THEPSBBMILLLENNIUMSSCHO

OOL

B
BIOLOGY
INVESTIG
GATORY
P
PROJECT
BLLOODGLU
UCOSETO
OLERANC
CE:ACASESTUDY

SA
AISUVETH
HASRI.S.K
K
12A
12128

ACKNOWLEDGEMENT
I express my sincere thanks to our Principal Mrs. Sita
Umamaheshwaran whose constant support and guidance has steered
usalongway.IamdeeplygratefultoourbiologyteacherMrs.V.T.R.S.
Gayathri and Mrs. Deepa Menon whose tips and supervision on the
studyhashelpedmealot.IwoulddefinitelythankmygrandfatherMr.
S. Sekar on whom my case study is based upon. A special mention to
my parents whose backing and encouragement has helped me finish
myprojectsuccessfully.

WHYICHOSETHISTOPIC?
Thesweetdevil,asitmayseemoxymoronic,istruly meaningfulinits
sense that sweets can take us to undulating rides during the lifetime
especially for the old aged. Being the most prevalent disorder for not
only people above 60 years, but for almost all age groups diabetes
holdstherecordforhighestincidenceinIndia.Type2diabeteswhichis
insulin independent can be kept under control with proper diet and
exerciseandotherlifestylehabits.Havingsuchaneasycureandcontrol
toaconditionthatisthreateningtheentirecountry,Ithoughtgivingit
a mention and focusing on it, shall be interesting to take up as a
project.

CONTENTS
I.
II.
III.
IV.
V.

INTRODUCTION
THEORY
CASESTUDY
INFERENCE
BIBLIOGRAPHY

INTRODUCTION
N
The word
w
Diab
betes, taakes its roots fro
om Greeece wherre it meeans
siphon. Aretu
us, a Greeek physiician durring the second
s
c
century
A
A.D.,
d the co
onditiond
diabainein
n. He deescribed patientss who were
w
named
passinggtoomuchwater(polyuriaa)likeasiphon.
In 167
75, Thom
mas Williss added mellitus to the term, although it
i is
commo
onlyreferredtosimplyas diabetess.MelinLLatinmeaans"honey";
and
the urine and blood
b
of people with
w diab
betes hass excess glucose,
g
glucosee is swe
eet like honey.
h
D
Diabetes
mellitus could litterally mean
m
"siphoningoffssweetwater".

Medically referred to as diabetes mellitus, it describes a group of

metabolicdiseasesinwhichthepersonhashighbloodglucose(blood
sugar),eitherbecauseinsulinproductionisinadequate,orbecausethe
body's cells do not respond properly to insulin, or both. The former
referstotype1ofdiabeteswhichcontributesonly10%ofthosewith
diabetes worldwide. The latter that pertains to type 2 of diabetes, is
mostprevalentwith90%ofthepeoplediagnosedwithdiabetesallover
the world. Patients with high blood sugar will typically experience
polyuria (frequent urination), they will become increasingly thirsty
(polydipsia)andhungry(polyphagia).

Type 1 of diabetes is referred to as insulindependent diabetes,

juvenilediabetes,orearlyonsetdiabetes.Peopleusuallydevelopthis
typebeforetheir40thyear,ofteninearlyadulthoodorteenageyears.
Patientswithtype1diabeteswillneedtotakeinsulininjectionsforthe
restoftheirlife.Theymustalsoensureproperbloodglucoselevelsby
carryingoutregularbloodtestsandfollowingaspecialdiet.
Type 2 of diabetes is typically a progressive disease it gradually gets
worse and the patient mostly ends up taking in insulin, usually in
tabletform.

Overweight and obese people have a much higher risk of developing

type2diabetescomparedtothosewithahealthybodyweight.Being
overweight/obese causes the body to release chemicals that can
destabilizethebody'scardiovascularandmetabolicsystems.
Being overweight, physically inactive and eating the wrong foods all
contribute to our risk of developing type 2 diabetes.A recent report
stated that drinking just one can of (nondiet) soda per day can raise
our risk of developing type 2 diabetes by 22%, The scientists believe
that the impact of sugary soft drinks on diabetes risk may be a direct
one,ratherthansimplyaninfluenceonbodyweight.
Theriskofdevelopingtype2diabetesisalsogreateraswegetolder.It
isnotknownwhy,butitissaidthatasweagewetendtoputonweight
andbecomelessphysicallyactive.Thosewithacloserelativewhohave
had type 2 of diabetes, people of Middle Eastern, African, or South
Asiandescentalsohaveahigherriskofdevelopingthedisease.
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Men whose testosterone levels are low have been found to have a
higherriskofdevelopingtype2diabetes.
Excessivethirstisamajorsymptomofhighbloodsugars.Othermajor
symptoms include dry mouth, increased hunger (especially after
eating), frequent urination, fatigue, unexplained weight loss, blurred
vision, and headaches. These symptoms are all caused by high blood
sugar. Other symptoms of type 2 diabetes may include slowhealing
wounds,itching,numbnessandtinglingofthehandsandfeet,weight
gain,frequentyeastinfections,andimpotency.
Before people developtype 2 diabetes, they almost always have
"prediabetes"bloodglucoselevelsthatarehigherthannormalbut
notyethighenoughtobediagnosedasdiabetes.
Doctorssometimesrefertoprediabetesasimpairedglucosetolerance
(IGT) or impaired fasting glucose (IFG), depending on what test was
usedwhenitwasdetected.Thisconditionputsyouatahigherriskfor
developingtype2diabetesandcardiovasculardisease.

10

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Many a times the terms diabetes insipidus and diabetes mellitus

mislead us to the thought that they refer to the same condition.
However, they are completely different. Diabetes insipidus is a rare
condition that arises due to the lack of sufficient release of the
Antidiuretichormone(ADH).Itmayalsobeduetothekidneysthatare
unresponsive to this hormone. In both these cases, there is excessive
loss of water and fluid through frequent urination and the body
demands extraordinarily large amounts of water to compensate the
lossoffluids.However,itisnotharmfulenoughtoendangerapersons
health.

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Medicationsandtreatmentusedforcuringdiabetes:
Type2usuallylastsalifetime;however,somepeoplehavemanagedto
get rid of their symptoms without medication, through a combination
ofexercise,dietandbodyweightcontrol.
Newdrugsandtypesofinsulinhavemadetreatmentbetter.
DPP4 inhibitorsinclude the oral drugs that protect a natural
compound in the body GLP1 from breaking down. GLP1
helpslowerbloodglucose.

Incretin mimetic or GLP analogs include the injected drugs that

usethebody'sownsignalingsystemtoboostinsulinaftermeals.

Sodiumglucose cotransporter 2 (SGLT2) inhibitorswork by

blocking glucose from being reabsorbed by the kidneys. That
raisestheamountofglucoseurinated,andlowerstheamountof
glucoseintheblood.

Other drugsinclude an injectable synthetic hormone that helps

lower blood sugar after meals in people with diabetes who use
insulin.

Combination drugshave made a difference. They join different

medications in one pill which cuts down the number of pills a
person has to take. There can be drawbacks. They tend to cost
more than generic drugs. They can also make it harder to fine
tunethetreatment.

Newtypesofinsulinallowsomepeopletotakejustoneinjection
oflongactinginsulineachday.

13

Future medications.Other classes of medication are in

development. One type doesn't affect insulin, unlike most
diabetesdrugs.Itblocksthebodyfromreabsorbingglucosefrom
urine.

14

THEORY
A question may arise What is the exact metabolism behind this
condition?Theprocessgoeslikethis.
Thefoodwhichweeat,richincarbohydrateisconvertedintoglucose
and other monosaccharides which serve as the sources for all the
energyandgrowth.Thebrokendowncarbohydrateglucose,thengets
into the bloodstream to reach the cells of our body. It is at this point
that the role of insulin becomes crucial for the maintenance of blood
glucoselevel.
ThepancreasendocrinepartpossessesaclusterofcellscalledIsletsof
Langerhansthatsensethepresenceofsugarintheblood.Inthiscluster
of cells, there exists a group of cells called the beta cells that are
responsibleforthesecretionofthehormoneinsulin.

Itisonlyinthepresenceofinsulinthatthecellscantakeuptheglucose
present in the bloodstream and utilize it for energy. Thus, in the
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presenceofinsulin,thecellsabsorbglucosefrombloodandtheblood
glucose levels drop. It is thus in the absence of insulin or if the cells
have become resistant and donot respond properly to the release of
insulin by pancreas that the condition diabetes arises. This condition
whereinthebloodglucoselevelsarehighistermedashyperglycemia.
Aconditionhypoglycemiaariseswhenthelevelofglucoseinbloodis
extremely low (<70mg/dL). The latter is also called insulin shock or
insulin reaction. Severe hypoglycemia has the potential to cause
accidents,injuries,coma,anddeath.
There is another hormone secreted by the alpha cells of Islets of
Langerhansinthepancreas,glucagonthatinstructsthelivertosecrete
glucose stored in it when the levels of blood glucose are less. Since
insulin and glucose are complementary in action and function, their
secretions need to be balanced so that the blood is neither over
brimmednorinshortageofglucose.

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The skeletal muscle is responsible for ~80 % of whole body glucose

uptake in insulinstimulated conditions and thus it is an important
tissue wherein there can be possible defects in insulin signaling and
action.

This is a brief overview of the lipid carbohydrate metabolism that

occursininsulinstimulatedconditions.

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CASESTUDY:
NAME

:S.SEKAR

AGE

:72

WEIGHT

:55KGS.

DIAGNOSEDWITH

:TYPE2OFDIABETESMELLITUS

BLOODSUGARLEVEL:
a) Randombloodsugarlevel:192mg/dL
b) Beforefood:151mg/dL
c) Afterfood:209mg/dL
FOODHABITS:
Descriptionforadailybaseddiet:
Breakfast rich in carbohydrates, intake of sufficient food
every2hours,consumptionofchocolateseveryday,partial
control over other sweets, limited food for dinner mainly
riceandwheat.
Frequent inclusion of spinach, green vegetables, otherwise
intakeoffatandproteinisless.
EXERCISE: Regular walking for half an hour to 45 minutes in the
evening.
MEDICATION:DosageofGlyciphage500and850mgbeforeand
afterfoodrespectivelyatanintervalof4hours.
MEDICALHISTORY:Underwentabypasssurgerybefore10years
FAMILYHISTORY:Hisfatherwasalsodiagnosedwithdiabetesbut
wasnotunderanymedicationandlaterhadparalysis.
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INFERENCE
Hisconditiondoesntseemtoodangerousbutalittlecautioninterms
offoodhabitsisrequired.Thepracticeofeatingchocolatesseemsbea
blackmarkinthediethefollows.Breakfastrichincarbohydrateseems
tobeagoodsourceofenergyandsafesincehepreferscarbohydrates
inthemorningbutareductioninthetotalintakeofcarbohydrateswill
helpinloweringbloodsugarlevel.Lessconsumptionoffatseemstobe
a positive sign of control. There must be an increase in the protein
intakesothathisdietismorebalanced.Ingestionoffenugreekseedsin
the early morning and regular consumption of garlic and ginger can
prove to be very much beneficial as new studies prove that glucose
levelismuchundercontrolwiththispractice.Heisneitherobesenor
overweight,thusa45minutewalksoundstobesufficientforhisage.
Ontheoverallnote,afewmorestepstakenonthebasisofhisexisting
dietandlifestylepracticescanbringhisdiabeticbodyundercomplete
regulationandcontrol.

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BIBLIO
OGRAPHY
Y

NCERTtexxtofbiolo
N
ogyforclaassXI
w
www.diab
betes.org
w
www.diab
betesindiaa.com
w
www.med
dicalnewsstoday.orrg

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