INTRODUCTION

Diabetes mellitus is a condition in which the pancreas no longer produces enough insulin or cells
stop responding to the insulin that is produced, so that glucose in the blood cannot be absorbed into the
cells of the body. Symptoms include frequent urination, lethargy, excessive thirst, and hunger. The
treatment includes changes in diet, oral medications, and in some cases, daily injections of insulin.
The most common form of diabetes is Type II, It is sometimes called age-onset or adult-onset
diabetes, and this form of diabetes occurs most often in people who are overweight and who do not
exercise. Type II is considered a milder form of diabetes because of its slow onset (sometimes developing
over the course of several years) and because it usually can be controlled with diet and oral medication.
The consequences of uncontrolled and untreated Type II diabetes, however, are the just as serious as
those for Type I. This form is also called noninsulin-dependent diabetes, a term that is somewhat
misleading. Many people with Type II diabetes can control the condition with diet and oral medications,
however, insulin injections are sometimes necessary if treatment with diet and oral medication is not
working.
The causes of diabetes mellitus are unclear, however, there seem to be both hereditary (genetic
factors passed on in families) and environmental factors involved. Research has shown that some people
who develop diabetes have common genetic markers. In Type I diabetes, the immune system, the body’s
defense system against infection, is believed to be triggered by a virus or another microorganism that
destroys cells in the pancreas that produce insulin. In Type II diabetes, age, obesity, and family history of
diabetes play a role.
In Type II diabetes, the pancreas may produce enough insulin, however, cells have become
resistant to the insulin produced and it may not work as effectively. Symptoms of Type II diabetes can
begin so gradually that a person may not know that he or she has it. Early signs are lethargy, extreme
thirst, and frequent urination. Other symptoms may include sudden weight loss, slow wound healing,
urinary tract infections, gum disease, or blurred vision. It is not unusual for Type II diabetes to be detected
while a patient is seeing a doctor about another health concern that is actually being caused by the yet
undiagnosed diabetes.
Individuals who are at high risk of developing Type II diabetes mellitus include people who:
• are obese (more than 20% above their ideal body weight)
• have a relative with diabetes mellitus
• belong to a high-risk ethnic population (African-American, Native American, Hispanic, or Native
Hawaiian)
• have been diagnosed with gestational diabetes or have delivered a baby weighing more than 9 lbs
(4 kg)
• have high blood pressure (140/90 mmHg or above)
• have a high density lipoprotein cholesterol level less than or equal to 35 mg/dL and/or a triglyceride
level greater than or equal to 250 mg/dL
• have had impaired glucose tolerance or impaired fasting glucose on previous testing
Diabetes mellitus is a common chronic disease requiring lifelong behavioral and lifestyle changes.
It is best managed with a team approach to empower the client to successfully manage the disease. As
part of the team the, the nurse plans, organizes, and coordinates care among the various health
disciplines involved; provides care and education and promotes the client’s health and well being.
Diabetes is a major public health worldwide. Its complications cause many devastating health problems.
 OBJECTIVES

General Objective

To present a comprehensive study of Diabetes Mellitus that will enhance the knowledge of the
patient, promote physical strength, uplift and encourage social relationship of the family as to provide
emotional support to the patient.

Specific Objectives

On completion of this case study, the patient will be able:

• to define Diabetes Mellitus Type II

• to identify the causes of the Diabetes Mellitus from the patient
• to enumerate sign and symptoms of Diabetes Mellitus
• to identify nursing diagnosis for the patient experiencing complication of Diabetes Mellitus
• to use nursing diagnosis as a framework for care of the patient with Diabetes Mellitus
• to identify essential aspects of managing Diabetes Mellitus
• to outline the structure and function of endocrine system
• to describe management and health strategies for a patient with Diabetes Mellitus
• to appreciate the significance of the case study in relation to the individual nurse care
• to apply the principles of nutrition, physical activity and weight control
• to demonstrate skin and foot care for personal hygiene of the patient
 PATIENT PROFILE

A. Biographic Data

Name : Antonio Aquino Armas

Age : 57 y/o
Address : #8 Batino St. Project 8, QC
Sex : Male
Birthday : April 11, 1953
Religion : Roman Catholic
Civil Status : Married
Occupation : Liaison Officer
Nationality : Filipino

Admitting Data
Admitting Date : September 2, 2010
Hospital : PNPGH
Ward : Male Surgical Ward
Admitting Physician : Dra. Cabasal
Admitting Diagnosis : Diabetic Foot Right

B. Chief Complaint
Diabetic Foot

C. History of Present Illness

5 days PTA, patient while at their backyard sustained a puncture wound on his right foot. No
consult was done and no medications were taken. No other associated symptoms were noted such as
fever, cough and colds. Few hours PTA, patient noted to have inflammation on his right foot which
prompted the patient to seek consult in this institution.

D. Past History
(+) HPN, BP 140/100, (+) DM, Maintained Metformin, Diamicron non-compliant, (-) asthma, (-)
allergies, (+) hospitalizations at PNPGH secondary to DM foot, (-) operations
 PHYSICAL ASSESSMENT

September 3, 2010

PART OF ACTUAL
MEASUREMENT NORMAL FINDINGS ANALYSIS
THE BODY FINDINGS

Skin Inspect of general Skin color varies to light Normal Normal

coloration to deep brown; from
ruddy pink from yellow
over tones to olive

Inspection and Skin is smooth and Non-healing At risk for

palpation without breaks in its punctured wound at infection
continuity right foot; edema

Palpation Skin temperature, Skin temperature, Normal

uniform within normal uniform within
range normal range

Skin moisture folds in Skin surfaces vary Normal

the axillae, lymph from moist to dry
nodes are not palpable depending on the
with body temperature area assessed.
.
Skin turgor, brings back Skin pinches easily Normal
to previous state when and immediately
pinched returns to its
original position

Nails Inspection Shape of the nails are Convex curvature Normal

convex curvature angle angle nail plate
nail plate about 160° aobutn 160°

Texture should be Nail texture is Normal

smooth smooth and nail
bases firm

Hair Inspection and Hair distribution Irregular hair Due to age

palpation normally covers all distribution
parts of the body
except the palms of the
hands and the soles of
the feet

Skull and Inspection Skulls should be Normocephalic and Normal

Face rounded symmetrical symmetrical

Facial features are Symmetric Normal

symmetric

Symmetrical facial Symmetrical facial Normal

 movements movements

Inspection Absence of masses or No masses or Normal

nodules nodules palpated

Eyes Palpation Sinuses cavities are not No tenderness of Normal

tender sinuses cavities

Inspection Hair distribution of Hair is evenly Normal

eyebrows are even distributed

Alignments of eyebrows Symmetric Normal

are symmetric alignment

Eyelashes evenly Equally distributed Normal

distributed and slightly and slightly curried
curled outward outward

Ability to blink 18 involuntary Normal

approximately 15-20 blinks/min bilateral
involuntary blinking, blinking
frequency of blinking is
bilateral

Sclera appears white in Sclera appears Normal

color, yellowish in dark- white
skinned person

Pupils black in color; Pupils black in Normal

equal in size color and equal
size

Pupils reaction to Pupils constrict Retina and

accommodation when at near neuronal visual
constrict- near object object, pupils dilate pathways to the
Dilate- far object when looking at far brain 2nd optic CN
object are functioning

Peripheral visual field Problem with left Complication of

when looking straight eye, when right eye DM Type II
ahead, client can see is closed and
object in the periphery patient only uses
left eye, he can
only see the
person’s outline.

When assessing six Eyes coordinated, Normal

ocular movements both moving in unison
eyes coordinated, move and with parallel
in unison with parallel alignment
alignment

Ears Inspection Absence of edema or No tenderness or Normal

tenderness over edema
lacrimal gland
 Auricle color same as Auricle color is Normal
facial color Auricle slightly red auricle
aligned with outer aligned with outer
canthus of the eye canthus of the eye

In external ear canal, Dry cerumen, Normal

distal third contains hair grayish tan color
follicles and glands. Dry
cerumen grayish-tan
color, or sticky wet
cerumen in
various shades of
brown

Auricle are mobile, firm Mobile, firm and not Normal

and not tender tender

Pinna shoul recoils Pinna recoils after it Normal

after it is folded is folded

Gross hearing Able to hear ticking in Able to hear ticking Normal

Acquity Yest both ears when in both ears
performing the Watch
Tick Test

Sound is heard in both Sound is heard in Normal

ears when performing both ears

Webber’s Test to AC>BC Normal

assess bone
conduction AC>BC

Nose and External nose is Symmetric Normal

Sinuses symmetric and straight

No discharge or flaring, No discharge Normal

uniform color

Maxillary and frontal Not tender Normal

sinuses are not tender

Mouth and Inspection Outer lips are soft, Uniform in color Normal
Oropharynx moist, smooth texture
and uniform in color

Gums are pink in color Gums are pink in Normal

color

Tongue is on central Central position, Normal

position pink in color, pink in color, no
no lesion lesion

Tongue moves freely Moves freely Normal

Salivary gland openings Same color Normal

are same color of
 buccal mucosa and
floor of mouth

Palpation and Tonsils are pink in color Pink and smooth Normal
Inspection and smooth, no no discharge
discharge

Inspection Inner lips are pink in The inner lips are Normal
color and buccal uniform pink color,
mucosa is smooth, buccal mucosa is
moist, glistening and smooth, moist, soft
elastic texture glistening and
elastic texture

Palpation Tongue is absence of No palpable Normal

any palpable nodules nodules

Neck Palpation Neck muscle are equal Neck muscles Normal

in size; head centered equal in size; head
Inspection centered

Head movements are Coordinated and Normal

coordinated, smooth smooth movement
with no discomfort with no discomfort

Thyroid glands are not Not visible on Normal

visible on inspection inspection

Lymph node are not Not palpable Normal

palpable

Thorax Palpation The anteroposterior Anteroposterior and Normal

diameter and transverse
transverse diameter is diameter is in ratio
in ratio of 1:2 of 1:2

Spines should be Spines are Normal

vertically aligned vertically aligned

Palpation and Breathing should be Breathing are quiet Normal

Inspection quiet, rhythmic and and rhythmic and
effortless respiration the respiration is
effortless

Chest wall intact; no Chest wall intact; Normal

tenderness; no masses no tenderness; no
masses

Skin of the hand and Skin of the hand Related to

feet are color pink and feet are pale decrease RBC

Skin’s temperature not Elevated skin Normal

excessively warm or temperature
cold
Abdomen Inspect the Unblemished skin Normal Normal
abdomen Uniform color
Silver-white striae or
surgical scars

Inspect for contour Flat, rounded, or Normal Normal

and symmetry scaphoid

Auscultation Audible bowel sounds Normo-active Normal

absence of arterial bowerl sounds
bruits
Absence of friction rub

Palpation No tenderness; relaxed Normal Normal

abdomen with smooth,
consistent tension.

Musculoskel Inspect the Equal size on both Normal Normal

etal Muscle muscles for size sides of body

Muscle and No contractures No contractures Normal

tendons for
contractures

Inspect tremors No tremors No tremors Normal

Palpate muscle at Normally firm No tonicity Normal

rest

Palpate muscles Smooth coordinated Weakness Flaccidity,

while client is active movement weakness, or
and passive laxness or
spasticity, sudden
involuntary
muscle
contraction.

25% or less of
Test muscle Equal strength on each Lower extremities: normal strength
strength body side 0% of Normal
strength; complete
paralysis.

Upper extremities:
25 % of normal
strength; full
muscle movement
against gravity, with
support.
Normal
Inspect the No deformities No deformities or
skeleton for swelling
structure
Normal
Palpate the bone to No tenderness or No swelling
locate area of swelling No tenderness
 edema or
tenderness

ACTIVITIES OF DAILY LIVING

September 3, 2010
GORDON’S
BEFORE DURING
FUNCTIONAL INTERPRETATION
HOSPITALIZATION HOSPITALIZATION
PATTERN
1. Health Perception The patient verbalized - Concerned about current Due to lack of
Pattern that although he is aware health status finances, patient
of his diagnosis and - Expressed desire to go failed maintain
possible complications, back to old life style pattern medication that
he did not comply with and try to maintain optimal was advised.
the doctor’s order such as health
to maintain a diabetic - Seeking a higher level of
diet. wellness without spending a
lot
2. Nutritional After being diagnosed as Verbalized the importance The patient is
Metabolic Pattern having DM Type II, of following the diabetic willing to follow
patient did not follow the diet. prescribed dietary
recommended diet. management plan.
Patient said that he still
eat sweets, drink
softdrinks and alcohol.
3. Elimination Pattern The patient defecates The patient said that he is Due to
every morning before not comfortable in immobilization
breakfast and urinate 4x defecating if he is not at during
a day. home. Patient was not able hospitalization, GIT
to defecate yesterday, when decreases motility.
he was first admitted in the
hospital.
4. Sleep-rest Pattern Patient usually sleeps The patient verbalized that Altered sleep
around 8:00 PM to 5:00 he cannot sleep well due to pattern due to
AM. the uncomfortable environment.
environment in the hospital.
5. Activity-exercise Patient admitted that Due to lack of physical Due to orthostatic
pattern exercising is not one of activity the patient is hypotension
his usual habits. Patient experiencing muscle caused by
said he is lazy. weakness in the lower neuropathy.
extremities.
6. Cognitive- The patient is coherent The patient was coherent Patient’s current
perceptual pattern and active in his daily during the interview. He condition has no
activities. was very cooperative and effect with brain
willing to answer our function.
questions about his history.
7. Self perception/ Has a positive perception Maintains a positive outlook Patient will not
 Self concept and is content with his that his wound would not have a hard time
self and life. get worse.
8. Role Relationship Patient is living with his Patient’s son is the only one Family and friends
son. Patient verbalized looking after him during his support is a factor
that he has 3 more hospital stay. that will help in
children from 3 other increasing patient’s
women but is not living willingness to
with him. comply with the
doctor’s orders.
9. Sexuality- Sexually inactive due to It is not a concern of the Inability to achieve
reproductive impotence. patient. desired satisfaction
Pattern due to age and
health condition.
10. Coping / Stress Patient usually spends Patient is coping well even Patient is very
Tolerance Pattern time with his family, if he is in the hospital, he optimistic.
friends and co-workers. tries to make do with what
Patient does not stress they have.
himself with the
challenges that he is
facing.
11. Value / Belief Patient is a Roman Patient believed that Disease cannot
Pattern Catholic but does not go praying well help them to altered the faith of
to church during Sunday. conquer the problem and the family even if
Patient said he normally God has plan for them. the patient does not
remembers to pray when go to church.
his health is not doing so
well like today.
Name : Antonio Aquino Armas
Date of Exam : September 2, 2010
Ward : Male Surgical Ward

NORMAL
DATE PROCEDURE RESULT INTERPRETATION ANALYSIS
VALUES
09/02/2010 Hemoglobin 136 140-180 g/L Low
Hematocrit 0.40 0.42-0.54 Low
WBC Count 10.3 5.0 - 10.0 x High
109/L
Segmenters 0.75 50-65%
Lymphocytes 0.25 25-40%
A.B.AB.O
 ANATOMY AND PHYSIOLOGY

What Is Glucose?
Glucose is a sugar serving as the fuel that provides energy for the body's cells. Your liver
produces some glucose and your body gets the rest by digesting sugars, starches, and other foods you
eat.

What Is Insulin?
Insulin is a hormone produced by beta cells in a part of the pancreas known as the islets of
Langerhans. Insulin controls how much glucose the liver produces and also helps to move glucose from
the bloodstream into your cells, where it is needed as a source of energy.
The uptake of glucose into your cells occurs through a complex series of events. It begins when
insulin attaches ("binds") to receptor sites on the surface of cells in muscles and other tissues and causes
carrier proteins (called glucose transporters) to move from inside the cell to the cell's surface. Like little
dump trucks, these transport proteins deliver glucose from outside the cell to the inside. Without the initial
binding of insulin to the receptor sites, glucose enters the cells too slowly.

Glucose, Insulin & Pancreas Function

In a healthy person
Normally, the pancreas makes enough insulin to keep the supply and use of glucose in balance.
When the blood contains enough insulin, the liver temporarily shuts down its production of glucose, and
glucose is transported from the blood into your cells. Cells use some of the glucose immediately. Most of
the remainder is converted to a substance called glycogen in the liver and muscles, where it is stored for
future use. The body's ability to store glycogen is limited, and any excess glucose that does not get stored
as glycogen is converted to triglycerides and stored in adipose (fat) tissue.
Pancreatic cells in the islets of Langerhans continuously monitor blood glucose levels. After a
meal, the carbohydrates you eat are digested and broken down into glucose and other sugars, which
pass into the bloodstream. As your blood glucose levels rise, beta cells in the pancreas respond by
secreting insulin into the blood. Glucose then passes into your cells and the liver shuts down glucose
production. Between meals, insulin also prevents excessive release of glucose from the liver into the
bloodstream. If blood glucose levels drop too low between meals, alpha cells in the pancreas release a
hormone called glucagon. This hormone signals the liver to convert amino acids and glycogen into
glucose that is sent into the blood.
When someone has diabetes
In diabetes, this glucose balancing system is disrupted, either because too little insulin is
produced or because the body's cells do not respond to insulin normally (a condition called insulin
resistance). The result is an unhealthy rise in blood glucose levels. If diabetes is left untreated, the two
principal dangers are the immediate results of high blood glucose levels (which include excessive
urination, dehydration, intense thirst, and fatigue) and long-term complications that can affect your eyes,
nerves, kidneys, and large blood vessels.

Anatomy of the Pancreas

 The pancreas is an organ that stretches partway across the abdomen, just below the stomach.
Because its main functions are to aid digestion and produce hormones that control blood glucose levels,
the pancreas is a focal point for understanding diabetes.
In addition to secreting certain enzymes that help you properly digest food, the pancreas manufactures
hormones that regulate blood glucose—the fuel that provides the body's cells with energy. Scattered
throughout the pancreas are tiny nests of cells known as islets of Langerhans; the majority of the cells are
beta cells that produce and store the hormone insulin until needed. Also located in the islets are alpha
cells, which make and store glucagon, a hormone that counteracts the effects of insulin.
After a meal, carbohydrates in foods are converted into glucose in the intestine and liver and
enter the bloodstream. Beta cells sense the rising blood glucose levels and secrete insulin into the blood.
Once in the bloodstream, insulin helps glucose enter the body's cells, where it can be "burned" by the
liver and muscles for energy. Liver and muscles can also convert glucose to glycogen, a type of reserve
form of energy that is stored there for future needs.When the body is working as it should, blood glucose
levels quickly return to normal, and insulin secretion decreases.
A drop in blood glucose levels—for example, when one hasn't eaten for several hours—
stimulates an opposite effect: alpha cells secrete glucagon into the blood, which converts stored glycogen
back into energy- producing glucose.
Normally, the secretion of these hormones by the pancreas is perfectly balanced: Beta and alpha
cells continuously monitor blood glucose levels and release insulin or glucagon as needed. In diabetes,
this balance is thrown off because beta cells produce little or no insulin or the body's cells are resistant to
insulin action—or often both. Glucose then fails to enter cells effectively and the fuel for energy remains
stuck in the bloodstream. The result is persistently high blood glucose levels (hyperglycemia). Without
treatment, hyperglycemia can lead to serious long-term complications, such as eye, kidney, and heart
disease and damage to nerves.
 DEVELOPMENTAL TASK

Patient : Mr. Armas

Age : 57 years old
Stage : Generativity vs Stagnation

Erik Erikson explains on his theory that life is a process of sequence of Developmental Stages.
Each stage must be accomplished and can be complete, partial or unsuccessful. He believed that
success of an individual in each developmental stage become the healthier the personality of the
individual. Failure to complete any development stage influences person’s ability to progress to the next
level. It reflects for both positive and negative aspect of the critical life periods and resolution of each
stage enables the person to function effectively in the society. Erikson’s empathized that people must
changed and adapt to their behavior to maintain control over their lives and there will be no stage in
regress to a previous stage under or in stressful condition.
Based on Erikson’s theory patient is at the seventh stage of development, the Generativity vs
Stagnation stage. Patient is working as a liaison officer in PNP wherein he feels needed and prevents him
from being stuck in the house and cause him to pity himself which would result to Stagnation instead of
what he is currenctin in, which is Generativity. The patient still sees himself as a productive individual by
earning a living while working for the government.
Now work is most crucial. Erikson observed that middle-age is when we tend to be occupied with
creative and meaningful work and with issues surrounding our family. Also, middle adulthood is when we
can expect to "be in charge," the role we've longer envied.
The significant task is to perpetuate culture and transmit values of the culture through the family
(taming the kids) and working to establish a stable environment. Strength comes through care of others
and production of something that contributes to the betterment of society, which Erikson calls generativity,
so when we're in this stage we often fear inactivity and meaninglessness.
As our children leave home, or our relationships or goals change, we may be faced with major life
changes—the mid-life crisis—and struggle with finding new meanings and purposes. If we don't get
through this stage successfully, we can become self-absorbed and stagnate.
Significant relationships are within the workplace, the community and the family.
 CASE STUDY:
Diabetes Mellitus Type II

SUBMITTED BY:

Colonia, Hannie
Dapar, Silver
Dapoc, Ma. Arlene
De Guzman, Clara Belle
 Group 18 3A2-5

SUBMITTED TO:

Ma’am Estuaria
PNPGH MSW

DISCHARGE PLANNING

D-RUG THERAPY:
• Sulfonylurea drugs. These medications stimulate your pancreas to produce and release more
insulin. For them to be effective, your pancreas must produce some insulin on its own. Second-
generation sulfonylureas such as glipizide (Glucotrol, Glucotrol XL), glyburide (DiaBeta, Glynase
PresTab, Micronase) and glimepiride (Amaryl) are prescribed most often. The most common side
effect of sulfonylureas is low blood sugar, especially during the first four months of therapy. You’re at
much greater risk of low blood sugar if you have impaired liver or kidney function.
• Meglitinides. These medications, such as repaglinide (Prandin), have effects similar to
sulfonylureas, but you’re not as likely to develop low blood sugar. Meglitinides work quickly, and the
results fade rapidly.
• Biguanides. Metformin (Glucophage, Glucophage XR) It works by inhibiting the production and
release of glucose from your liver, which means you need less insulin to transport blood sugar into
your cells. One advantage of metformin is that is tends to cause less weight gain than do other
diabetes medications. Possible side effects include a metallic taste in your mouth, loss of appetite,
nausea or vomiting, abdominal bloating, or pain, gas and diarrhea. These effects usually decrease
over time and are less likely to occur if you take the medication with food. A rare but serious side
effect is lactic acidosis, which results when lactic acid builds up in your body. Symptoms include
tiredness, weakness, muscle aches, dizziness and drowsiness. Lactic acidosis is especially likely to
occur if you mix this medication with alcohol or have impaired kidney function.
• Alpha-glucosidase inhibitors. These drugs block the action of enzymes in your digestive tract that
break down carbohydrates. That means sugar is absorbed into your bloodstream more slowly, which
helps prevent the rapid rise in blood sugar that usually occurs right after a meal. Drugs in this class
include acarbose (Precose) and miglitol (Glyset). Although safe and effective, alpha-glucosidase
inhibitors can cause abdominal bloating, gas and diarrhea. If taken in high doses, they may also
cause reversible liver damage.

I-NCREASE FLUID INTAKE:

Drink at least 8 to 10glasses of water per day to avoid dehydration

A-PPROPRIATE CHANGES IN LIFESTYLE:

1. Stops smoking (no. of year of smoking x no. of stick per day / 20 )
2. Exercise(walking, jogging for 30 minutes)
3. Give positive reinforcement for self care behavior changes instruct family to assist in the client.
4. Have regular interaction with patient to avoid low self-esteem; social support is very important to the
client.

B-EHAVIOR MODIFICATION:
Skin care
-keep clean dry, especially In areas of contact with two skin surfaces.
Example: axilla and groin
- assess for cracks, skin breakdown and redness
foot care
-inspect your feet every day
-wash your feet everyday
-wash in warm water
-dry your feet well
-do not soak your feet
- keep the skin soft and smooth
- rub a thin coat of skin lotion over the top and bottom of your feet but not between your toes.
-trim your toe nails each week or when needed
-wear shoes and socks at all times
-protect your feet from hot or cold.

E- NCOURAGE NUTRITIOUS DIET:

1. Decrease carbohydrate intake- reduced intake of rice
2. Increase fiber diet- eat fruit and vegetables , lowering total cholesterol and low density lipoprotein
cholesterol in the blood
3. Teach patient to read labels of healthy foods because they contain sugar product such as honey,
brown sugar and corn syrup
a. carbohydrates 50% – 60%
b. fats 20-30%
c. increase fibers diet
d. moderation in alcohol
e. multivitamins
g. protein

T-EACHING:
1. Advice patient about the importance of an individualized meal plan
2. Discuss the goals of dietary therapy for the patient
3. Explain the importance of exercise
4. Advise patient to assess blood glucose level before strenuous activity and to eat carbohydrate snack
before exercising to avoid hypoglycemia.
5. Maintain skin integrity by protecting feet from breakdown
6. Advice patient to stops smoking or reduce if possible, to reduce vasoconstriction and enhance
peripheral flow.
7. Emphasis that lifestyle changes should be maintainable for life
8. Advice the family to secure funds for the medicine
9. Teaching patient to self administering of insulin
a. equipment
b. preparation and administering insulin injection
c. knowledge of insulin action
d. incorporation of insulin injection into daily schedule
1. (TIE) test blood glucose, insulin injection, eat
2. describes information regarding hypoglycemia
10. advice to come back at OPD after a week for follow up check up.

E-XERCISE
30 minutes of moderate exercise (walking, jogging) increase insulin sensitivity, and enhance
energy and ability to cope with stress.

S-ELF- MONITORING GLUCOSE LEVEL

Demonstrate proper technique for monitoring blood glucose
Identify sign and symptoms of hypo and hyperglycemia
Describes appropriate treatment of hypoglycemia and hyperglycemia
a. Random blood glucose test:
Random blood glucose test, blood can be drawn at any time throughout the day, regardless of when the
person last ate. A random blood glucose level of 200 mg/dL (11.1 mmol/L) or higher
 b. fasting blood glucose test:
Fasting blood glucose testing involves measuring blood glucose after not eating or drinking for 8 to 12
hours (usually overnight). A normal fasting blood glucose level is less than 100 mg/dL