Case Study

AA, a 65 year-old obese female with history dyslipidemia and hypertension was referred to
the hospital with complaints of excessive hunger, excessive thirst, and large passage of urine
and tingling sensations on the feet.
Further assessment was conducted. She was then hospitalised for management of her
conditions. However, AA could not tolerate oral feeding while in the hospital and the doctor
was considering putting her on TPN to meet her nutritional needs, but there were some
concerns for TPN in this patient.

Learning Outcome
1. Define diabetes mellitus.
2. Classify and describe the types of diabetes mellitus.
3. Describe the aetiology and risk factors of diabetes mellitus.
4. Describe the pathophysiology of diabetes mellitus.
5. Discuss about the clinical presentations of diabetes mellitus.
6. Describe the acute and chronic complications of diabetes mellitus.
7. Discuss about the assessment of diabetes mellitus.
8. Discuss about the pharmacological management of Type II Diabetes Mellitus.
9. Discuss on the non-pharmacological management of diabetes mellitus.
10. Discuss on the monitoring parameters for diabetes mellitus.
11. Discuss about the indications for TPN.
12. Discuss about the potential complications of TPN in diabetes mellitus.
13. Discuss about the major concerns of TPN administration in diabetic patient.
14. Discuss on the management of total parenteral nutrition in diabetic patient.

Introduction

Diabetes Mellitus remains as a major medical problem in Malaysia in the 21 st century

despite significant advances in medical sector. According to International Diabetes
Federations Report 2014, in Malaysia, the prevalence of diabetes in adults (20-79 years old)
is 16.6%, upped by almost 88.6% in the space of 18 years from 1996 to 2014. This reflects
that the urbanised lifestyle of Malaysian coupled with physical inactivity, higher intake of
high calories and sugary foods have impacted our population which shows to be more
genetically predisposed to Type 2 Diabetes Mellitus. The percentage might be higher than the
reported value due to the fact that half of Malaysian with diabetes is unaware that they have
the disease.
Diabetes is much easier to treat in the early stages, hence early detection and
interventions during the course of disease can significantly decrease the risk of
complications, thereby reducing the healthcare cost and nation economic burden. Lifestyle
modifications which include weight loss, changes in diet and increased physical activity also
plays a major role in diabetes control.
As current diabetes care in Malaysia is still far from satisfactory with the majority of
patients not achieving the clinical goals and is accompanied by high complications rate, more
efforts are needed to address these issues. On top of that, as more and more novel antidiabetic agents come into the market, the importance of pharmacological management
advancement and the patient empowerment to achieve behavioural modification should be
emphasized so that good glycaemic control can be achieved and patients quality of life can
be improved.