➢ Introduction-

➢ Diabetes-
• What is diabetes?
• Types of diabetes
• Symptoms of diabetes
• Interesting facts
• Treatment for diabetes

➢ INSULIN

➢ Exercise-
• Physical activities and diabetes
• Diabetes medication and exercise
• How much exercise do we need
• Type 2 diabetes prevention tips

➢ Case Study 1

➢ Case Study 2

➢ Conclusion-

➢ Bibliography-
EXERCISE helps control weight, lowers blood pressure,
reduces harmful LDL cholesterol and triglycerides, raises
healthy HDL cholesterol, strengthens muscles and bones, and
reduces anxiety. Exercise can help regulate blood sugar and
increase the body’s sensitivity to insulin. Both are important
for people with diabetes

EXERCISE makes it easier to control Diabetes. When we have

type 2 diabetes. Physical activity is an important component
of your treatment plan. It’s also important to have a healthy
meal plan and maintain blood glucose levels through
medication or insulin, if necessary.
Now let us look into the various types of diabetes, the way it
affects our body, and how we can use EXERCISE to
controland regulate this deadly chronic disease
➢ What is Diabetes?
Diabetes is a disease that affects your body’s
ability to produce or use insulin. Insulin is a
hormone. When your body turns the food you eat
into energy (also called sugar or glucose), insulin
is released to help transport this energy to the
cells. Its chemical message tells the cell to open
and receive glucose.

If you produce little or no insulin or are insulin

resistant, too much sugar remains in your blood.
Blood glucose levels are higher than normal for
individuals with diabetes.
The three main types of diabetes are:
• Type 1 diabetes
• Type 2 diabetes
• Gestational diabetes

Type 1 diabetes
Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that
originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a
hormone required for the cells to use blood sugar for energy and it helps regulate glucose levels in the
bloodstream. Before treatment, this results in high blood sugar levels in the body. The common
symptoms of this elevated blood sugar are frequent urination, increased thirst, increased hunger, weight
loss, and other serious complications. Additional symptoms may include blurry vision, tiredness, and
slow wound healing. Symptoms typically develop over a short period, often in a matter of weeks.[1]
The cause of type 1 diabetes is unknown, but it is believed to involve a combination of genetic and
environmental factors. The underlying mechanism involves an autoimmune destruction of the insulin-
producing beta cells in the pancreas. Diabetes is diagnosed by testing the blood sugar or glycated
hemoglobin (HbA1C) level. Type 1 diabetes can be distinguished from type 2 by testing for the
presence of autoantibodies.
There is no known way to prevent type 1 diabetes. Treatment with insulin is required for survival. Insulin
therapy is usually given by injection just under the skin but can also be delivered by an insulin
pump. A diabetic diet and exercise are important parts of management. If left untreated, diabetes can
cause many complications. Complications of relatively rapid onset include diabetic
ketoacidosis and nonketotic hyperosmolar coma. Long-term complications include heart
disease, stroke, kidney failure, foot ulcers, and damage to the eyes. Furthermore, since insulin lowers
blood sugar levels, complications may arise from low blood sugar if more insulin is taken than
necessary.
Type 1 diabetes makes up an estimated 5–10% of all diabetes cases. The number of people affected
globally is unknown, although it is estimated that about 80,000 children develop the disease each
year. Within the United States, the number of people affected is estimated at one to three million. Rates
of disease vary widely, with approximately one new case per 100,000 per year in East Asia and Latin
America and around 30 new cases per 100,000 per year in Scandinavia and Kuwait. It typically begins
in children and young adults.
 Type 2 diabetes
Type 2 diabetes is due to insufficient insulin production from beta cells in the setting of insulin
resistance. Insulin resistance, which is the inability of cells to respond adequately to normal levels of
insulin, occurs primarily within the muscles, liver, and fat tissue. In the liver, insulin normally
suppresses glucose release. However, in the setting of insulin resistance, the liver inappropriately
releases glucose into the blood. The proportion of insulin resistance versus beta cell dysfunction differs
among individuals, with some having primarily insulin resistance and only a minor defect in insulin
secretion and others with slight insulin resistance and primarily a lack of insulin secretion.
Other potentially important mechanisms associated with type 2 diabetes and insulin resistance include
increased breakdown of lipids within fat cells, resistance to and lack of incretin, high glucagon levels in
the blood, increased retention of salt and water by the kidneys, and inappropriate regulation of
metabolism by the central nervous system. However, not all people with insulin resistance develop
diabetes since an impairment of insulin secretion by pancreatic beta cells is also required.
In the early stages of insulin resistance, the mass of beta cells expands, increasing the output of insulin
to compensate for insulin insensitivity. But when type 2 diabetes has become manifest, a type 2 diabetic
will have lost about half of their beta cells. Fatty in the beta cells activates FOXO1, resulting in
apoptosis of the beta cells.
The causes of the aging-related insulin resistance seen in obesity and type 2 diabetes are uncertain.
Effects of intracellular lipid metabolism and ATP production in liver and muscle cells may contribute to
insulin resistance. New evidence also points to a role of a brain region called the hypothalamus in the
development of insulin resistance. For one thing, a gene called Dusp8 is linked with an increased risk
for diabetes. This gene codes for a protein that regulates neuronal signaling in the hypothalamus. Also,
infusions into the hypothalamus of a hormone called leptin to normalize blood glucose and diminish
insulin resistance in diabetic animals. Activation of hypothalamic cells by leptin has an important role in
maintaining normal levels of blood glucose. Thus, both the endocrine cells of the pancreas AND cells in
the hypothalamus may have a role in the etiology of type 2 diabetes.
Hypothalamic cells regulate blood glucose via projections to the autonomic nervous system. Autonomic
innervation of liver and muscle cells stimulates increased uptake of glucose. In diabetic humans, the
control of blood glucose by the autonomic nervous system is abnormal. Leptin-sensitive, glucose-
regulating neurons become resistant to leptin during aging or exposure to a high-fat diet. These leptin-
resistant neurons fail to restrain food intake, obesity, and blood glucose. The reasons for this lowered
responsiveness to leptin are uncertain and are part of the puzzle of the causes of type 2 diabetes.
Blood glucose levels can also be normalized in diabetic rodents by a single intrahypothalamic infusion
of Fibroblast Growth Factor 1 (FGF1), an effect that persists for months even in severely diabetic
animals. This remarkable cure for diabetes is accomplished by the stimulation of accessory brain cells
called astrocytes. Hypothalamic astrocytes that produce Fatty Acid Binding Protein 7 (FABP7) are
targets of FGF1; these cells are also in close contact with leptin-sensitive neurons, influence their
function, and regulate leptin sensitivity An abnormal function of FABP7+ astrocytes thus may contribute
to the resistance to leptin and insulin that appear during aging and exposure to high-fat diets.
During aging, FABP7+ astrocytes develop cytoplasmic granules derived from
degenerating mitochondria. This mitochondrial degeneration is partly due to the oxidative stress of the
heightened amounts of fatty acids that are taken up by these cells and oxidized within mitochondria. A
pathological degeneration of mitochondria in these cells may compromise their normal functions and
contribute to abnormalities in the control of blood glucose by the hypothalamus.
 Gestational diabetes: -
Gestational diabetes is a condition in which a woman without diabetes develops high blood
sugar levels during pregnancy Gestational diabetes generally results in few symptoms; however, it
increases the risk of pre-eclampsia, depression, and needing a Caesarean section. Babies born to
mothers with poorly treated gestational diabetes are at increased risk of macrosomia, of
having hypoglycemia after birth, and jaundice. If untreated, diabetes can also result in stillbirth. Long
term, children are at higher risk of being overweight and developing type 2 diabetes.
Gestational diabetes can occur during pregnancy because of insulin resistance or reduced production
of insulin. Risk factors include being overweight, previously having gestational diabetes, a family history
of type 2 diabetes, and polycystic ovarian syndrome. Diagnosis is by blood tests. Screening is
recommended for those at normal risk between 24 and 28 weeks gestation. For those at high risk,
testing may occur at the first prenatal visit.
Maintenance of a healthy weight and exercising before pregnancy assist in prevention. Gestational
diabetes is treated with a diabetic diet, exercise, medication (such as metformin), and sometimes insulin
injections. Most women manage blood sugar with diet and exercise. Blood sugar testing among those
who are affected is often recommended four times a day Breastfeeding is recommended as soon as
possible after birth
Gestational diabetes affects 3–9% of pregnancies, depending on the population studied. It is especially
common during the third trimester. It affects 1% of those under the age of 20 and 13% of those over the
age of 44. Several ethnic groups including Asians, American Indians, Indigenous Australians,
and Pacific Islanders are at higher risk. In 90% of cases, gestational diabetes resolves after the baby is
born. Women, however, are at an increased risk of developing type 2 diabetes.
Diabetes symptoms vary depending on how much your
blood sugar is elevated. Some people, especially those
with prediabetes or type 2 diabetes, may not experience
symptoms initially. In type 1 diabetes, symptoms tend to
come on quickly and be more severe.
✓ Some of the signs and symptoms of type 1 and type 2 diabetes are:

• Always thirsty
• Blurry vision
• Always hungry
• Always tired
• Sexual problem
• Frequent urination
• Vaginal infection
➢ INTERESTING FACT
• Fact 1: About 422 million people worldwide
havediabetes
• Fact 2: Diabetes is 1 of the leading causes of
deathin the world
• Fact 3: Diabetes is not caused by eating sugar
• Fact 4: People with diabetes can enjoy sweets
• Fact 5: Diabetes causes a lot of emotions

• Fact 6: Diabetes takes time and adjustment

• Fact 7: Type 2 diabetes is much more common than
type 1 diabetes
• Fact 8: People with diabetes can live long and
healthy lives when their diabetes is detected
andwell managed
• Fact 9: Most diabetes deaths occur inlow and
middle-income countries
• Fact 10: Type 2 diabetes can be prevented
 TREATMENT FOR DIABETES 1: -
The most common forms of type 1 diabetes treatment are:

• Taking insulin
• Carbohydrate, fat, and protein counting
• Frequent blood sugar monitoring
• Eating healthy foods
• Exercising regularly and maintaining a healthy weight

There are four basic types of insulin:

• Rapid-acting: Takes effect within 15 minutes, and usually lasts 3-4 hours. Is
typically taken just before a meal, to compensate for an expected sudden, strong
increase in blood sugar levels.
• Short-acting: Starts working within about 30-60 minutes, and lasts 5-8 hours. Is
also typically taken before a meal.
• Intermediate-acting: Begins to take effect within 1-2 hours, and lasts up to 14
hours.
• Long-acting: Usually starts working within 2 hours, and lasts for up to 24 hours.
Generally used to maintain a background level of insulin, and is typically taken at
night before bed.

TREATMENT FOR DIABETES 2: -

A random blood sugar of greater than 11.1 mmol/L (200 mg/dL) in association with typical
symptoms or hemoglobin (HbA) of ≥ 48 mmol/mol (≥ 6.5 DCCT %) is another method of diagnosing
diabetes. In 2009 an International Expert Committee that included representatives of the American
Diabetes Association (ADA), the International Diabetes Federation (IDF), and the European Association
for the Study of Diabetes (EASD) recommended that a threshold of ≥ 48 mmol/mol (≥ 6.5 DCCT %)
should be used to diagnose diabetes. This recommendation was adopted by the American Diabetes
Association in 2010. Positive tests should be repeated unless the person presents with typical
symptoms and blood sugars >11.1 mmol/L (>200 mg/dL).
The threshold for diagnosis of diabetes is based on the relationship between results of glucose
tolerance tests, fasting glucose or Hb, and complications such as retinal problems A fasting or random
blood sugar is preferred over the glucose tolerance test, as they are more convenient for
people. HbA has the advantages that fasting is not required and results are more stable but have the
disadvantage that the test is more costly than the measurement of blood glucose. It is estimated that
20% of people with diabetes in the United States do not realize that they have the disease.
Type 2 diabetes is characterized by high blood glucose in the context of insulin resistance and relative
insulin deficiency. This is in contrast to type 1 diabetes in which there is an absolute insulin deficiency
due to the destruction of islet cells in the pancreas and gestational diabetes which is a new onset of
high blood sugars associated with pregnancy. Type 1 and type 2 diabetes can typically be distinguished
based on the presenting circumstances. If the diagnosis is in doubt antibody testing may be useful to
confirm type 1 diabetes and C-peptide levels may be useful to confirm type 2 diabetes, with C-peptide
levels normal or high in type 2 diabetes, but low in type 1 diabetes.
 INSULIN
Insulin from the Latin insula ( 'island') is a peptide hormone produced by beta cells of the pancreatic
islets encoded in humans by the INS gene. It is considered to be the main anabolic hormone of the
body. It regulates the metabolism of carbohydrates, fats, and protein by promoting the absorption
of glucose from the blood into the liver, fat, and skeletal muscle cells. In this tissue, es the absorbed
glucose is converted into either glycogen via glycogenesis or fats (triglycerides) via lipogenesis, or, in
the case of the liver, into both. Glucose production and secretion by the liveries are strongly inhibited by
high concentrations of insulin in the blood. Circulating insulin also affects the synthesis of proteins in a
wide variety of tissues. It is therefore an anabolic hormone, that promotes the conversion of small
molecules in the blood into large molecules inside the cells. Low insulin levels in the blood have the
opposite effect by promoting widespread catabolism, especially of reserve body fat.
Beta cells are sensitive to blood sugar levels so they secrete insulin into the blood in response to high
levels of glucose, and inhibit its secretion of insulin when glucose levels are low. Insulin enhances
glucose uptake and metabolism in the cells, thereby reducing blood sulevelsevel. Their
neighboring alpha cells, by taking their cues from the beta cells, secrete glucagon into the blood in the
opposite manner: increased secretion when blood glucose is low, and decreased secretion when
glucose concentrations are high. Glucagon increases blood glulevelslevel by
stimulating glycogenolysis and gluconeogenesis in the liver. The secretion of insulin and glucagon into
the blood in response to the blood glucose concentration is the primary mechanism of glucose
homeostasis
Decreased or absent insulin activity results in diabetes mellitus, a condition of high blood sugar level
(hyperglycemia). There are two types of disease. In diabetes mellitus type 1, the beta cells are
destroyed by an autoimmune reaction so that insulin can no longer be synthesized or be seated into the
blood. In diabetes mellitus type 2, the destruction of beta cells is less pronounced than in type 1 and is
not due to an autoimmune process. Instead, there is an accumulation of amyloid in the pancreatic islets,
which likely disrupts their anatomy and physiology. The pathogenesis of type 2 diabetes is not well
understood but the reduced population of islet beta-cells, reduced secretory function of islet beta-cells
that survive, and peripheral tissue insulin resistance are known to be involved. Type 2 diabetes is
characterized by increased glucagon secretion which is unaffected by, and unresponsive to the
concentration of blood glucose. But insulin is still secreted into the blood in response to the blood
glucose. As a result, glucose accumulates in the blood.
The human insulin protein is composed of 51 amino acids and has a molecular mass of 5808 Da. It is a
heterodimer of an A-chain and a B-chain, which are linked together by disulfide bonds. Insulin's
structure varies slightly between species of animals. Insulin from animal sources differs somewhat in
effectiveness (in carbohydrate metabolism effects) from human insulin because of these
variations. Porcine insulin is especially close to the human version, and was widely used to treat type 1
diabetics before human insulin could be produced in large quantities by recombinant DNA technologies.
Insulin was the first peptide hormone discovered. Frederick Banting and Charles Herbert Best, working
in the laboratory of J. J. R. Macleod at the University of Toronto, were the first to isolate insulin from a
dog pancreas in 1921. Frederick Sanger sequenced the amino acid structure in 1951, which made
insulin the first protein to be fully sequenced. The crystal structure of insulin in the solid state was
determined by Dorothy Hodgkin in 1969. Insulin is also the first protein to be chemically synthesized
and produced by DNA recombinant technology. It is on the WHO Model List of Essential Medicines, the
most important medications needed in a basic health system.
 Medical uses

Two vials of insulin. They have been given trade names, Actrapid (left) and NovoRapid (right) by the
manufacturers.
Biosynthetic human insulin (insulin human rDNA, INN) for clinical use is manufactured by recombinant
DNA technology. Biosynthetic human insulin has increased purity when compared with extractive
animal insulin, with enhanced purity reducing antibody formation. Researchers have succeeded in
introducing the gene for human insulin into plants as another method of producing insulin
("biopharming") in safflower. This technique is anticipated to reduce production costs.
Several analogies of human insulin are available. These analogs are closely related to the human
insulin structure and were developed for specific aspects of glycaemic control in terms of fast action
(prandial insulins) and long action (basal insulins). The first biosynthetic insulin analogy was developed
for clinical use at mealtime (prandial insulin), Humalog (insulin lispro), it is more rapidly absorbed after
subcutaneous injection than regular insulin, with an effect 15 minutes after injection. Other rapid-acting
analogs are NovoRapid and Apidra, with similar profiles. All are rapidly absorbed due to amino acid
sequences that will reduce the formation of dimers and hexamers (monomeric insulins are more rapidly
absorbed). Fast-acting insulins do not require the injection-to-meal interval previously recommended for
human insulin and animal insulins. The other type is long-acting insulin; the first of these
was Lantus (insulin glargine). These have a steady effect for an extended period from 18 to 24 hours.
Likewise, another protracted insulin analog (Levemir) is based on a fatty acid acylation approach.
A myristic acid molecule is attached to this analog, which associates the insulin molecule with the
abundant serum albumin, which in turn extends the effect and reduces the risk of hypoglycemia. Both
protracted analogs need to be taken only once daily and are used for type 1 diabetics as the basal
insulin. A combination of rapid-acting and protracted insulin is also available, making it more likely for
patients to achieve an insulin profile that mimics that of the body's insulin release. Insulin is also used in
many cell lines, such as CHO-s, HEK 293, or Sf9, for the manufacturing of monoclonal antibodies, virus
vaccines, and gene therapy products.
Insulin is usually taken as subcutaneous injections by single-use syringes with needles, via an insulin
pump, or by repeated-use insulin pens with disposable needles. Inhaled insulin is also available in the
U.S. market.
Unlike many medicines, insulin cannot be taken by mouth because, like nearly all other proteins
introduced into the gastrointestinal tract, it is reduced to fragments, whereupon all activity is lost. There
has been some research into ways to protect insulin from the digestive tract so that it can be
administered orally or sublingually.
In 2021, the World Health Organization added insulin to its model list of essential medicines.
➢ Aerobic (Endurance) Exercise
Aerobic exercises increase your breathing and heart rate and are the main
component of overall fitness programs. They keep the circulatory system
and lungs healthy, can stave off diabetes and heart disease, and help you
build up endurance. Some common aerobic activities include

• Dancing
• Biking
• Doing yard work like raking, digging, and gardening
• Swimming laps

➢ Strength exercises
These are important for strengthening your bones and muscles and
helping older adults maintain independence. Strength training is
beneficial in reducing falls and helping you do everyday activities that
require lifting, such as carrying groceries. Some examples of strength
training include:

• Lifting free weights

• Using resistance machines at the gym

➢ Flexibility
Though not part of the CDC’s official recommendations for maintaining
good physical health, flexibility exercises can keep your body limber and
help you maintain a wide range of motion. This is important because the
range of motion is often limited by things like arthritis. Here are some
ways to improve your flexibility:

• Stretching various parts of the body

• Doing yoga

➢ Balance exercises
Practicing and improving balance is important for older adults because
it can strengthen the body’s core and help prevent falls. Here are some
good balance exercises:

• Heel-to-toe walking
➢ Physical Activities and Diabetes
Physical activity is like a “secret weapon” to help fight
diabetes. When you exercise, your muscles use glucose for
energy. This reduces the amount of glucose in your blood.
Exercise also makes your body more sensitive to insulin,
which means that insulin can better move glucose from
your blood into your cells. Exercise also helpsimprove
other common medical problems in people with diabetes,
such as high blood pressure and highcholesterol.

➢ Medication & exercise

It is important for people with diabetes to
understand the mechanisms of blood glucose
response to exercise and how
their medications may affect their blood glucose
levels when they are physically active. The doses
and timing of certain medications may require
adjustment to avoid hypoglycemia during or
after exercise.

➢ HOW MUCH EXERCISE DO WE NEED?

The American Diabetes Association (ADA)
recommends the following physical activity for adults
with type 2 diabetes for blood sugar benefits and
overall health:
• At least two and a half hours of moderate to vigorous
intensity physical activity per week (i.e., brisk walking,
water aerobics, swimming, or jogging).

• Two to three sessions of resistance exercise per week.

Resistance exercise is a physical activity that
strengthensmuscle strength, such as lifting five-pound
weights or doing pushups.
• No more than two days in a row without physical activity.
• Breaking up sitting time every 30 minutes during the day.
• Incorporate flexibility exercises, like stretching or yoga
into your weekly routine.
❖ Type 2 Diabetes Prevention Tips
➢ Manage your weight.

Excess body fat, particularly if stored around the abdomen, can increase
the body’s resistance to the hormone insulin. This can lead to type 2
diabetes.

➢ Exercise regularly.

Moderate physical activity on most days of the week helps manage

weight, reduce blood glucose levels, and may also improve blood
pressure and cholesterol.

➢ Eat a balanced, healthy diet.

Reduce the amount of fat in your diet, especially saturated and trans
fats. Eat more fruit, vegetables, and high-fiber foods. Cut back on salt.

➢ Limit takeaway and processed foods.

‘Convenience meals’ are usually high in salt, fat, and kilojoules. It is

bestto cook for yourself using fresh ingredients whenever possible.

➢ Limit your alcohol intake.

Too much alcohol can lead to weight gain and may increase your blood
pressure and triglyceride levels. Men should have no more than two
standard drinks a day and women should have no more than one.

➢ Quit smoking.

Smokers are twice as likely to develop diabetes as non-smokers.

➢ Control your blood pressure.

Most people can do this with regular exercise, a balanced diet, and
keeping a healthy weight. In some cases, you might need medication
prescribed by your doctor.
➢ Reduce your risk of cardiovascular disease.

Diabetes and cardiovascular disease have many risk factors in common,

including obesity and physical inactivity.

➢ See your doctor for regular check-ups.

As you get older, it’s a good idea to regularly check your blood glucose,
blood pressure, and blood cholesterol levels.
 CASE STUDY 1
NAME: - Bijaya Mukherjee

AGE: - 72

GENDER: - female

Disease: - diabetes mellitus

Medicine used for treatment: - a) Insulin (10 units per day)

b) Amylinomimetic injectables

c) Alpha-glucosidase inhibitors
 Case study 2
NAME: - Amil Biswas

AGE: - 77

GENDER: - Male

DISEASE: - Diabetes mellitus

MEDICINE FOR TREATMENT: -

a) Amylinomimetic injectables

b) Alpha-glucosidase inhibitors
The coming years will be very exciting regarding the
advances in the field of the prevention of diabetes however
the cornerstone of therapy will likely remain a Healthy
lifestyle
 ACKNOWLEDGEMENT
I would like to express my gratitude and my heartful thanks to
my class teacher MRS. Sudipta Chatterjee who is also my biology
teacher for her excellent guidance, support, and encouragement
without which the successful completion of this project would not
have been possible.
I would also like to thank our lab coordinator Piyush sir for
the facilities that were provided by the school.
Last but not least I would like to thank my parents for their
constant support and efforts along with their useful opinions and
inputs which have helped me in completing the project.
 CERTIFICATE
I express my sincere gratitude to our biology teacher, Miss. Sudipta
Chatterjee for her support in the preparation of the project. I
gratefully acknowledge her for her guidance to foster the topic: -
Diabetes mellitus to me and also for her encouragement in completing
the project.

I also want to acknowledge our lab assistant Mr.Pijush Kanti Sur for
his support in the completion of the project.

I also want to acknowledge my parents and friends who supported me

and helped me throughout this project.

________________________________ ____________________________________
Signature of subject teacher Signature of an external teacher

(BIOLOGY)
❖ https://www.davita.com/education/kidney-disease/risk-factors/diabetes

❖ https://www.who.int/features/factfiles/diabetes/en/

❖ https://www.mayoclinic.org/diseases-conditions/diabetes/symptoms-causes/syc-20371444

❖ https://www.cdc.gov/diabetes/basics/quick-facts.html

❖ https://en.wikipedia.org/wiki/Exercise

❖ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2992225/

❖ https://www.betterhealth.vic.gov.au/health/ten-tips/10-tips-to-help-prevent-type-2-diabetes