MISSION

VISION MABINI COLLEGES provides quality instruction,

MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


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Nation-loving
 Law-abiding
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persons

INTRODUCTION
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


God-fearing
Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

Introduction

Diabetes Mellitus

Diabetes mellitus is a disease that prevents your body from properly using the

energy from the food you eat. Diabetes occurs in one of the following situations:

 The pancreas (an organ behind your stomach) produces little insulin or no insulin

at all. Insulin is a naturally occurring hormone, produced by the beta cells of the

pancreas, which helps the body use sugar for energy.

 The pancreas makes insulin, but the insulin made doesn't work as it should. This

condition is called insulin resistance.

Mild Dementia

Dementia is a syndrome – usually of a chronic or progressive nature – in which

there is deterioration in cognitive function (i.e. the ability to process thought) beyond

what might be expected from normal ageing. It affects memory, thinking, orientation,

comprehension, calculation, learning capacity, language, and judgement.

Consciousness is not affected. The impairment in cognitive function is commonly

accompanied, and occasionally preceded, by deterioration in emotional control, social

behaviour, or motivation.

Dementia results from a variety of diseases and injuries that primarily or secondarily

affect the brain, such as Alzheimer's disease or stroke.

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


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Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

People may still be able to function independently in mild dementia. However, they’ll

experience memory lapses that affect daily life, such as forgetting words or where

things are. Common symptoms of mild dementia include:

 Memory loss of recent events

 Personality changes, such as becoming more subdued or withdrawn

 Getting lost or misplacing objects

 Difficulty with problem-solving and complex tasks, such as managing finances

 Trouble organizing or expressing thoughts

Diet-controlled Diabetes Mellitus

A Diabetes diet simply means eating the healthiest foods in moderate amounts

and sticking to regular mealtimes. A healthy-eating plan that's naturally rich in nutrients

and low in fat and calories. Key elements are fruits, vegetables and whole grains. In

fact, a diabetes diet is the best eating plan for most everyone.

Infected bilateral leg ulcers

A leg ulcer is a long-lasting (chronic) sore that takes more than 2 weeks to heal.

They usually develop on the inside of the leg, just above the ankle. There may also be

discoloured or hardened skin around the ulcer, and the sore may produce a foul-

smelling discharge.

Usually because of weak blood circulation in the limb the legs with ulcer takes

time to heal. They can last anywhere from a few weeks to years. You may hear a doctor

or nurse call them “venous leg ulcers.” They can sometimes lead to more serious

problems if you don't have them treated.

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


God-fearing
Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

Chronic Venous Insufficiency

Chronic venous insufficiency occurs when your leg veins don’t allow blood to flow

back up to your heart. Normally, the valves in your veins make sure that blood flows

toward your heart. But when these valves don’t work well, blood can also flow

backwards. This can cause blood to collect (pool) in your legs.

If patient have CVI, valves in veins (usually in the leg or sometimes the

arms) don't work, causing blood to pool in patients legs and putting increased pressure

on the walls of the veins.  May be due to valve dysfunction (usually hereditary) or due to

valve destruction after a deep vein thrombosis (DVT) or blood clot.

Causes

Many medical conditions causes Diabetes Mellitus and those multiple problems

encountered by the patient such as Mild Dementia, Diet-controlled Diabetes Mellitus,

Infected bilateral leg ulcers and Chronic Venous Insufficiency. Common causes of each

diagnosis include the following:

Diabetes Mellitus

The causes of diabetes are not known. The following risk factors may increase your

chance of getting diabetes:

 Family history of diabetes or a personal history of gestational diabetes.

 African-American, Hispanic, Native American, or Asian-American race, Pacific

Islander or ethnic background.

 Injury to the pancreas (such as infection, tumor, surgery or accident).

 Autoimmune disease.

 Age (risk increases with age).

 Physical stress (such as surgery or illness).

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

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 Locally and Globally competitive
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There are risk factors that you might have more control over, including:

 High blood pressure.

 Abnormal blood cholesterol or triglyceride levels.

 Smoking.

 Being overweight.

 Use of certain medications, including steroids

It is important to note that sugar itself doesn't cause diabetes. Eating a lot of sugar can

lead to tooth decay, but it doesn't cause diabetes.

Mild Dementia

Dementia is caused by damage to or loss of nerve cells and their connections in

the brain. Depending on the area of the brain that's affected by the damage, dementia

can affect people differently and cause different symptoms.

Dementias are often grouped by what they have in common, such as the protein

or proteins deposited in the brain or the part of the brain that's affected. Some diseases

look like dementias, such as those caused by a reaction to medications or vitamin

deficiencies, and they might improve with treatment.

Infected bilateral leg ulcers

Wounds on the lower leg are often caused by problems with veins or arteries, or

a combination of both. The further away from the heart, the longer wounds may take to

heal, particularly in people over 50 years of age.

Around one per cent of the Australian population suffers from leg ulcers (chronic venous
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
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EDUCATION
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leg ulceration). The most common cause is poor blood circulation, particularly the

inability of the veins to return deoxygenated blood from the legs back to the heart.

Other causes or risk factors include prolonged pressure on an area (such as long-term

lying in bed in one position, which may cause bed sores), badly managed diabetes, high

cholesterol, smoking, dietary problems and poor arterial circulation.

Older people are at greater risk, and the number of women with leg ulcers is slightly

higher than men because women have a longer lifespan.

Chronic Venous Insufficiency

Veins return blood to the heart from all the body’s organs. To reach the heart, the

blood needs to flow upward from the veins in the legs. Calf muscles and the muscles in

the feet need to contract with each step to squeeze the veins and push the blood

upward. To keep the blood flowing up, and not back down, the veins contain one-way

valves.

Chronic venous insufficiency occurs when these valves become damaged,

allowing the blood to leak backward. Valve damage may occur as the result of aging,

extended sitting or standing or a combination of aging and reduced mobility. When the

veins and valves are weakened to the point where it is difficult for the blood to flow up to

the heart, blood pressure in the veins stays elevated for long periods of time, leading to

CVI.

CVI most commonly occurs as the result of a blood clot in the deep veins of the

legs, a disease known as deep vein thrombosis (DVT). CVI also results from pelvic

tumors and vascular malformations, and sometimes occurs for unknown reasons.
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


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 Earth-caring
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 Locally and Globally competitive
persons

Failure of the valves in leg veins to hold blood against gravity leads to sluggish

movement of blood out of the veins, resulting in swollen legs.

Chronic venous insufficiency that develops as a result of DVT is also known as

post-thrombotic syndrome. As many as 30 percent of people with DVT will develop this

problem within 10 years after diagnosis.

Risk Factors

Many factors can increase your risk on DM and other multiple problems such as Mild

Dementia, Diet-controlled Diabetes Mellitus, Infected bilateral leg ulcers and Chronic

Venous Insufficiency .Risk factors include:

Diabetes Mellitus

Risk factors for diabetes depend on the type of diabetes.

Risk factors for type 1 diabetes

Although the exact cause of type 1 diabetes is unknown, factors that may signal an

increased risk include:

 Family history. Your risk increases if a parent or sibling has type 1 diabetes.

 Environmental factors. Circumstances such as exposure to a viral illness likely

play some role in type 1 diabetes.

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


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Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

 The presence of damaging immune system cells

(autoantibodies). Sometimes family members of people with type 1 diabetes

are tested for the presence of diabetes autoantibodies. If you have these

autoantibodies, you have an increased risk of developing type 1 diabetes. But

not everyone who has these autoantibodies develops diabetes.

 Geography. Certain countries, such as Finland and Sweden, have higher rates

of type 1 diabetes.

Risk factors for prediabetes and type 2 diabetes

Researchers don't fully understand why some people develop prediabetes and type 2

diabetes and others don't. It's clear that certain factors increase the risk, however,

including:

 Weight. The more fatty tissue you have, the more resistant your cells become to

insulin.

 Inactivity. The less active you are, the greater your risk. Physical activity helps

you control your weight, uses up glucose as energy and makes your cells more

sensitive to insulin.

 Family history. Your risk increases if a parent or sibling has type 2 diabetes

Mild Dementia

Risk Factors for Dementia

Several risk factors that affect the likelihood of developing one or more kinds of

dementia. Some of these factors are modifiable, while others are not.
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
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College of Nursing and Midwifery 


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Nation-loving
 Law-abiding
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 Locally and Globally competitive
persons

Age. The risk of Alzheimer's disease, vascular dementia, and several other dementias

goes up significantly with advancing age.

Genetics/family history. Researchers have discovered a number of genes that

increase the risk of developing Alzheimer's disease. Although people with a family

history of Alzheimer's disease are generally considered to be at a heightened risk of

developing the disease themselves, many people who have relatives with Alzheimer's

disease never develop the disease, and many without a family history of the disease do

get it.

Smoking and alcohol use. Several recent studies have found that smoking

significantly increases the risk of mental decline and dementia. People who smoke have

a higher risk of atherosclerosis and other types of vascular disease, which may be the

underlying causes for the increased dementia risk.

Studies also have found that drinking large amounts of alcohol appears to increase the

risk of dementia.

Atherosclerosis. Atherosclerosis is the buildup of plaque – deposits of fatty

substances, cholesterol, and other matter – in the inner lining of an artery.

Cholesterol. High levels of low-density lipoprotein (LDL), the so-called "bad" form of

cholesterol, appear to significantly increase a person's risk of developing vascular

dementia. Some research has also linked high cholesterol to an increased risk of

Alzheimer's disease.

Plasma homocysteine. Research has shown that a higher-than-average blood level of

homocysteine, a type of amino acid, is a strong risk factor for the development of

Alzheimer's disease and vascular dementia.

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


God-fearing
Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

Diabetes. Diabetes is a risk factor for both Alzheimer's disease and vascular dementia.

It is also a known risk factor for atherosclerosis and stroke, both of which contribute to

vascular dementia.

Mild cognitive impairment. While not all people with mild cognitive impairment

develop dementia, people with this condition do have a significantly increased risk of

dementia compared to the rest of the population. 

Chronic Venous Insufficiency

Risk factors for venous insufficiency include:

 Age.

 Family history of this condition.

 Female gender (related to levels of the hormone progesterone)

 History of deep vein thrombosis in the legs.

 Obesity.

 Pregnancy.

 Sitting or standing for long periods.

 Tall height.

Signs and Symptoms

Some people may experience only a few symptoms that are listed above.

About 50 percent of people with type 2 diabetes don't experience any symptoms

and don't know they have the disease. Common symptoms include the following:

 Frequent urination
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
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EDUCATION
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 Excessive thirst

 Unexplained weight loss

 Extreme hunger

 Sudden vision changes

 Tingling or numbness in the hands or feet

 Feeling very tired much of the time

 Very dry skin

 Sores that are slow to heal

 More infections than usual

Mild Dementia

Common symptoms of mild dementia include:

 memory loss of recent events.

 personality changes, such as becoming more subdued or withdrawn.

 getting lost or misplacing objects.

 difficulty with problem-solving and complex tasks, such as managing finances.

 trouble organizing or expressing thoughts.

Infected bilateral leg ulcers

A venous ulcer often feels itchy or burns, and the leg around it may be swollen. Other signs

may include:

 A rash or dry skin
 MISSION
VISION MABINI COLLEGES provides quality instruction,
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 Brownish discoloration

 A foul-smelling fluid oozing from the sore

An ulcer can also become infected. If that happens, you might notice:

 A redness or swelling of the surrounding skin

 Worsening pain

 A fever

 Pus

Chronic Venous Insufficiency

Symptoms of chronic venous insufficiency may include:

 Swelling in your legs or ankles

 Tight feeling in your calves or itchy, painful legs

 Pain when walking that stops when you rest

 Brown-colored skin, often near the ankles

 Varicose veins

 Open sores on the legs (leg ulcers) that are sometimes hard to treat

 An uncomfortable feeling in your legs and an urge to move your legs (restless

legs syndrome)

 Painful leg cramps or muscle spasms (charley horse)

These symptoms may seem like other health problems.

Worldwide Epidemiology of Diabetes Mellitus

Diabetes is a serious, long-term condition with a major impact on the lives and

well-being of individuals, families, and societies worldwide. It is among the top 10

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VISION MABINI COLLEGES provides quality instruction,
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causes of death in adults, and was estimated to have caused four million deaths

globally in 2017

The global diabetes prevalence in 2019 is estimated to be 9.3% (463 million

people), rising to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The

prevalence is higher in urban (10.8%) than rural (7.2%) areas, and in high-income

(10.4%) than low-income countries (4.0%). One in two (50.1%) people living with

diabetes do not know that they have diabetes. The global prevalence of impaired

glucose tolerance is estimated to be 7.5% (374 million) in 2019 and projected to reach

8.0% (454 million) by 2030 and 8.6% (548 million) by 2045.

ig. 1Diabetes prevalence by age and sex in 2019.

Epidemiology of Diabetes Mellitus in the Philippines

In the 2014 prevalence estimates published by the International Diabetes Federation, it

is estimated that there are 3.2 million cases of T2D in the Philippines with a

5.9% prevalence rate in adults between the ages of 20 and 79 years. Around 1.7 million

people with T2D remain undiagnosed.

 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


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Nation-loving
 Law-abiding
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persons

PATIENT’S DATA
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EDUCATION
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persons

Patient CV is a 87 years old woman and She is admitted to a geriatric inpatient

medical unit because of her Dx including Chronic venous insufficiency, Infected bilateral

leg ulcers, diet-controlled diabetes-mellitus, and mild dementia.

Demographic Data

Name:Corona Virus Age: 87 y/o

Ward: Geriatric Inpatient Medical unit

Permanent Address:

Sex: Female Civil Status: Widowed

Nationality: Filipino Religion: Roman Catholic

Birthday: Birthplace:

Health History

Patient CV has no history of any health problems. Furthermore, he has no known

history of allergies. However, Her wounds were so severe that they were foul smelling

with areas of moist necrotic tissues, surrounded by peeled tissue and bleeding.

Chief Complaint
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VISION MABINI COLLEGES provides quality instruction,
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The chief complaint of the client is bilateral leg ulcers .

CHIEF COMPLAINT: Bilateral Leg Ulcers .

HISTORY OF PRESENT ILLNESS:

 Few hours prior to admission patients wounds were so severe that they were

foul smelling with areas of moist necrotic tissues, surrounded by peeled tissue

and bleeding

Physical Assessment

Patient X has no fever, no cough and colds, no nausea and vomiting, no CP.

Further physical assessment data are as follows:

 Conscious & coherent

GENERAL SURVEY
 Not in active distress

ADMITTING DIAGNOSIS:

Chronic Venous Insufficiency, Infected Bilateral Leg Ulcers, Diet-controlled

Diabetes Mellitus, and Mild Dementia.

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VISION MABINI COLLEGES provides quality instruction,
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EDUCATION
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PATHOPHYSIOLOGY
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Pathophysiology of Diabetes Mellitus

Diabetes mellitus is a syndrome with disordered metabolism and inappropriate

hyperglycemia due to either a deficiency of insulin secretion or to a combination of

insulin resistance and inadequate insulin secretion to compensate. Type 1 diabetes is

due to pancreatic islet B cell destruction predominantly by an autoimmune process, and

these persons are prone to ketoacidosis. While type 2 diabetes is the more prevalent

form and results from insulin resistance with a defect in compensatory insulin secretion.

Diabetes can lead to serious complications, resulting in multiple diseases or disorders

that affect multiple systems that may result in premature death.

Type 1 Diabetes

Type 1 diabetes is usually diagnosed in children and young adults. It develops when the

body’s immune system destroys pancreatic beta cells, the only cells in the body that

make the hormone insulin, which regulates blood glucose.

Only 5% of people with diabetes have this form of the disease. To survive, people with

type 1 diabetes must have insulin delivered by injection or a pump.

Type 2 Diabetes

Type 2 diabetes is the most common form of diabetes. The causes of type 2 diabetes

are multi-factorial and include both genetic and environmental elements that affect beta-
 MISSION
VISION MABINI COLLEGES provides quality instruction,
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cell function and tissue (muscle, liver, adipose tissue, and pancreas) insulin sensitivity.

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore

the insulin. It usually begins as insulin resistance, a disorder in which the cells do not

use insulin properly. As the need for insulin rises, the pancreas gradually loses its ability

to produce it.

When glucose builds up in the blood instead of going into cells, it can cause far-

reaching health implications like heart disease, nerve damage and kidney damage.

Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations,

and new cases of blindness among adults in the United States.

You can prevent or delay the onset of type 2 diabetes through a healthy lifestyle such

as changing your diet, increasing your level of physical activity, maintaining a healthy

weight... with these positive steps, you can stay healthier longer and reduce your risk of

diabetes.
 MISSION
VISION MABINI COLLEGES provides quality instruction,
MABINI COLLEGES shall cultivate a research and extension services as its monumental
CULTURE of EXCELLENCE in MABINI COLLEGES, INC. contribution to national and global growth and
development.
EDUCATION
Daet, Camarines, Norte into:
Specifically, it transforms students

College of Nursing and Midwifery 


God-fearing
Nation-loving
 Law-abiding
 Earth-caring
 Productive, and
 Locally and Globally competitive
persons

CASE ANALYSIS

Mrs. Corona Virus 87 y/o female was admitted to a geriatric inpatient medical unit

due to her multiple problems including chronic venous insufficiency, infected bilateral

leg ulcers, diet-controlled diabetes mellitus, and mild dementia. But the main problemof

Mrs. Corona Virus for me is her wounds because they were so severe that they were

foul smelling with areas of moist necrotic tissues, surrounded by peeled tissue and

bleeding. As per my observation I think it is caused by Diabetes Mellitus, because

many patient with DM develop wounds that are slow to heal, do not heal well , or never

heal. Sometimes an infection might develop.

An infection can spread to tissue and bone near the wound or more distant areas

of the body. In some cases, an infection can be life threatening or may be even fatal. On

Mrs. Corona Virus’s case it is essential for her to keep her Blood sugar levels uder-

control especially at her age to reduce the risk of slow healing wounds and

complications.

Mrs. Corona Virus should be treated appropriately, cooperate in the treatment,

and be in a safe environment.