp SYNDROME X

Diagnostic Tests : OGTT / IVGTT

Plasma insulin (fasting)

Waist–hip ratio

Triglycerides

Euglycemic – hyperinsulinemic clamp

Drugs that improve insulin sensitivity : Thiazolidinediones (caution): rosiglitazone, pioglitazone Metformin (anti – hyperglycemic) Insulin sensitizers – ? Vanadium, Chromium – ? Repaglinide, nateglinide Antilipolytics AGE inhibitors, e.g., 9–aminoguanidine (Pimagedine) Aldose reductase inhibitors, e.g., Zenarestat  – glucosidase inhibitors, e.g., acarbose, miglitol, voglibose 3 rd generation OHA, e.g., glimepiride  1 blockers, e.g., prazosin Nabivelol SYNDROME X

Drugs that improve insulin sensitivity :

Thiazolidinediones (caution): rosiglitazone, pioglitazone

Metformin (anti – hyperglycemic)

Insulin sensitizers – ? Vanadium, Chromium

– ? Repaglinide, nateglinide

Antilipolytics

AGE inhibitors, e.g., 9–aminoguanidine (Pimagedine)

Aldose reductase inhibitors, e.g., Zenarestat

 – glucosidase inhibitors, e.g., acarbose, miglitol, voglibose

3 rd generation OHA, e.g., glimepiride

 1 blockers, e.g., prazosin

Nabivelol

SOD Aspirin TxA 2 Statin B1 - Benfotamine Metformin

ACE activity Stress Glucose Transfat High Salt Angiotensin II Endothelin Superoxide anion Nitric Oxide TGF - ß Nabivolol Antioxidant EPA /DHA ACEI Blood Pressure

Central Effects of Leptin Sympathetic Activity  Cardiac Output  Blood Pressure  Sharma 2002 Adipose Tissue Leptin Volume Retention  Heart Rate 

AT 1 - Receptors are expressed on Human Adipocytes Negative Control AT 1 -expression Gorzelniak K et al, J Hypertens 2002

Obesity Tissue perfusion  Wirth A, Dtsch med Wschr 2000;125:944-949 Sympathetic activity  Blood volume  RAAS  Hypertension LV-dilatation LV-hypertrophy

Obesity leads to cardiac volume overload: To achieve adequate perfusion of fat-free mass, diastolic BP and LV volumes increase Obesity leads to cardiac pressure overload: Systolic BP and LV mass increase High prevalence of concentric and eccentric LVH: Subsequent development of diastolic and systolic dysfunction Weight loss reduces BP and volume overload resulting in improved LV geometry Significant regression of LVH was observed after weight loss induced by sibutramine in obese hypertensives MESSAGE

Obesity leads to cardiac volume overload:

To achieve adequate perfusion of fat-free mass, diastolic BP and LV volumes increase

Obesity leads to cardiac pressure overload:

Systolic BP and LV mass increase

High prevalence of concentric and eccentric LVH:

Subsequent development of diastolic and systolic dysfunction

Weight loss reduces BP and volume overload resulting in improved LV geometry

Significant regression of LVH was observed after weight loss induced by sibutramine in obese hypertensives

meat sweets eggs poultry fish Dairy Olive oil/soya protein Fruits-3 Beans&nuts-3 Vegetables,roots,salt-3gm 6 grains&starches,fibre,water. Daily physical activity monthly weekly Daily

IDEAL DIET S OUTH I NDIAN V EGETERIAN D IET (Leaf Model) MORNING 3 Idlis with Sambar, Chutney, Tomato, Chutney 1 Cup Tea Banana, Orange, Grape (Don’t miss the Breakfast) LUNCH 3 Spoons of Rice or 3 Chappathis Green & Vegetables Sambar, Rasam, Butter Milk Apple (Oil used for Deep – Frying must not be reused) TEA Biscuits or 30 Grams Nuts Sundal (Boiled) SUPPER 3 Chappathis, Dhal or Carrot 3 Idlis, Onion, Papaya 1 Tables Spoon Oil (Ground Nut or Gingely Oil) 1 Teaspoon salt – Sugar Fruits, Nuts, Roots 300 ml of milk, 3 liters water

MORNING 3 Idlis with Sambar, Chutney, Tomato, Chutney

1 Cup Tea

Banana, Orange, Grape

(Don’t miss the Breakfast)

LUNCH 3 Spoons of Rice or 3 Chappathis

Green & Vegetables

Sambar, Rasam, Butter Milk Apple

(Oil used for Deep – Frying must not be reused)

TEA Biscuits or 30 Grams Nuts

Sundal (Boiled)

SUPPER 3 Chappathis, Dhal or Carrot

3 Idlis, Onion, Papaya

1 Tables Spoon Oil

(Ground Nut or Gingely Oil)

1 Teaspoon salt – Sugar

Fruits, Nuts, Roots

300 ml of milk, 3 liters water

Common sources of the different dietary fats are as follows: SF : Butter,ghee,coconut oil,palm oil,tallow,lard.(Other dietary sources-Lamb,chicken,beef,pork,egg,milk,curd,cheese HDL LDL MUFA : Groundnut oil,palm oil,mustard oil,rapeseed oil,olive oil.Canola- LDL HDL (Other dietary sources-lamb,chicken,beef,pork,egg,fish) PUFA : n-6 : Safflower oil,til oil,soyabean oil,groundnut oil. LDL (but oxidised)HDL (Other dietary sources-Egg,chana&chana dal,pulses,whole grains.

ALA n-3 : Fish oil,linseed oil,mustard oil. ANTITHROMBOTIC,ANTIOXIDANT,ANTIINFLAMMATORY. (Other dietary sources-Fish,green leafy vegetables,Rajma,urad dal,moong dal,methi seeds,linseed,walnuts) AVOID TRANS FAT ( REUSED )

YOUR WORKOUT GOAL is to stay at RPE 6 to 7 or about 65 to75% of your maximum heart rate.Your workout will look like this(220-age)%. Warm-up 5 minutes at RPE 4 to 5(about 55% of MHR) workout 30 minutes at RPE 6 to 7(about 65 to 75% of MHR).Add 1 minute to your workout everytime. Cool-down 5 minutes at RPE 4 to 5 (about 55% of MHR) Total workout time-40+ minutes walking,jogging,treadmill,staircase(outdoor,indoor)

“ CHANGE THE PATTERN” “LIFESTYLE” RATE OF PERCEIVED EXERTION(RPE) The RPE scale is a way of gauging your intensity or effort level without using a heart-rate monitor. Estimate how hard you are working on a scale of 1 – 10, as follows: RPE 4 to 5 light to moderate effort RPE 6 to 7 moderately hard effort Sweating & able to talk. SHAPE March 2001(get fit)

HDL  ANTIINFLAM. Sugar  Wt  BP  Pulse  Calene expenditure on Time = MET on Type of Exercise 210 210 250 300 300 350 350 350 360 420 660 900 Cycling Walking (4 Kmph.) Golf Swimming (0.4 Kmph) Walking (5.5 Rmph) Badminton Volleyball Skating Table Tennis Tennis Cycling (19 Rmph) Running (16 Rmph) Moderate (210 – 350 Cal. / hr.) 2.5 MET 4 MET Vigorous 12 MET 16 MET CAL CONSUMPTION (PER HOUR) ACTIVITY LEVEL OF ACTIVITY

Yamas Niyamas Asanas Pranayams Pratyashara Dharma Dhyana The 8 steps of Raja yoga: By observing their own thoughts scientifically&objectively the ancient yogis studied many obstacles to bringing their mind under conscious control.Then sage patanjali compiled their findings in the Raja yoga sutras,a text that describes the inner working of the mind and also provides the 8 step Asthanga,The blueprint for controlling the restless mind and enjoying the eternal peace. What are the steps? 1)Yamas-Truthnonviolence,control of sexual energy.Non-stealing,non-covetousness. 2)Niyamas-Austerity,purity,contentment,surrender of ego. 3)Asanas-Steady poses. 4)Pranayam-Controlof vital energy. 5)Pratyashara-Vibration of senses 6)Dharma-Concentration of the mind 7)Dhyana-Meditation, 8)Samadhi-Super consciousness of the mind . Samadhi