Case Scenario:
Taking control of diabetes during fasting
http://www.asiaone.com/Health/Eat+Right/Story/A1Story20110803-292469.html
Mariam Abdullah, a diabetic for 25 years, is aware of the complications if her condition is uncontrolled.
She monitors her blood sugar level, eats the right food, exercises and never misses taking her
medication. This way, she does not have problems fasting during Ramadan.
"I've always been active and I eat right but I became more serious about my diet when I found out that
I have diabetes. I eat only small portions of rice with steamed vegetables or skinned chicken twice a
week. I like to walk or jog around my house," says Mariam.
The only problem she faced previously during Ramadan was a lack of energy because she did not
have proper meals during sahur (pre-dawn meal). Since she was worried about eating too much, she
avoided rice and carbohydrates, eating only fruit and vegetables with a glass of milk for sahur.
"I had to stop fasting a few days previously because I became weak. I realise my mistake and I now
eat at least a bowl of rice at sahur. For buka puasa, I avoid food rich in carbohydrates, to control my
blood sugar."
Mariam, 61, developed diabetes when she was pregnant with her youngest child.
Although her blood sugar level returned to normal after giving birth, the condition came back five
years later.
"Once I had diabetes, I made sure I took my medication and followed the doctor's advice. My blood
sugar level is only between six and seven and I do not have any complication."
Her daughter, Nor Salina Bee Mohd Nor, 36, has a different approach. She was diagnosed with
diabetes due to obesity, 11 years ago.
"Unlike my mother, I did not control my condition when I was first diagnosed. I had eczema on my foot
which caused an infection. Three years ago, when I became a single mother, I knew I had to change
my lifestyle. I am now following the advice by the doctor and diabetes educator."
Nor Salina has to have insulin injections three times a day in addition to medication to control her
blood sugar level. Currently her blood sugar level is 10 compared to 16 two years ago.
Despite her illness, Nor Salina has no problems when it comes to fasting.
"I did not change my diet completely but I eat smaller portions. I love food but now I am more aware of
my diet. For sahur and breaking fast, I eat small portions of rice with vegetables and fish or meat. And
I check my blood sugar level regularly."
Universiti Kebangsaan Malaysia Medical Centre senior consultant physician and endocrinologist
Professor Dr Nor Azmi Kamaruddin says diabetic patients who fast during Ramadan must eat proper
and adequate meals during sahur, drink a lot of water, make sure they inject their insulin, take their
medication and check their blood sugar level as well as weight every day.
Since their medication is taken after meals, patients should not fast if they do not eat the pre-dawn
meal. Medication lingers in body, causing blood sugar levels to go down if diabetics skip a meal. This
causes dizziness, drowsiness, jitters and headaches.
"They think that if they do not eat during sahur, their blood sugar level will not go up. This is a
misconception because the liver, which stores glucose, will immediately release it into the body if it
detects low levels of insulin," says Dr Nor Azmi.
During the fasting month, patients should check their blood sugar level before sahur and two hours
after that, because there is a tendency for it to drop because of lack of food. A blood test should also
be done two hours before breaking fast.
According to research, patients develop hypoglycaemia (low blood sugar) within four to six hours after
sahur and four to two hours before breaking fast.
"They also need to drink a lot of water - at least three glasses - during sahur or they may get
dehydrated. The sugar in their bodies will be excreted in the urine together with water. If they are
dehydrated, they risk falling into a coma."
Diabetics must check their weight every day during Ramadan. If they are losing weight too quickly,
they should not be fasting. If they lose more than three per cent of their body weight a day, they will
be in danger.
Patients with poor control of their condition and the elderly who live alone should not fast. This
includes diabetic children who have not reached puberty.
Resources for module:
1.
2.
3.
4.
5.
6.
7.
8.
Gap-minder
World Mapper
Health Promotion Board website
Glogster/ My brochure maker online resources
Youtube
Animations on genetic engineering of insulin
Cartoon guide to genetics
H2 Biology Textbook by Campbell
Activities or student investigations
1. Read the case study and do the analysis to define what they would like to report/ who the target
audience is based on the article
2. Search for relevant information using the internet
a. Visit Gapminder (no direct link to diabetes) thus obesity vs population, sugar vs age, BMI
vs GDP, to make meaningful connections between risk factors and diabeters/ World
mapper to look at Worldwide Diabetes prevalence
Gapminder Image on BMI vs GDP
Gapminder Image Daily sugar intake vs population
Worldmapper Image on Prevalence of Diabetes
b. Understanding the use and production of insulin as a method of management of diabetes
http://www.abpischools.org.uk/res/coResourceImport/modules/hormones/enflash/geneticeng.cfm
c. Any others (they may come up with things like WHO website etc)
3. Creating the poster/ brochure to create awareness
Sample rubric
Scientific Poster/ Brochure Rubric
Poor
Fair
Good
Excellent
0-1
2
3-4
5
Case Analysis
1-4 questions raised
1-4 questions raised
5 -7 questions
More than 8
Sheet
in each column.
in each column.
raised in each
questions raised in
Topic
Hypothesis or
Objective
Research or
Questions raised
Questions raised are
column. Questions
each column.
may not be relevant
mostly relevant to
raised are mostly
Questions raised are
to the topic.
the topic.
relevant to the
all relevant to the
topic.
topic.
Does not address
Addresses the topic
Related to the
Defines a clear
the research topic
broadly but does
research topic and
objective that is
not provide a
provides a specific
accurate and
specific idea
idea that may not
related to the
be accurate
research topic
Answers some
Answers most
Does not answer
Answers some
Score
Review
any questions
suggested by the
questions suggested
questions and
questions and
by the hypothesis.
includes a few other
includes other
interesting facts.
interesting facts.
hypothesis.
Results
Supporting data
Supporting data
Supporting data
Supporting data
and information are
and information are
and information are
and information are
missing and/ or
both present with 2
both present and
neatly compiled and
inaccurate.
or more minor
accurate with one
completely
inaccuracies.
mistake.
accurate.
Discussion &
Presents an illogical
Presents an illogical
Presents a logical
Presents a logical
Conclusions
explanation for
explanation for
explanation for
explanation for
findings - does not
findings - barely
findings -mostly
findings which
address hypothesis.
supports hypothesis.
support the
support the
hypothesis.
hypothesis.
Sources
Only one to two ICT
Only one to two ICT
Four to five sources
More than five
sources used. No
sources used. At
(ICT and non-ICT
credible sources
non-ICT sources
least one non-ICT
based) used
(ICT and non-ICT
used.
sources used.
based) used
Attractiveness
Information
Information
Information
Information
&
presented lacks
presented shows
presented shows
presented shows
Organization
organization.
some organization.
good organization
good and attractive
Minimal use of
Minimal use of
with use of
organization with
graphics to support
graphics to support
appropriate
use of appropriate
the information.
the information.
headings.
headings. Graphics
Appropriate use of
used are novel and
graphics to support
creative.
the information.
Overall
Below Average
Average
Good
Excellent
Project Title:________________________________ _Evaluator Name: __________________________
Comments:
Relevance to ‘O’ level and H2 Biology
Links to ‘O’ level syllabus
1.
2.
3.
4.
5.
Biological molecules (Nutrients, Enzymes)
Nutrition (Diets, Organs like Pancreas, Diabetes)
Homeostasis (Blood glucose control)
Endocrine Control (Insulin and Glucagon)
Molecular Genetics (Insulin Production)
http://www.mysacredheartdiet.com/dietfor-diabetics/
http://www.umm.edu/patiented/articles/
what_type_1_diabetes_000009_1.htm
Links to ‘A’ level syllabus
1. explain how the blood glucose concentration is regulated by insulin and glucagon. (Homeostasis).
2. outline the procedures involved in the production of insulin by genetic engineering technique.
(Isolating, Cloning and Sequencing DNA)
http://www.themedschoolproject.com/2
011/09/liberal-eugenics-medicine-or.html
Linkshttp://bohone09.wikispaces.com/Group+7
to 21st Century Competencies
21st century skill competencies
Relevance to the module
1. Students will gain awareness on global
distribution of diabetes
2. Students will understand how diet and other
Civic literacy, global awareness and crosscultural skills
3.
4.
1.
2.
Critical and inventive thinking
3.
4.
5.
1.
2.
Information and communication skills
3.
By: Adrian Tan, Angela Ng, Marilyn Ng
risk factors affect the chances of developing
diabetes.
Understand dietary restrictions across
populations and religions
Understanding world economy (countries that
manufacture synthetic insulin for injections/
make use of biotechnology)
Coming up with the case analysis and
question that they want to address
Students come up with hypothesis about the
relationship between the various risk factors
and diabetes
Test the hypothesis by generating correlation
using the data provided online eg.
Gapminder
Selection of appropriate
data/information/graphics for presentation to
their specified target audience
Selection of appropriate student product
Allows collaborative learning where students
can develop their communication skills
Students can learn to use different ICT tools
(glogster, brochure maker, gapminder, world
mapper etc) and internet search engines and
relevant websites
Reading the task aloud