Background

Discuss about the Existential Symptoms Of The Disease.

Diabetes refers to “a chronic condition that occurs when there are raised levels of glucose in the blood because the body cannot produce any or enough of the hormone insulin or use insulin effectively” (International Diabetes Federation 2018). Diabetes may be caused by either insufficient production of insulin or improper utilization of insulin. Ideally, diabetes is  metabolic disorder that occurs when starch or ingested sugar that cannot be assimilated into body cells is discarded through urine. The common symptoms of diabetes include fatigue, weight loss, frequent urination, numbness, and extreme hunger or thirst (Bilous 2012). Type I diabetes or insulin-dependent diabetes mellitus (IDDM) is a condition in which the body is not producing any insulin while Type II diabetes or non-insulin dependent diabetes mellitus (NIDDM) is a condition in which the body produces insufficient insulin or body cells re resisting insulin (WHO 2015). In most instances, Type II diabetes is concomitant with obesity since high insulin levels are incapable of channelling glucose into the body muscles. Instead, the glucose is converted into cholesterol and fats, which leads to obesity, poor blood circulations, and heart diseases. Usually, Type I diabetes is managed by insulin injections, to maintain “optimum blood glucose” and enable glucose to reach body cells thirst (Bilous 2012, p.28). On the other hand, Type II diabetes is managed by use of either glucose-lowering drugs or insulin injection.

International Diabetes Federation (IDF) estimates that 425 million people have diabetes in the world, with people below twenty years accounting for one million (International Diabetes Federation 2018). The organization projects that the number of people with diabetes may skyrocket to 629 million in 2015 if no adequate measures are put in place to control the situation. The global diabetes prevalence is 8.8 percent. Australia has 1,133,000 living with diabetes (Australian Institute of Health and Welfare 2018). In addition, Australia has the highest average of expenditure on diabetes per person— ID 5650 as at 2017. Diabetes has accounted for more than 4 billion deaths in 2017 (International Diabetes Federation 2018). As evident from the statistics, diabetes is a huge burden on both social and economic dimension. Although details on the specific cause of diabetes remains scanty, a complex interaction social, economic, as well as generic factors are at the fulcrum of its aetiology. The common management approaches to the disease include administration of insulin, observing diet, and physical exercise. The current anti-diabetic drugs are not adequate to manage the disease. This is due to heterogeneous and multifactorial aetiologies that are associated with diabetes (Erejuwa 2014). Additionally, diabetes drugs are expensive and not affordable to low-income earners.

Diabetes Management

Generally, honey is used as a food in baking, additive to beverages, additive flavour, and cooking. Honey has natural sugars like glucose— 28 percent and fructose— 38 percent. It also has small amount of Vitamin C and minerals— zinc, potassium, calcium, iron, and phosphorus (Erejuwa 2014). Compounds like antioxidants and bioflavonoids are also contained in honey. Honey can reduce metabolic stress and stabilize blood sugar levels. According to Erejuwa et al (2012), honey can reduce insulin resistance.

Systemic agents and anti-diabetes drugs for managing diabetic conditions are extremely expensive and sometimes unavailable (Ghosh 2018). Poor dietary has also been attributed to poor glycaemic management among patients. There has been renewed significance on tied to therapeutic functions of honey through oral ingestion and application on wounds or diabetic ulcers. This is because of increasing evidence on the effectiveness of honey to manage diabetic conditions. Honey is also effective in enhancing antioxidant defences and protecting kidneys and pancreas damage in diabetic and hypertensive rats (Erejuwa 2014, p. 57). Recent studies show study documents that diabetic patients were instructed by medical practitioners not to use sugar products including honey, unless it is a hypoglycaemia condition (Ghosh 2018). Pure honey, according to (Tan 2015, p. 56), is a better option in managing a diabetic diet compared to sugar and other non-nutritive sweeteners because it has a lower glycaemic index compared to sugar. Since it is threefold sweeter than sugar, it should be used in small portions (Tan 2015).

Due to increasing economic and social burden associated with the disease, diabetic patients should use honey based on its perceived importance associated with health. Hence, there is need to establish practices, attitude, and knowledge of using unprocessed honey, which is cheaper and can be affordable to low incomes earners. The paper explores the significance of incorporating honey in management of diabetes.

The study aims at contributing to the knowledge on diabetes management in Australia by providing in-depth analysis on clients’ attitude and knowledge in usage of honey. The study also seeks to investigate whether registered diabetics were using honey alongside their normal anti-diabetic drugs to manage their conditions. The expectations is that the outcome from the study will challenge medical practitioners as well as act as source of encouragement to those undergoing treatment to use honey in managing the disease.

Main objective is to assess patients’ cognisance, attitude, as well as practices on the use of honey in managing Type II diabetes.

• To establish diabetic patients on use of honey
• To assess diabetics cognisance on usage of honey in controlling diabetics
• To explore social and economic features of diabetic patients
• To establish diabetic patients’ practices on usage of honey

The Significance of Incorporating Honey in Diabetes Management

According to LAWI, diabetes was first documented in the Egyptian manuscript in 1500BC, where it was defined as “too great emptying of urine” (Porter 2017). Between 400-500BCE, scientists identified two distinct conditions of diabetes, in which Type I was linked to the youth while type II linked to obesity. Towards the end of 1600s, scientists added the term mellitus— a Latin word that means “from honey”— to distinguish it from diabetes insipidus that was attributed to frequent urination (Porter 2017, p. 90). In 1922, Sir Bating successfully treated the first diabetic patient through insulin injection. Bating would later receive Nobel Peace Prize for the discovery in 1923. Consequently, November 14^th, Bating’s birthday, is always commemorated as World Diabetes Day to honour him and create awareness, as well as reminding government on importance of their commitment to adopt policies that help to mitigate and treat diabetes.

Bilous (2012) acknowledges that changing diet— by adopting healthy eating habit— is integral part of managing diabetes. Unlike restrictive program, this is applicable to anybody with diabetes, particularly Type I diabetes. Type II diabetes requires both healthy diet and insulin injections to manage the situation, however. In most instances, patients coping with Type II diabetes use different kinds of tablets. Ghosh (2018) recognizes the importance physical exercise, avoidance of tobacco, and alcohol as effective ways of managing diabetes

Currently, there is no cure for diabetes, albeit the research is going on. Therefore, the preventing and managing diabetic conditions through healthy lifestyle and medication remains the only solution. Erejuwa (2014) contends that each person has a unique feature and therefore individuals should be cognizant of their bodies’ reaction to different range of carbohydrates. The focus should be on the amount of carbohydrates rather than the amount of sugar (International Diabetes Federation 2018).

In essence, honey is also a carbohydrate. A tablespoon of honey contains 17g of carbohydrate (Erejuwa et al. 2012, p. 23). According to Tan (2015), as diabetics do to control carbohydrates or other sweetener, they can control their daily consumption of honey considering the amount of kilocalories in it. Ediriweera and Premarathna (2012) hold that when buying honey, one should insist on quality by ensuring that it is pure or unrefined and not mixed with starch, sugar cane, or glucose, which needs to be avoided by diabetic patients. Pure honey is preferred for diabetic patients compared to artificial sweeteners like saccharin and aspartame (Abeshu & Geleta 2015, p. 8). Since it is threefold sweeter than sugar, it should be used in small portions. Ediriweera and Premarathna (2012) find that “5ml of natural honey (with a pinch of  powdered  seeds  of (Gossypium  herbaceum) has been seen to reduce blood sugar in diabetic patients.”

Patients’ Knowledge, Attitude, and Practices on the Use of Honey in Managing Type II Diabetes

Bilous (2012, p.146) attest that “honey has lower Glycaemic Index (GI) than sugar,” which means that it does not raise blood sugar levels apace like sugar. Besides, unlike white sugar, honey does not need more insulin to regulate. In another nuanced study, Gosh (2018) finds that one of the reasons why honey is more effective in controlling diabetes is its fructose-to-glucose ration, which is 1:1. Fructose facilitates absorption of glucose in the liver hence ensuring that that excess glucose does not enter circulation system. Considerably, only natural honey exudes this feature. Abeshu and Geleta (2015) identify oligosaccharides components in honey as the reason why honey is an ideal anti-diabetic. Erejuwa (2014) acknowledges the significance of mineral elements like zinc, copper, and chromium in honey that helps to normalize blood glucose and enhance secretion of insulin into pancreatic cells.

According to Ghosh (2018), subjecting diabetics to 75g of honey in 250ml of water for 15 consecutive days has the efficacy to reduce cholesterol, blood glucose, triglyceride, and low-density lipoprotein-cholesterol (LDL-C). However, the same amount results to increased level of high-density lipoprotein-cholesterol (HDL-C). A contrast experiment on health practices shows that ingestion of sucrose and dextrose increase the level of C-peptide and insulin. By measuring C-peptide, it is possible to validate “quantification of endogenous insulin secretion.” Since C-peptide is secreted alongside insulin during “enzymatic cleavage of pro-insulin to insulin,” serum C-peptide can be used s indicator of change in insulin level Ghosh (2018, p.214). Serum insulin can be increased by using honey while fructosamine and glucose can be reduced in diabetic rats. Combination of drugs and honey, according to LAWI, can lower glycaemic levels and serum levels of creatinine, fructosamine, and bilirubin (Erejuwa 2014).

The study will be conducted at Royal Melbourne Hospital (RMH)—City Centre, outpatient department, which receives an average of about 510 patients per day (Royal Melbourne Hospital 2018). The hospital has clients with wide range of disease stages and complications. The availability of experts in the area will make the study convenient. White and McBurney (2012) define expert as a person with deep knowledge in a given professional field. In Australia, public hospitals provide more than 58 percent health services (Australian Institute of Health and Welfare 2018). The study population will be patients with Type II diabetes at the RMH City Centre.

The study will employ cross-sectional survey to conduct the research. The exercise will involve data collection by a semi-structure interviewer. It will also be conducted by distributing questionnaire to diabetics. According to Terhanian and Bremer (2012), ideal questionnaire should be precise, concise and focus on specific questions. Additionally, the questionnaire should not contain personal and leading questions (Nix and Hall 2016, p. 9). The researcher will take into consideration the accepted code of conduct when designing questionnaire. The questionnaire will focus on the on their perceptions, cognisance, and practices of using honey in diabetes management. The study will focus majorly on diabetes outpatient from the RMH in the month of July 2018. The Study will also rely on secondary data from the hospital data system to help with analysis of data.

History of Diabetes

The study will employ Fisher’s formula to determine sample size (Patten and Newhart 2017)

Where N= sample size

Z= confidence level

P= estimated number of clients that use honey

q= 1-p

d= tolerance to margin error

The study will employ both probabilistic and non-probabilistic sampling. Purposive sampling technique will be used because only diabetic patients and experts have information that is relevant to the study. According to Shea et al (2013), non-probabilistic sampling generates hypothesis while probabilistic sampling tests it. The researcher will also use stratified sampling in selecting respondents in light of gender and age bracket. This technique will involve dividing the population (diabetics) into different strata then selecting samples from each stratum by using simple or systematic sampling. Shea et al (2013) argues that the sampling size should be expanded by at least 10 percent to address cases of non-responsiveness.

Inclusion criteria will be, recruiting individual respondents, which will include comprehensive case studies of patients that have blood sugar readings for the past three consecutive months. In addition, registered patients spotted at the clinic will be interviewed as they for doctor’s appointment. Exclusion criteria will be, not interviewing patients with Type I diabetes and excluding patients that do not have blood readings for the past three months.

The study will employ both quantitative and qualitative research methods. Quantitative data will be obtained through interviewing patients while mail questionnaire will be addressed to experts. The researcher prefers the two methods because they are considerably flexible and have high rate of feedback (ACSM 2015). The quantitative data will target the demographics, socio-economic aspects, frequency, and amount of honey used. The study will obtain qualitative data by using case studies and field research since the methods are unobtrusive and reliable (Check & Schutt 2011, p.4). The qualitative data will focus mainly on their experience and attitudes on using honey in diabetes management.

Before data collection, the researcher will conduct pilot study by consulting with professor in order to establish feasibility and validity of the study. On interviews, the researcher will use smart pen recorder to ensure that the collected data is accurate. However, before recording, the interviewer will first seek respondent’s permission. After recording the interviews, the data will be transcribed and the deleted in order to underscore confidentiality. In both interview and mail questionnaire, the respondents will be assured anonymity and confidentiality before the exercise. The respondents will also be assured that the results will be share with them after the study. However, their contacts, including email address, names, and phone number will be discarded immediately after sharing the results with them.

Maintaining Healthy Lifestyles and Medication

Conclusion

The paper leading principle on the study is the fact that diabetes is a chronic disease that requires urgent and adequate solution in order to reduce more deaths that results from the situation. Currently, there is no specific treatment to diabetes. However, the paper identifies honey as a possible solution to the existential symptoms of the disease. The paper has explored the possibility of using honey in managing diabetes condition by dissecting relevant literature sources. Honey could be a better choice in controlling Type II diabetes due to its lower glycaemic index. Honey also has low-density lipoprotein-cholesterol and rich in other important minerals— like zinc, copper, chromium— as well as antioxidants and bioflavonoids, which help to stabilize sugar.

References

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