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CHAPTER-4

RESULTS AND DISCUSSION

The Research was undertaken in three phases to assess the glycemic control

on Non- insulin dependant diabetes mellitus patients by diet. The first part of the

study comprised of interviewing the samples and collecting the baseline data. Second

phase of the research dealt with the supplementation of soyabean flour to selected

subjects or experimental group and third phase portrayed the Nutrition Education

Programme. Data collected by interview were coded, consolidated and presented

under the following sub-heads along with statistical analysis.

PHASE I

4.1 Socio demographic profile

4.1.1 Age

4.1.2 Type of birth

4.1.3 Gender

4.1.4 Religion

4.1.5 Caste

4.1.6 Marital Status

4.1.7 Number of Children

4.1.8 Education

4.1.9 Occupation

4.1.10 Monthly Income

4.1.11 Number of Family members

4.1.12 Total family income

4.2 Lifestyle Pattern

4.2.1 Type of physical activity of the Respondents

4.2.2 Sharing of Work

4.2.3 Lifestyle Leading To Stress

4.2.4 Treatment Undergone To Lower the Stress Levels

4.2.5 Energy-Saving Devices Used

4.2.6 Habit of consuming the Harmful items

id17420968 pdfMachine by Broadgun Software - a great PDF writer! - a great PDF creator! - http://www.pdfmachine.com http://www.broadgun.com

108

4.3 Health Status

4.3.1 Duration of the Disease

4.3.2 Family History

4.3.3 Height

4.3.4 Weight

4.3.5 Body Mass Index

4.3.6 Waist-Hip Ratio

4.3.7 Blood Pressure

4.3.8 Blood Glucose

4.3.9 Blood Haemoglobin

4.3.10 Lipid Profile

4.3.11 Serum Creatinine

4.3.12 Blood Urea

4.3.13 Sodium Level

4.3.14 Potassium Level

4.3.15 Symptoms

4.3.16 Delayed Wound Healing

4.3.17 Lung Complications

4.3.18 Cardiovascular Disease

4.3.19 Dental Problems

4.3.20 Carbuncles

4.3.21 Foot Problems

4.3.22 Present Condition

4.3.23 Physique

4.3.24 Hyperinsulinemia

4.3.25 Albuminuria

4.3.26 Diabetic Nephropathy

4.3.27 Diabetic Eye Disease

4.4. TREATMENT

4.4.1 Methods used to lower blood sugar level

4.4.2 Medications

4.4.3 Drugs recommended by the physician

4.4.4 Side effects on consumption of drugs

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4.4.5 Clinical tests conducted

4.4.6 Consumption of multivitamin/ multimineral tablets

4.5 FOOD HABITS

4.5.1 Type of Food Consumed

4.5.2 Trying New Foods

4.5.3 Inclusion of Special Diabetic Recipes

4.5.4 Diabetic Instant Foods Purchased in the Market

4.5.5 Artificial Sweeteners used to replace sugar

4.5.6 Knowledge on foods recommended for diabetes

4.5.7 Food Consumption Pattern

4.5.8 Suggestions for Future Generations

PHASE II

4.6 24 hour Dietary Recall Method

4.6.1 Statistical analysis for 24 hour Dietary Recall Method

4.6.2 Statistical analysis of the Experimental group and Control group with

regard to Anthropometric measurements, Blood pressure and

Biochemical tests ( Pre- test & Post test)

PHASE III

4.7 Evaluation of Nutrition education imparted to type 2 diabetics and

relatives

PHASE I

4.1 SOCIO DEMOGRAPHIC PROFILE

The investigator collected data on socio-demographic variables such as age,

type of birth, gender, religion, caste, marital status, education, occupation, income

and number of family members and total family income.

110

Table 4.1: SOCIO DEMOGRAPHIC PROFILE

S.NO FACTORS CATEGORY FREQUENCY PERCENT

1

Age (In Years)

Below 45 46 15.3

46-55 104 34.7

56-65 150 50.0

Total 300 100.0

2 Birth Single 300 100.0

3 Gender Female 300 100.0

4

Religion

Christian 15 5.0

Hindu 237 79.0

Muslim 48 16.0

Total

300

100.0

5

Caste

Forward 93 31

Backward 40 13

Most backward 59 20

Other backward 39 13

Schedule caste 27 09

Extreme backward 05 2

Backward caste

Muslim 37 12

Total 300 100.0

6

Marital Status

Married 294 98.0

Single 6 2.0

Total 300 100.0

7 Number of

Children

0 33 11.0

1 22 7.3

2 65 21.7

3 72 24.0

4 108 36.0

Total 300 100.0

111

8 Education

Primary School 31 10

Middle School 128 43

High school 95 31

Higher Secondary 05 02

College 02 01

Illiterate 39 13

Total 300 100.0

9

Occupational

Status

Unemployed 221 73.7

Employed 43 14.3

Self employed 36 12.0

Total 300 100.0

10

Monthly

Income( )

Below 1000 94 31.3

1001-1500 104 34.7

1501-2000 48 16.0

Above 2000 54 18.0

Total 300 100.0

11

( i )

Number of

Family

members:

Number of

Male members

0 48 16.0

1 108 36.0

2 96 32.0

3 29 9.7

>=4 19 6.3

Total 300 100.0

( ii )

Number of

Female

members

1 141 47.0

2 102 34.0

3 27 9.0

>=4 30 10.0

Total 300 100.0

112

( iii )

Total

Members in

the Family

Upto 2 87 29.0

3-4 152 50.7

5-6 54 18.0

Above 6 07 2.3

Total 300 100.0

12

Total Monthly

Family

Income

( )

1400-3000 110 37

3001-5000 84 28

>5000 106 35

Total 300

100.0

4.1.1 AGE

A stage of development at which the body has arrived, as measured by

physical and laboratory standards, to what is normal for a male or female of the same

chronological age (Mosby Dictionary, 2008).

Type 2 diabetes is one of the major non-communicable diseases worldwide,

and its complications have significant socio-economic impacts and develop

predominantly in older populations.

Thus, from table.4.1 it is clear that 46(15%) of the diabetic subjects were less

than 45 years, 104(35%) of them were between 46-55 years and 150(50%) were

between 56-65 years. This is due to the fact, that the older we get, greater is the risk

of type 2 diabetes. Even if an elderly person is thin, they still may be predisposed to

getting diabetes.

Scientists have also theorized that the pancreas ages right along with us, and

doesnt pump insulin, as efficiently as it did when we are younger. Also as our cells

age, they become more resistant to insulin as well.

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Diabetes mellitus is a worldwide, pandemic disease. According to the last

estimations of the International Diabetes Federation, the age group from 40 to 59

years has the largest number of persons suffering from diabetes with some 113

million; in the age group from 60 to 79 years, 97 million people have diabetes. By

2025, because of the aging of the world's population, there will be 166 million with

diabetes aged from 40 to 59 years and almost as many aged from 60 to 79 years,

approximately 164 million. This corresponds to an increase of 47% in the age group

from 40 to 59 years and to an increase of 69% in the age group from 60 to 79 years

(International Diabetes Foundation, 2006).

4.1.2 TYPE OF BIRTH

The emergence and separation of the infant from the maternal body after

cutting of the umbilical cord (http:// the free dictionary.com/birth, 2011).

Type 2 diabetes is a complex disease with a multifactorial etiology (Poulsen P

etal, 2009). Low birth weight is another known risk factor for type 2 diabetes and is

more common in twins compared with singletons (Hall JG, 2003). This situation was

not witnessed in the selected subjects. All 300(100%) of the respondents were born

single and were not born as twins or triplets. Therefore question of identical or

fraternal twins never arises.

4.1.3 GENDER

All 300(100%) of the diabetic patients selected for the study were only the

female subjects, as per the requirement of the University.

4.1.4 RELIGION

Religion is a strong belief in a supernatural power or powers that control

human destiny (http://www. allaboutreligion.org, 2002-2015).

Among the type 2 diabetic patients, 15(5%) percent belonged to Christians,

237(79%) Hindus, and 48(16%) were Muslims. Domination of Hindus was obvious

coinciding with that of Indian Scenario. Food habits are related to religion and hence

have connection with the occurrence of diabetes.

114

4.1.5 CASTE

The word Caste is defined from the Portuguese word Casta, meaning lineage,

breed or race. The term caste, when used in human culture, is usually in

conjunction with the social division in Hindu Society, particularly in India

(http://whitewolf.wikia.com).

Among the selected respondents, 59(20%) percent belonged to Most

Backward Caste, 40(13%) to Backward Caste (BC) community, 93(31%) to Forward

Caste (FC), 37(12%) belonged to Backward Caste Muslim (BCM), 39(13%) belonged

to Other Backward Caste (OBC), and only 27(9%) belonged to Schedule Caste

whereas 5(2%) were Extreme Backward Caste.

As far as caste was concerned with that of occurrence of Type 2 diabetes,

factors such as heredity and lifestyle as well as food consumption may be the leading

factors.

4.1.6 MARITAL STATUS

Only 6(2%) were unmarried and remaining 294(98%) of the respondents were

married but some of them had lost their husbands and were dependant on their sons

and daughters. This is understandable if seen in the light of the age of selected

subjects.

4.1.7 NUMBER OF CHILDREN

Children indicates a young person of either sex especially one between

infancy and youth (http://thinkexist.com/dictionary/meaning/child,1999-2015).

Among the 300 type 2 diabetic patients selected for the study 108(36%) had

more than 4 children, 72(24%) had three children, and 65(21.7%) had two children

and only 22(7.3%) had one child, and 33(11%) of them had no children. Totally 60

percent of the selected women had three or more children. With all the propaganda

and activated family planning programmes still parents are not realising the benefits

of small families.

115

4.1.8 EDUCATION

Education in the largest sense is any act or experience that has a formative

effect on the mind, character or physical ability of an individual

(http://en.wikipedia.org/wiki/Education, 2007-2010).

The level of education and place of residence are important determinants for

quick diagnosis. Though type 2 diabetes produces few symptoms and is initially not

life threatening, education plays a major role in the prognosis of diabetes. Middle

school level education and high school level was found with 128(43%) and 95(31%)

subjects and 39(13%) did not have any education.

116

The investigator noticed that the educated subjects visited the hospital in the

initial stage bothered about the weakness and tiredness which often are the only

manifestation of the disease.

4.1.9 OCCUPATION

An activity that serves as ones regular source of livelihood, a vocation (http://

www. the freedictionary.com/occupation,2011).

Socio-economic environment influences occupation, lifestyle, and nutrition of

social classes which in turn would influence the prevalence and profile of glucose

intolerance and diabetic complications. A number of studies have addressed this

issue in Western countries (Kelly WF etal, 1993; Meadows P, 1995; Unwin N, 1995).

In Urban India, there are wide social and economic disparities.

Free health care facilities are available for the economically backward classes,

but due to low level of education and occupational problems, the facilities are not

always used (Morgan CLI etal, 1997; Evans JMM etal, 2000).

From Table 4.1 it is clear that 221(74%) of them were unemployed, 43 (14%)

were employed, and 36(12%) self-employed. The employed subjects, were working

as labourers in the mill, tobacco company, construction company and at Phone booth.

They also worked as Balwadi worker, Hostel Warden, Bus Conductress, vegetable

vendor, Preacher in Hosanna Ministries, Attender at Government Hospitals and

saleswoman at Textile shop, Grocery shop, Ashram Press, Fruit Shops and

Amudhasurabhi Cost Price shop. Among them one person who had finished her

Master of Arts in Social work was a Woman Activist at World of Solidarity. She

dealt with Women issues and female infanticide and another subject was working as a

Government School teacher.

Among the self employed people who mostly had their own lands and did

agriculture work as farmers, and also owned coconut grooves, some had cycle repair

shop, tailoring and petty business like a vegetable shop.

117

Unemployed subjects were mostly dependant on their husbands, sons or

daughters and widows got widow Pensioners Income (widow Pension) granted by the

Government. They were looked after either financially or provisionally by their

children and some of them lived with their blood relations especially the childless

widows and deserted women.

4.1.10 INCOME

Income is the consumption and savings opportunity gained by an entity within

a specified time frame, which is generally expressed in monetary terms

(http://en.wikipedia.org/wiki/Income).

118

From the above table it is evident that 104(34.7%) had monthly income

between 1001-1500, 48(16%) earned between 1501-2000, 54(18%) above 2000

and 94(31.3%) of them below 1000. Income generated by the subjects was derived

either through Government or through self-employed jobs. Unemployed were

dependant on their husbands or children.

4.1.11 FAMILY MEMBERS

Family is a fundamental social group in society typically consisting of one or

two parents and their children (http://www.answers.com/Q/Mishpahca-Family).

108(36%) of the families had 1 male member, 48(16%) had either husbands

deserted or divorced or dead or single as a spinster and 96(32%) had 2 male members

including the head of the family, 29(10%) had 3 male members and only 19(6%) of

them had more than 4 male members.

In the same way, 141(47%) of the families had one female member and

102(34%) had two female members either daughter, daughtersin-law, brothers

wife, or sisters and the subjects. Nearly 30(10%) had more than 4 members and only

27(9%) of them had 3 members.

119

As far as total members in the family was concerned which included children,

152(51%) had total family members between 3-4, 87(29%) upto 2, 54(18%) between

5-6, and a meagre of 7(2.3%) above 6, which also comprised of grandchildren or

nieces living with the respondents, and some did not have children with them, may be

all are grown up and gone out.

4.1.12 TOTAL FAMILY INCOME

Out of 100 percent, 110(37%) of them had a total family income between the

range of 1400-3000, 84(28%) between 3001-5000, and another 106(35%) above

5000. Conclusion is that 65 percent of families were in the low income bracket only.

4.2 LIFESTYLE PATTERN

A way of life or style of living that reflects the attitudes and values of a person

or group or a composite of traits or features characteristic of an individual or a group

(http://www.answers.com).

120

4.2.1 TYPE OF PHYSICAL ACTIVITY OF THE RESPONDENTS

Physical activity is any body movement that works ones muscles and uses

more energy that you use when you are resting (www.nhibi.nih.gov/health/html).

In a developing country like India, increasing urbanization and lifestyle

changes have led to an increased incidence of diabetes (Ramachandran A etal, 2008).

Only 9 percent of them had the practice of walking as physical activity, and 100

percent were of course involved in household activity such as cooking and none of

them were found to be involved in jogging activity. Walking was practised daily for

30 minutes to 1 hour duration by the respondents.

Household activity was associated with a lower risk of diabetes in

unemployed participants. Participants in the higher household activity category are

less likely to participate in leisure time physical activity or commute to work, most

likely reflecting time constraints (Villegas R etal, 2006).

Table 4.2: TYPE OF ACTIVITIES PERFORMED BY THE RESPONDENTS

TYPE OF

ACTIVITY

YES NO TOTAL

Count % Count %

Tailoring 5 1.67 295 98.33 300

Marketing 152 50.67 148 49.33 300

Gardening 62 20.67 238 79.33 300

Sweeping 62 20.67 238 79.33 300

Washing Clothes 71 23.67 229 76.33 300

Mopping Floor 119 39.67 181 60.33 300

Cutting vegetables 94 31.33 206 68.67 300

Washing vessels 221 73.67 79 26.33 300

Employment or self employment and commutation absorbed major portion of

day time. Then 221(73.67%) performed washing of vessels, 152(50.67%) did

marketing, 119(39.67%) of type 2 diabetics were mopping the floor, 94(31.33%) did

vegetable cutting, 71(23.67%) did washing of clothes manually, and 62(20.67%) did

121

sweeping and gardening and 5(1.67%) did tailoring work. As far as gardening was

concerned house owners reared only ornamental plants. Heavy physical activities

like mopping and washing clothes performed by the subjects may control their

glycosylated haemoglobin levels.

4.2.2 SHARING OF WORK

Among themselves if family members share the household activities, strain

and fatigue of each individual will be less.

Table 4.3: WORK PERFORMED BY FAMILY MEMBERS AND THE

RESPONDENTS

INDIVIDUALS INVOLVED FREQUENCY PERCENT

Self 177 59

Self & Daughter 50 17

Self & Daughter-in-law 30 10

Daughter 18 06

Daughter-in-law 20 07

Self & Others 05 02

Total 300 100

Respondents 177(59%) performed household activities by themselves,

whereas 50(17%) shared the work along with their daughters, and 30(10%) along

with their daughters-in-law. In 18(6%) of houses daughters alone were involved, and

in 20(7%) only daughters-in-law were doing complete activities. In 5(2%) of

respondents households either brothers wife or servants were helping the

respondents.

4.2.3 LIFESTYLE LEADING TO STRESS

Results of longitudinal studies suggest that not only depression but also

general emotional stress and anxiety, sleeping problems, anger and hostility are

associated with an increased risk for the development of type 2 diabetes (Pouwer F,

2010).

122

Stress faced by all T2DM patients were mainly by financial and social

problems. In the first case they had no independant income and were depending on

children or relatives or had very low income, low economic status and debts to be

repaid. The social problems like loneliness, separation, ill health of spouse or

children, unmarried daughters at home etc., were disturbing them.

Hence, emotional signs exhibited included moodiness and even depression,

excessive worrying, irritability and agitated even while waiting to see the doctor or

while getting medicines (tablets) and deserted cases felt lonely and isolated. Physical

symptoms reported were aches and pains in the extremities nausea, dizziness, chest

pain and rapid heartbeat and in few cases diarrhoea or constipation, sleeplessness, and

not eating enough. Behavioural symptoms of stress reported by the individuals were

social withdrawal procrastination or neglect of responsibilities.

4.2.4 TREATMENT UNDERGONE TO LOWER THE STRESS LEVELS

Normally at time of stress people who have type 2 diabetes have a harder time

maintaining or keeping their blood glucose at the right level. Hence this cycle of

stress, can result in poor health and can exhibit impact on their quality of life causing

life threatening complications such as blindness, kidney disease, cardiovascular

problems and can require limb amputation.

300(100%) did not take any measures to lower their stress levels; only one

percent underwent some relaxation therapy such as prayer, meditation, and exercise

to decrease stress. Stress management and relief techniques should be taught to them.

123

4.2.5 ENERGY-SAVING DEVICES USED

Table 4.4: ENERGY-SAVING DEVICES USED

S.NO ENERGY-SAVING DEVICES FREQUENCY PERCENT

1 Mixie 19 6.3

2 Grinder 12 4.0

3 Mixie & Grinder 50 16.7

4

Mixie, Grinder & Washing

machine

02 0.7

5 None 217 72.3

Total 300 100.0

The standard of living has been improved and the access to services has

increased which poses negative consequence on health related problems such as type

2 diabetes. Another cause for health problems is, combined with a decline in energy

expenditure that is associated with a sedentary lifestyle-motorized transport and

labour-saving devices in the home and the occupational environment, largely

replacing physically demanding manual tasks at work and leisure time.

In the present study, luckily 217(72.3%) of the patients did not use any energy

saving devices, 19(6.3%) used mixie, 12(4%) used grinder for grinding purpose,

50(16.7%) used mixie and grinder and a meagre 2(0.7%) used mixie, grinder and

washing machine. Cooking and washing activities consuming high energy were

performed manually by 72 percent of the subjects, confirms more energy output and

positive influence on glucose metabolism.

4.2.6 HABIT OF CONSUMING THE HARMFUL ITEMS

Alcohol is processed in the body very similarly to the way fat is processed,

and alcohol provides almost as many calories. Therefore drinking alcohol in people

with diabetes can cause blood sugar to rise (http://diabetes.webmd.com/drinking-

alcohol). People who smoke cigarettes, or who are exposed to any amount of second-

hand smoke, experience a higher risk of cardiovascular disease, lung cancer, and head

and neck cancers than the general population. Smoking-related cardiovascular

124

problems include high blood pressure, heart attack, high cholesterol, and peripheral

vascular disease (claudification). Smoking also causes insulin resistance in both

diabetic and non-diabetic people (http:// diabetes.about.com). All 300(100%)

respondents reported not to consume alcohol, abusive drugs or cigarettes. This habit

of non consuming of harmful products may be due to good values or low economic

status but luckily it reduces the complications of diabetics.

4.3 HEALTH STATUS

4.3.1 DURATION OF THE DISEASE

It indicates the length of time that something lasts or

continues (http://dictionary.reverso.net/english-definition).

The occurrence of Diabetes condition seems to prolong for number of years.

The duration for the disease is discussed in the following table:

Table 4.5: DURATION OF THE DISEASE

NUMBER OF YEARS FREQUENCY PERCENT

Below 5 115 38.3

5-10 122 40.7

Above 10 63 21.0

Total 300 100.0

Nearly 115(38%) of type 2 diabetic subjects had been suffering from this

silent killer disease for less than 5 years, 122(41%) of the subjects between 5-10

years, another 63(21%) for more than 10 years.

4.3.2 FAMILY HISTORY

Family health history is critical in predicting someone's risk of diabetes, high

blood pressure and obesity. Family history is one of the most important parts of

predicting the risk of what are often genetically-passed-on illnesses

(http://abclocal.go.com).

125

Subjects with a family history of diabetes develop the disease earlier

compared to subjects without family history (Mohan V etal, 2003). The frequency of

family history ranges from 74-100 percent among the first or second degree relatives

(Madhu SV & Vinod K, 2004). The off springs of diabetic parents develop diabetes

at least a decade earlier than their parents (Jacob CS, 2005).

Hence, it is clearly understood that heredity is one of the main factors

transmitting diabetes mellitus to the offspring. The present study confirmed that

117(39%) had inherited by blood relations. Out of which one percent inherited from

their grandparents, 13 percent reported from fathers, whereas 12 percent had their

brothers and mothers affected. Additionally 13 of them also reported that their

children either the son or daughter also suffered by this disease.

4.3.3 HEIGHT

Human height is the distance from the bottom of the feet to the top of the head

in a human body standing erect (http://en.wikipedia.org/wiki/Human_height).

Table 4.6: HEIGHT OF THE RESPONDENTS

HEIGHT(Metres)[m] FREQUENCY PERCENT

< 1.39 12 4

1.39-1.44 56 19

1.45-1.50 108 36

1.51-1.56 78 26

1.57-1.62 37 12

1.63-1.68 9 3

Total 300 100

With reference to the average Indian female height of 1.50 metres, 108(36%)

of the T2DM subjects came closer. Another 12(4%) and 9(3%) were in the lowest

and highest side in the height scale.

126

4.3.4 WEIGHT

The term body weight is overwhelmingly used in daily English speech as well

as in the contexts of biological and medical sciences to describe the mass of an

organism's body. Body weight is measured in kilograms throughout the world,

although in some countries it is still measured in pounds (e.g. United States) or stones

and pounds (e.g. among people in the United Kingdom) and thus may not be well

acquainted with measurement in kilograms. Body weight of a person is theoretically

the weight of the person without any items on. However, for all practical purposes,

body weight is taken with clothes on but often without the shoes and heavy

accessories like mobile phones and wallets (http://en.wikipedia.org/

wiki/Body_weight).

Table 4.7: WEIGHT OF THE RESPONDENTS

WEIGHT(KGS) FREQUENCY PERCENT

30.6-40.5 5 2

40.6-50.5 43 14

50.6-60.5 118 39

60.6-70.5 98 33

70.6-80.5 14 5

80.6-90.5 20 6

90.6-100.5 2 1

Total 300 100

According to the National Health and Nutrition Examination Survey (1999-

2002), 48(16%) of the female T2DM subjects were below the normal weight range of

50.8 Kilograms (Kgs). 118(39%) were found between 50.6- 60.5 Kgs, 98(33%)

between 60.6-70.5 Kgs and only 36(13%) of them between 70.6-100.5 Kgs. The

relationship between height and weight is discussed under the head Body Mass Index

( BMI ). Annexure - VIII displays the standard height and weight of Indian men and

women.

127

4.3.5 BODY MASS INDEX

Body mass Index or BMI (Weight in Kilograms divided by the square of the

height in metres) is promulgated by the World Health Organisation (Annexure-IX)

as the most useful epidemiological measure of obesity. It is nevertheless a crude

index that does not take into account the distribution of body fat, resulting in

variability in different individuals and populations (www.nih.gov.pdf, 2003).

Table 4.8: BODY MASS INDEX (BMI) OF THE RESPONDENTS

BMI CATEGORY FREQUENCY PERCENT

>18.5 Underweight 02 1

18.6-24.9 Normal 96 32

25-29.9 Overweight 129 42

30-34.9 Obesity-Class I 50 17

35-39.9 Obesity-Class II 20 7

>40 Obesity-Class III(Morbid Obesity) 03 1

Total 300 100

128

Body Mass Index (BMI) is a reliable indicator of total body fat, which is

related to the risk of life-threatening diseases.

96(32%)of them indicated healthy amount of body fat and normal and a

number of studies have proven that a BMI between 18.5 and 24.9 is the one that

people find to be most aesthetically pleasing.

A BMI of less than 18.5 is considered to be a lean BMI and in the present

study only 2(1%) were found in the above mentioned range, whereas 129(42%) were

between 25 and 29.9 which is indicated as overweight (routine), and requires to take a

healthy diet and exercise.

50(17%) fall in the range between 30- 34.9 considered as class I obesity,

whereas 20(7%) were in class II obesity, between 35- 39.9. Diabetic persons tend to

get obese and especially a person with diabetes type 2 does not react enough upon the

insulin secreted. The pancreatic gland will often counteract the lack of reaction by

secreting even more insulin will then lower the metabolism thereby lowering the

burning fat.

Lastly, 3(1%) of the type 2 diabetic individual were considered extremely

obese and had more than a BMI of 40, which is an unhealthy condition, were excess

body fat can put the person at a greater risk to other forms such as cancer, gall bladder

disease, high blood pressure and heart disease.

4.3.6 WAIST-HIP RATIO

Waist-hip circumference ratio (WHR), Waist-height ratio (WHtR) and waist

circumference are commonly used to predict the risk of obesity related morbidity and

mortality as they account for regional abdominal adiposity (Welborn TA etal, 2003;

Ko GT etal, 1999; Dalton M etal, 2003).

129

Table 4.9: WAIST-HIP RATIO OF THE RESPONDENTS

WAIST-HIP

RATIO CATEGORY FREQUENCY PERCENT

>0.75 Excellent 01 0.33

0.75-.80 Good 17 5.67

0.80-0.85 Average 89 30

0.85-0.90 Risk 69 23

>0.90 Extreme 124 41

Total 300 100.0

According to the National Heart, Lung & Blood Institute, Waist

circumference is a good indicator of abdominal fat, which is another predictor of your

risk for developing hypertension, cardiovascular disease, Type 2 diabetes & other

conditions (http://www.nytimes.com/ref/health/bmi.html).

From the above table it is clear that 89(30%) had a waist-hip ratio within

average level for females, and 17(6%) in good level. But 124(41%) were in extreme

level and 23 percent in risk levels, who were prone to various diseases such as

hypertension. In the excellent range ie.< 0.75 waist-hip ratio only one person was

identified. Age may also be one major factor for this condition.

4.3.7 BLOOD PRESSURE

Along with body temperature, respiratory rate and pulse rate, blood pressure is

one of the four main vital signs routinely monitored by medical professionals and

health- care providers (OHSU Health Information, 2010).

130

Table 4.10: BLOOD PRESSURE OF THE RESPONDENTS

BLOOD

PRESSURE

(mm / Hg)

CATEGORY FREQUENCY PERCENT

180/110 High B.P-Stage 3 12 04

160/100 High B.P- Stage 2 16 05

140/90 High B.P- Stage 1 68 23

130/85 High Normal B.P 74 25

120/80 Normal Blood Pressure

109 36

110/85 Low Normal B.P 21 07

Total 300 100

High blood pressure is one of the hallmark risk factors for many diseases and

conditions, including type 2 diabetes. Not only do they damage the individuals heart

vessels but they are the key components in metabolic syndrome, with a cluster of

symptoms including obesity, due to high fat diet and lack of exercise.

Blood pressure was measured at the brachial artery of the individual, which is

the upper arms major blood vessel that carries blood away from the heart. A

persons Blood Pressure (B.P) is usually expressed in terms of the systolic pressure

and diastolic pressure (mm/Hg) for example 120/80.

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Systolic pressure is peak pressure in the arteries which occurs near the end of

the cardiac cycle when the ventricles are contracting. Diastolic pressure in the artery

which occurs near the beginning of the cardiac cycle when the ventricles are filled

with blood.

Table: 4.10 depicted that systolic blood pressure and diastolic blood pressure

of 109(36%) of the samples were in the normal range of 120/80mm Hg. In 170(57%)

of the cases diastolic pressure was high hence hypertension lowering drugs were

prescribed by the physicians.

Hypertension is one amongst various risk factors in type 2 diabetes which

leads to macro vascular diseases. This factor was in great need to be identified earlier

to prevent peripheral vascular disease. Taking this factor into account, the researcher

probed into the details of the individuals blood pressure level, with an aim to prevent

further blood vessel complications.

Table 4.11: STATISTICAL ANALYSIS OF ANTHROPOMETRIC AND

BLOOD PRESSURE MEASUREMENTS OF THE RESPONDENTS (N=300)

Anthropometric & Blood Pressure measurements

Mean Std. Deviation

Height 1.49 0.07

Weight 60.10 10.40

Body mass Index 27.12 4.54

Waist Hip ratio 0.91 0.04

Systolic B.P 131.13 15.17

Diastolic B.P 82.94 8.09

Compared to the standard height of 1.5 metres, mean height of the subjects

falls as 1.49 metres, very close to the normal. As per Indian female normal weight of

50.8 Kilograms, the mean weight is calculated as 60.10 and depicts a higher side.

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In the Body mass Index also mean categorises them in the overweight type.

Waist-hip ratio falls in the risk category. But blood pressure concluded by mean

systolic and diastolic were in the normal range only. Weight and waist hip ratio were

deviating and physical exercises like walking, jogging or gardening can be

recommended to reduce the problem.

4.3.8 BLOOD GLUCOSE

The blood glucose level is the amount of glucose in the blood. Glucose is a

sugar that comes from the foods we eat, and it's also formed and stored inside the

body. It's the main source of energy for the cells of our body, and it's carried to each

cell through the bloodstream (http://kidshealth.org/parent/diabetes_center/html).

Table 4.12: BLOOD GLUCOSE LEVELS OF THE RESPONDENTS

BLOOD

GLUCOSE(mg/dl)

FREQUENCY PERCENT

(i) Fasting

60-100 17 5.66

101-140 48 16

141-180 55 18.33

181-220 37 12.33

221-260 56 18.67

261-300 80 26.67

301-340 07 2.33

>340 - -

Total 300 100

(ii) Post- Prandial

(a) 90 minutes

120-160 60 20

161-200 27 09

201-240 35 11.67

241-280 57 19

281-320 17 5.67

321-360 64 21.33

133

361-400 16 5.33

401-440 16 5.33

>440 08 2.67

Total 300 100

(b) 120 minutes

100-140 32 10.66

141-180 42 14

181-220 24 08

221-240 26 8.67

241-280 28 9.33

281-320 84 28

321-360 32 10.66

361-400 18 6

>400 14 4.67

Total 300 100

*Normal: Fasting-70-105mg/dl, Post-prandial: 90 minutes-100-140mg/dl, 120

minutes-70-120mg/dl.

*Diabetic: Fasting- >140mg/dl, Post-prandial: 90 minutes- ≥ 200mg/dl, 120

minutes- ≥ 140mg/dl.

Blood glucose levels during fasting and post-prandial states which includes

tests taken at 90 minutes, and 120 minutes is depicted in the Table 4.12.

Generally, type 2 diabetics faces two life threatening extreme states namely

hypoglycaemia and hyperglycaemia. Hypoglycaemia, or low blood sugar, occurs

from time to time in most people with diabetes. It may be caused as a result from

taking too much diabetes medication or insulin (sometimes called as an insulin

reaction), missing a meal, doing more exercise than usual, addicted to alcohol, or

taking certain medications for other conditions. It is important for the individual to

recognise the symptoms of hypoglycaemia and should be prepared at all times to take

immediate action to raise the blood glucose levels.

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Type 2 diabetes mellitus (T2DM) is characterized by an increase in blood

glucose concentration due to resistance of insulin action. High blood glucose

(hyperglycemia) is the main pathogenic factor for the development of diabetic

complications such as coronary artery disease, retinopathy, nephropathy, and

neuropathy. In addition to this, chronic hyperglycemia, insulin resistance of

peripheral tissues is known as glucose toxicity.

It was obvious that 65(21.66%) of them fell in the normal category of 60-

140mg/dl in the fasting state as far as blood glucose was concerned. 80(26.67%)

showed extremely higher values in the range between 261-300mg/dl and 7(2.33%)

were between 301-340mg/dl.

135

In post- prandial blood sugar level at 90 minutes 87(29%) were in the normal

range of ≥200mg/dl, proved to be on the safer side, maintaining good health

condition. But, 64(21.33%) were in the 321-360mg/dl category, 57(19%) in between

241-280mg/dl, and 40(13.33%) above 360mg/dl to be taken care seriously due to

hyperglycemia.

Blood glucose in the Post-prandial state at 120 minutes 32(10.66%) fell in

the normal range of ≥140mg/dl, 84(28%) and 32(10.66%) were between 281-

136

320mg/dl and 321-360mg/dl category respectively. 18(6%) were in between 360-

400mg/dl and 14(4.67%) above 400mg/dl. The last four categories were in the

abnormal range requiring treatment both medical and dietary advice.

4.3.9 BLOOD HAEMOGLOBIN

Haemoglobin (abbreviated Hb or Hgb) is the iron-containing oxygen-transport

metalloprotein in the red blood cells of all vertebrates. Haemoglobin in the blood

carries oxygen from the respiratory organs (lungs or gills) to the rest of the body

(i.e., the tissues) where it releases the oxygen to burn nutrients to provide energy to

power the functions of the organism, and collects the resultant carbon dioxide to bring

it back to the respiratory organs to be dispensed from the organism.

(http://en.wikipedia.org/wiki/Haemoglobin).

Table 4.13: BLOOD HAEMOGLOBIN LEVELS OF THE RESPONDENTS

HAEMOGLOBIN

LEVELS (g/dl)

FREQUENCY PERCENT

< 6 2 01

6.1-8 3 01

8.1-10 33 11

10.1-12 129 43

12.1-14 66 22

>14 67 22

Total 300 100

*Females: Hb-12 to 15g/dl

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From the above table it is seen that 129(43%) of them had haemoglobin (Hb)

levels in the normal range between 10.1-12gms/dl, 67(22%) had more than 14 gms/dl,

and another 66(22%) between 12.1-14 gms/dl range. So totally 262(87%) were in the

safe zone. In the border line 33(11%) and below normal level 5(2%) of the samples

were categorised. Risk of anaemia was lesser in the selected samples.

4.3.10 LIPID PROFILE

Lipid profile or lipid panel, is the collective term given to the estimation of,

typically, total cholesterol, high-density lipoprotein cholesterol, low-density

lipoprotein cholesterol, and triglycerides. An extended lipid profile may include very

low-density lipoprotein. This is used to identify hyperlipidemia (various disturbances

of cholesterol and triglyceride levels), many forms of which are recognized risk

factors for cardiovascular disease and sometimes

pancreatitis(http://en.wikipedia.org/wiki/Lipid_profile).

138

Table 4.14: LIPID PROFILE OF THE RESPONDENTS

LIPID PROFILE(mg/dl) FREQUENCY PERCENT

TOTAL CHOLESTEROL

< 200 101 34

200-230 79 26

230-240 18 06

> 240 102 34

Total 300 100

LOW DENSITY

LIPOPROTEIN(LDL)

169 114 38

Total 300 100

HIGH DENSITY

LIPOPROTEIN(HDL)

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The strong association between increased small, dense LDL particles and

elevated triglycerides, for example, appears to be linked to the altered insulin

sensitivity common in the metabolic syndrome and type 2 diabetes (Marcovina S &

Packard CJ, 2006; Goldberg IJ, 2001).

Patients with diabetes frequently have lipid profiles that appear more benign

than those of other higher-risk people without diabetes. Lipid profile comprised of

total cholesterol, high density lipoproteins (HDL), Low Density lipoproteins (LDL),

and Triglycerides (TG).

140

As far as total cholesterol was concerned 102(34%) of them had more than

240mg/dl, 101(34%) below 200mg/dl and 79(26%) between 200-230mg/dl, and

18(6%) percent had cholesterol level between 230-240 mg/dl.

Next category where Low Density Lipoprotein (LDL), considered as bad or

poor cholesterol mostly found in foods in the form of unsaturated fats which

114(38%) of them had above 169mg/dl and this is one of the contributing factor

leading to the silent killer disease. Only 36(12%) had LDL of less than 130 mg/dl,

80(27%) had between 130-159mg/dl, 70(23%) between 160-169mg/dl.

High Density Lipoprotein (HDL) otherwise termed as good or rich

cholesterol, 229(78%) were in the range between 35-95 mg/dl, and 60(20%) had

below 35mg/dl.

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As far as triglycerides was concerned 97(32%) of them were between 200-350

mg/dl, 173(58%) below 200mg/dl, 12(4%) of the diabetics were between 350-400

mg/dl and whereas 18(6%) were above 400mg/dl which is considered to cause

deleterious effect to the individuals health.

4.3.11 SERUM CREATININE

Creatinine (from the Greek êñÝáò, flesh, pronounced, krç-'a-tə-nçn, -ən

cre·at·i·nine) is a break-down product of creatine phosphate in muscle, and is usually

produced at a fairly constant rate by the body (depending on muscle mass)

(http://en.wikipedia.org/wiki/Creatinine).

Table 4.15: SERUM CREATININE LEVELS OF THE RESPONDENTS

SERUM CREATININE mg/dl FREQUENCY PERCENT

0.5- 0.6 74 25

0.7- 0.8 127 42

0.9- 1.0 92 31

1.1-1.2 04 01

1.3-1.4 03 01

Total 300 100

* Serum Creatinine- 0.6-1.5 mg/dl

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With reference to the values the ranges for creatinine was evaluated. From the

above table it is clear that 127(42%) of the type 2 diabetics had creatinine levels

between 0.7 and 0.8 mg/dl range, 92(31%) between 0.9-1.0 mg/dl range, 74(25%) of

them between 0.5-0.6 mg/dl range, 4(1%) between 1.1-1.2 mg/dl, 3(1%) of them

between 1.3-1.4 mg/dl ranges.

Creatinine is formed from creatine. Muscle contains 98 percent of total body

creatinine (Medline Plus Encyclopedia). Creatinine leaves muscle and enters blood,

from where it is removed by kidneys. If the kidneys are failing serum creatinine

levels increase (Wagle TJ, 2010). Hence from the present study referring to the

normal values, the diabetic type 2 patients were found to be in the normal range.

4.3.12 BLOOD UREA

Urea is a nitrogen-containing substance normally cleared from the blood by

the kidney into the urine. Diseases that compromise the function of the kidney often

lead to increased blood levels of urea, as measured by the Blood Urea Nitrogen

(BUN) test. An elevation of blood urea usually signifies decreased renal function

(http://en.wikipedia.org/wiki/Blood_urea_nitrogen).

143

Table 4.16: UREA LEVELS OF THE RESPONDENTS

UREA LEVELS(mg/dl) FREQUENCY PERCENT

8-11.9 - -

12-15.9 08 2

16-19.9 41 14

20-23.9 45 15

24-27.9 107 36

>30 99 33

Total 300 100

*Urea:15-45 mg/dl

Plasma creatinine and urea are useful clinical tools in assessing renal function,

despite some limitations (Research Journal of Medical Sciences, 2011).

Based on the laboratory values given it is clear from the table 4.16 that 107(36%) of

T2DM patients had urea levels between the range of 24-27.9 mg/dl, 99(33%) more

than 30mg/dl, 45(15%) between 20-23.9 mg/dl, and 8(2%) between 12-15.9 mg/dl.

Urea levels of T2DM patients was in normal range only.

4.3.13 SODIUM LEVELS

Sodium test checks how much sodium (an electrolyte and a mineral) is in the

blood. It helps keep the water (the amount of fluid inside and outside the body's cells)

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and electrolyte balance of the body. Sodium is also important in how nerves and

muscles work (http://www.webmd.com/a-to-z-guides/sodium-na-in-blood).

Table 4.17: SODIUM LEVELS OF THE RESPONDENTS

SODIUM LEVELS

(mEq/dl)

FREQUENCY PERCENT

120-129 29 9

130-139 149 50

140-149 98 33

150-159 24 8

Total 300 100

* Sodium: 135-145 mEq/L

149(50%) of the subjects had sodium levels in the ranges between 130-139 M

Eq/l, 98(33%) of them between 140-149 m Eq /L, 29(9%) of them between 120-129

m Eq/ L; and 24(8%) of them between 150-159 m Eq/L. While sodium is an essential

nutrient for the body to function, consuming a diet that is high in sodium in subjects

who have high sodium levels can have negative effects on the body. Thus too much

of sodium in the blood increases the blood volume, which will put stress on the heart

and increases pressure in the arteries which can be leading to high blood pressure.

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4.3.14 POTASSIUM LEVELS

Potassium test checks how much potassium is in the blood. Potassium is both

an electrolyte and a mineral. It helps keep the water (the amount of fluid inside and

outside the body's cells) and electrolyte balance of the body. Potassium is also

important in how nerves and muscles work (http://www.webmd.com/a-to-z-

guides/potassium-k-in-blood).

Table 4.18: POTASSIUM LEVELS OF THE RESPONDENTS

POTASSIUM LEVELS

(mEq / L)

FREQUENCY PERCENT

3.0-3.4 11 3.66

3.5-3.9 33 11.00

4.0-4.4 70 23.33

4.5-4.9 94 31.33

5.0-5.4 70 23.33

>5.4 22 7.33

Total 300 100.0

* Potassium: 3.5-5.5 mEq/dl

Potassium has blood pressure lowering effects. In fact, low levels of

potassium in the body lead to increased sodium retention, calcium loss and raises

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blood pressure. Potassium helps to normalize blood pressure by relaxing blood

vessels and helping the body get rid of excess water and salt.

94(31%) of the diabetics were between 4.5- 4.9 m Eq/ L potassium, whereas

70(23%) each in the 4.0-4.4 M Eq/L and 5.0-5.4 M Eq/L ranges respectively.

33(11%) were between 3.5-3.9 M Eq/L, 22(7%) of them, were above 5.4 M Eq/L, and

finally only 11(4%) were between 3.0-3.4 M Eq/L. Only 11(3.66%) had low level and

22(7.33%) had high level of Potassium.

Table 4.19 STATISTICAL ANALYSIS OF BIOCHEMICAL TESTS OF THE

RESPONDENTS (N=300)

Biochemical Tests Mean Std. Deviation

Blood Glucose-Fasting 180.41 63.96

Blood glucose -Post

prandial(90 minutes)

253.03 91.85

Blood glucose -Post

prandial (120 minutes)

255.85 93.57

Blood haemoglobin 11.86 1.91

Total cholesterol 210.53 45.48

High Density Lipoprotein(HDL)

42.76 10.84

Low Density Lipoprotein(LDL)

139.18 39.47

Triglycerides 153.95 76.81

Serum Creatinine 0.739 0.23

Urea 27.62 6.73

Sodium 139.04 8.94

Potassium 4.610 0.69

Mean blood glucose levels in the fasting state, Post prandial tests at 90

minutes and 120 minutes were found to exceed the normal range. Mean values first

at fasting was 180.41 when compared to the normal value of 140mg/dl, and post-

prandial glucose level at 90 minutes was 253.03 in comparison to the normal

laboratory value of ≥ 200 mg/dl were at high levels. The last category of post-

prandial glucose level at 120 minutes, mean value was 255.85, exceeding the normal

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range of ≥ 140mg/dl. Hence to conclude glucose levels depicted a high range which

is a danger signal and may lead to other blood capillary complications. Blood

haemoglobin was found to be almost equal to the normal value of 12 gms/dl with a

mean of 11.86.

As far as lipid profile was concerned, the mean value was higher for total

cholesterol with 210.53 where normal range was seen to be within 140-220mg/dl,

high density lipoprotein, normally considered to be good cholesterol with a mean

value of 42.76 was little above the normal range of 30-60mg/dl, LDL(bad cholesterol)

had a mean value of 139.18, fell within the normal range of 60-160mg/dl, and the

same in the case of triglycerides with mean of 153.95, the usual value being 80-

160mg/dl.

Serum creatinine had a mean value of 0.739 also depicted to be normal in

between 0.6-1.5mg/dl, and urea with a mean of 27.62 in the range within 15-45mg/dl.

Sodium and potassium did not exhibit any difference and mean values were 139.04

and 4.610 within normal range of 135-145 mEq/l and 3.5 - 5.5 mEq/l.

Hence to conclude, glucose level very vital component for determining type

2 diabetes showed tremendous increase when compared to normal values, whereas

haemoglobin was almost normal, lipid profile, serum creatinine, urea, sodium and

potassium were in normal range except total cholesterol. The samples had specially

hyperglycaemia without any accompanying complications.

4.3.15 SYMPTOMS

It denotes any sensation or change in bodily function experienced by a patient

that is associated with a particular disease (http://dictionary.reference.com).

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Table 4.20: SYMPTOMS EXPERIENCED

SIGNS & SYMPTOMS YES NO TOTAL

Count % Count %

Excessive thirst 294 98.00 6 2.00 300

Excessive hunger 294 98.00 6 2.00 300

Excessive urination 288 96.00 12 4.00 300

Fatigue on exertion 140 46.67 160 53.33 300

Vomiting 75 25.00 225 75.00 300

Abdominal pain 112 37.33 188 62.67 300

Breath of Acetone 1 0.33 299 99.67 300

As the concentration of glucose increases in the blood, brain receives signal

for diluting it, and, in its counteraction we feel thirsty otherwise termed as polydypsia

and in the present study 294(98%) had the above symptom. Again 294(98%) suffered

from polyphagia, because to cope up with high sugar levels in blood, body produces

insulin which leads to increased hunger in type 2 diabetics.

Polyuria or increased urination is due to an increase in urine production

because of excess glucose present in the body. This can lead to dehydration because

along with sugar (glucose) a large amount of water is excreted out from the body. It

is seen that 288(96%) suffered from excess urination and among them 1 percent

reported to excrete scanty urine and could be due to urinary infection and was advised

by the physician to undergo urine tests. Most of the patients were observed to suffer

from nocturia, and some of them reported to excrete starchy, dark yellow urine, one

of the symptoms of type 2 diabetes.

149

Fatigue on exertion was reported by 140(46.67%) due to fasting on religious

bondage or travelling. This could be due to insufficiency of the cell to metabolize

glucose; reserve fat of body is metabolized to gain energy. When fat is broken down

in the body it uses more energy as compared to glucose, hence the body goes in

negative calorie effect, which results in fatigue. To overcome fatigue feeling they

took breaks while performing household activities.

Only 75(25%) had the problem of vomiting due to ulcer problems, and

acidity. Still 112(37.33%) of them suffered from abdominal pain due to fibroid in the

uterus, during menstrual periods who underwent hystectomy, and constipation and in

one case the patient suffered from vulvitis which is the inflammation of the external

genital organs of the female due to infections and just, 1(0.33%) reported to suffer

from breath of acetone.

4.3.16 DELAYED WOUND HEALING

Only 9(3%) of the type 2 diabetic patients had delay in healing of wounds due

to caesarean operation, and athletes foot. One person had head injury and had 9

stitches. Delayed healing could be due to high blood sugar resisting the flourishing of

WBC (White Blood Cell) which are responsible for the body immune system. When

these cells do not function actively, wound healing is not at good pace. Secondly,

150

long standing diabetes leads to thickening of blood vessels which affect proper

circulation of blood in different body parts.

4.3.17 LUNG COMPLICATIONS

It was reported that only 33(11%) suffered from the respiratory problem such

as common cold accompanied by throat infection, breathlessness due to phlegm, and

coughing and one percent suffered by asthma for more than 12 years.

4.3.18 CARDIOVASCULAR DISEASE

Diabetes predisposes an individual to high blood pressure and high cholesterol

and triglycerides levels and accelerates atherosclerosis (the formation of fatty plaques

inside the arteries), which can lead to blockages or a clot (thrombus). Hence this

metabolic syndrome has been observed in many ethnic groups and is estimated in

about a quarter of the worlds adults (Dunstan DW etal, 2002).

It is also an independant predictor of the disease and is also related to an

increased risk of morbidity and mortality. In the present study it was found that

28(9%) were suffering from cardiovascular problems such as chest pain,

breathlessness along with hypertension for more than 5 years.

4.3.19 DENTAL PROBLEMS

Most of the reviewed studies reported greater tooth loss in people with

diabetes. The literature does not describe a consistent relationship between type 2

diabetes and dental caries (Taylor GW etal, 2004).

Individuals generally suffering from diabetes are more vulnerable to the

millions of germs that line in their mouth. They are more likely to have infections in

their gums and the bones that hold the teeth in place.

Diabetes also causes a decrease in blood supply to the gums making them

more susceptible to disease. In addition, high blood sugars may cause dry mouth and

an increase in tooth decaying bacteria and plaque build up, frequent infections and

bad breath.

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Table 4.21: DENTAL PROBLEMS

DENTAL

PROBLEMS

YES NO TOTAL

Count % Count %

Gum disease 23 7.67 277 92.33 300

Periodontal

Problems

- - 300 100.00 300

Abscess - - 300 100.00 300

Others 43 14.33 257 85.67 300

Actually 23(7.67%) were affected by gum disease, none by the periodontal

problems or abscess. But 43(14.33%) of them suffered in a number of ways such as

one percent had swelling of gums due to uprooted tooth, 2 percent had mostly their

molars uprooted from dental caries, 2 percent reported to have pain in the tooth, 2

percent had tooth shaking and one percent was found to suffer from bleeding of

gums. Dental problems should be attended immediately to avoid more complications

like infection.

4.3.20 CARBUNCLES

A carbuncle is formed when several boils merge to form a single deep abscess

with several heads or drainage points. An abscess may be so deep that it may not

surface for a long time (http://www.diagnose-me.com/cond/html).

In the selected subjects only one (0.33%) was suffering by carbuncle at the

back. None of them seem to have carbuncle at the nape of the back, buttocks or

thighs.

4.3.21 FOOT PROBLEMS

Proper foot care is very essential for avoiding this devastating complication of

Diabetes. Choice of footwear is very important, shoes should be comfortable without

any areas of excessive pressure, insoles or custom made shoes should be used if

theres any difficulty in finding adequate footwear. Feet should be inspected daily, if

there are any cracks, wounds etc and they should be taken care of. A Diabetologist or

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foot specialist must inspect the feet and conduct tests to ascertain the status of nerves

(http://diabetestotalcontrol.com).

Table 4.22: FOOT PROBLEMS

FOOT

PROBLEMS

YES NO TOTAL

Count % Count %

Neuropathy 8 2.67 292 97.33 300

Ischaemia 3 1.00 297 99.00 300

Infection 2 0.67 298 99.33 300

Others - -- 300 100.00 300

Over a long period of time, diabetes ultimately leads to damage to the nerves

due to hyperglycemia termed as diabetic neuropathy. Again this causes the foot

wounds and ulcers, which frequently leads to foot and leg amputations.

The body gives few signals whenever there is fluctuation in blood sugar due

to suppression of immune system by frequent skin infections like fungal or bacterial

or UTI (Urinary Tract Infection).

The above table depicts that 8(3%) of them developed peripheral neuropathy,

leading to hip and leg pain, leg cramps, and cracks which caused pain on foot. 3(1%)

suffered from ischaemia whereas 2(0.6%) suffered from infection.

4.3.22 PRESENT CONDITION

The vast majority of amputations are performed because the arteries of the

legs have become blocked due to hardening of the arteries (atherosclerosis).

Blockage in the arteries results in insufficient blood supply to the limb. Because

diabetes can cause hardening of the arteries, about 30 - 40 percent of amputations are

performed in patients with diabetes (Moxey PW etal, 2010).

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Table 4.23: PRESENT CONDITION

PRESENT

CONDITION

YES NO TOTAL

Count % Count %

Non-healing 5 1.67 295 98.33 300

Cellulites - - 300 100.00 300

Gangrene 1 0.33 299 99.67 300

Amputation of

limbs

3 1.00 297 99.00 300

As described above due to the insufficiency of blood circulation to the limbs

5(1.67%) of the subjects had non- healing ulcers of the foot, 3(1%) of the subjects

first toe was amputated at JIPMER (Jawaharlal Institute of Post-Graduate and

Medical Research) one of the Pioneer Institution at Pondicherry whereas 1(0.33%)

suffered from gangrene, wound caused by iron rod which pierced her leg and caused

infection.

4.3.23 PHYSIQUE

The ectomorph physique have narrow shoulders and hips, whereas

mesomorphs have well built muscled arms and legs with a slim midriff. The body of

the extreme endomorph is round and soft. The physique presents the illusion that

much of the mass has been concentrated in the abdominal area. This may or may not

be true. The arms and legs of the extreme endomorph are short in length and taper.

This may give the appearance of stalkiness (www.naturesintentionsnaturopathy.com).

It is clear that 160(53.33%) belonged to endomorph category and they have

high body-fat ratio which may be compounded by a lack of interest or no aptitude for

physical exercise, and 135(45%) belonged to ectomorph category, this can be due to

high metabolic rates, therefore they dont gain weight as their body fat content is

lower than average, and 5(1.67%) in the mesomorph category have high muscle-to-

body-fat ratio.

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4.3.24 HYPERINSULINEMIA

Symptoms include excessive hunger, shakiness and hypoglycaemia (Concise

Dictionary of Modern Medicine, 2002).

Beta cells in the pancreas produce insulin. Insulin stimulates uptake of

glucose (sugar) from the blood to the cells in the body. When the bodys cells are

resistant to the action of the insulin, it is called insulin resistance. In this condition the

pancreas produces much more insulin than normal. This is called hyperinsulinaemia.

Only 2(0.7%) were found to suffer from hyperinsulinemia characterised by increased

production or secretion by pancreatic beta cells, or decreased hepatic clearance.

4.3.25 ALBUMINURIA

Albumin is a protein which is present in the blood. The kidneys act as a filter

for waste products in the blood. Protein is not allowed to spill over into the urine

unless the filter system is leaky.

Microalbuminuria refers to the appearance of small but abnormal amounts of

albumin in the urine. If measured, this protein excretion is between 30 and 300 mg

during a 24-hour period (www.diabetesuffolk.com).

Table 4.24: TYPE 2 SUBJECTS SUFFERING FROM ALBUMINURIA

ALBUMINURIA YES NO TOTAL

Count % Count %

Micro albuminuria 219 73.00 81 27.00 300

Macro albuminuria 15 5.00 285 95.00 300

Normo albuminuria 33 11.00 267 89.00 300

Macroalbuminuria a type of albuminuria that is characterised by high levels of

albumin in the urine more than 300 mg in one day and this condition can be a

symptom of many kidney diseases and disorders, because its presence indicates that

the kidney is leaking albumin and is also known as proteinuria.

About 219(73%) of type 2 diabetics were found to have microalbuminuria,

15(5%) of them suffered from macroalbuminuria and only 33(11%) showed

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normoalbuminuria. As microalbuminuria and macroalbuminuria can definitely lead

to kidney disease and is discussed in the next section.

4.3.26 DIABETIC NEPHROPATHY

Diabetic nephropathy (nephropatia diabetica), also known as Kimmelsteil-

Wilson syndrome, or nodular glomerulosis and intercapillary glomerulonephritis, is a

progressive kidney disease caused by angiopathy of capillaries in the kidney

glomeruli. It is due to longstanding diabetes mellitus and is a prime indication in

many Western Countries (http://en.wikipedia.org).

Increased urinary excretion is an early clinical manifestation of diabetic

nephropathy. Only 1(0.3%) of type 2 diabetic patient suffered from nephropathy

accompanied by oedema. It may be caused by hypoproteinemia due to large amount

of protein loss in urine. Only 1(0.3%) suffered from renal failure and had underwent

renal replacement.

4.3.27 DIABETIC EYE DISEASE

Diabetes mellitus is one of the leading causes of irreversible blindness

worldwide, and, in the United States, it is the most common cause of blindness in

people younger than 65 years of age. In addition to being a leading cause of

blindness, diabetic eye disease encompasses a wide range of problems that can affect

the eyes.

Diabetes mellitus may cause a reversible, temporary blurring of the vision, or

it can cause a severe, permanent loss of vision. Diabetes mellitus increases the risk of

developing cataracts and glaucoma. Some people may not even realize they have

had diabetes mellitus for several years until they begin to experience problems with

their eyes or vision. Severe diabetic eye disease most commonly develops in people

who have had diabetes mellitus for many years and who have had little or poor

control of their blood sugars over that period of time

(http://www.emedicinehealth.com).

156

Table 4.25: DIABETIC EYE DISEASE

DIABETIC EYE

DISEASE

YES NO TOTAL

Count % Count %

Blurred vision 190 63.33 110 36.67 300

Cataracts 55 18.33 245 81.67 300

Blindness 2 0.67 298 99.33 300

Others 1 0.33 299 99.67 300

190(63.33%) of the T2DM patients were suffering from blurred vision,

55(18.33%) had underwent eye operation due to cataract and out of them (14%) had

both eyes operated, (2%) had their left eyes operated, and (2.33%) of them in their

right eye.

Blindness on the left eye was reported by 2(0.67%) of type 2 diabetics and

one percent reported that right eye was hit by a coconut shell and had lost her sight.

One (0.33%) had bleeding in the eye, an important symptom observed in type 2

diabetes.

4.4 TREATMENT

The mainstay of treatment of Type 2 diabetics includes diet, lifestyle

modifications and oral hypoglycaemic therapy.

4.4.1 METHODS USED TO LOWER BLOOD SUGAR LEVEL

People with diabetes can manage it with meal planning, physical activity, and

if needed, medications. The first line-treatment for type 2 diabetes is diet, weight

control and physical activity. If ones blood glucose level remains high despite a trial

of these lifestyle measures, then tablets to reduce the blood glucose level are usually

added.

157

Table 4.26: METHODS USED TO LOWER BLOOD SUGAR LEVEL

METHODS

USED TO

LOWER SUGAR

LEVEL

YES NO TOTAL

Count % Count %

Diet 92 30.67 208 69.33 300

Exercise 2 0.67 298 99.33 300

Drugs 300 100.00 - - 300

Others,specify - - 300 100.0 300

Only 92(30.67%) of T2DM patients followed diabetic diets, reason behind

this was that others, lived along with their sons or daughters or daughters-in-law. But

addition of oil alone was restricted. Only 2(0.67%) practiced walking for one hour

daily who had collegiate education and went for purchase to the market, or to the

hospital by walking. All the 300(100%) consumed drugs prescribed by the doctors in

the diabetic clinic of the hospital.

4.4.2 MEDICATIONS

Medications for type 2 diabetes come in various classes-alpha-glucosidase

inhibitors, amylin antagonists, dipeptidyl - peptidase 4 (DPP) inhibitors, meglitinides,

sulfonylureas and drugs thiazoldinediones. Each class contains one or more specific

drugs. Some of these are taken orally, while others must be injected.

Various diabetic drugs work in different ways to lower blood sugar. A drug

may work by stimulating the pancreas to produce and release more insulin,

inhibiting the production and release of glucose from the liver, which means one

needs less insulin to transport sugar into the cells, blocking the action of stomach

enzymes that breakdown carbohydrates make tissues more sensitive to

insulin(www.mayoclinic.org/diseases-conditions/type-2-diabetes/in-depth/diabetes-

treatment).

300(100%) consumed drugs as prescribed by the physician. Tablets

recommended where Daonil, Metformin and injections were namely glycophage,

158

monotarol, Sorbitorate, the dosage varied depending upon the sugar levels of the

patients. Injections included once in a day but only 62(21%) were undertaking. One

percent of the patient took additional psychiatric drug namely Decoine and people

suffering from hypertension consumed amylodepin (5 milligrams) in a day.

4.4.3 SIDE EFFECTS ON CONSUMPTION OF DRUGS

Although there are many contributors to the observed difficulty in achieving

goals of glycemic control, effective medication prescription remains a central task for

physicians (Grant RW etal, 2007). 300(100%) of the patients had no side effects on

consumption of hypoglycaemic drugs prescribed by the physician.

4.4.4 CLINICAL TESTS CONDUCTED

Some people have a normal fasting blood sugar reading, but their blood sugar

rapidly rises as they eat. One is required to abstain from eating prior to the test. A

glucose level greater than 200 mg/dl may indicate diabetes especially if the test is

repeated at a later time and shows similar results.

300(100%) of the patients underwent urine tests before visiting the physician

and waited for half an hour and after getting the results attended the physician, which

was conducted for every 5 days. But at times the results were given after 2 hours and

hence the patient has to come fasting and some of them either brought their breakfast

and lunch which was consumed after giving their urine samples for analysis.

4.4.5 CONSUMPTION OF MULTIVITAMIN/MULTIMINERAL TABLETS

A multivitamin is a preparation intended to supplement a human diet with

vitamins, dietary minerals and other nutritional supplements

(http://en.wikipedia.org/wiki/multivitamin).

As far as multivitamin tablets were concerned 141(47%) consumed B-

complex vitamin tablet as recommended by the endocrinologists, and none of them

consumed multimineral tablets.

159

4.5 FOOD HABITS

4.5.1 TYPE OF FOOD CONSUMED

Those living with type 2 diabetes be particularly careful about monitoring the

blood glucose levels and maintaining a stable balance in these levels. Knowing how

foods affect blood glucose levels is important in order to avoid symptoms of

hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar).

Number of studies have shown that a very low fat, mostly whole foods vegan

diet can lower body weight, reduce blood sugar, and improve other parameters. A

vegetarian diet also improves plasma lipid concentrations and have shown to reverse

atherosclerosis progression.

Table 4.27: TYPE OF FOOD CONSUMED

TYPE OF FOOD

CONSUMED

YES NO TOTAL

Count % Count %

Vegetarian 3 1.00 297 99.00 300

Non-vegetarian 296 98.67 4 1.33 300

Ovo-vegetarian - - 300 100.00 300

Lacto- vegetarian 4 1.33 296 98.67 300

Pesci- vegetarian 1 0.33 299 99.67 300

Vegetarianism encompasses the practice of following plant-based diets (fruits,

vegetables etc.,) with or without the inclusion of dairy products or eggs, and with the

exclusion of meat (red meat, poultry and seafood). Abstention from by products of

animal slaughter, such as animal-derived rennet and gelatine, may also be practised

(http://en.wikipedia.org/wiki/vegetarianism).

Non- vegetarians include plant-based diets as well as animal foods in their

diet.

Lacto-vegetarian is used to describe a vegetarian who does not eat eggs and

dairy products. Many Hindu vegetarians are lacto-vegetarians who avoid eggs for

160

religious reasons while continuing to eat dairy. The prefix lacto comes from the

Latin word for milk (http://vegetarian.about.com/ od/glossary/g/lactovegetarian.htm).

Pesci-vegetarians consumed vegetarian foods but as far as animal foods are

concerned, only fish is being consumed.

Among the respondents 296(99%) were found to be non- vegetarians and the

incidence of high blood pressure, heart disease, obesity and high cholesterol levels is

found to be greater among non-vegetarians, 4(1.33%) were lacto vegetarians,

1(0.33%) pesci-vegetarian and 3(1%) pure vegetarians. Though non vegetarian foods

are rich in protein of high biological value and in vitamin B- complex, especially B12

which is not available in plant foods, elders who suffer from problems such as

diabetes should reduce the intake of fleshy foods in their diet.

4.5.2 TRYING NEW FOODS

All the 300(100%) of the subjects did not try any new food or modifying their

foods as they were not independent on income generation.

4.5.3 INCLUSION OF SPECIAL DIABETIC RECIPES

Complete 300(100%) revealed that they did not try out any special diabetic

recipes at home.

4.5.4 DIABETIC INSTANT FOODS PURCHASED IN THE MARKET

Only one (0.3%) patient reported to purchase and include diabetic instant

foods sold in Departmental Stores such as Delight, Manna brands in the form of

cereal flours, or as a beverage. 299(99.7%) of them never consumed any instant

diabetic foods sold in the market. Lack of awareness and purchasing capacity may be

the reason.

4.5.5 ARTIFICIAL SWEETENERS USED TO REPLACE SUGAR

Artificial sweeteners, which are also called sugar substitutes, alternative

sweeteners, or non-sugar sweeteners, are substances used to replace sugar in foods

and beverages. They can be divided into two large groups: nutritive sweeteners,

which add some energy value (calories) to food; and non-nutritive sweeteners, which

161

are also called high-intensity sweeteners because they are used in very small

quantities as well as adding no energy value to food. Nutritive sweeteners include the

natural sugars - sucrose (table sugar; a compound of glucose and fructose), fructose

(found in fruit as well as table sugar), and galactose (milk sugar) - as well as the

polyols, which are a group of carbohydrate compounds that are not sugars but provide

about half the calories of the natural sugars. Non-nutritive sweeteners approved by

the Food and Drug Administration (FDA) 2007 are saccharin, aspartame, acesulfame-

potassium(or acesulfame-K), sucralose, and neotame (http://www.diet.com/g/

artificial-sweeteners).

Only 2(0.7%) of T2DM subjects consumed artificial sweetener as Sweetex

which contains Saccharin and was used instead of sugar while consuming tea or

coffee and said that it had no side effects.

4.5.6 KNOWLEDGE ON FOODS RECOMMENDED FOR DIABETES

Diet plays a significant role in controlling the diabetes. The diabetic diet may

be used alone or else in combination with oral hypoglycaemic drugs. Main objective

of diabetic diet is to maintain ideal body weight, by providing adequate nutrition

along with normal blood sugar levels in blood. The diet plan for a diabetic is based

on height, weight, sex, physical activity and nature of diabetes. While planning diet,

the dietician has to consider complications such as high blood pressure, high

cholesterol levels (http://diabetesinformationhub.com/Diabetesdiet.php).

All the 300(100%) respondents accepted that physicians advised them on

foods and additionally 10(3.33%) gathered information from dietician and 1(0.33%)

from mass media in Doordarshan channel. But the effect of this knowledge gathered

was not reflected in their diet

4.5.7 FOOD CONSUMPTION PATTERN

Maintaining a healthy diet is important for everyone and it is especially

important for people with diabetes. Dietary factors are important and are potentially

modifiable risk factors of type 2 diabetes. A type 2 diabetes diet with the right meal

plan can make all the difference to a person struggling to keep the blood sugar under

control.

162

Table 4.28: FOOD CONSUMPTION PATTERN

*Note: The value with bracket refers to Row Percentage

Name of the Foodstuff

Daily 3-4 times a week

Once a week

Once in a

month

Rarely Not at all

Total

I CEREAL

GRAINS & ITS

PRODUCTS

1. Bajra 0

(0.0)

0

(0.0)

76

(25.33)

44

(14.66)

142

(47.33)

38

(12.66)

300

(100)

2. Barley 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

19

(6.33)

281

(93.66)

300

(100)

3. Jowar 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

3

(1.00)

297

(99.00)

300

(100)

4. Maize, dry 0

(0.0)

1

(0.33)

20

(6.66 )

43

(14.33)

147

(49.00)

89

(29.66)

300

(100)

5. Panivaragu 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

6. Ragi

12

(4.00 )

109

(36.33)

133

(44.33)

10

(3.33 )

1

( 0.33 )

35

(11.67)

300

(100)

7.Rice, parboiled,handpou-nded

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

24

(8.00)

276

(92.00)

300

(100)

8.Rice, parboiled,

milled

300

(100.00)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100)

9. Rice flakes 0

(0.0)

0

(0.0)

44

(14.6 )

45

(15.00)

138

(46.00)

73

(24.33)

300

(100)

10. Samai 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

11. Varagu 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

12. Wheat

bulgar(parboiled)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

163

13. Wheat,whole 72

(24.00)

169

(56.33)

49

(16.33)

7

( 2.33 )

0

(0.0)

3

(1.00)

300

(100)

14. Wheat flour,

refined(Maida)

17

( 5.66 )

112

(37.33)

54

(18.00)

15

(5.00)

41

(13.66)

61

(20.33)

300

(100)

II PULSES &

LEGUMES

15. Red gram dhal 34

( 11.33)

145

(48.33)

29

(9.66 )

89

(29.67

3

(1.00)

0

(0.0)

300

(100)

16. Bengal gram

dhal (whole)

16

(5.33)

241

(80.33)

30

(10.00)

4

(1.33)

6

(2.00)

3

(1.00)

300

(100)

17. Bengal gram

dhal

24

( 8.00 )

112

(37.33)

47

(15.66)

12

(4.00)

3

(1.00 )

2

( 0.66 )

300

(100)

18. Black gram,

whole

16

( 5.33 )

148

(49.33)

86

(28.66)

2

(0.66 )

48

(16.00)

0

(0.0)

300

(100)

19. Black gram

dhal

14

(4.66 )

192

(64.00)

94

(31.33)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100)

20. Green gram,

whole

112

( 37.33)

97

(32.33)

31

(10.33)

17

(5.66 )

43

(14.33)

0

(0.0)

300

(100)

21. Green gram

dhal

117

(39.00)

89

(29.66)

40

(13.33)

54

(18.00)

0

(0.0)

0

(0.0)

300

(100)

22. Peas, dry 9

( 3.00)

10

( 3.33 )

23

(7.66 )

52

(17.33)

61

(20.33)

145

(48.33)

300

(100)

23. Peas, roasted 11

( 3.66 )

29

(9.66 )

48

(16.00)

62

(20.66)

31

(10.33)

119

(39.66)

300

(100)

24. Cow pea 0

(0.0)

14

(4.66 )

34

(11.33)

61

(20.33)

42

(14.00)

149

(49.66)

300

(100)

25. Rajmah 0

(0.0)

3

(1.00 )

0

(0.0)

14

(4.66)

0

(0.0)

283

( 94.33)

300

(100)

26. Soyabean

(Black)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

27. Soyabean

(White)

0

(0.0)

14

(4.66 )

19

(6.33 )

0

(0.0)

112

(37.33)

155

(51.66)

300

(100)

164

28. Horse gram 0

(0.0)

27

(9.00)

45

(15.00)

138

(46.00)

46

(15.33)

44

(14.67)

300

(100)

29. Moth beans 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

III LEAFY VEGETABLES

30. Amaranth 19

(6.33)

112

(37.33)

58

(19.33)

6

(2.00)

75

(25.00)

30

(10.00)

300

(100)

31. Ambat chiku 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

100.00

300

(100)

32. Betel leaves 4

(1.33)

0

(0.0)

21

(7.00)

0

(0.0)

187

(62.33)

88

(29.33)

300

(100)

33. Cabbage 0

(0.0)

56

(18.66)

92

(30.66)

78

(26.00)

42

(14.00)

32

(10.67)

300

(100)

34. Coriander

leaves

3

(1.00)

44

(14.66)

84

(28.00)

66

(22.00)

52

(17.33)

51

(17.00)

300

(100)

35. Curry leaves 192

(64.00)

85

(28.33)

18

(6.00)

5

(1.66)

0

(0.0)

0

(0.0)

300

(100)

36. Drumstick

leaves

0

(0.0)

120

(40.00)

113

(37.66)

62

(20.67)

3

(1.00)

2

(0.67)

300

(100)

37. Gogu 0

(0.0)

3

(1.00)

14

(4.67)

28

(9.33)

30

(10.00)

225

(75.00)

300

(100)

38. Fenugreek

leaves

0

(0.0)

12

(4.00)

24

(8.00)

34

(11.33)

127

(42.33)

103

(34.33)

300

(100)

39. Mint 0

(0.0)

45

(15.00)

76

(25.33)

27

(9.00)

109

(36.33)

43

(14.33)

300

(100)

40. Paruppu leaves 0

(0.0)

44

(14.66)

32

(10.66)

45

(15.00)

34

(11.33)

145

(48.33)

300

(100)

41. Spinach 0

(0.0)

59

(19.66)

64

(21.33)

21

(7.00)

62

(20.66)

94

(31.33)

300

(100)

42. Tamarind

leaves

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

12

(4.00)

288

(96.00)

300

(100)

165

43. Ponnangani 0

(0.0)

0

(0.0)

14

(4.66)

28

(9.33)

116

(38.66)

142

47.33

300

(100)

44. Soya leaves 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

45. Neem leaves 0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100.00)

300

(100)

IV ROOTS & TUBERS

46. Beetroot 0

(0.0)

132

(44.00)

114

(38.00)

31

(10.33)

17

(5.67)

6

(2.00)

300

(100)

47. Carrot 0

(0.0)

65

(21.66)

123

(41.00)

74

(24.67)

31

(10.33)

7

(2.33)

300

(100)

48. Colocasia 0

(0.0)

0

(0.0)

39

(13.00)

69

(23.00)

114

(38.00)

78

(26.00)

300

(100)

49. Onion, big 198

(66.00)

102

(34.00)

0

(0.0)

0

(0.0)

0

(0.0)

0

(0.0)

300

(100)

50. Potato 41

(13.66)

45

(15.00)

34

(11.33)

4

(1.33)

98

(32.67)

78

(26.00)

300

(100)

51. Raddish, pink 0

(0.0)

141

(47.00)

24

(8.00)

11

(3.67)

50

(16.67)

74

(24.67)

300

(100)

52. Sweet

potato(pink)

0

(0.0)

0

(0.0)

98

(32.67)

112

(37.33)

35

(11.67)

55

(18.33)

300

(100)

53. Tapioca, chips

(dried)

0

(0.0)

49

(16.33)

62

(20.67)