Biology Project By Sumedha Sharma

History and Statistic

Diabetes is not a newly born disease, it has been with human race from long abetes 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 e, 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, rmulated oats and other fiber containing foods in 1900 1900-1915. Function of insulin, its nature, along with its use , Universal Blue Symbol started from 1920 -1923, discovered by Dr. Banting, 1923, 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 e 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.

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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 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 S unaware of the diabetes existence in there life.

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 ting on rising charts. Hence, scientists are continuously working to relieve us from it, by discovering the relevant drugs and making new researches.

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 dont 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:

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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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Biology Project By Sumedha Sharma

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.

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Type 2 diabetes Type 2 Diabetes is also called non insulindependent diabetes mellitus (NIDDM) or adultonset 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
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previous case and if both the parents are diabetic, the child has much greater risk for diabetes. 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
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scheming the carbohydrates, proteins, fats, type of carbohydrate, amount of fiber and so on. 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

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1. 2. 3. 4. Management Diet Management During Diabetes Diabetes Care Diabetic Diet Dos Diabetic Diet Donts Don

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 neednt 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.

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
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Biology Project By Sumedha Sharma

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 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.

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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 days 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). Dont 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.
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Check your hemoglobin and proteins in blood samples at 6 months or 1 years interval, Suitable correction in diet format or supplementation may become necessary. 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

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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

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Diabetic Diet Don'ts

For breakfast, take cholesterollowering 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

Don't fry foods instead bake, boil, poach or saut 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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Biology Project By Sumedha Sharma

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

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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 8-10 weeks, the concentration of glycosylated hemoglobin (HbA1c) arises. A (HbA1c) measurement therefore reflects the blood glucose control over a preceding 2 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 6-7% 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 ose 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.

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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 diabetes. presence of urinary infections, the bacteria eats up the sugar present in urine, thereby making urine test for sugar unreliable.

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