more details on metformin and the body as a machine

So my last post was just a general overview of how metformin and the different organs act together as a machine system. Here is the actual design diagram of how it targets various parts in the body to lower plasma glucose level

some research on metformin

I did some more research over the past week on the background of type 2 diabetes, insulin, metformin, how it works, and other pertinent information. A general overview of how everything functions from an engineer's point of view is that the whole human body is one huge machine and metformin is input into the machine that affects the smaller mechanisms withing the whole system. Essentially, the different types of cells and organs within the body are the smaller mechanisms in the machine, and the metformin is what's keeping the whole machine functioning efficiently. Without the metformin, the body wouldn't be able to maintain a normal level of blood sugar, insulin production, and blood pressure level, leading to cardiovascular disease, obesity, and many others. Eventually, this will lead to death and thus the machine stops functioning.

Resources on antidiabetic drugs

So here are some journal articles I found regarding the three different types of antidiabetic drugs. Basicially sulfonylurea works by increasing the insulin release from the pancreas while biguanides regulates the glucose production in the liver and thiazolidinediones help cells become more insulin sensitive. I will talk about all these in much more detail in the research paper and the diagrams.

Actually, after researching some more, I decided to just focus on biguanides.

Metabolic Effects of Metformin in Non-Insulin-Dependent Diabetes Mellitus - http://content.nejm.org/cgi/content/full/333/9/550

Re-evaluation of a biguanide, metformin: mechanism of action and tolerability
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WP9-4BRT5VY-11&_user=489256&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_acct=C000022721&_version=1&_urlVersion=0&_userid=489256&md5=9e3c9b336b5fad0f7c74d43c947271af

Metformin
http://proxy.library.upenn.edu:2252/cgi/content/short/334/9/574

The antidiabetic drug metformin activates the AMP-activated protein kinase cascade via an adenine nucleotide-independent mechanism.
http://www.ncbi.nlm.nih.gov/pubmed/12145153

Metformin: a new treatment option for non-insulin-dependent diabetes mellitus
http://findarticles.com/p/articles/mi_m0689/is_n6_v42/ai_18448465/

Metformin. A review of its pharmacological properties and therapeutic use in non-insulin-dependent diabetes mellitus
this one isn't available online, but it says it's available through Penn's catalog, so I will go check it out soon.
http://elinks.library.upenn.edu/sfx_local?sid=google&auinit=CJ&aulast=Dunn&atitle=Metformin.+A+review+of+its+pharmacological+properties+and+therapeutic+use+in+non-insulin-dependent+diabetes+mellitus.&id=pmid:7601013

Cellular mechanism of action of metformin
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=pubmed&doptcmdl=Abstract&term=0149-5992%20AND%201990%5BPublication%20Date%5D%20AND%2013%5BVolume%5D%20AND%20696%5BPage%20Number%5D

Research Project

I've always really been interested in diabetes since it's such a prevalent issue in society, especially during the past few decades because of the increasing obesity problems in America. More specifically, I really wanted to find out more about the varieties of drugs available for type 2 diabetes mellitus because it is the most common form of diabetes affecting the population today. The general idea is that these patients either are insulin-resistant or insulin-deficient; both will lead to high blood glucose level, leading to problems in the eye, liver, heart and other organs if left untreated.

Originially, I was going to compare and contrast some of the specific medicines used to treat diabetes to find out which is the most efficient one. However, after doing some research, I found out that there were way too many drugs available on the market, and there isn't a single "best" way for treating this condition. Each medicine acts differently on the body and there's almost a "trial and error" period for each person to find out the best medicine that suits his/her body. Also, focusing on why diabetes occur would be too broad and I really wouldn't be able to come up with a conclusive answer. Yet just zooming in on one particular drug was a bit of narrow because 1. I'm not sure which drug I would pick and 2. There aren't many journal articles about one specific drug.

Finally I decided to focus on three common different kinds of type 2 diabetes drug - biguanides, thiazolidinediones, and sulfonylureas - to see how they work both separately and together sometimes to help a person maintain good health.

The Structure cont.

Although I did not use a plant as my structure, the molecular bonds of the glass on a nanoscale do share some similarities with the cells of a liverwort leaf. If I took one layer of cell from the surface of the leaf and compared the outlines that the cells made, they almost resemble exactly the one dimensional shapes of the bonds between the silicon dioxides. The way in which the bonds are connected, which is in a tetrahedral shape, provides the whole structure with stability. The crystalline forms of the molecules give the glass its hardness.

On the next scale, each window pane resembles a regular glass picture frame. Almost all picture frames are made of some transparent material surrounded by a frame of some sort, just like the various window panes connected by frames as well. From one perspective, the transparent nature of the panes allows us to enjoy a great view of the city. From another, the smaller panes connected by frames also provide the entire structure with more support, stability, and strength.
The largest length scale, which is the all the windows/walls of the Rooftop Lounge, is similar to different compartments of a jewelry box. The whole lounge is composed of frames and glass with the frame dividing up the glass. Likewise, a jewelry box contains many different rectangular compartments with the frames dividing up different spaces. Similar to the previous length scale, the walls, frames, and glass together create a better aesthetic view and make the entire structure much more stable than if it was just composed of glass alone.

Silicon Element Facts. (2009). http://www.green-planet-solar-energy.com/silicon-element-facts.html

The Structure

I originally planned on using a type of plant form as my structure with the chloroplasts and other organelles as one scale, the veins another, and finally a single leaf as the last scale. Later, though, when I heard people discussing bike racks and the Penn card swipe system, I decided to find a structure that is more unique to Penn.
Since I live in the Harnwell college house, I chose the glass windows/walls of the Rooftop Lounge as my structure. Besides the one side that accommodates the entrance, the lounge is surrounded by almost wall-length windows that look out onto the city on three sides.
On the smallest scale, the windows are composed primarily of silica, soda, and other molecules. These chemical interactions and bonds that make up the glass occur in the nanoscopic world, which is 1 X 10-9 m length scale. Switching to a slightly larger scale, the entire structure is made of numerous, smaller, window panes. These sheets of glass vary in size a bit, but they are all fractions or small multiples of 1 m, so the panes are 1 m length scale. For example, the smallest pane is .6 x 1 m (.6 m2) where as the largest one is approximately 1.7 x 2.9 m (4.93 m2). The final length scale is the whole structure, which resembles a rectangle that measures approximately 14 x 9 m with the area being 126 m2. Therefore, the largest length scale is 1 X 102 m.

more technology & healthcare costs

Just recently, I saw a commerical that demonstrated another indirect method in which technology decreases healthcare costs. The commercial was advertising one of those fitness routines anyone can do in his/her home. In addition, he/she can do many different exercises with just one innovative machine. Although this method initially costs money and has financial benefits for that company, it increases a person's fitness level and improves his/her health, reducing the potential cost of hospital bills for a heart attack or other illness due to poor exercise or obesity.
Although this is not probable right now, another futuristic way that technology helps with reducing healthcare costs is that if researchers perfected the "personalized healthcare" system from the Grand Challenges for Engineering where physicians would be able to know the specific diseases a person could contract based on his/her blood or genome. This method would eliminate the costs of many unnecessary tests and improve healthcare overall.

Grand Challenges for Engineering. (2009). National Academy of Engineering of the National Academics. https://courseweb.library.upenn.edu/webapps/portal/frameset.jsp?tab_id=_2_1&url=%2fwebapps%2fblackboard%2fexecute%2flauncher%3ftype%3dCourse%26id%3d_23684_1%26url%3d

technology and healthcare cont.

Automated contact centers at hospitals and insurance companies also help reduce our healthcare costs. [1] Interestingly, I found this information from another blog known as the Communications and Technology Blog, which might make this claim a bit biased towards whatever company the blogger works for. However, his reason – automated answering systems reduces the costs of employing workers for simple questions such as office hours – seems legitimate. A more general way that technology decreases healthcare costs is that as more over-the-counter drugs become available in more places (CVS, Wal-Mart), people don’t have to travel as far to obtain the drugs, reducing the traveling costs. As I mentioned in my previous blog, the electronic system reduces the costs of paperwork. This, in turn, also decreases the costs of hiring a number of employees needed to enter this paperwork information into databases each time. Metavante, a financial technology service company, claims that for one medical practice, only 4 staffs are needed instead of 12 to work on information from insurance payers.[2] This claim obviously has a vested financial interest because it wants people to join its company. Nevertheless, the digital world does reduce the number of employees needed to manage a medical practice.

[1] Tehrani, Rich. Nortel: Unified Communications Reduces Healthcare Costs. (2009). http://blog.tmcnet.com/blog/rich-tehrani/nortel/nortel-unified-communications-reduces-healthcare-costs.html

[2] Metavante. Technology Reduces Healthcare Costs, Drives Efficiencies for Providers. (2009). http://www.metavante.com/cmspub/groups/public/documents/document/mvp0_014945.pdf

how can technology reduce healthcare costs

Technology helps us every day in improving our healthcare system and reducing the cost of it as well. One example could be that as more technological advances occur, more commonly used medicine such as insulin for diabetics becomes cheaper simply because mass production becomes easier due to technology. Similarly, new medical equipments are facilitating with diagnosing patients faster, eliminating the costs for extra tests. Now, because most patient identification information and many other healthcare records are stored in a database, the information can be easily changed and accessed, reducing the amount of paperwork in healthcare costs. In addition, since most medical related information can be found on the internet, it is easier for patients to self-diagnose themselves rather than going to a physician. For example, instead of paying a $25 co-pay to see a doctor, the person could just ask a doctor online for free by posting his/her symptoms. Today, while going to the Penn Nanotech Society meeting, I learned a more indirect way that technology reduces healthcare costs. Silver nano uses nanotechnology to instill silver nanoparticles in water pipes and medical equipments as an antimicrobial device. This method reduces the risk of people contracting bacterial infections, thus indirectly reducing their potential healthcare costs. This last claim is a bit skeptical simply because the companies producing this technology have financial benefits.

Kage, Ben. EPA uses nanotech regulation ploy to target colloidal silver while ignoring all other nanotech particles. NaturalNews.com. (2006). http://www.naturalnews.com/021231.html

swine flu cont. - transformation into engineer

I'm not exactly sure what I'm suppose to be blogging about for this entry as tranformation into an engineer, so I guess I'll just discuss how I found most of my sources. There were a lot of random sites on the internet about swine flu, so it was difficult at first to find a legitimate article unless it was the CDC website. In addition, almost all the published news articles on swine flu were biased. Some were trying to create a mass media hype about it while others tried to persuade the audience that the swine flu wasn't that different from the regular flu. Most of my information on the vaccine came from the New England Journal of Medicine, which published a few clinical trial studies. Other medical journal sites such as Pubmed also had a few articles on the swine flu vaccine. I based my decisions on who should receive the shot first and whether I should get the vaccine shot on not mostly on the results of the clinical trials, which didn't seem that promising to me seeing that nearly half had uncomfortable side effects.

swine flu

Personally, I would definitely not get the swine flu vaccine right now. It really is not that different from the regular seasonal flu; this flu just seems a lot more severe due to vast media coverage. According to the CDC, there's a low mortality rate for the swine flu, and only people who are pregnant or have other chronic illnesses are at an increased risk of complications from the flu. In addition, the New England Journal of Medicine just published several studies from the clinical trials of experimental swine flu vaccine that said almost half of the people who were given the vaccine had some form of side effects while others didn't really respond to the vaccine. After reading all this and discussing it in my recitation groups, I'm a little skeptical on this vaccine. When my recitation class voted on whether he/she should get the shot, the majority of the people said no and I agree.
As for who should get the shot first, we, as a class, decided that the most logical yet risky way is by giving it to people most likely to spread it. It's the most reasonable one in that this method benefits the society as a whole more and can protect as many people as possible. For example, we can give it to the caregivers, the children, and people living in dense population areas. However, this plan is rather risky becuase it's an indirect form to protect people from getting swine flu. For example, when giving it to people most at risk (direct method), the media can say that an X number of people was saved today by the swine flu vaccine. In contrast, the media can't say how many people will actually be saved from the swine flu using the indirect method becuase there's no way to know. Also, if the vaccine didn't work or if the flu virus mutates, then there could be a mass epidemic, and the plan would fail.
I'm not exactly sure what biomedical technologies would help with the swine flu pandemic. But if there was a way to biologically tag the virus to know what it mutates to when it does, then perhaps the vaccine that's made would be more efficient. Also, since the virus spreads through contact with other people, sneezing or coughing, maybe scientists could develop a method to keep the air in a really populated building such as school difficult for the virus to survive so the flu won't be as easily transmitted. For example, a technology known as AiroCide developed by Nasa has helped prevent transmission of infections in hospitals. I guess more general technologies for managing the swine flu at Penn are maybe installing more hand sanitizers in classrooms/labs and buildings. Another way could be to install heat sensors at building entrances so that if a student was really sick, then the sensor could detect his/her body temperature and inform the student health service.

BE100 Blog

1. I originally picked bioengineering because like probably half of my peers, I wanted to do pre-med. A biology or chemistry major didn't really appeal to me because if I didn't get into medical school, I would most likely enroll in graduate school and I'm not sure that's what I want to do. After doing an internship this past year at the hospital though, I became really interested in how people design synthetic biomaterials, new drugs, and artificial tissues....
2. I'm not exactly sure what bioengineers do. Before, I always imagined that bioengineers develop new materials and process for curing diseases and making better prosthetics. After hearing some Penn graduates talk, I know some people go into consulting, others do research for pharmaceutical companies, and others become professors.
3. For my senior year in high school, I did a mentorship in the endocrinology department at a hospital in Va. My mentor does numerous research in diabetes, insulin, and metformin. Likewise, I really loved the subject as well. Thus if I had a chance to go back in history to work on some biomedical technology, I would like to have been around Banting and Best isolated insulin, and later in history when other scientists perfected other drugs like Lantus and Humalog.
4. I want to learn as much as I can about everything in bioengineering, especially how prosthetic hearts, valves and other materials are made, which will definitely take a lot longer than 4 years.
5. For now, I really want to learn how researchers develop the right kind of drugs for a particular diseases. For example, how do they program the cure or medicine to target a specific organ part or various cells. In addition, I really want to learn how the body builds resistance against a drug and how researchers can solve that problem other than increasing the dosage or just giving another medicine.
6. Hospitals have dialysis for kidney failures, but what about livers? http://www.eurekalert.org/pub_releases/2009-09/vt-ett091409.php This article talkes about Va Tech researchers trying to create tissues that will mimic the liver. Though liver transplants are available, they are extremely dangerous and pose high risk of rejection by the recipient. These group of researchers will try to assemble a 3D model that can mimic liver cells in vitro. I think it's really great how modern technology is able to help researchers create more and more methods to cure diseases. Maybe if I can, I would like to do research in this area later as well.
7. I'm interested in genetic engineering as well, especially the clinical aspect of it. For example, I want to learn how researchers are trying to alter a part of a person's DNA to make them less susceptible to a disease and in general, just more about genes and DNA.