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IB HIGHER LEVEL BIOLOGY

DIABETES GUIDE Topics D3.3, B1.1

In collaboration: Isabel Diaz Christianne kafie Claudia Molina Adrian Suarez Mateo Jacome Valentina Sevilla Anjelie Asencio Samia Mahomar Laura Simon Marianne Rodriguez Mrs. Ali Swanson

INDEX PART I - CONTEXT 1.1. Why we need food

1.2. Food in the body

1.3. Glucose

1.4. Low and high glucose levels

1.5. Blood Spikes

1.6. Insulin

1.7. Diabetes

1.8. Impacts in Honduras

1.9. Carbohydrates

1.10. Monosaccharides

1.11. Fiber

1.12. Starches

1.13. Fats

1.14. Blood Spikes

INDEX PART II - GUIDE 2.1. Refined Grains vs Whole Grains

2.2 Smart Sugar Strategy

2.3. Starches

2.4. Choose High-Amylose Starches

2.5. Debunking the “Good and Bad” Food Myth

2.6. Debunking the Fruit Myth

2.7. Fats

2.8. Exercise

2.9. Supermarket Guide

2.10. Cheap Alternatives

CONTEXT

WHY WE NEED FOOD Our body uses food as a source of energy, a place to get raw materials needed for development, and the molecules required for growth and repair. Energy provides chemical energy in the form of ATP (adenosine triphosphate), which is needed throughout the body in the form of cellular respiration. What comes into the body (carbohydrates, lipids, proteins) are broken down into smaller molecules that can enter metabolic pathways in order to generate ATP, which is used to fuel cellular activities like muscle contraction, the passing of nutrients through the wall of a cell, etc. The body also uses food as building materials, due to the fact that nutrients supply monomers, which are used for anabolism. This leans to the essential components needed for growth, tissue repair, and hormone production.

FOOD IN THE BODY 1.Food enters through the mouth, where mechanical digestion begins through chewing, and chemical digestion begins with saliva. Saliva contains amylase, an enzyme that breaks down starches into maltose (simple sugars). 2. The food then passes through the esophagus into the stomach, where pepsin and hydrochloric acid break down proteins into smaller peptides. 3. From there, it moves into the small intestine, where enzymes from the pancreas (like lipase for lipids) and bile from the liver further digest fats, carbohydrates, and proteins. Finally, the nutrients are absorbed into the bloodstream through the intestinal walls. 4. Then, it moves to the large intestine, where water and minerals are absorbed, which leave the remaining material to form feces. The nutrients that are absorbed into the body and the circulatory system, where it will reach the cells where they are needed. Unnecessary waste is removed through the rectum (pee) and anus (poop).

GLUCOSE Our body keeps the level of glucose, a type of sugar that provides energy to our cells, stable through a process called homeostasis, which means keeping balance inside the body. This balance depends on two main hormones produced by the pancreas, an organ located behind the stomach. Insulin: Helps lower blood glucose levels. After eating, blood glucose rises, and the pancreas releases insulin. This hormone allows glucose to enter the body’s cells to be used for energy. If there’s extra glucose, insulin helps store it in the liver and muscles as glycogen, a stored form of sugar for later use. Glucagon: Helps raise blood glucose levels. When blood sugar becomes too low, the pancreas releases glucagon, which tells the liver to break down stored glycogen into glucose and release it into the bloodstream. Together, insulin and glucagon act as a balancing system, keeping blood sugar levels within a healthy range so the body can work properly.

LOW AND HIGH GLUCOSE LEVELS BLOOD GLUCOSE LEVELS Blood glucose is the amount of sugar in the bloodstream. It’s the main energy source for body cells, especially the brain, which depends almost entirely on glucose to function. The body keeps glucose within a narrow range through homeostasis. If not controlled, high blood glucose can damage organs like the heart, kidneys, eyes, and nerves over time.

HIGH GLUCOSE LEVELS Occurs when too much glucose stays in the blood instead of entering cells. This can happen when insulin isn’t produced (Type 1 diabetes) or when the body doesn’t respond to insulin properly (insulin resistance, Type 2 diabetes).

LOW GLUCOSE LEVELS Happens when there isn’t enough glucose to fuel the body’s cells. This causes dizziness, weakness, confusion, sweating, and shaking, and in severe cases, fainting because the brain doesn’t get enough energy.

BLOOD SPIKES A blood-glucose spike happens when sugar levels in the blood rise quickly, usually after eating foods high in sugar or refined carbohydrates like sweets or soda. In response, the pancreas releases a large amount of insulin, the hormone that helps move glucose into cells for energy. However, when these spikes happen often, they can harm the body in several ways: They overwork the pancreas: Constantly producing large amounts of insulin can wear out the insulin-producing cells, making it harder to control blood sugar over time. They cause insulin resistance: When cells are repeatedly exposed to high insulin levels, they stop responding properly. This leads to Type 2 diabetes, where glucose stays in the blood instead of entering cells. They cause energy crashes: After insulin lowers the sugar too fast, blood glucose drops, leading to fatigue, hunger, and mood swings because the brain isn’t getting steady energy. To avoid spikes, it’s important to: Eat balanced meals with complex carbohydrates (like whole grains and vegetables), protein, and healthy fats, which slow down sugar absorption. Exercise regularly, since muscles use glucose for energy. Limit processed foods and sugary drinks that cause quick rises and drops in blood sugar. Keeping glucose levels stable helps the body stay energized and protects it from long-term health problems like diabetes and heart disease. These two graphs show how different diets affect blood sugar levels throughout the day. In the top graph, the red line represents a high-sugar diet. After eating foods high in sugar (like candy, soda, or white bread), blood glucose levels spike quickly, rising far above the healthy zone. Then, as insulin lowers the sugar rapidly, levels drop below normal, leaving a person feeling hungry, tired, or shaky. These ups and downs repeat after every meal, showing how unhealthy foods cause unstable energy and stress the pancreas. In the bottom graph, the green line shows a balanced, low-sugar diet. Here, blood glucose stays mostly within the healthy zone, with smaller rises and gradual drops. This means the person’s body gets a steady supply of energy without extreme highs or lows. A balanced diet that includes whole grains, vegetables, proteins, and healthy fats helps prevent spikes and keeps energy levels stable throughout the day. Overall, the graphs show that eating too much sugar leads to large, harmful fluctuations in blood sugar, while a balanced diet keeps glucose steady, supporting better focus, mood, and long-term health.

INSULIN Insulin is a hormone produced and secreted by the pancreas’ beta cells when blood sugar levels are high. Being a hormone, insulin is a chemical messenger. In short, insulin tells our body cells to absorb glucose found in our bloodstream. In detail, insulin binds to specific insulin receptors and activates a series of chemical reactions within the cell, one of these reactions (and the most important for our purpose) is that channel proteins made for glucose activate (open) and they allow glucose to enter the cell.

DIABETES

5 Type I diabetes is a genetic autoimmune disease where the body destroys most or all of the beta cells found in the pancreas. Beta cells produce insulin so when they are destroyed, little to no insulin is produced which leads to a constant rise in blood glucose levels as glucose is not being collected by the body cells. This happens because the receptors are “worn out” because of constant use, as unhealthy lifestyle choices lead to more glucose in the blood so more insulin is made and the receptors eventually stop working.insert comparative images of a healthy receptor and a not healthy receptor. Some health complications associated with diabetes are eye diseases, foot problems, gum disease and other dental problems, heart diseases, strokes, kidney diseases, high blood pressure, nerve problems, sexual and bladder problems, skin conditions, more vulnerable to skin infections, among other complications. These are all the products of prolonged or constant hyperglycemia. A diabetes diagnosis does not mean that a person will have the diseases previously mentioned.

IMPACTS IN HONDURAS According to the International Diabetes Federation, less than 5% of the Honduran population has diabetes as of 2024 so it’s not really common amongst our population. On a global scale, diabetes is fairly common as 11.1% of the global population has diabetes which is 1 in 9 adults (aged 20-79). As of 2024, about 589 million adults are living with diabetes. In comparison to other conditions, diabetes still is fairly common.

CARBOHYDRATES Saccharides come from sugar molecules, and the word behind, like mono, di, and poly, indicates how many sugar molecules there are. Mono means one, Di means two, and poly means more than two. The different types of carbohydrates that we consume are monosaccharides, disaccharides, and polysaccharides. Carbohydrates can be found in fruits, dairy products, honey, potatoes, legumes, vegetables, and whole grains.

The effect of monosaccharides is that since they are single sugar molecules, they are much easier to break down, which is good for quick bursts of energy, but it causes blood sugar levels to rise very easily. For example, fruits and honey are monosaccharides. Disaccharides are two sugar molecules that can affect the body by providing a temporary energy spike, which can cause blood sugar levels to be unstable and high. Examples of disaccharides are dairy products and bread. Polysaccharides are more than two sugar molecules that allow blood sugar levels to be more stable as they are harder to break down, and provide energy throughout the day, such as whole grains, vegetables, and legumes. The general idea of where you can find these is that monosaccharides and disaccharides are found in natural sugars and milk, while polysaccharides are found in plants and meat.

MONOSACCHARIDES Monosaccharides are the simplest type of carbohydrates: small sugar molecules like glucose or fructose that provide quick energy to cells. They can’t be broken down into smaller sugars. Main types of monosaccharides: Fructose Gluctose Galactose Found in foods such as: Apples Mangoes (most) Candies Milk Yogurt, etc. Monosaccharides can be seen as a rapid boost of energy that immediately rejuvenates your energy levels. To most people, that's all monosaccharides are to them, but what they don't realize is that overeating/wrongly eating foods containing monosaccharides can seriously impact your health. Monosaccharides are made of single compounds rather than chain-like links, meaning your body doesn't have to work too hard to break them down and can absorb them very fast. On the one hand, this does provide a fast, sweet, and reliable energy source that lasts for a short time. However, on the other hand, monosaccharides can raise your blood sugar levels very high and quickly, which can put a significant strain on your heart, liver, and other bodily systems, including your personality. Monosaccharides

are

typically

consumed by people seeking a quick and sweet snack. And most of

the

people

consuming

monosaccharides are people who do

not

include

much

physical

activity in their daily routines. In reality, monosaccharides should be consumed by individuals with highenergy jobs or athletes during competition. This is because if you gain that energy from the monosaccharides without expelling it from your body with physical movement, your body stores that energy inside of you, which can build up as fat, which can harmfully affect your heart, blood vessels, weight, and seriously push you closer to diabetes. So moving forward, consider cutting down on foods containing monosaccharides, and try to stick to foods containing disaccharides or polysaccharides, which will supply you with energy throughout the day instead of a quick rush. But if you are, let's say, an athlete, or anyone who does some sort of physical activity often, then eating something high in monosaccharides while doing your activity is a great idea, since you need that energy and you use that energy in that moment.

FIBER AND STABLE BLOOD SUGAR Dietary fiber plays a very important role in maintaining stable blood glucose levels. As previously mentioned, when people eat foods with carbohydrates, they’re broken down into glucose, which provides the body with energy. However, when someone consumes simple carbohydrates—like sweets, sugary drinks, or certain fruits—the glucose from these foods enters the bloodstream very quickly because these carbs are made of simple sugar molecules that the body can digest and absorb almost immediately. It can cause very high blood sugar, which is where insulin comes into the picture to bring it back down. When this repeats, it’s harder for the body to control blood sugar and can lead to type 2 diabetes or other diseases. This is where fiber helps the body, and what makes it so important to the body.

Fiber is a part of plant foods that the human body isn’t able to digest fully, and it slows down how fast food leaves the stomach and how quickly sugar is absorbed into the bloodstream Eating a lot of fiber helps keep energy levels steady, supports a healthy digestive system, and makes it easier for the body to manage insulin. That’s why foods such as fruits and beans are so important for overall health.

STARCHES The main type of digestible starch we eat is made of two forms: Amylose Amylopectin Amylose: this is a curly chain of glucose molecules that is digested slower, as it is more compact and harder to break apart by the digestive enzymes. It is found in foods like potatoes, rice, corn, oats, and legumes. (Jenkins et al., 1981)

Amylopectin: this is a highly branched form of starch that is easily broken down by digestive enzymes, as it is not as compact as amylose. It is found in foods like white bread and certain types of rice. (Jenkins et al., 1981).

For people with diabetes, foods with amylose are better than those with amylopectin.

Cellulose: this is an indigestible polysaccharide found in plant cell walls, humans do not have the enzymes to break down cellulose, so it passes through the digestive system as fiber and does not contribute to blood sugar spikes. (Slavin, 2005).

Blood sugar response

Starch

Digestion

Example foods

Amylose

Broken down more slowly due to its coily structure.

Slower rise in blood sugar.

Corn Potatoes Oats Rice Beans Lentils

Amylopectin

Broken down faster due to its branched structure.

Fast spike in blood sugar.

Waxy corn Sticky or waxy rice White bread

The structure of starch affects how fast it is digested and how it impacts blood sugar levels. Linear starch structures like amylose result in slower digestion and as they take longer to break down, meaning glucose is released gradually into the blood stream, which helps prevent sudden spikes in blood sugar levels. While highly branched structures, like amylopectin, are digested quickly, as they are easier to break down, meaning that glucose is released quicker into the blood stream which causes a quick spike in sugar levels. Understanding this helps explain why some carbohydrate-rich foods raise blood sugar faster than others. (Damon et al., 2023, p. 188-190).

FATS The 4 main types of fats we consume are saturated, trans, monounsaturated, and polyunsaturated. Saturated: mostly found in animal products like butter, cheese, red meat, and whole milk. Eating too much of these can raise cholesterol levels and increase the risk of heart disease. Trans: are the most unhealthy type of fat and often found in processed foods, fried items, and baked goods. They raise bad cholesterol and lower good cholesterol. Eating too many saturated and trans fats can also make it harder for the body to use insulin properly, increasing the risk of high blood sugar and type 2 diabetes. Monounsaturated: They are healthy fats in food like olive oil, avocados, and nuts. They can help lower bad cholesterol and improve heart health. Polyunsaturated: they include omega-3 and omega-6 fatty acids, found in foods like salmon, walnuts, and sunflower oil. These fats are essential for brain function and can reduce inflammation.

BLOOD SPIKES The types of fats that help stabilize blood sugar are monounsaturated and polyunsaturated fats, and they help in several ways: They make it easier for your body to use insulin effectively, keeping blood sugar levels more stable. They can slow digestion, meaning glucose enters the body at a gradual rate to prevent sudden spikes and drops in blood sugar after meals. As monounsaturated fats mainly help your cells respond better to insulin, polyunsaturated fats help reduce inflammation that can interfere with insulin. Simple changes like substituting butter for olive oil or adding nuts and seeds to meals can make a big difference in keeping blood sugar steady.

GUIDE

REFINED GRAINS VS WHOLE GRAINS

SMART SUGAR STRATEGY

STARCHES Whole Grains: One of the main foods that are good for maintaining a stable blood sugar is whole grains. A meta-analysis conducted in 2024, which compares cohort studies and RCTs, shows that 150g of whole grains daily will improve blood sugar control. (Ying, et. al, 2024) Resistant Starches: Resistant starches are starches that are not broken down; they go to the large intestine and feed the microbes in there. A study in 2017 presented that eating 30 grams of High-amylose maize resistant starch type 2 on a daily basis for 6 weeks would significantly help homeostasis in your blood-glucose levels. (Patterson Maziarz, et. al, 2017) Carbohydrate exchange: A study in 1981 tested 62 foods, ranging from fruits and vegetables to high-protein foods, on 5-10 volunteers. This was to test the effect of different foods on blood glucose. This study found high rises in foods such as vegetables, fruits, cereals, dairy products, and legumes. However, there was a negative relationship between the blood sugar spike and proteins & fats. (Jenkins, et. al, 1981)

To have a stable blood sugar: Eating resistant starches (highamylose) daily for 6 weeks will help

with

your

blood

sugar

homeostasis. Whole grains are the key to stable blood sugar. Rather than relying on refined starches, have foods like brown rice, corn, and quinoa. To

help

prevent

post-meal

glucose spikes, carbohydrates that

are

resistant

digestion will be the best option. Portion control is very important. Even though you are only having starches and grains that will slow

digestion,

also

important to have proteins and fats,

since

counteract glucose spike.

that

will

help

the

post-meal

CHOOSING HIGH AMYLOSE STARCHES Why should you choose foods with high amylose as a diabetic: Foods that are high in amylose are digested more slowly because of their linear and coiled structure. This means that it is harder for digestive enzymes to break it down = glucose being released gradually into the blood stream, which helps prevent sudden spikes in blood sugar levels. Choosing high-amylose foods helps maintain more stable and controlled blood sugar, which is especially important for people with diabetes. Below are examples of common foods high in amylose, along with healthier substitutions that can be included in your diet.

Food

~% of Amylose

Corn

~25%

Potatoes

~20%

Oats

~25%

Rice

~20%

Beans

~35%

Lentils

~30%

Instead of having:

A healthier alternative is:

DEBUNKING THE “GOOD AND BAD” MYTH No food will ever be simply “good” or “bad” because every person needs carbohydrates, sugars, starches, etc. It’s not as much about the food we eat, but more about how we eat and how we balance our meals. By labelling foods as “good” and “bad” we often gravitate towards some foods and away from others, this can lead to binging. For example, if we label our favorite chocolate chip cookies as bad, we are more likely to binge-eat them whenever we feel sad or down and we “treat” ourselves because we see the cookies as a reward. Instead of labelling food, we should label extreme behavior as “bad”, because it is. We don’t need to stick to a specific food group, but learn to balance our eating according to what is best for our body. If you are lacking “___”, try eating:

Protein

Fiber

Carbohydrates

18 Psychological evidence for this is: “...tie their own self-worth to what they eat and don’t eat. This means that their days are governed by strict food rules, leading to mental exhaustion, physical hunger, and almost inevitable “slip-ups.” And when a slip-up happens, “since we know we ‘shouldn’t’ be eating that food, the now-ornever mentality kicks in, which leads to a binge, followed by the same-restriction cycle,” says [Gabriela] Cohen. This explanation clearly shows the way in which restriction contributes to binge eating disorder.” (National Alliance for Eating Disorders).

When it comes to sweet and savory treats, we shouldn’t restrict ourselves When referring to balance, we all need a certain amount of carbohydrates, sugars, starches, etc. according to what your body needs, the information on how our body interacts with different foods can be found in earlier pages. Here is a pyramid that visually shows all the foods that should be in a diet: fiber, grains, vegetables, dairy, meats/proteins/animal products, oil, salts, fruits, etc. We should always look to eat an oil, a fat, a protein, a vegetable, a fruit, and a grain. These foods should be a combination of both starches, cellulose, and types of fats (information on these particular topics can be found in previous pages).

In short, we shouldn’t label foods as “good” or “bad”, we should focus more on what they’re composed of and how to balance them. When we label our foods, we tend to create a binge/restrict eating pattern, which is not healthy.

DEBUNKING THE FRUIT MYTH Is fruit really bad for you? Some people avoid fruits due to their sugar content, although it's important to distinguish the difference between processed sugars and healthy ones, according to JeffersonHealth. “The natural sugar in fruit—paired with fiber, vitamins, and minerals—slows down digestion, helps you feel fuller longer, and helps prevent blood sugar spikes,” says Jessica. “Fruits are low-calorie, high-nutrient foods, which are a great substitute for processed foods like cookies or candy. These processed foods don’t have the natural balance to stabilize sugars like fruit does.”” Fruits' nutrients include fiber, vitamins, minerals, carbohydrates, and antioxidants.

20 Fiber improves digestion and helps to regulate blood sugar levels. Doctor Jessica- a Dietitian -suggests, “There’s no need to limit fruit consumption to a specific time of day. “Fruit can be enjoyed anytime—for breakfast, snacks, meals, and more,” says Jessica. “Try adding a piece of fruit to a meal, swapping it in as a dessert, or adding it into your go-to snack rotation.”” In the end, no fruit is “bad” or “good.” What matters is the amount you eat, depending on the fruit, as eating the same amount of a lower-carb fruit as a higher-carb fruit will not produce the same results.

FATS There are 2 main types of fats - the good ones and the not-so-good ones. The good fats are called unsaturated fats (monounsaturated and polyunsaturated), and they are usually found in avocado, fish, whole grains, olive oils, etc. The not-so-good fats are called saturated or trans fats, usually found in butter, fast foods, fried stuff, etc. You can find easy ways to substitute saturated for unsaturated; you just need to know your options. If you have to choose, go for unsaturated fats; your body will thank you later!

Instead of this (saturated)

Eat this (unsaturated)

Butter

Bacon or Sausage

Olive Oil

Eggs with Vegetables

Fried Chicken

Red Meat

Grilled Chicken

Fish (Tuna/Salmon)

Whole MIlk

Mayonnaise

Almond/Soy Milf

Humus/yogurt dip

Ice cream

Store-Bought Cookie

Yogurt with fruits

Homemade Cookies

Grilled Cheese

Avocado Toast

EXERCISE Exercise is essential for everyone, and even more for those who suffer from diabetes, as being active brings health benefits, improves insulin sensitivity, enhances mood, and overall improves quality of life. You can refer back to the page (donde esta lo de clau lo de insulin receptor glucose entering the cell) to see how muscle cells receive glucose from the bloodstream to power your body’s physical activity. The effect of physical activity could lower your blood glucose up to 24 hours after exercise, according to the American Diabetes Association. A common myth is that doing physical activities, such as sprints, heavy lifting, and competitive sports, is bad because it raises their blood sugar levels It is based on the fact that exercise promotes the production of the stress hormone adrenaline, which raises blood sugar levels by stimulating your liver to release glucose. This means that the reason why your blood sugar levels rise is not because of your food, but rather your body needing more energy and using stored energy to do so. Thus, the food you eat before and during exercise is still important to reduce blood sugar levels or keep them in range. It is important to learn how your blood sugar levels interact with exercise. Checking your levels before and after activity will help you understand the benefits of exercise, as well as see which exercises are better for you. This will help you maintain stable levels, not being

too

high

too

low,

and

remember that doing something is better than not doing it.

If you are closely monitoring your blood sugar levels: Choose moderate-intensity aerobic workouts or circuit weight training. Use light weights and high repetitions. Practice relaxation techniques such as paced breathing, visualization, or meditation before and during your workout. This will minimize the adrenaline effect. Exercise later in the day to prevent the dawn phenomenon, a natural rise in blood glucose that occurs between about 4:00 a.m. and 8:00 a.m. This can result in higher levels during morning exercise. Avoid eating excessive amounts of carbohydrates before and during your workouts. Instead, try some yogurt with nuts or peanut butter.

SUPERMARKET GUIDE

CHEAP ALTERNATIVES When talking about good food alternatives for a healthy diet, people, especially when creating their meals or inside of supermarkets, face challenges about what to buy. Mostly because low-carb diet-friendly ingredients tend to be expensive, however, multiple affordable alternatives can help manage blood sugar levels effectively. Here are some good swaps that you can make in your diet.

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