Biology Project

By – Sumedha Sharma

History and Statistic

Diabetes is not a newly born disease, it has been with human race from long
back but, we came to knew about it in 1552 B.C. Since this period, many of
Greek as well French physicians had worked on it
and made us aware of the nature of disease, organs
responsible for it etc. In 1870s, a French physician
had discovered a link between Diabetes and diet
intake, and an idea to formulate individual diet plan
came into picture.

Diabetic diet was formulated with inclusion of milk,

oats and other fiber containing foods in 1900-1915.
Function of insulin, its nature, along with its use
Universal Blue Symbol started from 1920 -1923, discovered by Dr. Banting,
of Diabetes Prof. Macleod and Dr .Collip, who were awarded a
Noble prize. In the decade of 1940, it has been discovered that different organs
like kidney and skin are also affected if diabetes is creeping from a long term. A
major turn in this research was in the year 1955, when the oral hypogycemic
drugs had been manufactured.

Diabetes was recognized with complete details and its types (Type 1and Type 2
diabetes - that is insulin dependent and non insulin dependent) in the year, 1959.
As we know this is one of the old diseases, existing in many individuals and still
on rising charts. Hence, scientists are continuously working to relieve us from it,
by discovering the relevant drugs and making new researches.

According to W.H.O estimates, by 2025 total 300 million of the worldwide

population will be affected by diabetes. For every 21 seconds, someone is
diagnosed with diabetes, an estimation given by American Diabetes Association.
And, there are 20.8 million diabetics in US at present, which is roughly
estimated as 7% of US population, out of this figure about 6.2 millions are
unaware of the diabetes existence in there life.

Symptoms of Diabetes
In both types of diabetes, signs and symptoms are more likely to be similar as
the blood sugar is high, either due to less or no production of insulin, or insulin
resistance. In any case, if there is inadequate glucose in the cells, it is identifiable
through certain signs and symptoms. These symptoms are quickly relieved once
the Diabetes is treated and also reduce the chances of developing serious health
problems.

Diabetes Type 1:

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In type 1, the pancreas stop producing insulin due to autuimmune response or

possibly viral attack on pancreas. In absence of insulin, body cells don’t get the
required glucose for producing ATP (Adenosin Triphosphate) units which
results into primary symptom in the form of nausea and vomiting. In later stage,
which leads to ketoacidosis, the body starts breaking down the muscle tissue and
fat for producing energy hence, causing fast weight loss. Dehydration is also
usually observed due to electrolyte disturbance. In advanced stages, coma and
death is witnessed.

Diabetes Type 2:

• Increased fatigue : Due to inefficiency of the cell to metabolize glucose,

reserve fat of body is metabolized to gain energy. When fat is broken
down in the body, it uses more energy as compared to glucose, hence
body goes in negative calorie effect, which results in fatigue.
• Polydipsia : As the concentration of glucose increases in the blood, brain
receives signal for diluting it and, in its counteraction we feel thirsty.
• Polyuria: Increase in urine production is due to excess glucose present in
body. Body gets rid of the extra sugar in the blood by excreting it through
urine. This leads to dehydration because along with the sugar, a large
amount of water is excreted out of the body.
• Polyphegia : The hormone insulin is also responsible for stimulating
hunger. In order to cope up with high sugar levels in blood, body produces
insulin which leads to increased hunger.
• Weight flactuation : Factors like loss of water (polyuria), glucosuria ,
metabolism of body fat and protein may lead to weight loss. Few cases
may show weight gain due to increased appetite.
• Blurry vision : Hyperosmolar hyperglycemia nonketotic syndrome is the
condition when body fluid is pulled out of tissues including lenses of the
eye, which affects its ability to focus, resulting blurry vision.
• Irritability : It is a sign of high blood sugar because of the inefficient
glucose supply to the brain and other body organs, which makes us feel
tired and uneasy.
• Infections : The body gives few signals whenever there is fluctuation in
blood sugar (due to suppression of immune system) by frequent skin
infections like fungal or bacterial or UTI (urinary tract infection).
• Poor wound healing : High blood sugar resists the flourishing of WBC,
(white blood cell) which are responsible for body immune system. When
these cells do not function accordingly, wound healing is not at good pace.
Secondly, long standing diabetes leads to thickening of blood vessels
which affect proper circulation of blood in different body parts.

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What Causes Diabetes

The precise Etiology of most cases of diabetes is uncertain, although certain
contributing factors are as follows:

Type 1 diabetes

Type 1 Diabetes is autoimmune disease

that affects 0.3% on average. It is result of
destruction of beta cells due to aggressive
nature of cells present in the body.
Researchers believe that some of the
Etiology and Risk factors which may
trigger type 1 diabetes may be genetic,
poor diet (malnutrition) and environment
(virus affecting pancreas). Secondly, in
most of the cases, diabetes occurs because
there is abnormal secretion of some
hormones in blood which act as antagonists to insulin. Example- Adrenocortical
hormone, Adrenaline hormone and Thyroid hormone.

Type 2 diabetes

Type 2 Diabetes is also called non insulin-

dependent diabetes mellitus (NIDDM) or adult-
onset diabetes. It occurs when the body
produces enough insulin but cannot utilize it
effectively. This type of diabetes usually
develops in middle age. A general observation
says that about 90-95 % of people suffering
with diabetes are type 2; about 80 percent are
overweight. It is more common among people
who are older; obese; have a family history of
diabetes; have had gestational diabetes. There
are number of risk factors found to be responsible for type 2 diabetes like, the
more the Etiology and Risk factors carried by an individual, the higher the risk
for developing diabetes.

Following are the Causes of Diabetes

• Hereditary or Inherited Traits : It is strongly believed that due to some

genes which passes from one generation to another, a person can inherit
diabetes. It depends upon closeness of blood relationship as mother is
diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the
previous case and if both the parents are diabetic, the child has much
greater risk for diabetes.
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• Age : Increased age is a factor which gives more possibility than in

younger age. This disease may occur at any age, but 80% of cases occur
after 50 year, incidences increase with the age factor.
• Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low
protein and fiber intake, high intake of refined products are the expected
reasons for developing diabetes.
• Obesity and Fat Distribution : Being overweight means increased insulin
resistance, that is if body fat is more than 30%, BMI 25+, waist grith 35
inches in women or 40 inches in males.
• Sedentary Lifestyle : People with sedentary lifestyle are more prone to
diabetes, when compared to those who exercise thrice a week, are at
low risk of falling prey to diabetes.
• Stress : Either physical injury or emotional disturbance is frequently
blamed as the initial cause of the disease. Any disturbance in
Cortiosteroid or ACTH therapy may lead to clinical signs of the disease.
• Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone
(Risperdal), quetiapine (Seroquel) and ziprasidone (Geodon) are known
to induce this lethal disease.
• Infection : Some of the strephylococci is suppose to be responsible factor
for infection in pancreas.
• Sex : Diabetes is commonly seen in elderly especially males but, strongly
in women and those females with multiple pregnancy or suffering from
(PCOS) Polycystic Ovarian Syndrome.
• Hypertension : It had been reported in many studies that there is direct
relation between high systolic pressure and diabetes.
• Serum lipids and lipoproteins : High triglyceride and cholesterol level in
the blood is related to high blood sugars, in some cases it has been
studied that risk is involved even with low HDL levels in circulating blood.

Diabetes Diet
Diet plays a significant role in controlling the diabetes. The diabetic diet may be
used alone or else in combination with insulin doses or with oral hypoglycemic
drugs. Main objective of diabetic diet is to maintain ideal body weight, by
providing adequate nutrition along with normal blood sugar levels in blood. The
diet plan for a diabetic is based on height, weight, age, sex, physical activity and
nature of diabetes. While planning diet, the dietician has to consider
complications such as high blood pressure, high cholesterol levels.

With respect to the above factors, a dietician will assess calories to be given, like
scheming the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber
and so on.

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Exchange meal plan is a diet program which balances the amount of

carbohydrate that we intake per day. Glucose is a sugar released from
carbohydrate so, if we want to control blood sugar we have to limit the
consumption of simple carbohydrate. Carbohydrate foods are given as value per
portion, known as the exchange. This plan helps us to decide on the type of food
to be taken, the amount of food and also the time to eat. You can plan for more
flexible meals as you get more knowledge about the diet for a diabetic, may be
like the counting carbohydrate meal plan or constant carbohydrate. But there is
no common diet that works for everyone. Nor is there any particular diet that
works perfectly for any diabetic over a long period. While planning diabetes diet
we should adhere to certain important factors, they are as follows:

• Fiber should be at least 1.4 oz / day

• Instead of 3 heavy meals, we should go for 4-5 small mid intervals
• Replace bakery products and fast foods by simple whole cooked cereals,
and don't eat carbohydrates 2 hours before bedtime
• Consume fresh fruit and vegetables at least 5 exchange/ day

Diabetics always need to take care of their diet and also about the food they eat.
Care has to be taken because all foods contain not only carbohydrate, but also
some energy value. Protein and fat available in the food are converted to glucose
in the body. This glucose has some effect on the blood sugar level, which has to
be taken care of. Furthermore, you needn’t have to eat only the bland boring
diet. Instead, you can eat more fruits, vegetables and whole grains. All it means
is that you need to select foods that are high in nutrition and low in calories.

1. Diet Management During Diabetes

2. Diabetes Care

3. Diabetic Diet Dos

4. Diabetic Diet Don’ts

Diet Management during Diabetes

Most of the food items contain carbohydrate, protein and fat. Cereals are rich in
carbohydrate, lentils, lean meat, chicken and fish are rich in protein while oils,
nuts and milk creams are rich in fat. Fat foods are high in calories; 1g of it
provides 9 calories, while 1g carbohydrate or 1g protein gives only 4 calories.

Carbohydrate is easily digested than fat and protein. The rise in blood glucose
after a meal is due to absorption of glucose from a carbohydrate digestion and
increase in production of glucose by liver. Sucrose (cane sugar), sweets and

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syrups cause a rapid rise in blood glucose than whole cereals like finger millet
and wheat products.

In people with no diabetes, the rise in blood glucose after a meal comes down to
the pre-meal level with in 2 hrs. In diabetes, the rise in blood glucose after a
meal is not only higher but the fall to pre-meal level is slower (3-4 hrs).
Therefore, snacks in between meals or frequent meals at short intervals tend to
cause progressive increase in blood glucose in people with diabetes.

Glucose is constantly needed to provide ready energy for the proper functioning
of brain, heart, kidneys, liver and blood cells. When glucose is not available
from ingested food, our liver produces from its store of carbohydrate (glycocen)
and body stores of fats and proteins. The liver produces about 0.1058 oz of
glucose/lbs body weight in a day. For example the liver of a man or woman
weighing 154 lbs produces 7.0547 oz of glucose in a day. The production of
glucose by the liver is kept in a check by small amounts of insulin secreted by
the pancreas.

These considerations and the modality of your treatment (tablets/insulin) are

taken into account for formulating your diet management during diabetes and
meal timings. The dietician would give your information on your diet.

The general guidelines on diet are:

In a typical day’s meals and snacks, you should have 1500-1800 calories with –
60% contribution from the carbohydrate, 20% from fat and 20% from proteins.
You may need extra weight reduction. If you are on calorie-restricted diet, make
sure to take 50-60% of calories as complex carbohydrate (whole cereals) to
prevent any feeling of weakness.

• You should eat a variety of food items everyday. Do not skip meals. Avoid
snacks, unless you are advised to (example during insulin treatment).
Don’t over eat.
• Eat fruits and vegetables. Use less oil in cooking. Avoid fried foods, milk
cream or food items cooked in coconut milk.
• Avoid ready to eat food preparations, sweets and sugary drinks (canned
beverages) that provide empty calories (no vitamin or essential
minerals).
• Keep a regular check on your weight – maintain it within the estimated
limit.
• Check your hemoglobin and proteins in blood samples at 6 months or 1
year’s interval, Suitable correction in diet format or supplementation
may become necessary.
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• Despite a good control of blood glucose, if your blood lipids are high, you
will need lipid lowering drugs regularly. Some times your doctor may
advice you lipid-lowering drugs from the beginning of your diabetes
treatment.
• Match your mealtime to the form of insulin and insulin injection
schedules as explained by your doctor or the diabetes nurse.

Diabetes Care
• Eat food at fixed hours
• Do not overeat
• Do not eat immediately after a
workout
• Make sure you have three proper
meals & light snacks in between
• Eat about the same amounts of
food each day
• Eat your meals and snacks at about the same times each day
• Make sure the gaps between your meals are short
• Do not eat fast; masticate and munch your food well before you
swallow
• Drink a lot of water that will help flush the toxins off your system
• Avoid fried foods and sweetmeats
• Include fresh vegetable salad in every meal
• Include sprouts in the diet
• Take your medicines at the same times each day
• Exercise at about the same times each day
• Avoid smoking. Smoking leads to heart disease and poor
circulation
• Check your feet for cuts, blisters, and swelling which are likely to
result from diabetes-related nerve damage
• Take good sleep daily
• Check your blood sugar level regularly
• Try to stick up to the plan made up for sugar control
• Check the other tests such as kidney function, liver function, heart
function, ketone level etc
• Check your weight periodically and maintain ideal body weight

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Diabetic Diet Dos

• For breakfast, take cholesterol-
lowering oatmeal
• Have nuts rich in mono unsaturated
fat, such as pecans, walnuts, and
almonds
• Eat pasta, stews and leafy salads
along with beans-- kidney beans,
chick peas, and dry beans, navy
beans and peas which can reduce
LDL "bad"; cholesterol
• Fat free milk, yogurt, and cheese to
be taken
• Eggs whites to be included
• White meat chicken and Fish and shellfish (not battered) are good
• Increase intake of dry beans and peas
• Have at least 20 to 25 grams of raw onion daily
• Add wheat bran to your wheat flour (50% wheat flour + 50% wheat
bran). This helps increase fiber in your diet
• You can also add flaxseed and fenugreek seeds into the wheat flour
• Increase fiber intake in the form of raw fruits, vegetables, whole
cereals etc
• Intake of cinnamon, garlic, onion, bitter melon, guar gum is known
to considerably reduce blood glucose level

Diabetic Diet Don'ts

• Don't fry foods instead bake, boil, poach or sauté in a nonstick pan.
Steam or microwave vegetables. Buy tuna packed in water, not oil
• Eat less high-fat red meat and more low-fat turkey and fish. Avoid
organ meats
• Limit the use of condiments such as ketchup, mustard and salad
dress ion--they're high in salt and can be high in sugar, too
• Rinse processed foods in water and, wherever possible, choose
fresh foods over canned
• Limit your salt (sodium content)
• Read labels carefully. Soy sauce, brine and MSG, for example,
contain a lot of sodium
• Don't select ready to eat and junk foods items available to you
• Don't smoke and stop alcohol consumption
• Don't skip meals and medicine times

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Diabetes Complications
Once we have crossed the reversible stage of
prediabetes and enter diabetes stage, certain
changes start developing in our body. These
changes occur due to high blood sugar level
with instability in the hormones as well as
blood vessels and nerves. When these changes
become permanent in the body it develops into
serious Diabetes Complications and body
indicates these changes by steady symptoms.

Symptoms of the Diabetes Complications

• Diabetic retinopathy shows symptoms of pain in the eyes and may even
result in loss of vision.
• Renal (kidney) disease shows symptoms of swelling (edema) in the feet
and legs. It then passes over total body and as the disease progresses,
blood pressure also increases.
• Tingling, burning, numbness, tightness, shooting or stabbing pain in the
hands, feet or other parts of your body, especially at night. Digestive
problems also occur if, the nerves controlling internal organs get
damaged (autonomic neuropathy).
• You may have scanty or profuse sweating, difficulty of sensing when your
bladder is full, when there is a low blood sugar, increased sexual
problems, weakness, dizziness, and fainting.
• Chest pain (angina) or shortness of breath dizziness or light headache,
shoulder or stomach pain, fast heartbeat. You might not show any
symptoms until having a heart attack or stroke.

When alarming symptoms given by the body are ignored and the same status is
maintained, it starts damaging body organs, such as heart, kidney, eye, feet, and
skin. The physiology for each and every affected organ is explained one by one.

Diabetes Control
Whether your treatment consists of diet alone, diet and tablets or diet and
insulin, you need regular blood tests to keep a check on your blood sugar. Urine
sugar test is not a reliable indicator of diabetes control.

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When blood glucose remains higher than 200mg/dl for 8-10 weeks, the
concentration of glycosylated hemoglobin (HbA1c) arises. A (HbA1c)
measurement therefore reflects the blood glucose control over a preceding 2-3
months period, while the estimates of blood glucose indicate the glucose value at
the time of blood test. HbA1c values between 6-7% indicate very good control
on diabetes. You should
aim at keeping your blood
glucose in the normal range
i.e. between 90-130 mg/dl
while fasting and less than
180 mg/dl after meals
and HbA1c around 7%.
Frequent tests for blood
glucose are necessary
when starting treatment with
insulin.

If you are doing capillary

blood glucose test using a hand held glucometer, do not squeeze the finger to
bring out a sample after you have picked. This invariably gives a low glucose
value. Ask your diabetes nurse for a demonstration of capillary blood glucose
test.

Urine test for sugar is not reliable indicator of diabetes control. Although
spillage of sugar in urine occurs when the blood glucose exceeds 180 mg/dl in
the majority of healthy persons, this is not always so in a patient with diabetes.
Most patients with diabetes of many years acquire an increase in the renal
threshold for glucose (capacity to prevent spillage of glucose into urine). Hence
urine test for glucose is not helpful for assessing control of diabetes. In the
presence of urinary infections, the bacteria eats up the sugar present in urine,
thereby making urine test for sugar unreliable.

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