• Group 3-PARTICIPANTS

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• AADITYA SUNDARAM
• ADVIK SHUKLA
• AYUSH TRIVEDI
• RABIA MUSTAFA SAYA
• RIDDHI WADHWANI
• RIYA VENKATESH
• SHREY GUPTA
• YOGESH KRISHNA

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DIABETES

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TABLE OF CONTENT

INTRODUCTION

BASIC DESCRIPTION

INSULIN RESISTANCE

BRIEF HISTORY

SITE OF OCCURRENCE AND TARGET POPULATION

GENETIC LIFESTYLE

INSULIN

BATTLE OF SCIENCE AGAINST DIABETES

JUVENILE DIABETES

INTRODUCTION

Diabetes is a disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar

BASIC DESCRIPTION

• Most of the food you eat is broken down into sugar (also called glucose) and released into your bloodstream. When your blood sugar goes up, it signals your pancreas to release insulin. Insulin acts like a key to let the blood sugar into your body’s cells for use as energy.
• If you have diabetes, your body either doesn’t make enough insulin or can’t use the insulin it makes as well as it should. When there isn’t enough insulin or cells stop responding to insulin too much blood sugar stays in your bloodstream. Over time, that can cause serious health problems, such as heart disease, vision loss, and kidney disease

INSULIN AND ABSORPTION OF BLOOD SUGAR

• The food you eat is broken down into blood sugar.
• Blood sugar enters your bloodstream, which signals the pancreas to release insulin.
• Insulin helps blood sugar enter the body’s cells so it can be used for energy.
• Insulin also signals the liver to store blood sugar for later use.
• Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
• Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you haven’t eaten for a while.

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INSULIN RESISTANCE

• A lot of blood sugar enters the bloodstream.
• The pancreas pumps out more insulin to get blood sugar into cells.
• Over time, cells stop responding to all that insulin—they’ve become insulin resistant.
• The pancreas keeps making more insulin to try to make cells respond.
• Eventually, the pancreas can’t keep up, and blood sugar keeps rising.

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DIABETES MElLITUS AND DIABETES INSIPIDUS

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• Diabetes mellitus - It is simply known as diabetes happens when pancreas does not produce enough insulin to control blood sugar.

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• Diabetes insipidus - Occurs when the body can’t regulate how it handles fluids. It has nothing to do with the pancreas or insulin.

The Battle of Science Against Diabetes�(Past and Present)

Brief History of Disease (Diabetes Mellitus )

• The term diabetes mellitus comes from the Greek word “diabetes” (to siphon or pass through) and the Latin word “mellitus” (honey or sweet)
• Sushruta & Charak (6th century BCE) an Indian healer identified diabetes and classified it as “Madhumeha”. Here the word “madhu” means honey and combined the term means sweet urine.
• Another mention of diabetes symptoms was in 1552 B.C., when Hesy-Ra, an Egyptian physician, documented frequent urination as a symptom of a mysterious disease that also caused emaciation.

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History of Detection of Disease

• Earlier people discovered that they could use ants to test for diabetes by presenting urine to them. If the ants came to the urine, this was a sign that it contained high sugar levels. They called the condition “madhumeha”, meaning honey urine.
• Later in 1950s, the method a person used to control his blood glucose levels was to drop a reagent (Benedict's Reagent) tablet/ solution, into a small test tube containing a few drops of urine and warm it slightly. The resulting colour – from dark blue to orange (Using shade card) – indicated the amount of sugar in the urine.

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History of Treatment

• Ayurveda from Vedic period used the herbs to treat diabetes include shilajit, turmeric, neem, coccinea indica, amalaki, triphala, bitter gourd, rose apple, leaves of bilva, cinnamon, gymnema, fenugreek, bay leaf and aloe vera.

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• Ancient Egyptians used Elderberry, Fibres of the Asit plant, Fresh Milk, Beer-Swill, Flower of the Cucumber, and Green Dates to treat Diabetes.

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• The early Greek physicians recommended treating diabetes with exercise, if possible, on horseback. They believed that this activity would reduce the need for excessive urination.

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• Other treatment options have included:

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• A “non-irritating” milk-and-carb diet, for example, milk with rice and starchy, gummy foods “to thicken the blood and supply salts” or milk and barley water boiled with bread.
• Powders of fenugreek, lupin, and wormseed
• Foods that are “easy of digestion,” such as veal and mutton
• Green vegetables
• A carb-free diet & fasting

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INSULIN: The Breakthrough

• In 1889, Joseph von Mering and Oskar Minkowski found that removing the pancreas from dogs led them to develop diabetes and die shortly afterward. This discovery helped scientists understand the role of the pancreas in regulating blood sugar levels.
• In 1910, Sir Edward Albert Sharpey-Schafer proposed that diabetes developed when there was a lack of a particular chemical that the pancreas produced. He called it insulin, meaning island, because the cells in the islets of Langerhans in the pancreas produce it.
• In 1921, Frederick Banting and Charles Best introduced an extract of pancreatic islet cells from healthy dogs into dogs with diabetes. Doing this reversed diabetes and marked the discovery of the hormone insulin. They worked with two other scientists to purify insulin that they took from the pancreas of cows and produce the first treatment for diabetes.
• In January 1922, 14-year-old Leonard Thompson was the first person to receive an injection of insulin to treat diabetes. Thompson lived another 13 years with the condition.

Diabetes�Site of Occurence�&�Target Population�

Age Groups Most affected by Diabetes Type 1

• Type 1 diabetes (T1D) usually begins before 40 years of age, although occasionally people have been people diagnosed at an older age. The peak age at diagnosis is most often around 14 years old and mostly occurs in children.

Why Does Type 1 Diabetes Occur More In children than Adults?

• Due to the intake of excessive sugar
• which is more than what the body can handle causes the production of the Insulin hormone to be stopped causing diabetes.

Age Groups Most affected by Type 2 Diabetes

• However, Type 2 diabetes occurs most often in middle-aged and older people. You are more likely to develop type 2 diabetes if you are age 45 or older adults than children or young adults.

Why does type 2 diabetes usually occur in Middle aged or older people?

• It Usually occurs in middle aged or older adults mostly because the body has put on a lot of weight causing people to have a higher chance of becoming overweight or obese which is a major risk Factor of diabetes.

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Ethnic Groups Most affected by Diabetes

• Diabetes is more common in people who are:
• African American
• Hispanic/Latino
• American Indian
• Asian American
• Pacific Islander
• These are mostly cases of Diabetes Type 2.

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Other Reasons For having a Higher chance of getting Diabetes?

• Other reasons that could make the probability of having Diabetes are :
• If you have a family history of diabetes
• If you are not physically active

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Men or Women , Who have a higher chance of getting Diabetes?

• While you might think that males and females experience diabetes in the same way, there are some important differences. A number of studies have shown that both type 1 and type 2 diabetes are more common in men than in women.

Why does Diabetes occur More In Men?

• Men carry more Fat than Women and the excess Fat present is a huge Risk Factor for the Onset of Diabetes.

Where does Diabetes occur more, in Rural or Urban areas?

• Rural areas : People there have higher rates of obesity,environmental characteristics and access barriers, which can make it more challenging to consume healthy foods, such as fruits and vegetables putting them at an increased likelihood of developing diabetes.

Type 1 Diabetes Site Of Occurence In the Body

Type 2 Diabetes Site of occurence in the body.

• Type 2 diabetes is an impairment in the way the Body regulates and uses sugar , glucose which causes your fat , liver and muscle cells to not respond correctly to insulin.

Causes - Genetic / Lifestyle

G Genetics

�How is type 2 diabetes caused? What is the role of the genetics in type II diabetes?��Type 2 diabetes can be inherited and is linked to your family history and genetics, but environmental factors also play a role. Not everyone with a family history of type 2 diabetes will get it, but you're more likely to develop it if a parent or sibling has it.���

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GENETICS:

How are genetic mutations responsible? How can we identify these?��The genetic mutations that cause diabetes involve the proteins responsible for insulin production or the ability of the body to use insulin. Mutations cause the proteins to function improperly. Genetic testing can identify these mutations in certain cases, but the usefulness of the information they provide varies.

Type 1 Diabetes / Mody - Genetics

Type 1 Diabetes��Type 1 Diabetes First degree relatives have a higher risk of developing T1D than unrelated individuals from the general population (approximately 6% vs. <1%, respectively) (Dorman and Bunker, 2000). These data suggest that genetic factors are involved with the development of the disease. ���

Maturity Onset Diabetes of the Young ��MODY displays an autosomal dominant pattern inheritance, generally spanning three generations (Stride and Hattersley, 2002). Because of advances in molecular genetics, it is now known that there are at least six forms of MODY, each of which caused by a mutation in a different gene that is directly involved

They include polluted air, soil, water, unhealthy diet, stress, lack of physical activity, vitamin-D deficiency, exposure to enteroviruses, and damage to immune cells.

Environmental Causes

• Hygiene, pollutants, vaccines, maternal age, psychological stress and seasonal variation

Causes for Type 2 Diabetes

• Lack of physical activity
• Poor dietary habits
• Lack of sleep
• Stress

• An individual more likely to develop type 2 diabetes if he/she is not physically active and are overweight or obese.

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• Extra weight sometimes causes insulin resistance and is common in people with type 2 diabetes. The location of body fat also makes a difference.

Lifestyle

Habits to prevent Diabetes

• Quit smoking.
• Keep your blood pressure and cholesterol within a healthy range.
• Maintain a healthy weight.

• Stay physically active, at least 30 minutes most days of the week.
• Consult a nutritionist or certified diabetes educator (CDE) for meal planning advice.

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Gestational DIABETES

MYTH!

“Only overweight women develop gestational diabetes”- This is just a myth. It has been found that even in cases of low BMI among people there is an increased risk.

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What is gestational Diabetes

• A condition in which your blood sugar levels become high during pregnancy.

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• It affects pregnant women who haven’t ever been diagnosed with diabetes.

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• It can cause health problems in both mother and baby.

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Prevalence in India

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• The prevalence of gestational diabetes has been reported from 3.8% to 17.9% in different parts of India.

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• It is difficult to predict any uniform prevalence levels of GDM (Gestational Diabetes Mellitus) in India, because of wide differences in living conditions, socioeconomic levels, and dietary habits.

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Classes/Types of Gestational Diabetes

• There are two classes of gestational diabetes: A1 and A2.
• Women with class A1 can manage it through diet and exercise.
• Those who have class A2 need to take insulin or other medications.
• Gestational diabetes goes away after giving birth. But it can affect the baby’s health, and it raises the mother’s risk of getting type 2 diabetes later in life.

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Symptoms

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• Fatigue

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• Nausea

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• Blurred vision

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• Excessive thirst & hunger

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• Excessive need to urinate

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• Yeast infections

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Causes of Gestational Diabetes

• When we eat, our pancreas releases insulin, a hormone that helps move a sugar called glucose from our blood to our cells, which is used for energy.

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• During pregnancy, the placenta makes hormones that cause glucose to build up in the mother’s blood.

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• Usually, the pancreas can send out enough insulin to handle it. But if the body can’t make enough insulin or stops using insulin as it should, then blood sugar levels rise, and gestational diabetes occurs.

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Risk Factors

• Being overweight 
• Having blood sugar levels that are higher than they should be but not high enough to be diabetes (this is called prediabetes).
• Having a family member with diabetes
• Having gestational diabetes before
• Having polycystic ovary syndrome (PCOS) or another health condition linked to problems with insulin
• Having high blood pressure, high cholesterol, heart disease, or other medical complications
• Having given birth to a large baby (weighing more than 9 pounds)
• Having had a miscarriage

Tests And Diagnosis

Gestational diabetes usually happens in the second half of pregnancy. Doctor will check for it between weeks 24 and 28, or sooner if a woman is at at high risk.

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• Glucose challenge test: The patient drinks a sweet liquid. After about an hour, a blood test is done to check the blood sugar level. If the blood sugar is high, then the healthcare provider will do a glucose tolerance test.

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• Glucose tolerance test: An oral glucose tolerance test is only done if the challenge test results are unusual. One need not fast (don’t eat for eight hours) before the tolerance test. The healthcare provider draws the patient’s blood before and after drinking a sweet liquid. The tolerance test can confirm a diagnosis of gestational diabetes.

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• If a woman at high risk but her test results are normal, the doctor might test the mother again in the later stages of pregnancy to rule out the presence of the condition.

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Treatment

If a woman has gestational diabetes, she will need treatment as soon as possible to keep herself and the baby healthy during your pregnancy and delivery. The doctor will ask the patient to:

• Check urine for ketones, chemicals that mean that diabetes isn’t under control
• Consume the prescribed medications
• Take insulin regularly as advised
• Learn GDM management (upcoming slide)
• The doctor will keep track of the mother’s weight and the baby’s development. They might give insulin or another medicine to keep blood sugar under control.

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Outlook

• Mother’s blood sugar should return to normal after giving birth.

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• Developing gestational diabetes raises risk of type 2 diabetes later in life.

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• It is advisable to consult a doctor to lower the risk of developing this condition and associated complications.

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Complications

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Mother’s risk :

• Cesarean birth (C-section) if the baby gets too big.
• Hypoglycemia (low blood sugar).
• Preeclampsia (high blood pressure during pregnancy).
• Type 2 diabetes.

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The baby’s risk include:

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• Breathing problems
• Hypoglycemia
• Obesity
• Premature birth
• Type 2 diabetes
• Shoulder dystocia, which causes their shoulders to get stuck in the birth canal during labor

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GDM Management

Make diabetes management part of your daily routine. Create a schedule and stick to it. Try to:

• Check your blood glucose levels thrice (or around four/more times) at the same time each day.

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• Choose three days each week to get 30 minutes of light exercise – like taking a walk and being active through the day.

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• Plan small, balanced meals ahead of time and always eat healthy - Diet: pay special attention to their carbohydrate, protein, and fat intake.

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• Eating regularly — as often as every 2 hours — can also help you manage your blood sugar levels.

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• Health-promoting carbohydrate choices include: whole grains, brown rice, beans, peas, lentils, and other legumes, starchy vegetables, low-sugar fruit.

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• Good sources of protein include lean meats and poultry, fish, and tofu.

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• Health-promoting fats to incorporate into your diet include: unsalted nuts, seeds, olive oil, avocado.
• Talk with your healthcare provider or a diabetes educator about other tips for daily diabetes management.

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Preventive measures

• It’s not possible to prevent gestational diabetes entirely.
• Adopting health-promoting habits can help reduce one’s chances of developing the condition.
• Furthermore, it’s important for pregnant women to seek prenatal care and follow all doctor-recommended visits to receive the appropriate screenings and evaluations during their pregnancies.

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Juvenile Diabetes

What is Juvenile Diabetes

Type 1 diabetes in children is a condition in which a child’s body no longer produces insulin (an Important hormone). Juvenile diabetes is mostly an autoimmune disorder. Insulin is important for a child’s survival because it transports glucose present in the bloodstream to the body, so it needs to be replaced by injections or insulin pumps. Type 1 Diabetes in Children was previously known as Juvenile Diabetes. It’s less common but adults can also get it. The most common age for a juvenile diabetes diagnosis is between 10 and 16.

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Symptoms

1. Increased Thirst
2. Frequent Urination
3. Unintentional Weight Loss
4. Bad or fruity-smelling breath
5. Fatigue,Blurred vision
6. Extreme hunger
7. Stomach ache, vomiting, and fainting
8. Irritability or behavior changes

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Causes

The exact cause of type 1 diabetes is unknown. In most patients with type 1 diabetes, the body’s immune system mistakenly destroys the insulin-producing cells in the pancreas rather than fighting harmful bacteria and viruses. Environmental factors, family history, and genetics play an important role in this process.

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Complications

Heart and Blood vessel disease – narrowed blood vessels, high blood vessels, heart disease, and stroke.

Nerve damage - Excess sugar can injure the walls of the tiny blood vessels that nourish a child's nerves. This can cause tingling, numbness, burning, or pain.

Kidney Damage - Diabetes can damage the numerous tiny blood vessel clusters that filter waste from your child's blood.

Eye Damage - Diabetes can damage the blood vessels of the retina, which may lead to vision problems.

Osteoporosis - Diabetes may lead to lower-than-normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

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Tests for Juvenile Diabetes

• · Blood test

1. A1C test

2. Fasting blood sugar test

3. Random Blood sugar test

4. Antibody test

5. Urine test

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Prevention

Researchers are working on:

· Preventing type 1 diabetes in people who have a high risk of the disease, and recently identified at least one drug that may slow down the development of the condition.

Doctors can detect the antibodies associated with type 1 diabetes in children who have a high risk of the disorder. These antibodies can be detected months or even years before the first symptoms of type 1 diabetes appear, but there's currently no known way to slow or prevent the disease when antibodies are found.

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Modern Treatment with Insulin

• People with diabetes need to use insulin every day. People continued to use injectable animal-based insulin for many years, but recent years have seen further advances in treatment.
• These include the introduction of insulin analogs and the development of new ways to deliver insulin. Both of these factors have made diabetes treatment more effective.
• In 1978, scientists created the first human-based insulin, which they named Humulin. Humulin is identical in structure to human insulin. Lispro, the first short-acting insulin, appeared on the market in 1996. It begins to work about 15 minutes after injection and keeps working for 2–4 hours.
• Long-acting insulins, such as insulin glargine, take longer to absorb and remain active for up to 24 hours.
• People who use insulin tend to combine long- and short-acting types. The long-acting dose works throughout the day, while the short-acting dose boosts insulin levels around mealtimes.

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Non Insulin Therapies : Current and Upcoming

There are six types of non-insulin medicines used to treat diabetes:

• Metformin:�Pills that reduce sugar production from the liver

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• Thiazolidinediones (glitazones):�Pills that enhance sugar removal from the blood stream

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• Insulin releasing pills (secretagogues):�Pills that increase insulin release from the pancreas

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• Starch blockers:�Pills that slow starch (sugar) absorption from the gut

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• Incretin based therapies:�Pills and injections that reduce sugar production in the liver and slow the absorption of food

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• Amylin analogs:�Injections that reduce sugar production in the liver and slow the absorption of food

Scientists are working on other Non-Insulin medications which are more effective and have lesser or no serious side effects

Present Testing Options

• In the 1980s, the first blood glucose monitors became available for home use, providing an accurate way to monitor blood sugar. People who use insulin have to measure their glucose levels to determine how much insulin they need and how well their treatment is working.
• You prick your finger with a small, sharp needle called a lancet, put a drop of blood on a test strip, and then place the strip into a meter that displays your blood sugar levels. 

Another device called Continuous blood glucose monitors, CGMs for short. These are wireless devices, first created in 2006, that can be attached to the body with a small sensor under the skin to measure glucose levels as frequently as every 5 minutes, 24 hours a day, for up to 10 days (depending on the device).

Present Trends in Controlling Diabetes: Insulin Injections

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Currently most popular and cost effective insulin delivery method is by filling small hypodermic syringes with insulin from vials. In these instances, special care must be taken to ensure that the correct dose of the diluted insulin is administered with an ordinary insulin syringe.

Present Trends in Controlling Diabetes: Insulin Pumps

Insulin pumps

• Insulin-dependent diabetes need the medication insulin to regulate their blood sugar. It can only be administered through the skin, and needs to be delivered into the body throughout the day. This can mean an average of four to six injections a day in the thigh or abdomen, which can be time-consuming and painful to manage in busy, everyday life.
• But, insulin pumps are devices that can help provide continuous insulin without requiring multiple injections throughout the day. There are two types that both work in similar ways; One is a pod that contains the insulin, and the mechanism that delivers the insulin into the skin through sharp plastic tube that the user inserts. It connects wirelessly to a controller half the size of an iPhone.

Future Trends : Testing, Treatment & Cure�(The best way to predict the future is to create it.)

Looking into various options that may help people with diabetes in the future.

• Digital Contact Lenses: Tiny contact lens type device that is placed under the eyelid, through the lens, one can get more information from the digital world plus it can measure blood glucose levels from tears as an added benefit.
• Digital tattoos: An electronic skin patch that senses excess glucose in sweat and automatically administers drugs by heating up microneedles that penetrate the skin.
• Cell Therapy: Replacing the missing insulin-producing cells could potentially recover normal insulin production and cure patients.
• Immunotherapy:Designed to stop type 1 diabetes by specifically killing the immune cells that destroy the pancreas
• Artificial pancreas:The device, also referred to as closed-loop glucose control, involves using an external pump and continuous glucose monitoring to deliver insulin in a single system.
• Nanomedicine: Involves measurement and therapy at the level of 1-100 nm. Although the science is still in its infancy, it has major potential applications in diabetes. These include solving needs such as non-invasive glucose monitoring using implanted nano-sensors, with key techniques being fluorescence resonance energy transfer (FRET) and fluorescence lifetime sensing, as well as new nano-encapsulation technologies for sensors such as layer-by-layer (LBL) films.

Artificial Intelligence: The Future for Diabetes Care

Artificial Intelligence

• AI has been described as “a branch of computer science that aims to create systems or methods that analyze information and allow the handling of complexity in a wide range of applications.” The application of AI to diabetes is feasible and desirable for efficient data handling and the development of tools and devices for its management. To provide safer technology through AI, it is recommended to have safe designs, safety reserves, and procedural safeguards, with all uncertainties identified for all potential technical systems.
• Technical advances- wearables, smart-phones, and other gadgets that can aid in the continuous monitoring and tracking of patients symptoms and disease status. Physicians and health care professionals should allow patients to choose AI-assisted care for the effective management of diabetes.⁹
• AI can influence and improve 3 main domains of diabetes care: patients with diabetes, health care professionals, and health care systems . AI has added newer dimensions of self-care for patients with diabetes, introduced rapid and reliable decision making and flexible follow-ups for health care providers, and optimized resource utilization in health care systems.

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Conclusion

So has it been conquered?

We might have won the battle but the war is still on! There's no cure yet, the number of people with diabetes, is growing. A range of treatment options and lifestyle measures can help people manage the condition. Scientists are continuing to develop ground breaking & improved treatment options to give people with diabetes the best possible quality of life.

Maybe we can say that we have partially conquered the diabetes with prevention, early detection and Maintaining the disease.

LET’S PLAY

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DOWNLOAD AND PLAY:

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https://drive.google.com/file/d/1_IbDO4c-L_3MuZZ_xM8jkWxzOKtfWrLr/view?usp=sharing

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