II.

INTRODUCTION 

Diabetes mellitus is a heterogeneous group of disorders characterized by

hyperglycemia due to an absolute or relative deficit in insulin production or

action. Diabetes mellitus is a broad term describing a variety of metabolic

disorders, the most prominent of which is chronic hyperglycemia. poor insulin

secretion, poor insulin action, or both are the culprits. Diabetes mellitus is one of

the most common chronic diseases in nearly all countries, and continues to

increase in numbers and significance, as economic development and

urbanization lead to changing lifestyles characterized by reduced physical

activity, and increased obesity. (D.R. Whiting et al. 2019). Diabetes mellitus is

one of the most common chronic diseases in nearly all countries, and its

prevalence and impact are growing as economic development and urbanization

result in changing lifestyles marked by decreased physical activity and increased

obesity. Estimates of the current and future burden of diabetes are critical for

allocating community and health resources, emphasizing the importance of

lifestyle, and encouraging steps to prevent rising prevalence trends.

According to Blair, M. (2020), diabetes mellitus is a group of physiological

dysfunctions characterized by hyper-glycemia resulting directly from insulin

resistance, inadequate insulin secretion, or excessive glucagon secretion. Type 1

diabetes (T1D) is an autoimmune disorder leading to the destruction of

pancreatic beta-cells. Type 2 diabetes (T2D), which is much more common, is

primarily a problem of progressively impaired glucose regulation due to a

combination of dysfunctional pancreatic beta cells and insulin resistance.

 Now diabetes mellitus is a collection of physiological dysfunctions defined

by hyperglycemia caused by insulin resistance, insufficient insulin production, or

excessive glucagon secretion. Type 1 diabetes (T1D) is an autoimmune

condition that causes the death of pancreatic beta-cells. While on the other hand

Type 2 diabetes (T2D), which is far more frequent, is essentially a condition of

progressively poor glucose regulation caused by a combination of malfunctioning

pancreatic beta cells and insulin resistance.

Diabetes is a complicated disease with numerous subgroups each with its

own etiology, diagnostic indications, and clinical care options. T2DM is the most

prevalent type of diabetes (95%) and can be treated with diet and exercise, oral

medicine, or insulin. (Petersmann, A. et al. 2019).

Also, Diabetes is a complex disease with numerous subgroups each with

its own etiology, diagnostic indications, and clinical care options. Type 2 diabetes

mellitus (T2DM) is the most common type of diabetes (95%) and can be treated

with diet and exercise, oral medication, or insulin.

The rising disease burden of diabetes mellitus globally is a major public

health priority, placing unsustainable demands on individuals, their careers,

health systems and society. Globally, the latest estimates show that there was a

global prevalence of 425 million people with diabetes in 2018, which is expected

to rise to 629 million by 2045. This is fueled by the global rise in the prevalence

of obesity and unhealthy behaviors including poor diets and physical inactivity;

these are in turn promoted by wider societal determinants, including changes in

nutrition in a global context (the so-called ‘nutrition transition’). Diabetes mellitus

is a major public health problem that is putting unsustainable demands on

individuals, their careers, health systems, and society. According to the most

recent projections, there were 425 million diabetics worldwide in 2018, with the

number anticipated to climb to 629 million by 2045. This is caused by the global

growth in the incidence of obesity and unhealthy behaviors such as poor diets

and physical inactivity, which is exacerbated by broader socioeconomic variables

such as global shifts in nutrition (the so-called 'nutrition transition'). The

etiological classification of diabetes principally separates diabetes mellitus into

two main types, type 1 and type 2, with type 2 diabetes accounting for most of

the total diabetes mellitus prevalence. Both of the common forms of diabetes can

lead to multisystem complications of microvascular endpoints, including

retinopathy, nephropathy and neuropathy, and macrovascular endpoints,

including ischemic heart disease, stroke and peripheral vascular disease. The

role of modifiable factors in the causation of type 2 diabetes is better understood,

making prevention a realistic public health goal. (Forouhi, N. G., & Wareham, N.

J. 2019). Diabetes mellitus is classified etiologically into two types: type 1 and

type 2, with type 2 diabetes accounting for the majority of the total diabetes

mellitus prevalence. Both types of diabetes can cause multisystem

consequences including microvascular endpoints such as retinopathy,

nephropathy, and neuropathy, as well as macrovascular endpoints such as

ischemic heart disease, stroke, and peripheral vascular disease. Because the
significance of modifiable factors in the cause of type 2 diabetes is better

recognized, prevention has become a practical public health aim.

Diabetes is becoming more common in the Philippines. Rapid

urbanization, growing reliance on electronic devices, and sedentary lifestyles all

contribute considerably to this epidemic. Diabetes care in the Philippines is

limited in terms of resources, government support, and economics. In a

preventive model, the national insurance system does not cover full diabetic

care, and private insurance firms only provide minimal diabetes coverage. As a

result, the majority of patients rely on "out-of-pocket" charges, such as laboratory

procedures and daily prescriptions. As a result, poor medication adherence

compromises the prevention of problems. Furthermore, behavioral changes are

challenging due to cultural preferences for a traditional refined sugar diet, which

includes white rice and bread. (Tan, G. H. 2020).

Diabetes is increasing at an alarming rate in Asian countries including the

Philippines. Both the prevalence and incidence of type 2 diabetes (T2D) continue

to increase with a commensurate upward trend in the prevalence of prediabetes.

Diabetes is on the rise in the Philippines. Rapid urbanization, increased

reliance on electronic devices, and sedentary lifestyles all play a significant role

in this epidemic. Diabetes care is limited in the Philippines due to a lack of

resources, government assistance, and economics. In a preventive paradigm,

the national insurance system does not cover full diabetic care, and private

insurance companies only cover the basics. As a result, the majority of patients
are forced to pay for "out-of-pocket" expenses such as laboratory tests and daily

medications. As a result, poor medication adherence jeopardizes issue

prevention. Furthermore, cultural inclinations for a traditional refined sugar diet,

which includes white rice and bread, make behavioral changes difficult.

According to the Handicap International Philippines Program Framework

(2018), diabetes is the sixth largest cause of death in the Davao region,

accounting for 70% of amputations, despite the fact that many diabetics die after

refusing amputation, despite the fact that it is the sole way to prevent gangrene.

Diabetes is no longer solely a disease of the wealthy. On the contrary, the

poorest individuals suffer the most as a result of rural depopulation. Indeed,

population urbanization has resulted in more sedentary lifestyles and less

balanced meals, including foods with higher fat and sugar content and less fresh

produce. Diabetes onset is also influenced by genetic factors.

In Davao City, Diabetes is the region's sixth leading cause of mortality,

accounting for 70% of amputations, despite the fact that many diabetics die after

refusing amputation, despite the fact that it is the only method to prevent

gangrene. Diabetes is no longer just an affluent person's condition. On the

contrary, as a result of rural depopulation, the poorest people suffer the most.

Indeed, population urbanization has resulted in more sedentary lifestyles and

less balanced diets, including foods with higher fat and sugar content and fewer

fresh fruits and vegetables. Diabetes onset is impacted by hereditary factors as

well.
 Patient ASD is a 56-year-old male who was admitted to the hospital due to

a right foot infection wound. A month ago, he was burned in the motorcycle

tailpipe; unfortunately, one week before admission, he scraped off the damaged

skin, resulting in an infection. Upon admission on March 21, 2023, he was only

complaining about his unhealed wound and rated the pain as 3/10.

We, the BSN3-13E-Group 18 student nurses of Davao Doctors College,

Inc. were permitted to analyze the case of the patient with Diabetes Mellitus.

While working on this case study, we will be able to use what we have learned in

the classroom and online lectures and gather additional knowledge. This has the

potential to greatly improve the nursing practice, education, and research of

student nurses and registered nurses. This case study in nursing education on a

patient with Diabetes Mellitus would be a great resource for clinical instructors

and student nurses to learn everything they can about the condition that may be

used to supplement prior studies.

LABORATORY AND DIAGNOSTICS

URINE ANALYSIS - It's used to detect and manage a wide range of
disorders, such as urinary tract infections, kidney disease and diabetes. A
urinalysis involves checking the appearance, concentration and content of
urine. Although not as accurate as a blood glucose test, urine testing
can be used as a screening tool in patients known to have diabetes.
Even in patients with no ketoacidosis, high glucose levels may be an
indication that their diabetes is poorly controlled. These patients can
be referred for counselling, patient education, and-as soon as possible
-for an eye examination to look for signs of diabetic retinopathy. Urine
testing can also be used to detect glucose in the urine in undiagnosed
patients; they will need to be referred for further tests and perhaps a
diagnosis of diabetes.
NORMAL RANGE - Color:Transparent, clear or Straw-coloured

 -Normal amount of albumin in the urine is less than 30mg/g. Normal is

negative or 0-50/hpf.

 -Normal is 0-3 /hpf

-Normally, very few casts are seen in urine examinations without renal
dysfunction.

Reaction: 5-9 Specific gravity:   1.003-1.030

Up to 10,000 colonies of bacteria/ml are considered normal. Greater than

100,000 colonies/ml represents urinary tract infection. For counts between
10,000 and 100,000, the culture is indeterminate.

RESULT – Color: Yellow

Character: Clean
Reaction: 5.0
Specific gravity: 1.025
Albumin: (+)
-Trace of Albumin in the urine means that the patient has Albuminuria.
Sugar: (++)
-Two plus protein means that you have protein in your urine. This can be a
sign of kidney disease.
LIVER FUNCTION TEST - Liver function tests (also known as liver panels)
are blood tests that evaluate the amount of several enzymes, proteins, and
other chemicals produced by the liver. These tests assess your liver's
overall health.

NORMAL RANGE: SGPT: 0-45 IU/L SGOT: 0-40 IU/L

RESULTS: SGPT: 27 IU/L SGOT: 27.00 IU/L

COVID – 19 TEST RESULT - COVID-19 tests identify either the

coronavirus itself or antibodies produced in reaction to it. The viral test is
most effective during the first seven days of symptoms and reveals active
infection. The antibody test detects past infection and works best around 10
days after symptoms begin.

RESULT: NEGATIVE