A STUDY ON AWARENESS OF DAIBETES MELLITUS IN MY NAWARGAON VILLAGE

Project work
In
Clinical Nutrition and Dietetics

Submitted By
Miss Ragini Shersingh Tembhare
Msc Final Year
( Semister IV)

Guided by
Dr. Durgesh Wasnik
(Principal & Professor )

Department of Home Science

Shreemati Nathibai Damodar Thackersey Women's University (SNDT)
Mumbai 2023-2024
INTRODUCTION

The chronic metabolic disorder diabetes mellitus is a fast-growing global problem with huge
social, health, and economic consequences. It is estimated that in 2010 there were globally 285
millionpeople (approximately 6.4% of the adult population) suffering from this disease. This
number is estimated to increase to 430 million in the absence of better control or cure. An ageing
population and obesity are two main reasons for the increase. Furthermore it has been shown that
almost 50% of the putative diabetics are not diagnosed until 10 years after onset of the disease,
hence the real prevalence of global diabetes must be astronomically high.Diabetes mellitus is a
group of physiological dysfunctions characterized by hyper-glycemia resulting directly from
insulin resistance, inadequate insulin secretion, or excessive glucagon secretion. CR seType 1
diabetes (T1D) is an autoimmune disorder leading to the destruction of pancreatic beta-cells .
Type 2 diabetes (T2D), which is much more common, is primarily a problem of progressively
impaired glucose regulation due to a combination of dysfunctional pancreatic beta cells and
insulin resistance The purpose of this article is to review the basic science of type 2 diabetes and
its complications, and to discuss the most recent treatment guideline.Diabetes mellitus (DM) is a
metabolic disorder resulting from a defect in insulin secretion, insulin action, or both. Insulin
deficiency in turn leads to chronic hyperglycaemia with disturbances of carbohydrate, fat and
protein metabolism. It is the most common endocrine disorder and by the year 2010, it is
estimated that more than 200 million people worldwide will have DM and 300 million will
subsequently have the disease by 2025 (1) As the disease progresses tissue or vascular damage
ensues leading to severe diabetic complications such as retinopathy, neuropathy, nephropathy,
cardiovascular complications and ulceration. Thus, diabetes covers a wide range of
heterogeneous diseases. Diabetes mellitus may be categorized into several types but the two
major types are type 1 and type 2. Drugs are used primarily to save life and alleviate symptoms.
Secondary aims are to prevent long-term diabetic complications and, by eliminating various risk
factors, to increase longevity. Insulin replacement therapy is the mainstay for patients with type 1
DM while diet and lifestyle modifications are considered the cornerstone for the treatment and
management of type 2 DM. Insulin is also important in type 2 DM when blood glucose levels
cannot be controlled by diet, weight loss, exercise and oral medications (2)

CAUSES
Causes Of Diabetes Melilitous It is indicated by the study conducted by that Obesity and
diabetes are major causes of morbidity and mortality in th TTe United States. Obesity and weight
gain, both are associated with an increased risk of diabetes among the people. progression over
time in type 2 diabetes. Although aging, smoking, etc are independent risk factors of the
pathogenesis of type 2 diabetes mellitus. Over eating, Smoking, increase in alcohol inta+ke,
disorders of nervous and
endocrine systems, increase in cortisol, abnor-mality in sex hormone secretion, lowered energy
consump-tion due to a lack of exercise and Genetic factors such as aging can cause diabetes
mellitus(DM). consumption of energy, smoking and alcohol drinking etc play important role in
pathogenesis of type I or II diabetes mellitus.
SIGN AND SYMPTOMS
Symptoms of diabetes include:
Increased thirst (polydipsia) and dry mouth.
Frequent urination.
Fatigue.
Blurred vision.
Unexplained weight loss.
Numbness or tingling in your hands or
feet. Slow-healing sores or cuts.
Frequent skin and/or vaginal yeast infections.
It’s important to talk to your healthcare provider if you or your child has these symptoms.
Additional details about symptoms per type of diabetes include:
Type 1 diabetes: Symptoms of T1D can develop quickly — over a few weeks or months. You
may develop additional symptoms that are signs of a severe complication called diabetes-related
ketoacidosis (DKA). DKA is life-threatening and requires immediate medical treatment. DKA
symptoms include vomiting, stomach pains, fruity-smelling breath and labored breathing.
Type 2 diabetes and prediabetes: You may not have any symptoms at all, or you may not notice
them since they develop slowly. Routine bloodwork may show a high blood sugar level before
you recognize symptoms. Another possible sign of prediabetes is darkened skin on certain parts
of your body (acanthosis nigricans).
Gestational diabetes: You typically won’t notice symptoms of gestational diabetes. Your
healthcare provider will test you for gestational diabetes between 24 and 28 weeks of pregnancy.
The classic symptoms of untreated diabetes are weight loss, polyuria (frequent urination),
polydipsia (increased thirst), and polyphagia (increased hunger).
Symptoms may develop rapidly (weeks or months) in typeusually develop much more slowly
and may be subtle or absent in typeSeveral other signs and symptoms can mark the onset of
diabetes, anot specific to the disease. In addition to the known ones above, they include blurry
vision, headache, fatigue, slow healing of cuts, and itchy skin. Prolonged high blood glucose can
cause glucose absorption in the lens of the eye, which its shape, resulting in vision changes. A
number of skin rashes that can occur in diabetes are collectively known as Diabetic
emergenciesPeople
(usually with type1 diabetes) may also experience episodes of ketoacidosis, a type of metabolic
problems characterized byabdominal pain, the smell of Kussmaul breathing, and in severe cases
a decreased level of consciousness.A rare but equally severe possibility is common in type2
diabetes and is mainly the result of dehydration.Complications: All forms of diabetes increase
the risk of longdevelop after many years (10otherwise not received a diagnosis before that
time.Symptoms may develop rapidly (weeks or months) in type1 diabetes, while they usually
develop much more slowly and may be subtle or absent in type2 diabetes.Several other signs and
symptoms can mark the onset of diabetes, although they are not specific to the disease. In
addition to the known ones above, they include blurry vision, headache, fatigue, slow healing of
cuts, and itchy skin. Prolonged high blood glucose can cause glucose absorption in the lens of the
eye, which leads to changes in its shape, resulting in vision changes. A number of skin rashes
that can occur in diabetes are collectively known as diabetic dermadromes.1 diabetes) may also
experience episodes of diabetic , a type of metabolic problems characterized bynausea, vomiting
and , the smell of acetoneon the breath, deep breathing known as , and in severe cases a
decreased level of consciousness.A rare but equally severe possibility is hyperosmolar nonketotic
state, which is more 2 diabetes and is mainly the result of dehydration.All forms of diabetes
increase the risk of long- term complications. These typically lop after many years (10–20), but
may be the first symptom in those who have otherwise not received a diagnosis before that time.
1 diabetes, while they 2 diabetes.lthough they are not specific to the disease. In addition to the
known ones above, they include blurry vision, headache, fatigue, slow healing of cuts, and itchy
skin. Prolonged high blood leads to changes in its shape, resulting in vision changes. A number
of skin rashes that can occur in diabetic nausea, vomiting and on the breath, deep breathing
known as , which is more term complications. These typically but may be the first symptom in
those who have othervised not received a diagnosis before that time.

COMPLICATIONS
Diabetes complications are common among patients with type 1 or type 2 diabetes but, at the
same time, are responsible for significant morbidity and mortality. The chronic complications of
diabetes are broadly divided into microvascular and macrovascular, with the former having much
higher prevalence than the latter . Microvascular complications include neuropathy, nephropathy,
and retinopathy, while macrovascular complications consist of cardiovascular disease, stroke,
and peripheral artery disease (PAD). Diabetic foot syndrome has been defined as the presence of
foot ulcer associated with neuropathy, PAD, and infection, and it is a major cause of lower limb
amputation. Finally, there are other complications of diabetes that cannot be included in the two
aforementioned categories such as dental disease, reduced resistance to infections, and birth
complications among women with gestational diabetes . The present special issue has been
devoted to showcase a broad spectrum of research and review papers addressing recent
fundamental advances in our understanding of diabetic complications. It includes 12 articles in
total, which cover 5 thematic areas: (a) epidemiology and pathogenesis of diabetic
complications, (b) microvascular complications, (c) macrovascular complications, (d)
miscellaneous complications, and € treatment options.
PREVENTION
Lifestyle changes can help prevent the onset of type 2 diabetes, the most common form of the
disease. Prevention is especially important if you’re currently at an increased risk of type 2
diabetes because of excess weight or obesity, high cholesterol, or a family history of diabetes.
Losing weight reduces the risk of diabetes. People in one large study reduced their risk of
developing diabetes by almost 60% after losing approximately 7% of their body weight with
changes in exercise and diet.There are many benefits to regular physical activity. Exercise can
help you: Lose weight, Lower your blood sugar. Boost your sensitivity to insulin which helps
keep your blood sugar within a normal range Goals for most adults to promote weight loss and
maintain a healthy weight include:
Aerobic exercise. Aim for 30 minutes or more of moderate to vigorous aerobic exercise such as
brisk walking, swimming, biking or running on most days for a total of at least 150 minutes a
week.
Resistance exercise. Resistance exercise at least 2 to 3 times a week increases your strength,
balance and ability to maintain an active life. Resistance training includes weightlifting, yoga
and calisthenics.
Limited inactivity. Breaking up long bouts of inactivity, such as sitting at the computer, can help
control blood sugar levels. Take a few minutes to stand, walk around or do some light activity
every 30 minutes.
Fatty foods are high in calories and should be eaten in moderation. To help lose and manage
weight, your diet should include a variety of foods with unsaturated fats, sometimes called “good
fats.” Unsaturated fats both monounsaturated and polyunsaturated fats promote healthy blood
cholesterol levels and good heart and vascular health. Sources of good fats include:
Olive, sunflower, safflower, cottonseed and canola oils, Nuts and seeds, such as almonds,
peanuts, flaxseed and pumpkin seeds, Fatty fish, such as salmon, mackerel, sardines, tuna and
cod, Saturated fats, the “bad fats,” are found in dairy products and meats. These should be a
small part of your diet. You can limit saturated fats by eating low-fat dairy products and lean
chicken and pork.
Many fad diets such as the glycemic index, paleo or keto diets may help you lose weight. There
is little research, however, about the long-term benefits of these diets or their benefit in
preventing diabetes. Dietary goal should be to lose weight and then maintain a healthier weight
moving forward. Healthy dietary decisions, therefore, need to include a strategy that you can
maintain as a lifelong habit. Making healthy decisions that reflect some of your own preferences
for food and traditions may be beneficial for you over time.

NUTRITIONAL CONSIDERATION
Diabetes mellitus is a common endocrine disease of dogs and requires life-long therapy.
Nutritional management is an important part of the treatment regimen and feeding guidelines
based on evidence from well-designed clinical studies are essential. The first part of this chapter
provides an understanding of the pathogenesis of diabetes in dogs, which is required before
evaluation of issues relating to nutritional management. This allows comparison of the current,
evidence-based, nutritional recommendations for human patients with types of diabetes
analogous to canine diabetes. The second part reviews the available evidence from feeding
studies in dogs and provides detailed analysis of the recommendations for dietary fiber,
carbohydrate, fat, protein, and selected micronutrients in diabetic dogs. The final summary uses
the American Diabetes Association grading system to rank the scientific basis of the nutritional
recommendations for canine diabetes.Limit intake of saturated fats by cutting back on processed
and fast foods, red meat, and full-fat dairy foods. Try replacing red meat with beans, nuts,
skinless poultry, and fish whenever possible, and switching from whole milk and other full-fat
dairy foods to lower fat.In place of butter or margarine, use liquid vegetable oils rich in
polyunsaturated and monounsaturated fats in cooking and at the table. Eat one or more good
sources of omega-3 fats every day fatty fish, walnuts, soybean oil, ground flax seeds or flaxseed
oil.
The important part of the foundation for the treatment of diabetes. appropriate nutritional
intervention, implementation, and ultimate compliance with the plan remain some of the most
vexing problems in diabetes management for three major reasons: First, there are some
differences in the dietary structure to consider, depending on the type of diabetes and medication
the PWD is taking. Second, a plethora of dietary information is available from many sources to
the PWD and healthcare provider. Nutritional science is constantly evolving, so that what may be
considered true today may be outdated in the near future. Nutritional intervention may vary
based on the type of diabetes; however, many of the basic dietary principles are similar for all
PWD, prediabetes, metabolic syndrome or who are overweight or obese. Lastly, there is not
perfect agreement among professionals as to the best nutritional therapy for individuals with
diabetes, and ongoing scientific debate reported in the popular press may confuse PWD and
health care providers.
Include a good source of fiber containing food with every meal or snack.
Add some whole grain to the morning meal. Hot cereals – Old-fashioned or steel-cut oats. Cold
cereals – Look for those that list whole wheat, whole oats, or other whole grain first on the
ingredient list without added sugars. Use whole grain breads for lunch or snacks. Check the label
to make sure that whole wheat or another whole grain is the first ingredient listed. Eat less
potatoes. Instead, try brown rice or less well-known grains like bulgur, wheat berries, millet,
hulled barley, faro, or quinoa. Switch to whole grain pasta. If the whole grain products are too
chewy, look for those that are made with half whole wheat or brown rice or other whole grain
flour. Newer pasta products made from legumes such as chickpeas are now available. Include
beans/legumes which are an excellent source of slowly digested carbohydrate as well as a great
source of lean protein. Substitute for meat as a protein and fiber source.
Good sources of lean animal protein, such as skinless poultry, lower fat cuts of beef or pork, fish
or egg (1 egg =1 oz protein), and reduced fat dairy products (1 c low fat or skim milk/yogurt, 1
oz cheese = 1 oz protein. Plant protein sources such as tofu, tempeh, legumes, (1/2c = 2 oz
protein)
or meat alternative products are options but be aware of possible higher sodium content. Nuts or
seeds: 1 oz equals 24 almonds, 18 medium cashews, 12 hazelnuts or filberts, 8 medium Brazil
nuts, 12 macadamia nuts, 35 peanuts, 15 pecan halves and 14 English walnut halves Nut butters
2 Tbsps. Equals 1oz protein Protein should be a supplement to vegetables, fruits and whole
grains in a meal, not the entire meal.

AWARENESS
Diabetes awareness the prevention of the onset of the condition. Healthy eating and more active
lifestyles can ward off type 2 diabetes induced by being overweight.
Literature survey
Diabetes mellitus is a major clinical and public health problem accounting for 4.6 million deaths
annually world-wide. According to the International Diabetes Federation, around 366 million
people globally are currently estimated to have diabetes, of which 80% live in low and middle
income countries. The more worrisome fact is that about 50% of those with diabetes remain
undiagnosed. The Indian Council of Medical Research India Diabetes Study showed that India
had
62.4 million people with diabetes in 2011. These numbers are projected to increase to 101.2
million by 2030. Education is one of the key components in ensuring better treatment and control
of diabetes. There is also evidence to show that increasing knowledge regarding diabetes and its
complications has significant benefits including increase in compliance to treatment, thereby
decreasing the complications associated with diabetes. Although there have been small regional
studies on the subject of diabetes awareness in India,there is no data at a national level or indeed
even in a whole state of India on the awareness about diabetes. This article focuses on the level
of awareness and knowledge of diabetes in the general, as well as the diabetic population in four
regions of India based on the first phase of the ICMR-INDIAB study. Type II diabetes has risen
dramatically among rural women in India, specifically in the states of Gujarat, Karnataka, Tamil
Nadu and Uttar Pradesh. Recent studies suggest that rural Indian women's low level of self-
efficacy, or confidence in their ability to carry out tasks, such as managing diabetes, is a key
reason for this increase. Therefore, this study utilizes the Health Belief Model to analyze whether
increased awareness of diabetes leads to a positive increase in levels of self-efficacy among
diabetic women in two rural villages of Gujarat. Diabetes mellitus is a major clinical and public
health problem accounting for 4.6 million deaths annually world-wide. According to the recent
World Health Organization report (WHO), India today leads the world with over 32 million
diabetic patients and this number is projected to increase to 79.4 million by the year 2030. The
recent surveys indicate that Diabetes now affects a large part of the population i.e. 10-16% of
urban and 5-8% of rural population in India.India has the largest number of patients with
diabetes in the world, accounting for more than 50 million subject There are limited studies on
diabetes awareness, attitude, and prevalence in rural communities, especially in the northeastern
part of India.The worldwide prevalence of diabetes mellitus has reached epidemic proportions
over the past two decades. The World Health Organization (WHO) predicts that developing
countries will bear the brunt of this epidemic in the 21st century. Currently, more than 70% of
people with diabetes live in low- and middle-income countries. Today, India has about 50 million
patients with diabetes and this number is projected to increase to 79.4 million by the year
2030.Prevalence studies have previously estimated that around 6–12% of urban and 2–3% of
rural Indians have diabetes.India is a country with diverse social, economic, cultural, and
educational patterns. A large proportion of the population of India is from the rural sector. A
number of these regions are still underdeveloped and people have varied beliefs and
misconceptions regarding disease (4) Not much is known about the level of awareness and
prevalence of diabetes in developing countries like India. There is very little epidemiological
data available from some regions of India such as the northeastern states which are ethnically
distinct from the other states of India. Linguistically, the region is distinguished by a
preponderance of Tibeto-Burman languages.This region primarily consists of a tribal population,
having low educational status with around 22% of males and 42% of females being illiterate. The
terrain and climatic conditions in this region make these health care institutions physically
difficult to access. The average time taken to reach a doctor in these areas
is about half an hour and may range anywhere between 5 minutes and 3 hours.The lack of
awareness regarding diabetes in the study population is very evident with barely 21.4% of them
being aware of the disease condition when compared to 50.8% reported in a study done amongst
the rural South Indian population of Tamaka village by Muninarayana et al. Studies have shown
that the burden of overweight and obesity is much lower in the rural population when compared
to the urban population, which is consistent with our findings where only 28.38% were found to
be obese or overweight using the revised cut-off values for normal anthropometric variables in
Asian Indian adults.Our study also revealed that most participants had a very active lifestyle,
which, with their racial background, could partly explain the lower prevalence of overweight and
obesity when compared to a similar study conducted in Tripura. The prevalence of alcohol
addiction and smoking was found to be 49.7 and 72.3%, respectively, which was significantly
greater when compared to the 19% alcohol consumption and 51% tobacco abuse in a study done
by Gupta et al. in a rural population near Jaipur.The major finding of our study was that 21.8%
of the study participants had impaired glucose tolerance and 8.3% of them had blood glucose
levels in the diabetic range, in contrast to other prevalence studies which showed only 2–3% of
rural India to have diabetes (5)
Diabetes mellitus (DM) also known as simply diabetes, is a group of metabolic diseases in which
there are high blood sugar levels over a prolonged period This high blood sugar produces the
symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can
cause many complications. Acutecomplications include diabetic ketoacidosis and nonketotic
hyperosmolar coma. Serious long-term complications include heart disease, stroke, kidney
failure, foot ulcers and damage to the eyes.Diabetes is due to either the pancreas not producing
enough insulin, or the cells of the body not responding properly to the insulin produced. There
are three main types of diabetes mellitus: Type 1 DM results from the body's failure to produce
enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus"
(IDDM) or "juvenile diabetes". The cause is unknown Type 2 DM begins with insulin resistance,
a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of
insulin may also develop. This form was previously referred to as "non insulin-dependent
diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body
weight and not enough exercise. Gestational diabetes, is the third main form and occurs when
pregnant women without a previous history of diabetes develop a high blood glucose level.
Prevention and treatment involves a healthy diet, physical exercise, not using tobacco, and being
a normal body weight. Blood pressure control and proper foot care are also important for people
with the disease. Type 1 diabetes must be managed with insulininjections. Type 2 diabetes may
be treated with medications with or without insulin. Insulin and some oral medications can cause
low blood sugar.Weight loss surgery in those with obesity is an effective measure in those with
type 2 DM. Gestational diabetes usually resolves after the birth of the baby.
Type 1:
Type1 diabetes mellitus is characterized by loss of the insulinthe islets of Langerhansin the
pancreas, leading to insulin deficiency. This type canbe further classified as immunediabetes is
of the immune-mediated nature, in which a attack leads to the loss of beta cells and thus
insulin.of
diabetes mellitus cases in North Amerotherwise healthy and of a healthy weight when onset
occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early
stages. Typediabetes can affect children or adults, but was tradibecause a majority of these
diabetes cases were in children."Brittle" diabetes, also known as unstable diabetes or labile
diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in
often occurring for no apparent reason in however, has no biologic basis accompanied by
irregular and unpredictable and sometimes with serious hypoglycemiacounterregulatory response
to hypoglycemia, infection, erratic absorption of dietary carbohydrates), and endocrinopathies
(e.g., disease). These phenomena are believed to occur no more frequently than in 1% to 2% of
persons with type1 diabetes.Type1 diabetes is partly inherited, with multiple gengenotypes,
known to influence the risk of diabetes. In genetically susceptible people, the onset of diabetes
can be triggered by one or more environmental factors, such as a viral infection or diet. There is
some evidence that suggests an association between type 1 diabetes and Coxsackie B4
virusdiabetes is unrelated to lifestyle.1 diabetes mellitus is characterized by loss of the insulin-
producing beta cellsin the pancreas, leading to insulin deficiency. This type canbe further
classified as immune-mediated or idiopathic. The majority of typemediated nature, in which a T-
cell-mediated autoimmuneattack leads to the loss of beta cells and thus insulin. It causes
approximately 10% of diabetes mellitus cases in North America and Europe. Most affected
people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and
responsiveness to insulin are usually normal, especially in the early stages. Typediabetes can
affect children or adults, but was traditionally termed "juvenile diabetes" because a majority of
these diabetes cases were in children."Brittle" diabetes, also known as unstable diabetes or labile
diabetes, is a term that was traditionally used to describe the dramatic and recurrent swings in
glucoseoften occurring for no apparent reason in insulin-dependent diabetes. This term, however,
has no biologic basis and should not be used. Still, type1 diabetes can be accompanied by
irregular and unpredictable hyperglycemia, frequently with hypoglycemia. Other complications
include animpaired counterregulatory response to hypoglycemia, infection, gastroparesis(which
leads to erratic absorption of dietary carbohydrates), and endocrinopathies (e.g., Addison's These
phenomena are believed to occur no more frequently than in 1% to 1 diabetes. 1 diabetes is
partly inherited, with multiple genes, including certain HLA , known to influence the risk of
diabetes. In genetically susceptible people, of diabetes can be triggered by one or more
environmental factors, such as a viral infection or diet. There is some evidence that suggests an
association between Coxsackie B4 virus. Unlike type 2 diabetes, the onset of typediabetes is
unrelated to lifestyle.beta cellsof in the pancreas, leading to insulin deficiency. This type
canmediated or idiopathic. The majority of type1 autoimmuneIt causes approximately 10% ica
and Europe. Most affected people are otherwise healthy and of a healthy weight when onset
occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early
stages. Type1 tionally termed "juvenile diabetes" "Brittle" diabetes, also known as unstable
diabetes or labile diabetes, is a term that glucoselevels, dependent diabetes. This term, 1 diabetes
can be , frequently with ketosis, impaired (which leads to Addison's These phenomena are
believed to occur no more frequently than in 1% to HLA , known to influence the risk of
diabetes. In genetically susceptible people, of diabetes can be triggered by one or more
environmental factors, such as a viral infection or diet. There is some evidence that suggests an
association between type 1 diabetes.
Type 2:
Type 2 diabetes mellitus is characterized by insulin resistance, which may be combined with
relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is
believed to involve the insulin receptor. However, the specific defects are not known. Diabetes
mellitus cases due to a known defect are classified separately. Type 2 diabetes is the most
common type.In the early stage of type 2, the predominant abnormality is reduced insulin
sensitivity. At this stage, hyperglycemia can be reversed by a variety of measures and
medications that improve insulin sensitivity or reduce glucose production by the liver.Type 2
diabetes is due primarily to lifestyle factors and genetics. A number of lifestyle factors are
known to be important to the development of type 2 diabetes, including obesity (defined by a
body mass index of greater than thirty), lack of physical activity, poor diet, stress, and
urbanization. Excess body fat is associated with 30% of cases in those of Chinese and Japanese
descent, 60-80% of cases in those of European and African descent, and 100% of Pima Indians
and Pacific Islanders.Those who are not obese often have a high waist–hip ratio. Dietary factors
also influence the risk of developing type 2 diabetes. Consumption of sugar-sweetened drinks in
excess is associated with an increased risk. The type of fats in the diet is also important, with
saturated fats and trans fatty acids increasing the risk and polyunsaturated and monounsaturated
fat decreasing the risk. Eating lots of white rice appears to also play a role in increasing risk. A
lack of exercise is believed to cause 7% of cases.
Gestational diabetes:
Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a
combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2-
10% of all pregnancies and may improve or disappear after delivery However, after pregnancy
approximately 5-10% of women with gestational diabetes are found to have diabetes mellitus,
most commonly type 2. Gestational diabetes is fully treatable, but requires careful medical
supervision throughout the pregnancy. Management may include dietary changes, blood glucose
monitoring, and in some cases insulin may be required.
Though it may be transient, untreated gestational diabetes can damage the health of the fetus or
mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central
nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may
inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia
may result from red blood cell destruction. In severe cases, perinatal death may occur, most
commonly as a result of poor placental perfusion due to vascular impairment. Labor induction
may be indicated with decreased placental function. A Caesarean section may be performed if
there is marked fetal distress or an increased risk of injury associated with macrosomia, such as
shoulder dystocia.
Diagnosis:
Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by
demonstrating any one of the following: Fasting plasma glucose level ≥7.0 mmol/l (126 mg/dl)
Plasma glucose ≥11.1 mmol/l (200 mg/dl) two hours after a 75 g oral glucose load as in a
glucose tolerance test Symptoms of hyperglycemia and casual plasma glucose ≥11.1 mmol/l.
A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat
of any of the above methods on a different day. It is preferable to measure a fasting glucose level
because of the ease of measurement and the considerable time commitment of formal glucose
tolerance testing, which takes two hours to complete and offers no prognostic advantage over the
fasting test. According to the current definition, two fasting glucose measurements above 126
mg/dl (7.0 mmol/l) is considered diagnostic for diabetes mellitus.
Prevention:
2 diabetes can often be Type 1 diabetes.There is no known preventive measure for typesical
exercise, and following a , phynormal body weightprevented by a person being a healthy diet
Dietary changes known to be effective in helping to prevent diabetes include a polyunsaturated
fats, and choosing good fats, such as fiberand whole grainsdiet rich in Limiting sugary beverages
and eating less red meat found in nuts, vegetable oils, and fish.Active n of diabetes.can also help
in the preventiosaturated fatand other sources of can be an smoking cessationsmoking is also
associated with an increased risk of diabetes, so important preventive measure as well.
Management:
Diabetes mellitus is a chronic disease, for which there is no known cure except in very specific
situations. Management concentrates on keeping blood sugar levels as close to normal
("euglycemia") as possible, without causing hypoglycemia. This can usually be accomplished
with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes; oral
medications, as well as possibly insulin, in type 2 diabetes).
Learning about the disease and actively participating in the treatment is vital for people with
diabetes, since the complications of diabetes are far less common and less severe in people who
have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but
should not be lower than that, and may be set higher. Attention is also paid to other health
problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated
cholesterol levels, obesity, high blood pressure, and lack of regular exercise. Specialised
footwear is widely used to reduce the risk of ulceration, or re-ulceration, in at-risk diabetic feet.
Evidence for the efficacy of this remains equivocal, however.
Lifestyle:
People with diabetes can benefit from education about the disease and treatment, good to achieve
a normal body weight, and sensible exercise, with the goal of keeping nutrition. In addition,
within acceptable boundsterm blood glucose levels -term and long-both shortgiven the associated
higher risks of cardiovascular disease, lifestyle modifications are recommended to control blood
pressureMedications:Metformin is generally recommended as a first line treatment for type 2
diabetes, as there is good evidence that it decreases mortality. Routine use of aspirin, however,
has not been found to improve outcomes in uncomplicated diabetes.[56] Angiotensin converting
enzyme inhibitors (ACEIs) improve outcomes in those with DM while the similar medications
angiotensin receptor blockers (ARBs) do not. Type 1 diabetes is typically treated with a
combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in
type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral
medications.[55] Doses of insulin are then increased to effect. In those with diabetes some
recommend blood pressure levels below 120/80 mmHg; however, evidence only supports less
than or equal to somewhere between 140/90 mmHg to 160/100 mmHg.

Need for the study

1. Study is to create awareness in adulthood age group (20-30) years

2. To give better understanding regarding diabetes mellitus to improve quality of living.

Limitations

1. Consuming food that much frequently.

2. Consuming fruits and vegetables in every meals.

Methodology- the study will be an survey method

1. study design- Observational Cross-sectional study

2. Target group- 20-30 years people of diabetes mellitus from Nawargaon village.

Inclusion Criteria:

Patients ages 20-30 years both males and females living in Nawargaon village

Patients willing to participate.

Patients who is newly Diagnosed and having longterm diabetes mellitus

Exclusion Criteria:

Unwilling to participate patient..

People who has obesity .

Sampling size- The study will be carried out on 40-50 diabetis mellitus patients

Sampling Techniques- Purposive

Data Collection- Data will be collected preferably through online mode via Google form
or through verbal communication via phone or interview or questionnaire will be
distributed to the patients.

Questionnaire:

This will collect information regarding their:

1. Diebetes mellitus duration, socio-economic status, education qualification,

age, lifestyle

2. Anthropometric Measurements- height, weight, BMI

3. What do they know About, Insulin, carbs in their meals, eating habits, etc

4. Has anyone in the family history had diabetes before

5. How long have you had diabetes mellitus

6. Do you know what to eat and what not to eat in diabetes

7. Last time how much did your sugar level rise

8. Your sugar spikes and what do you do

9. What sweets do you take and in what quantity?

10. Do you take insulin and how many times a month do you take insulin
11. Do you take rice for dinner or lunch and in what quantity?

12. Do you eat rice? While cooking rice, do you throw away the rice starch from the
rice and add fresh water again?

13. Have you consulted a dietitian before?

14. Has anyone ever told you about diabetic mellitus before? Or has anyone ever told
you what a diabetic patient should eat and what he should not eat ?

15. Do you know how diabetes can be cured? And what changes do you need to make
in your diet?

16. Do you know what a diabetic patient should eat and what he should not eat in
dry fruits?

17. When do you take sugar tablets?

18. You have you met any dietitian before this and communicate them?

19. When have you needed insulin before and when have you taken

insulin? 20How did you feel after meeting a dietitian?.

Duration of the study- 4-5 months

Conclusion :

Through this study, we get to know if the Diebetes patients know about T1DM and
T2DM they consume carbs in adequate quantity and maintain there glucose level.This
study will help in bringing awareness regarding they should include fruits and vegetables
in there food plate in appropriate manner and all essential nutrients , food groups in
adequate quantity.then from this study patient are so knowledgeble and know about the
diabetes mellitus.There people aware for the diabetic mellitus. They know about which
meals are helpful for the diet. And what foods are nutritious for health.
References :

1. Kirti kaul, Joanna M Tarr Shamim l Ahmad, Eva M kohner , Rakesh chhibber.

2. Salim Bastaki

Dubai Diabetes and Endocrinology Journal 13 (3) 111-134,2005

3. Ashita Singh, Pratibha E Milton, Amrit Nanaiah, Prasanna Samuel, Nihal Thomas

4. Indian journal of endocrinology and metabolism 16 (Suppl1), S83, 2012

5 .M Deepa, A Bhansali, RM Anjana, R Pradeepa, SR Joshi, PP Joshi, VK Dhandhania,

PV Rao, R Subashini, R Unnikrishnan, DK Shukla, SV Madhu, AK Das, V Mohan, T
Kaur

6. Indian journal of endocrinology and metabolism 18 (3), 379, 2014

7. "Diabetes Blue Circle Symbol". International Diabetes Federation. 17 March 2006.