Environmental Heavy Metals on Diabetes Mellitus Type II
ADVERSE HEALTH EFFECT OF ENVIRONMENTAL HEAVY METALS ON DIABETES MELLITUS (TYPE II) AMONG TANNERY WORKERS IN VELLORE DISTRICT
Health is a vital aspect of life. It is determined by the controlled way of life activities. It takes in to account cleanliness and proportionate nutrition, clean habits and whole environment. Disturbance(s) in any one of these reasons may cause ill-health. Changes in life-style, genetic traits independently (or) jointly, hereditary and environment end up to a life threatening disorder / metabolic syndrome called diabetes.
Diabetes mellitus decides a striking transformation of the disease over the past decades. If the pancreas does not produce required insulin or it cannot efficiently utilize the insulin it produces it results in a long term illness known as Diabetes. This result in shoot up of blood glucose level called hyperglycaemia. Due to the shift towards modern lifestyle many people are subjected to diabetes mellitus Fatigue hike in thirst sudden loss in weight abnormal urine excretion frequent headaches and intake of large amount of food dullness in the eye power arte the symptoms of development of diabetes mellitus. Heavy diabetes results in chronic disorders in heart, brain, eyes, kidneys etc
1.1. About Vellore district
Vellore district is one among the 32 districts in the Tamil Nadu state of India. Vellore city is the headquarters of this district and it has the blend of rich heritage and culture representing the ancient Dravidian civilization. The area of Vellore district covered 6077 km2 and the total population was 3477317[update] (3.47 million) in 2001. It is 37.62% urbanized and density is 573 km2. Vellore district lies between 78°20’ to 79°50’ east longitudes and 12°15’ to 13°15’ north latitudes in Tamil Nadu state. The average maximum temperature experienced in the plains is 39.5° Celsius and the average minimum temperature experienced is 15.6° Celsius. The area experiences an average annual rainfall of 795 mm, Contributed by north east monsoon (535 mm) and the south west monsoon (442 mm). Major towns in the district include Vellore, Ambur, Vaniyambadi, Tiruppattur, Arakkonam, Arcot, Gudiyattam, Ranipet, Sholinghur, and Walajapet. The city is the hub of many hundreds of tanneries and chemical industries which are located around Vellore and its nearby towns with an estimated workers more than one lakh. Vellore district is the leading exporter of finished leather goods [image: lvellore map]in the country
1.2. Leather industries in Vellore district
Vellore district lies between 12° 15’ to 13° 15’ of Northern latitude and 78o 20’ and 79o 50’ of Eastern longitude. The land in Eastern part is flat and it slopes from East to West. There are 230-240 tanneries in and around Vellore district. Vellore district is a major leather- processing centre in Tamil Nadu, with an estimated 60,000 tannery workers. Vaniyambadi, Ambur, Vellore, Ranipet, and Walajah are municipal towns of Vellore district. As per 2001 census population of each of these towns is 103,841; 99,855; 41,323; 36,675 respectively, with83 tanneries in Ambur, 138 tanneries in Vaniyambadi, 18 tanneries in Pernambut, and 39 tanneries in Ranipet (Data from French Institute Pondicherry). The number of tanneries does not reflect the exact value as more number of unorganized tanneries is coming up day by day
The leather goods production of Tamil Nadu is 44 % of the total production of India. Over 66 % of total production is from the Vellore district regions. Vellore district leather accounts for more than 37 % of the country’s export in leather and leather related products such as finished leathers, shoes, shoe uppers, garments, and gloves etc.,
Leather processing involves several chemical processes. Therefore the resultant tannery effluent is found to be highly concentrated with heavy metals. When these tannery effluents percolate the ground water, it gets contaminated. Ground water is the major source of irrigation in these areas throughout the year. Heavy metals concentration in the ground water and surface water of Ranipet was in the higher limit compared to WHO permissible limit of heavy metals in drinking water. Human population in this area is seriously affected from occupational diseases such as asthma, Chromium ulcers and skin diseases .
The Government of Tamil Nadu provides all the possible investment subsidies and infrastructural support in the form of setting up industrial estates and common effluent treatment plant. Thus this substantial share of the district, in the leather market will be ensured in the near future. Even though many industries located in Vellore district, many of the tanning industries only focus on their profits and not on the positive health of the society. The small and large scale industries, especially industries discharge the polluted water into the lands contain toxic heavy metals such as chromium, lead, arsenic, calcium, magnesium, zinc, iron, and organic substances such as fluoride, iodine, sulphate and nitrates. This causes environment pollution and also spreads diabetes diseases mainly to the workers of tanneries and nearby dwellers. In the interim, many studies expanded our understanding of the physiological and molecular mechanisms involved. We particularly focus on the tanneries located areas in Vellore district, for exhibiting the amount of contaminated water eliminated from tanneries and its effects such as diabetes diseases caused by water found in Vaniyambadi, Ambur, Pernambut, Vellore and Ranipettai.
However, polluted water can spread disease and cause infection. Microorganisms such as bacteria, viruses, and parasites can diffuse in water and cause contagious diseases. Most of these are considered infectious because they can transmit from one person to another via infected water or other vectors. So water is a carrier for spread of the microorganisms and other environmental health hazards.
1.3. Diabetes Mellitus
Diabetes is a tangled group of diseases with a variety of reasons. People with sugar are found to have high blood glucose, called high blood sugar or hyperglycemia. Diabetes is the situation in which the body does not properly develop food for use as energy. Most of the food we intake is converted into glucose, or sugar, for our bodies to use as energy. The pancreas, an organ that lies near the stomach, produces a hormone called insulin which helps the glucose to get into the cells of our bodies.
Diabetes develops when the pancreas doesn’t produce enough insulin or is not able to produce insulin effectively, or both. As a outcome, glucose develops in the blood instead of being consumed by cells in the body. The body’s cells are then anorexic of energy despite high blood sugar levels. This causes sugar to shoot up in the blood. This is why diabetes is referred as “sugar.”
1.3.1. Types of diabetes
Diabetes (Type 1), insulin-dependent with juvenile or childhood onset, is characterized by a lack of insulin production due to the destruction of the islet ?-cells in the pancreas. The pathology of T1 diabetes is still unexplained, but the genetic factor is pivotal. The indications include excessive urination, thirstiness, constant appetite, lowering in weight, changes in vision, and dullness.
Diabetes (Type 2), non-insulin-dependent with adult onset, result from the body’s ineffective use of insulin and it is largely associated with increasing trends towards overweight and obesity, unhealthy diets, physical inactivity, and socioeconomic disadvantage.
Table-1: Types of diabetes mellitus
Type 1 Diabetes
Type 2 Diabetes
- Increased or extreme thirst
- Increased appetite
- Increased fatigue
- Increased or frequent urination
- Unusual weight loss
- Blurred vision
- Fruity odor or breath
- In some cases, no symptoms
- Increased thirst
- Increased appetite
- Increased urination, especially at night
- Weight loss
- Blurred vision
- Sores that do not heal
- In some cases, no symptoms
1.3.2. Gestational diabetes
This type is created in females during pregnancy. Some women have very high levels of sugar in their blood, and their body will be unable to produce required insulin to transport all the sugar into their cells, culminating in more and more increasing levels of glucose. Analysis of gestational diabetes is done during pregnancy. Gestational diabetes progress from 2% to 5% in all pregnancies but usually vanishes when a pregnancy is over.
The infinite majority of patients with type 2 diabetes originally had Prediabetes. Their blood glucose levels were higher than normal, but not high enough to meet a diabetes diagnosis. The cells in the body are fairly rebellious to insulin. Studies have indicated that even at the prediabetes stage, some damage to the circulatory system and the heart may have already occurred.
1.3.4. Diabetes is a Metabolism disorder
Diabetes is grouped as a metabolic irregularity. Metabolism refers to the way our body use digested food for energy and growth. Most of what take is confined into glucose. Glucose is a form of sugar in the blood – it is the main source of nourishment for our body. When our food is absorbed, the glucose gets way into the bloodstream. Our cells take up glucose for energy and growth. However, glucose cannot get in to our cells without insulin being produced – insulin makes it possible for our cells to take in the glucose. Insulin is a hormone produced by the pancreas. After taking food, the pancreas automatically releases an adequate amount of insulin to transfer the glucose present in our blood into the cells, as soon as glucose gets in to the cells the blood-sugar level drops down. A person with diabetes ends up in a condition in which the amount of glucose in the blood is highly elevated (hyperglycemia). This is because the body does not produce required amount of insulin or does not produce insulin, or has cells does not respond properly to the insulin that the pancreas produces. This results in too much of glucose building up in the blood. This excess blood glucose ultimately passes out of the body through urination. So, even though the blood has greater amount of glucose, the cells are not receiving it for their essential energy and growth requirements.
A person with diabetes is more likely to be hospitalized than a person without diabetes. The stress of illness often significantly increases blood glucose level in the hospitalized patient. These individuals are quite often managed using a sliding-scale insulin regimen during hospitalization. Diabetes hospitalizations are largely due to other major health problems caused or worsened by diabetes Figure-3 For example:
- Heart disease – The probability of deaths due to heart attacks are found to be higher in diabetic people than non diabetic people.
- Stroke – Diabetic patients are 2 to 4 times more likely to have a stroke than non-diabetic patients
- High blood pressure – 75% of the diabetic patients have been found to suffer from hypertension.
- Eye damage – Adult blindness is found to be a leading cause due to diabetes.
- Kidney disease – Very high diabetes leads to kidney failure.
- Nerve damage – 70% of people with diabetes have found to suffer from nerve damage.
- Amputations – Non traumatic leg or foot amputations are found majority in people with diabetes.
- [image: Main symptoms of diabetes]Dental disease. – Diabetes also ends up in severe periodontal disease.
After the dawn of civilization, man has started using adequate level of nutrients, especially sugar and sugar enriched stuffs. Moreover, uncontrolled way of life is the root cause of all sorts of miseries and many ill-fated diseases to mankind. Of course, diabetes is one such kind of its nature. Diabetes mellitus, a predictable and preventable metabolic disorder is becoming a global epidemic . It is predicted that the diabetes incidence will be doubled in most nations within 20 yrs and 19% world’s diabetic cases are Indians . Diabetes mellitus is a group of chronic metabolic conditions with elevated blood glucose levels due to the body’s inability to produce insulin (or) resistance to insulin action (or) both . The etiology of the disease is multi-factorial in nature. Some of the prime risk factors for the onset of diabetes and its associated complications include body mass index (BMI) [5,6], age [7,8], ethnicity , family history [9,10] sedentary life style and lack of physical activity [11,12], sex [8,13], many set of genes , socio-economic status , waist-hip ratio  and systolic blood pressure . Studies on diabetes prevalence show that around 6-12% in urban and 2-3% in rural Indian populations are recorded [18, 19].
Several studies have reported that the imbalance of some essential metals might adversely affect pancreatic islet and cause development of diabetes . It is also evident that some reactive oxygen species (ROS) are formed during diabetes due to lack of balance of essential metals. This oxidative stress might decrease the insulin gene promoter activity and mRNA expression in pancreatic islet cells due to hyperglycemic condition [21-23].
Diabetes mellitus is one of the most often and alarming disease for human morphology. The existence of bivalent metal ions both macro and trace elements is modified in DM. The DM controls all tissues from our body. The diabetes aggravations are important causes of death. Regrettably, the number of patients with diabetes increases. The clinical and experimental studies have explained a large number of factors involved in the origination and development of DM. Bivalent metal ions Concentration inequality are among these.
Diabetes mellitus is defined by absolute or relative deficit in insulin secretion and/or insulin action assisted with serious hyperglycemia and disruption of carbohydrate, lipid and protein metabolism. Long-term vascular complexity represents a major cause of oppression and fatality in patients with diabetes mellitus. Metal ions play an essential part in living systems, both in growth and in metabolism. Defective metabolism of trace elements is found in diabetic patients. It has been recorded that the urinary excretion of calcium, zinc and magnesium is elevated in both the types of diabetes mellitus causing a decrease in blood levels of these elements from these patients [24, 25]. Another study reported that the levels of zinc and magnesium were significantly lower while the level of copper was significantly higher in serum of patients with IDDM . In diabetes mellitus (DM), the disorders of carbohydrates, lipids and proteins metabolism play a vital role in diabetic complications. Hypercholesterolemia (CHOL) and hypertriglyceridemia (TG) are mostly observed and related largely to the degree of diabetic control . Serum HDL was reported to be low in diabetic patients of both types of DM . Hyperglycemia may change lipoproteins to a system that promotes atherogenesis. In diabetic patients the low-density lipoprotein-cholesterol (LDL) levels are found to be altered frequently.
Diabetes mellitus is a heterogeneous metabolic disorder defined by hyperglycemia resulting from abnormal insulin secretion, opposing to insulin action or both. The aspect of trace elements in some of the metabolic malfunctions and their contributions in the improvement of vascular difficulties is not clear. Therefore, the present study investigates the relationship among diabetes mellitus, trace elements status, lipid profiles in the serum of 500 diabetes mellitus patients and healthy subjects. The serum level of Cu was higher, whereas, Zn, Mg and Ca levels were significantly lower in diabetic patients as compared to the healthy subjects. The levels of total cholesterol (CHOL), triglyceride (TG) and low-density lipoprotein-cholesterol (LDL) were on increase in diabetes mellitus in comparison to the non-diabetic subjects. The mean value of high-density lipoprotein cholesterol (HDL) was lessened in diabetic patients (AL-Maroof, 2006). These records may determine the role of abnormal trace element status.
1.4. Heavy metals found in Ground water
Groundwater plays a fundamental role in human life and advancement. The safe potable water is exactly essential for healthy living. Groundwater is basic and most suitable fresh water resource for human utilization in both urban as well as rural areas. In many places groundwater is polluted by the inflow of sewage and industrial wastewater (Freeze, 1979), The residents who used contaminated groundwater as drinking water may suffer from health problems in near future. But it is very difficult to elucidate or predict the pollution pattern because potential sources which include land disposal of solid wastes, sewage disposal on land, agricultural activities, petroleum leakages, disposal of radioactive waste and other sources and pollutants move through groundwater (Fetter, 1994).
The importance of groundwater for existence of human society cannot be over emphasized (Rizwan and singh, 2009). The nature of ground water depends on a large number of individual hydrological, physical, chemical and biological factors. Generally, higher proportions of dissolved components are found in underground water than in surface water because of greater interaction of ground water with various materials in geologic strata. The water used for drinking purpose must be free from toxic elements, living and nonliving organism and higher amount of minerals that may be hazardous to health. Some of the heavy metals are extremely essential to humans, but large quantities of them may cause physiological disorders. The contamination of ground water by heavy metals has also assumed a great significance due to their toxicity and accumulative behavior. These elements, contradictory to most pollutants, are non biodegradable and undergo a global eco-biological cycle in which natural waters are the main pathways. The ascertain of the concentration levels of heavy metals in these waters, as well as the clarification of the chemical forms in which they appear is a prime target in environmental research today (CPCB, 2008).
Heavy metals are important for proper functioning of biological systems, but their deficiency or excess could lead to a number of disorders . Industrial effluents which discharge from the tannery contain a higher amount of metals especially chromium, copper, lead, iron, magnesium, manganese, zinc and nickel. These effluents are released on the land as well as dumped in to the surface water which ultimately leaches to ground water and lead to contamination due to accumulation of toxic metallic components and result in a series of well documented problems in living beings because they cannot be completely degraded . Hence, industrial pollutants offer a wide scope of environmental problems and health hazards are becoming more complex and critical not only in developing countries like India but also in developed countries.
1.5. Heavy metals found in Soil
Of various environmental threats, pollution of soil and water caused by various effluents has become a serious problem. The tannery industries discharge large quantities of common salt during the process of tanning. Deposition of these salts into the soil takes place when the effluent comes in contact with the soil. Besides chlorides, toxic substances like chromium, sodium sulphide, sodium carbonate and ammonium sulphate are present in the discharged effluent which manifolds the soil pollution.
Heavy metals are considered to be one of the main sources of pollution in the environment, because of their significant effect on the ecological quality . The main sources of heavy metal pollution in the environment are man-made effects, including combustion of fossil fuels, mining activities, wastewater discharges of tannery industries, and waste disposal . High levels of heavy metals in the sediments and soils may percolate to the aquatic environment, groundwater, and plants through the transfer processes and reach to the animals and humans. Therefore, the use of simple and accurate methods for monitoring heavy metals using Analytical instruments and techniques have been developed over the past 30 years to determine the concentrations of metals in our ecosystem; atmosphere, water, soils and sediments . Highly sensitive spectroscopic techniques such as flame atomic absorption spectroscopy (FAAS, ETAAS) and inductively coupled plasma-optical emission spectrometry and inductively coupled plasma mass spectrometry (ICP- OES and ICP-MS) are the most widely used methods to determine heavy metals in environmental samples .
For solid samples such as sludge’s, soils and sediments, the solid form must be transformed to liquid phase. This process of digestion is required for the spectroscopic analysis. The basic principle during the extraction process is the releasing of metals from the solid matrix to the acid solution. Conventional acid leaching procedures and microwave assisted acid digestion systems are used to prepare the sample for further spectroscopic analysis. The traditional procedures are open systems in which the solid material is extracted on a heating source in the presence of acid and/or acid mixtures. In this procedure, different heating systems may be used such as sand-bath, heating plate and aluminum blocks . Microwave assisted acid digestion procedures and pressure digestion bombs are closed systems rendering higher temperature and pressure in closed vessels. The need for the rapid and accurate determination of heavy metals in sediments and other solid matrixes (soils, sludge’s, etc.) has led to the development of various microwave procedures which provide the efficient dissolution of metals . EPA’s Acid Digestion Procedure (EPA 3050B) was used as a typical technique and three different microwave-assisted acid digestion procedures were corrected and applied to the standard reference materials. The approved and the obtained values were compared with each other to obtain the most appropriate procedure for each element.
Currently, it has been estimated that more than 50,000 ha of productive agricultural lands have been contaminated with Cr alone due to the disposal of tannery wastes in Tamil Nadu, where more than 60% of Indian tanneries are located in Vellore district. Estimation of Cr levels in contaminated soils in Vellore district revealed that the soils surrounding tannery industries are severely polluted with Cr. Large amounts of Cr (16731-79865mg/kg) were found in surface and subsurface soils in Vellore districts, where large number of tanneries exist . The accumulation of Cr in soil is of concern because of its possible phytotoxicity or increased movement of metals into the food chain and the potential for surface and groundwater contamination. Chromium pollution in soil and water has dreadfully reduced the crop yields (25% to 40%) over the years and decreased significantly .
The reaction of the collagen fibers in the hides with tannins, chromium, alum or other chemical agents are termed as Tanning. Alums, syntans, formaldehyde, glutaraldehyde and heavy oils are employed as tanning agents. During the tanning process, about 300kg chemicals are involved per ton of hides. The tanning processes can result in heavy metal contamination of urban and agricultural soils. Heavy metals also occur naturally, but rarely at chronic levels. Potentially contaminated soils may occur at old landfill sites (particularly those that accepted industrial wastes), old orchards that was fed with insecticides containing arsenic as an active ingredient, fields that had past applications of waste water or sludge, areas in or around mining waste piles and tailings, tannery areas where chemicals may have been dumped on the ground, or in areas downwind from tannery sites.
Excess heavy metal concentrate in soils is toxic to humans and other animals. Exposure to heavy metals is normally serious (exposure over a longer period of time), due to food chain transfer. Intense (immediate) poisoning from heavy metals is rare through ingestion or dermal contact, but is possible. Serious problems associated with long-term heavy metal exposures are:
Lead – mental lapse.
Cadmium – affects kidney, liver, and GI tract.
Arsenic – poisons the skin, affects kidneys and central nervous system.
The most typical cationic metals (metallic elements which accumulates in soil are positively charged cations e.g., Pb2+) are mercury, cadmium, lead, nickel, copper, zinc, chromium, and manganese. The most frequent anionic compounds (elements that accumulate in soil are combined with oxygen and are negatively charged e.g., MoO42-) are arsenic, molybdenum, selenium, and boron.
1.6. Microbial contamination
Epidemic diseases caused by pathogenic bacteria, viruses and parasites are the most common and outspread health risk associated with drinking water. The elimination of all these agents from drinking water has to be of high priority. The provision of a safe supply of drinking water depends upon the use of either a protected high-quality ground water, surface water, or a properly selected and operated series of treatments capable to reduce pathogens and other contaminants to the negligible health risk .
1.7. Heavy metals and Chemical contamination
The environment and the human health are closely interrelated. The wellbeing of the people is the reflection of the healthy environment, but both can be damaged by pollution. Prolonged discharge of industrial effluent, domestic sewage and solid waste dump cause the ground water to become polluted and create health problem. Hence there is always a need and concern for the protection and management of ground water quality; it should be protected with great care.
Some essential elements and chemicals present in water are of particular importance with regard to their effect on human health. These include chromium, lead, arsenic, calcium, magnesium, zinc, iron, fluoride, iodine and nitrates that are a mandatory part of dietary intake to sustain human health. Deficiencies or high concentrations of these elements cause a variety of adverse health effects . The toxicity of heavy metals at greater levels of risk is well known, but a current concern is the possibility that continual exposure to relatively low levels of heavy metals may lead to unfavorable health effects. The potential association between chronic heavy metal exposure and diabetes mellitus has a number of implications.
Metal ions are known to play an important role in living systems, both in growth and in metabolism. Impaired metabolism of trace elements is observed in diabetic patient . Copper (Cu) is one of the essential trace elements, and has a particular role in cytochrome oxidase function at the terminal end of the mitochondrial electron transport chain. The loss of this activity may attribute to the characteristic swelling and distortion of mitochondria which can be found in copper deficiency, particularly in metabolically active tissues such as pancreatic acinar cells, enterocytes, and hepatocytes . Magnesium (Mg), other essential trace elements, is a cofactor in both glucose transporting mechanism of cell membranes and various enzymes important in carbohydrate oxidation. It also plays an important role in mechanism for energy transfer mediated by phosphate bonds. Previous studies depicted that magnesium metabolism might be altered in patients with diabetes mellitus. Some authors found a strong positive association of diabetes with hypomagnesaemia, while other demonstrated that increased urinary loss of magnesium caused by osmotic diuresis might contribute to diabetic hypomagnesaemia . Zinc (Zn) is one of the essential trace elements that is required to maintain the normal physiological function of all form of life . It is a component of many enzymes, and plays an important role in the maintenance of several tissue functions, including synthesis, storage and release of insulin. Zinc deficiency has now been remembered to be associated with many serious illnesses. Diabetes mellitus (DM) is one of the diseases, which affect zinc homeostasis in different ways .
Several studies have proposed a possible role of minerals such as iron in insulin resistance or diabetes. Iron (Fe) is a transitional metal and a potential catalyst in many cellular reactions that produce reactive oxygen species. Such reactions contribute to tissue damage and increase oxidative stress, thereby potentially altering the risk of type 2 diabetes [43, 44]. It is highly recognized that iron has greater impact in glucose metabolism, even in the absence of significant iron overload. In the general population, body iron stores are positively associated with the development of glucose intolerance, type 2 diabetes [45, 46]. Calcium (Ca) is a versatile intracellular messenger that is used throughout the life cycle of an organism to control diverse biological processes. It has been suggested that diabetes and cardiovascular disease are linked by a common defect of divalent cation metabolism, including calcium .
Diabetes mellitus is characterized by absolute or relative deficiencies in insulin secretion and/or insulin action associated with serious hyperglycemia and disturbances of carbohydrate, lipid and protein metabolism. Long-term vascular complications present a major cause of morbidity and mortality in patients with diabetes mellitus. Metal ions are known to play an important role in living systems, both in growth and in metabolism. Impaired metabolism of trace elements is found in diabetic patients. It has been reported that the urinary excretion of calcium, zinc and magnesium is greater in two types of diabetes mellitus causing a decrement in blood levels of these elements from these patients [48, 49]. Another study reported that the levels of zinc and magnesium were significantly lower while the level of copper was significantly higher in serum of patients with IDDM . In diabetes mellitus (DM), the disorders of carbohydrates, lipids and proteins metabolism play a vital role in diabetic complications. Hypercholesterolemia (CHOL) and hypertriglyceridemia (TG) are mostly observed and related largely to the degree of diabetic control . Serum HDL was reported to be low in diabetic patients of both types of DM . Hyperglycemia may alter lipoproteins to a pattern that promotes atherogenesis. Low-density lipoprotein-cholesterol (LDL) levels are most often altered in diabetic patients.
1.8. Pancreas and Insulin production
The pancreas is a very quiet little organ that lies behind the stomach and produces digestive enzymes and a couple of hormones called insulin and glucagon. When we take in food, our body breaks it down into materials that are needed by the organs to function. One of those materials is sugar which is in the form of glucose. Our cells use glucose for energy and our brains specifically run on glucose. To get the glucose into the cells, the sugar migrates into the bloodstream and triggers the pancreas to produce insulin. Insulin lets the sugar move from the blood into the cells. When sugar is converted to energy, it’s either utilized or stored until we require it. Beta cells are groups of cells located in the pancreas and designed to produce insulin. Beta cells located throughout the pancreas is called the islets of Langerhans. A person is analysed with diabetes when his pancreas either doesn’t produce any insulin or the insulin they do produce is ineffective.
The primary objective of the present study was to assess the heavy metal contamination and their distribution in groundwater in five taluks namely Vaniyambadi, Ambur, Pernambut, Vellore and Ranipet of Vellore district where more tanneries located. A persisting challenge of public health in resource poor settings is scaling-up efficacious technical innovations into programmes with high community effectiveness. This challenge is to find interventions whose targets are linked, socially and aetiologically.