Diabetes Management: A Study of Possible IMPACTS OF HONEY IN DIABETES

Running Head: FOOD SCIENCE1 Food Science 1 POTENTIAL IMPACTS OF HONEY IN DIABETES MANAGEMENT Name Institution Course Tutor City/State Date Executive Summary 2 1.0 Introduction 3 1.1 Justification tied to the Study 5 1.2 Aims/Objectives of the study 6 1.2.1 General objective 6 1.2.2 Specific objectives 6 2.0 Literature Review 6 2.1 History of Diabetes 6 2.2 Management of Diabetes 7 2.3 Using Honey in Diabetes management 7 3.0 Methodology 9 3.1 Study area/ population 9 3.2 Research Design

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POTENTIAL IMPACTS OF HONEY IN DIABETES MANAGEMENT
Name
Institution
Course
Tutor
City/State
Date

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Table of Contents
Executive Summary.................................................................................................................2
1.0 Introduction...............................................................................................................3
1.1 Justification of the Study..........................................................................................5
1.2 Aims/Objectives of the study....................................................................................6
1.2.1 General objective................................................................................................6
1.2.2 Specific objectives...............................................................................................6
2.0 Literature Review......................................................................................................6
2.1 History of Diabetes.................................................................................................6
2.2 Management of Diabetes............................................................................................7
2.3 Using Honey in Diabetes management......................................................................7
3.0 Methodology...............................................................................................................9
3.1 Study area/ population..........................................................................................9
3.2 Research Design.....................................................................................................9
3.3 Sample Size...........................................................................................................10
3.4 Sampling procedure.............................................................................................10
3.5 Inclusion and Exclusion Criteria........................................................................11
3.6 Data Collection Method.......................................................................................11
4.0 Conclusion................................................................................................................12
5.0 References................................................................................................................12

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Executive Summary
Diabetes is a metabolic disorder that stems from either improper utilization or
insufficient production of insulin in the body. Over the past decade, increasing prevalence
and deaths of Type II diabetes has been an increasing concern across the globe and Australia
in particular. The prevalence of diabetes has resulted to serious socio-economic burden,
which necessitates adequate and effective ways to contain the condition. With increasing
number of deaths, it is downrightly evident that the current modus operandi of controlling
and managing diabetes, which is insulin injection and practice of dietary habit, are not
satisfactory. The study seeks to explore the extent and the efficaciousness of using honey to
manage diabetes. The paper relies on the recent literature sources to establish the prevalence
of diabetes and potential impact of honey in controlling the illness. The study will employ
cross-sectional survey to conduct research in Royal Melbourne Hospital. Both qualitative and
quantitative data collection techniques are identified as fundamental in the study.

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1.0 Introduction
Diabetes refers to “a chronic condition that occurs when there are raised levels of
glucose in the blood because the body cannot produce any or enough of the hormone insulin
or use insulin effectively” (International Diabetes Federation 2018). Diabetes may be caused
by either insufficient production of insulin or improper utilization of insulin. Ideally, diabetes
is metabolic disorder that occurs when starch or ingested sugar that cannot be assimilated
into body cells is discarded through urine. The common symptoms of diabetes include
fatigue, weight loss, frequent urination, numbness, and extreme hunger or thirst (Bilous
2012). Type I diabetes or insulin-dependent diabetes mellitus (IDDM) is a condition in which
the body is not producing any insulin while Type II diabetes or non-insulin dependent
diabetes mellitus (NIDDM) is a condition in which the body produces insufficient insulin or
body cells re resisting insulin (WHO 2015). In most instances, Type II diabetes is
concomitant with obesity since high insulin levels are incapable of channelling glucose into
the body muscles. Instead, the glucose is converted into cholesterol and fats, which leads to
obesity, poor blood circulations, and heart diseases. Usually, Type I diabetes is managed by
insulin injections, to maintain “optimum blood glucose” and enable glucose to reach body
cells thirst (Bilous 2012, p.28). On the other hand, Type II diabetes is managed by use of
either glucose-lowering drugs or insulin injection.
International Diabetes Federation (IDF) estimates that 425 million people have
diabetes in the world, with people below twenty years accounting for one million
(International Diabetes Federation 2018). The organization projects that the number of people
with diabetes may skyrocket to 629 million in 2015 if no adequate measures are put in place
to control the situation. The global diabetes prevalence is 8.8 percent. Australia has 1,133,000
living with diabetes (Australian Institute of Health and Welfare 2018). In addition, Australia
has the highest average of expenditure on diabetes per person— ID 5650 as at 2017. Diabetes

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has accounted for more than 4 billion deaths in 2017 (International Diabetes Federation
2018). As evident from the statistics, diabetes is a huge burden on both social and economic
dimension. Although details on the specific cause of diabetes remains scanty, a complex
interaction social, economic, as well as generic factors are at the fulcrum of its aetiology. The
common management approaches to the disease include administration of insulin, observing
diet, and physical exercise. The current anti-diabetic drugs are not adequate to manage the
disease. This is due to heterogeneous and multifactorial aetiologies that are associated with
diabetes (Erejuwa 2014). Additionally, diabetes drugs are expensive and not affordable to
low-income earners.
Generally, honey is used as a food in baking, additive to beverages, additive flavour,
and cooking. Honey has natural sugars like glucose— 28 percent and fructose— 38 percent.
It also has small amount of Vitamin C and minerals— zinc, potassium, calcium, iron, and
phosphorus (Erejuwa 2014). Compounds like antioxidants and bioflavonoids are also
contained in honey. Honey can reduce metabolic stress and stabilize blood sugar levels.
According to Erejuwa et al (2012), honey can reduce insulin resistance.
1.1 Justification of the Study
Systemic agents and anti-diabetes drugs for managing diabetic conditions are
extremely expensive and sometimes unavailable (Ghosh 2018). Poor dietary has also been
attributed to poor glycaemic management among patients. There has been renewed
significance on tied to therapeutic functions of honey through oral ingestion and application
on wounds or diabetic ulcers. This is because of increasing evidence on the effectiveness of
honey to manage diabetic conditions. Honey is also effective in enhancing antioxidant
defences and protecting kidneys and pancreas damage in diabetic and hypertensive rats
(Erejuwa 2014, p. 57). Recent studies show study documents that diabetic patients were
instructed by medical practitioners not to use sugar products including honey, unless it is a

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hypoglycaemia condition (Ghosh 2018). Pure honey, according to (Tan 2015, p. 56), is a
better option in managing a diabetic diet compared to sugar and other non-nutritive
sweeteners because it has a lower glycaemic index compared to sugar. Since it is threefold
sweeter than sugar, it should be used in small portions (Tan 2015).
Due to increasing economic and social burden associated with the disease, diabetic
patients should use honey based on its perceived importance associated with health. Hence,
there is need to establish practices, attitude, and knowledge of using unprocessed honey,
which is cheaper and can be affordable to low incomes earners. The paper explores the
significance of incorporating honey in management of diabetes.
1.2 Aims/Objectives of the study
The study aims at contributing to the knowledge on diabetes management in Australia
by providing in-depth analysis on clients’ attitude and knowledge in usage of honey. The
study also seeks to investigate whether registered diabetics were using honey alongside their
normal anti-diabetic drugs to manage their conditions. The expectations is that the outcome
from the study will challenge medical practitioners as well as act as source of encouragement
to those undergoing treatment to use honey in managing the disease.
1.2.1 General objective
Main objective is to assess patients’ cognisance, attitude, as well as practices on the
use of honey in managing Type II diabetes.
1.2.2 Specific objectives
1.1 To establish diabetic patients on use of honey
1.2 To assess diabetics cognisance on usage of honey in controlling diabetics
1.3 To explore social and economic features of diabetic patients
1.4 To establish diabetic patients’ practices on usage of honey

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2.0 Literature Review
2.1 History of Diabetes
According to LAWI, diabetes was first documented in the Egyptian manuscript in
1500BC, where it was defined as “too great emptying of urine” (Porter 2017). Between 400-
500BCE, scientists identified two distinct conditions of diabetes, in which Type I was linked
to the youth while type II linked to obesity. Towards the end of 1600s, scientists added the
term mellitus— a Latin word that means “from honey”— to distinguish it from diabetes
insipidus that was attributed to frequent urination (Porter 2017, p. 90). In 1922, Sir Bating
successfully treated the first diabetic patient through insulin injection. Bating would later
receive Nobel Peace Prize for the discovery in 1923. Consequently, November 14th, Bating’s
birthday, is always commemorated as World Diabetes Day to honour him and create
awareness, as well as reminding government on importance of their commitment to adopt
policies that help to mitigate and treat diabetes.
2.2 Management of Diabetes
Bilous (2012) acknowledges that changing diet— by adopting healthy eating habit—
is integral part of managing diabetes. Unlike restrictive program, this is applicable to
anybody with diabetes, particularly Type I diabetes. Type II diabetes requires both healthy
diet and insulin injections to manage the situation, however. In most instances, patients
coping with Type II diabetes use different kinds of tablets. Ghosh (2018) recognizes the
importance physical exercise, avoidance of tobacco, and alcohol as effective ways of
managing diabetes
2.3 Using Honey in Diabetes management
Currently, there is no cure for diabetes, albeit the research is going on. Therefore, the
preventing and managing diabetic conditions through healthy lifestyle and medication
remains the only solution. Erejuwa (2014) contends that each person has a unique feature and

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therefore individuals should be cognizant of their bodies’ reaction to different range of
carbohydrates. The focus should be on the amount of carbohydrates rather than the amount of
sugar (International Diabetes Federation 2018).
In essence, honey is also a carbohydrate. A tablespoon of honey contains 17g of
carbohydrate (Erejuwa et al. 2012, p. 23). According to Tan (2015), as diabetics do to control
carbohydrates or other sweetener, they can control their daily consumption of honey
considering the amount of kilocalories in it. Ediriweera and Premarathna (2012) hold that
when buying honey, one should insist on quality by ensuring that it is pure or unrefined and
not mixed with starch, sugar cane, or glucose, which needs to be avoided by diabetic patients.
Pure honey is preferred for diabetic patients compared to artificial sweeteners like saccharin
and aspartame (Abeshu & Geleta 2015, p. 8). Since it is threefold sweeter than sugar, it
should be used in small portions. Ediriweera and Premarathna (2012) find that “5ml of
natural honey (with a pinch of powdered seeds of (Gossypium herbaceum) has been seen to
reduce blood sugar in diabetic patients.”
Bilous (2012, p.146) attest that “honey has lower Glycaemic Index (GI) than sugar,”
which means that it does not raise blood sugar levels apace like sugar. Besides, unlike white
sugar, honey does not need more insulin to regulate. In another nuanced study, Gosh (2018)
finds that one of the reasons why honey is more effective in controlling diabetes is its
fructose-to-glucose ration, which is 1:1. Fructose facilitates absorption of glucose in the liver
hence ensuring that that excess glucose does not enter circulation system. Considerably, only
natural honey exudes this feature. Abeshu and Geleta (2015) identify oligosaccharides
components in honey as the reason why honey is an ideal anti-diabetic. Erejuwa (2014)
acknowledges the significance of mineral elements like zinc, copper, and chromium in honey
that helps to normalize blood glucose and enhance secretion of insulin into pancreatic cells.

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According to Ghosh (2018), subjecting diabetics to 75g of honey in 250ml of water
for 15 consecutive days has the efficacy to reduce cholesterol, blood glucose, triglyceride,
and low-density lipoprotein-cholesterol (LDL-C). However, the same amount results to
increased level of high-density lipoprotein-cholesterol (HDL-C). A contrast experiment on
health practices shows that ingestion of sucrose and dextrose increase the level of C-peptide
and insulin. By measuring C-peptide, it is possible to validate “quantification of endogenous
insulin secretion.” Since C-peptide is secreted alongside insulin during “enzymatic cleavage
of pro-insulin to insulin,” serum C-peptide can be used s indicator of change in insulin level
Ghosh (2018, p.214). Serum insulin can be increased by using honey while fructosamine and
glucose can be reduced in diabetic rats. Combination of drugs and honey, according to
LAWI, can lower glycaemic levels and serum levels of creatinine, fructosamine, and bilirubin
(Erejuwa 2014).
3.0 Methodology
3.1 Study area/ population
The study will be conducted at Royal Melbourne Hospital (RMH)—City Centre,
outpatient department, which receives an average of about 510 patients per day (Royal
Melbourne Hospital 2018). The hospital has clients with wide range of disease stages and
complications. The availability of experts in the area will make the study convenient. White
and McBurney (2012) define expert as a person with deep knowledge in a given professional
field. In Australia, public hospitals provide more than 58 percent health services (Australian
Institute of Health and Welfare 2018). The study population will be patients with Type II
diabetes at the RMH City Centre.
3.2 Research Design
The study will employ cross-sectional survey to conduct the research. The exercise
will involve data collection by a semi-structure interviewer. It will also be conducted by

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distributing questionnaire to diabetics. According to Terhanian and Bremer (2012), ideal
questionnaire should be precise, concise and focus on specific questions. Additionally, the
questionnaire should not contain personal and leading questions (Nix and Hall 2016, p. 9).
The researcher will take into consideration the accepted code of conduct when designing
questionnaire. The questionnaire will focus on the on their perceptions, cognisance, and
practices of using honey in diabetes management. The study will focus majorly on diabetes
outpatient from the RMH in the month of July 2018. The Study will also rely on secondary
data from the hospital data system to help with analysis of data.
3.3 Sample Size
The study will employ Fisher’s formula to determine sample size (Patten and Newhart
2017)
N= z2 pq
d2
Where N= sample size
Z= confidence level
P= estimated number of clients that use honey
q= 1-p
d= tolerance to margin error
3.4 Sampling procedure
The study will employ both probabilistic and non-probabilistic sampling. Purposive
sampling technique will be used because only diabetic patients and experts have information
that is relevant to the study. According to Shea et al (2013), non-probabilistic sampling
generates hypothesis while probabilistic sampling tests it. The researcher will also use

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stratified sampling in selecting respondents in light of gender and age bracket. This technique
will involve dividing the population (diabetics) into different strata then selecting samples
from each stratum by using simple or systematic sampling. Shea et al (2013) argues that the
sampling size should be expanded by at least 10 percent to address cases of non-
responsiveness.
3.5 Inclusion and Exclusion Criteria
Inclusion criteria will be, recruiting individual respondents, which will include
comprehensive case studies of patients that have blood sugar readings for the past three
consecutive months. In addition, registered patients spotted at the clinic will be interviewed
as they for doctor’s appointment. Exclusion criteria will be, not interviewing patients with
Type I diabetes and excluding patients that do not have blood readings for the past three
months.
3.6 Data Collection Method
The study will employ both quantitative and qualitative research methods.
Quantitative data will be obtained through interviewing patients while mail questionnaire will
be addressed to experts. The researcher prefers the two methods because they are
considerably flexible and have high rate of feedback (ACSM 2015). The quantitative data
will target the demographics, socio-economic aspects, frequency, and amount of honey used.
The study will obtain qualitative data by using case studies and field research since the
methods are unobtrusive and reliable (Check & Schutt 2011, p.4). The qualitative data will
focus mainly on their experience and attitudes on using honey in diabetes management.
Before data collection, the researcher will conduct pilot study by consulting with
professor in order to establish feasibility and validity of the study. On interviews, the
researcher will use smart pen recorder to ensure that the collected data is accurate. However,

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before recording, the interviewer will first seek respondent’s permission. After recording the
interviews, the data will be transcribed and the deleted in order to underscore confidentiality.
In both interview and mail questionnaire, the respondents will be assured anonymity and
confidentiality before the exercise. The respondents will also be assured that the results will
be share with them after the study. However, their contacts, including email address, names,
and phone number will be discarded immediately after sharing the results with them.
4.0 Conclusion
The paper leading principle on the study is the fact that diabetes is a chronic disease
that requires urgent and adequate solution in order to reduce more deaths that results from the
situation. Currently, there is no specific treatment to diabetes. However, the paper identifies
honey as a possible solution to the existential symptoms of the disease. The paper has
explored the possibility of using honey in managing diabetes condition by dissecting relevant
literature sources. Honey could be a better choice in controlling Type II diabetes due to its
lower glycaemic index. Honey also has low-density lipoprotein-cholesterol and rich in other
important minerals— like zinc, copper, chromium— as well as antioxidants and
bioflavonoids, which help to stabilize sugar.

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5.0 References
Abeshu, M A, & Geleta, B, 2015, ‘Medicinal Uses of Honey’ Biology and Medicine, Vol. 08,
no.2, pp.1-7. doi:10.4172/0974-8369.1000276
ACSM, 2015, ACSM's Research Methods, 1st edn, Wolters Kluwer Health.
Adams, KA., & Lawrence, EK, 2018, Research methods, statistics, and applications, 2nd
edn, SAGE Publications, Inc.
Australian Institute of Health and Welfare, 2018, Home, Retrieved from
https://www.aihw.gov.au/ (Viewed on 2018 May 14)
Bilous, R, 2012, Understanding Diabetes, 1st edn, Family Doctors Publication Ltd & British
Medical Association.
Check, JW, & Schutt, RK, 2011, Research methods in education, 1st edn, SAGE
Publications, Inc;.
Ediriweera, ER, & Premarathna, NY, 2012, ‘Medicinal and cosmetic uses of Bee′s Honey - A
review’ An International Quarterly Journal of Research in Ayurveda, vol.33, no.2, pp.178-
182. doi:10.4103/0974-8520.105233
Erejuwa, OO, Sulaiman, SA., & Wahab, MS, 2012, ‘Honey - A Novel Antidiabetic Agent’
International Journal of Biological Sciences , vol. 8, no.6, pp.913-934. Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399220/ (Viewed on 2018 May 14)
Erejuwa, OO, 2014, ‘Effect of honey in diabetes mellitus: matters arising’ Journal of
Diabetes & Metabolic Disorders, vol.13, no.1, pp1-10. doi:10.1186/2251-6581-13-23
Ghosh, S, 2018,Yearbook of Diabetes 2017, Delhi: Jaypee Brothers, Medical Publishers Pvt.
Ltd.

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International Diabetes Federation (IDF), 2018, IDF Diabetes Atlas (8th Edition), Retrieved
from https://www.idf.org/e-library/welcome.html (Viewed on 2018 May 14)
Nix, I, & Hall, M,2016, Collecting questionnaire and interview data: Evaluating approaches
to developing digital literacy skills, London: SAGE Publications.
Patten, ML, & Newhart, M, 2017, Understanding Research Methods: An Overview of the
Essentials, 10th edn, Routledge.
Porter, E, 2017, October 25, History of Diabetes: From Ancient Egypt to Modern Medicine,
Retrieved from https://www.healthline.com/health/history-type-1-diabetes (Viewed on 2018
May 14)
Royal Melbourne Hospital, 2017, Melbourne Health Annual Report 2016/17, Retrieved from
https://www.thermh.org.au/sites/default/files/media/documents/CKA8606_MH.AnnualRepor
t2017_FINAL_WEB.pdf (Viewed on 2018 May 14)
Shea, C, Roberts, M, Johnson, E P, & Hadlock, W, 2013, ‘Matching Data Collection Method
to Purpose: In the Moment Data Collection with Mobile Devices for Occasioned Based
Analysis.’ Survey Practice, vol.6, no., pp.1-7. doi:10.29115/sp-2013-0003
Tan, R, 2015, Benefits of Honey, Retrieved from
https://www.benefits-of-honey.com/diabetic-diet.html (Viewed on 2018 May 14)
Terhanian G, & Bremer, J, 2012, ‘A Smarter Way to Select Respondents for Surveys’
International Journal of Market Research, vol.54, no.6, pp.751-780. doi:10.2501/ijmr-54-6-
751-780
White, T, & McBurney, DH, 2012, Research Methods, 9th edn, Wadsworth Publishing.
WHO, 2017, November 15, Diabetes. Retrieved from http://www.who.int/news-room/fact-
sheets/detail/diabetes (Viewed on 2018 May 14)