A CASE PRESENTATION OF A PATIENT

WITH DIABETES MELLITUS

SACRED HEART HOSPITAL

MEDICAL WARD

SUBMITTED BY:
Capili, Maida Joy
Chan, Luigi Anthonoel
De Leon, Shawn Jefferson
Dupio, Precious Gift
Fulache, Jane
Hernandez, Jessan
Holares, Faith Alyssa
Iba-oc, Agnes

SUBMITTED TO:
Mr. Regie Tumala,
Clinical Instructor

PHC2: Case Presentation Page 1

I. General & Specific Objectives
General Objectives:
After 4 hours of case presentation, the level 2 students will be able to gain prompt and
concise knowledge, develop effective and appropriate skills and manifest a positive attitude
towards the case of Diabetes Mellitus in accordance with the concept of Promotion of Health
and Prevention of Illness.

Specific Objectives:
1. Establish a connection between the student nurse and the assigned client in the ward.
2. Identify the demographic and biographic profile of the assigned client.
3. Conduct a throrough assessment using Gordon’s Functional Health Pattern.
4. Perform a thorough physical assessment of the body systems of the assigned client using
IPPA (Inspection, Palpation, Percussion, Auscultation).
5. Illustrate the anatomy and physiology of affected system.
6. Collate the significant lab results and explain its significance to the condition of the client
7. Enumerate the medications administered to the client, indicating its mechanism of action,
indication, contraindication, adverse effects and its corresponding nursing responsibilities
8. Discover the nursing problems of the assigned client
9. Sort and prioritize problems acccording to Actual, Potential & Wellness Problems
10. Deduce an efficient nursing care plan based from the identified and prioritized problems
of the assigned client
11. Formulate a discharge plan accordingly
12. Research for readings related to the topic presented
13. Evaluate case presentation with the help of pannelists

PHC2: Case Presentation Page 2

II. Nursing History
Name: Patient DOF
Age: 51 years old
Sex: Female
Nationality: Filipino
Date of Birth: October 24, 1959
Place of Birth: Inayawan, Cebu City
Home Address: Torre, Inayawan, Cebu City
Occupation: NONE
Religion: Roman Catholic
Civil Status: Married
Significant Others: Mr. AF
Relationship: Husband
Date & Time of Admission: February 13, 2011, 12:10PM
Attending Physician: Dr. Manuel Villamor Jr.
Dr. Nicanor Duarte
Chief Complaint: Abdominal Pain
Admitting Diagnosis: Diabetes Mellitus 2
Source of Information: Significant Other and Client
Reationship to Client: Husband

Current Health History

A case of Mrs. DOF, married, 51 years old, a resident of Torre Inayawan, Cebu City was
admitted to Sacred Heart Hospital Medical Ward for the second time last February 13, 2011,
12:10PM due to abdominal pain.
The abdominal pain recurred the evening of February 12, 2011. She was not aware
however what triggered such pain. She did not seek medical attention since it was on bearable
limits. She applied Omega pain killer to the affected part and drank Buscopan to relieve the
adominal pain and make her rest.
February 13, 2011, patient woke up 6am, earlier than the usual, complaining of the
excruciating abdominal pain that radiated to his back. “Makahilak ko sa kasakit”, verbalized
the patient. They tried their usual regimen but it failed to work. So, she decided to be
admitted to to Sacred Heart Hospital where she finally went for the operation,
Cholecystectomy to rid off her disease.
Two days prior to admission, February 11, 2011, patient suffered from the same
manifestations: Back Pains. It started as pt experienced partial pain at Right Upper Quadrant

PHC2: Case Presentation Page 3

 area of Abdomen which radiated to her back. She medicated herself with Buscopan, and was
temporarily relieved. No consultation was done.
One month after recurrence of pain, she was prompted to get herself medical help at
San Carlos Doctor’s Hospital. The Ultrasound revealed Cholelithiasis. After her diagnosis, she
was discharged after wards. Her attending physician, however, referred her for surgery.
Patient sought consultation for admission.

Past Health History

SO claimed that patient was able to be provided with the necessary immunizations
(BCG, DPT, OPV, HepB, MMR). As far as SO recalls, this is her second time to get hospitalized.
(The first time was mentioned above) Coming from a poor family, patient was used to home-
based remedies. When she was younger, she exprienced stomach aches as well, and some
episodes of cough, fever and migraine from stress. She treats them with over-the-counter
medications like pain relievers (Alaxan, Biogesic, Buscopan, Solmux). She had some minor
injuries , but SO was not able to recall exact details about them. SO added that she does not
have any food allergies. Aside from the existing disease, she is struggling with hypertension.
Her high blood pressure, however, is within controllable limits. She already has medications
for her high blood pressure.

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Family Health History with GENOGRAM
According to the patient, the maternal side of the patient has heredofamilial disease
such as hypertension, diabetes, and leukemia. Among the six siblings of her mother’s side,
three of them has already passed away. One was as a result of liver cancer, the other was as a
result of leukemia and finally the last one which also included her mother died with the
complications of hypertension. Two of the siblings, still alive today, suffer from Type II –
Diabeted Mellitus. On the other hand, on the paternal side of the patient, recognized
hypertension and diabetes among the diseases in the family affecting two of three siblings.
One, the father of the patient, is still struggling with hypertension, while the other passed
away with the complications of Diabeted Mellitus and old age. However, a stab wound ended
the life of the father of the patient.
Maternal Side Paternal Side

56 65 70 77

D H D D HD
L L
72 70 52 30 55 61 87 79 75

H HD D

61 59 51 45
Legend:
Male Female H –hypertension
D – Diabets Mellitus
Deceased Male Deceased Female L – Leukemia
As seen in the illustration of the genogram above, the heredofamiliar disease passed on
to the generations are hypertension and diabetes.

Psychosocial History
Patient DOF received her diploma for successfully finishing high school at Abellana
National High School and quit school afterwards. Without a college diploma at hand, she was
not able to land a decent job. Before, she helps at home by doing the household chores and
taking care of her parents. Now that she’s older, she cooks food and sells them at a little food
stall she funded right outisde their residence. Upon marrying her husband, she stopped
working and focused herself to being a housewife. She still resides in the same residence
together with her husband. The patient does not have children, that is why, her affection goes

PHC2: Case Presentation Page 5

 on to the nephews and nieces. Patient does not smoke nor drink alcoholic beverages. Patient
busy herself with cooking food for the family and keeping the house clean.

III. Gordon’s Functional Health Pattern

A. Health Perception – Health Management Pattern
Before Admission:
SO stated that his wife defined health as “importante para malikayan ang sakit”. In contrary,
the wife cannot even maintain the state of being healthy as her husband states that she is not
watchful of her diet. According to him, the patient prefer self – medication compared to
professional medical consultation. The patient had good hygiene and was able to keep a clean
environment.
During Admission:
Since the disease, patient was unable to perform the activities of daily living like cooking food,
grocery and doing household chores. He said that she was always lying on bed, dependent to
the significant others for personal care.
Remarks:
Altered health maintenance related to ineffective individual coping as evidenced by
inability to take the responsibility of meeting basic health pracitices.

B. Nutritional Metabolic Pattern

Before Admission:
According to SO, the patient was fond of drinking softdrinks especially when she gets thirsty.
An estimate of 5- bottles of softdrinks can be consumed by the patient in a day. Although not
an alcoholic, the patient has a sweet tooth. She always makes sure that he ends every meal
with a serving of a dessert. No diet restrictions was observed by the patient. She weighs 55kg
During Admission:
Patient is subjected to a full diabetic diet with 1800 calories a day with mid morning and
midnight snack. She became more thirsty and weak with the diet. She had to give up the
sweets she had every after meal. Her diet has been strictly monitored. She was not able to eat
as much as she ate before. Since the full diabetic diet, she loss weight to 49.5kg
Remarks:
Fluid Volume Deficit related to excessive fluid loss as evidenced by weakness & thirst;
Imbalanced Nutrition related to increased metabolic demands as evidenced by weight loss
Breakfast 2 slices of bread
1 cup of skimmed milk
1 banana

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 Mid Day Snack ! bananastea
Lunch ¾ cup of pasta
1 c steamed brocolli
1 grilled meat
Dinner 3 oz of chicken
Half of a baked potato
1 serving of vegetable salad
1 banana
Mid Night Snack 1 banana
As seen from the table above, the pateint’s diet was modified to fit for her condition.

C. Elimination Pattern
Before Admission:
Patient defecates at a rate of at least once or twice in a day. She added that she micturates at a
rate of 4-5 times in a day with dark yellow tinge.
Upon Admission:
Since her movements as limited due to her operation, she made use of a catheter. She
defecates once a day and at least thrice a week. Patient described stool as black watery and
unformed stool. She micturates at a faster rate of 9 times a day with a sticky charcateristic and
a dark brown tinge.
Remarks:
Altered urinary elimination related to increased fluid volume loss as evidenced by increase in
urinary output

D. Activity – Exercise Pattern

Before Admission:
According to SO, patient is very hard working in preparing their food at home. She makes sure
that with every meal, there’s that personal touch. To provide for the best food, she even does
the grocery by herself. Indeed, she works hard without experiencing any form of fatigue as she
allows for periods of relaxation every day. With her strenuous activities, she has good breathing
patterns
Upon Admission:
She was not anymore able to prepare food. Instead, she just lay on her bed, not that
cooperative during the assessment. SO indicated that she has changed since she finds it tiring to
even talk to people. She is not able to stand or walk around however due to the operation
done. She gasps for breath upon rigorous activity like during assessment, when blood samples

PHC2: Case Presentation Page 7

are taken and when she is talking a lot. Patient complains of pain at the pain scale of 8. (0 for no
pain and 10 as severe pain)
Remarks:
Fatigue related to poor physical condition as evidenced by decreased performance
Activity intolerance Level 2 related to bed rest as evidenced by report of fatigue or weakness
Ineffective breathing pattern related to increased metabolic demands and underlying
respiratory illness.

E. Sleep – Rest Pattern

Before Admission:
The patient had no difficulty in sleeping. She usually sleeps at 9:00PM and wakes up early in the
morning at 7:00AM. During Sundays, a little modification is observed as she wakes up at
5:00AM to attend the 6:00AM mass. She is able to get an average of 9 horus of sleep. No
sleeping aids were used like pillows or music as she can manage herself. Moreover, she doesn’t
find difficulty going back to sleep after voiding in the evening.
Upon Admission:
With the onset of her illness, her normal sleep pattern got disturbed. Patient’s drowsiness
increased in regards to her illness. Sound sleep is better achieved in the morning rather than in
the night. Most importantly, the new environment and the constant monitoring make it hard
for the patient to get enough sleep. Patient complained that she is not satisfied with the
amount of sleep that she gets and feels she is not well rested.
Remarks:
Disturbed sleep pattern related to physiological discomfort and unfamiliar environment
setting
Sleep Deprivation related to unfamiliar and uncomfortable sleep environment as evidenced
by day time drowsiness.

F. Cognitive Perceptual Pattern

Before Admission:
As SO reports, patient possesses good memory. She could still recall the names, together with
the birthday of her siblings and her parents. She could even recall details like the ingredients for
a certain recipe she heard on TV that she plan to cook. Finally, the patient could follow clearly
instructions as seen with her following recipes from cook books and on TV.
Upon Admission:

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The patient has inquiries of the complications of her disease and the interventions done. She
constantly asks questions and is willing to learn about the cause and the treatment of her
condition.
Remarks: Knowledge deificit related to unfamiliarity of information sources as evidenced by
request of information about her condition

G. Self Perception and Self Management Pattern

Before Admission:
Patient is conscious about her personal hygiene as she takes regular baths twice a day and
performs oral hygiene. Unaware of her being diabetic, she indulges in foods high in sugar like
desserts and other confections.
Upon Admission:
SO gives her a sponge bath when she was admitted. She cannot do it herself since her activity is
limited only. SO is required by her side for oral hygiene. Moreover, the patient was discovered
to have a low self- esteem. Instead of showing a positive attitude towards her recovery, she got
used to her condition and accepted it as a natural occurrence to women her age.
Remarks:
Self –esteem disturbance related to perceived helplessness as evidenced by evaluation of self
as unabel to deal with current situation

H. Role – Relationship Model

Before Admission:
Patient lives with her husband and her father. Ocassionally, nieces and nephews pay them a
visit. Expenses at home were shouldered by her husband who works as a Sanitary Officer in a
Public School. She is also able to deal with the people around her well.
Upon Admission:
Instead of her husband, the patient became dependent to her elder sibling, who sponsored her
hospitalization, in decisions concerning the medication and compliance. Her husband cannot
afford the expensive treatments that she has to go through. During the interview, the patient
indicated that her siblings were very supportive to her. Patient quoted “pasalamat ko nga
gikuyugan jud ko nila, hilabi na karun nga nag-antos ko ani nga sakit.”
Remarks:
Risk for altered family process related to expensive treatments

I. Sexuality / Reproductive Patterns

Before Admission:

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Patient had her first menstrual period at the age of 12. With regards to the issue of sexual
relations, she is proud to claim that she has been loyal to her first and last sexual partner, his
loving spouse. She indicated irregularities in menstruation. “dili jud regualr ako regla, naa gani
usahay nga layagan ko ug usa ka bulan.” She had her menopause at the age of 49. She further
claimed, “magdug ra mi manghigda kay wala na kaayo koy gana makighilawas.”
Upon Admission:
No changes in sexuality – reproductive patterns since patient is in her menopause already.
Remarks: Altered role function related to inadequate coping skills: menopause

J. Coping Stress Tolerance

Before Admission:
Patient describes stress to be fatigue or overwork. Cooking, is not only her hobby and
responsibility at home, but at the same time a good stress reliever. Seeing the people delighted
by the food she prepares relieves her from any form of stress.
Upon Admission:
Her hospitalization is by far the most stressful episode in her life. Since she is not anymore able
to practice her favorite activity, she cannot find an outlet for her stresses. She is hopeful
however that she be discharged immediately to rid out of the stresses of hospitalization.
Remarks:
Mild Anxiety related to stress of hospitalization as evidenced by expressed concerns due to
change in life events.

K. Value Belief Pattern

Before Admission:
Mrs. DOF is a baptized Roman Catholic. She is faithful to her devotion to partaking in the Holy
Mass every Sunday. Moreover, she highlights important beliefs in her life like Fear of the Lord,
Honesty, Generosity and Humility. All her life, she has remained true to her faith.
Upon Admission:
Since she is hospitalized, she is not anymore able to attend mass eveyr Sunday. SO provides her
with prayer books at the ward to continue the faith by praying by herself or sometimes
together with the SO.
Remarks: Impaired religiosity related to illness

PHC2: Case Presentation Page 10

IV. Review of Systems:
General Survey:
The case of patient FOD, 51 years old, female was admitted for the 2 nd time in SHH due to
Diabetes Mellitus. Patient appeared to be pale . She cannot speak clearly and with husky
voice. She is cooperative but fatigue and anxiety was observed. The patient has poor hygiene,
has oily hair and untrimmed nails. The patient is generally weak in appearance.
Vital Signs
Date Taken 0213: 2PM 0213: 6PM 0213: 10PM 0214: 12PM 0214: 4PM
1. Temperature 37˚C 37.2˚C 36˚C 36.7˚C 36.7˚C
2. Pulse 78 89 78 82 89
3. Respiratory Rate 23 17 22 24 20
4. Blood Pressure 120/90 110/90 110/80 120/80 110/90

A. Integumentary Assessment
Inspection: The color of the skin is brown in complexion. There were also appearance of
enlarged stretch marks on the lower extremities.
Palpaton:the skin is warm and no masses felt.
Percussion: not applicable.
Auscultation: not applicable.
nails:
Inspection: Fingernails and toenails were perfectly intact, but was not properly trimmed and
there was no presence of any lesions.
Palpation:capillary refill test was good.
Percussion: not applicable.
Auscultation: not applicable.

B. Head and Neck:

Head:
Inspection: Head is normocephalic, symmetric and its color is the same as the rest of the
body. Patient’s face is symmetric, restless expression, color is the same as the rest of the
body. Facial chewing muscles are functioning correctly .
Palpation: Patient’s head is smooth and is free from any deformities.No masses felt. The nose
is midline in the body, nasal septum is intact. The lips are pale and slightly dry. The tongue is
central in proportion, the uvula is positioned midline of the soft palate and the tonsils are not
inflamed.
Percussion:not applicable.
Auscultation: not applicable.

PHC2: Case Presentation Page 11

 neck:
inspection:Neck is midline and angle of jaw is equidistant to shoulders. Noticeable pulsation
of the carotid artery.
Palpation. No lymph nodes was palpated in the neck.
Percussion: NA
Auscultation: NA

B. Thorax and Lungs:

Inspection: (Observed at sleep of patient. She slept in a side-lying position.) Patient was
observed to have quiet respiration with slight increase from the normal range of respiratory
rate (tachypnea). There was a symmetric rise and fall of the chest wihtout discomfort.
Palpation: Not done
Percussion: Not done
Auscultation: Not done

C. Abdomen:
Inspection: The color of the abdomen is lighter than the rest of the body. The texture of the
rest of the abdomen is smooth. No lesions were observed.
Incision Site: An open wound around 4cm is seen at the URQ of the abdomen where the
operation, Cholecystectomy, was done. It was covered by bandages.
Palpation: Not performed, patient said that it was painful to touch
Percussion: Not performed
Auscultation: Not performed

D. Cardiovascular System:
Inspection: NA
Palpation: NA
Percussion: NA
Auscultation: Heart rate was observed at 87bpm

E. Musculoskeletal System:
* Patient was observed with limited activity and weakness. Thus, further tests for the reflexes
was not done. Furthermore, it would strain the patient.

F. Hematologic System

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 *Refer to hematologic exam in the laboratory exams

G. Reproductive System
*Patient refused

H. Neurologic System
* Patient was observed with limited activity and weakness. Thus, further tests for the
neurologic exam was not done. Furthermore, it would strain the patient.

I. Assessment of Cranial Nerves

CN I: No impairment in smelling
CN II: No impairment in sight and reactivity to light
CN III: Not performed
CN IV: No impairment in looking upward
CN V: No impairment in facial movements and sensations
CN VI: No impairment in looking side to side
CN VII: Not performed
CN VIII: No impairment in hearing
CN IX: Not performed
CN X: Not performed
CN XI: Not performed
CN XII: Husky voice in speech

PHC2: Case Presentation Page 13

V. Priority Nursing Diagnoses and Its Related Factors
PRIORITY PROBLEMS Actual Potential Wellness
1.
2.
3.
4.
5.

VI. Diagnostic and Laboratory Results

LABORATORY EXAMINATIONS
NAME OF PURPOSE OF NORMAL
DATE LABORATORY LAB RESULTS VALUES SIGNIFICANCE
TAKEN PROCEDURE PROCEDURE
0214 Blood Chemistry Blood chemistry BUN 2.9-8.9 Normal
tests are often
Analysis ordered prior to 5.7mmol/L umol/L
surgery or a CO2 24-30 Normal
procedure to
examine the 27mmol/L mmol/L
general health of CREATININE 62 – 124 Normal
a patient. This 38umol/L umol/L
blood test,
commonly GLUCOSE 70 – 100 Increased blood sugar levels
referred to as a FBS 218.08mg/dl mg/dL are due to malabsorption of
Chem 7 because
it looks at 7 blood sugar into the cells
different
substances found due to lack of insulin.
in the blood, is
routinely
performed after Source: Brunner &
surgery as well.
Suddarth’s Textbook of
Source: Medical – Surgical Nursing
medscape.com
Eleventh Edition
SERUM K 3.5 – 5 Excessive Urine Excretion.
3.48mEq/l mEq/L
http://www.livestrong.com/
SERUM Cl 97 – 107 Normal
105mEq/l mEq/L
SERUM Na 135 – 145 Normal
138mEq/l mEq/L
HbA Ic 4.4% - HbA1c has become the most
6.8% 6.4% important way of measuring
long-term metabolic control.
Increased HBA1c implies

PHC2: Case Presentation Page 14

 suboptimal glucose control.

Source: Brunner &

Suddarth’s Textbook of
Medical – Surgical Nursing
Eleventh Edition
0214 LIPID PROFILE HDL CHOLESTEROL
The lipid profile is 35-70 Normal
a group of tests 75mg/dl
that are often mg/dL
ordered together LDL CHOLESTEROL 130-159 increased small, dense LDL-P
to determine risk 145.59mg/dl
of coronary heart mg/dL due to enhanced production of
disease. The tests TG-rich VLDL
that make up a
medlineplus.com
lipid profile are
tests that have
been shown to be
good indicators TRIGLYCERIDES 100 – 200 Normal
of whether
148 mg/dl mg/dL
someone is likely
to have a heart
CHOLESTEROL 150 – 200 Too much cholesterol
attack or stroke 205.95mg/dl mg/dL deposits clogging up blood
caused by CHOLESTEROL 5
blockage of blood vessels
vessels TO HDL RATIO
("hardening of
the arteries").
5.61
Source: Brunner &
Suddarth’s Textbook of
Medical – Surgical Nursing
Eleventh Edition
0213 HGT Blood Sugar Constant 241 Fasting: Increased blood sugar levels
0214 measurement 262
Monitoring 60 – 100 are due to malabsorption of
0214 of whole blood 191
0214 glucose 129 mg/dl blood sugar into the cells
0214 identifies 188 due to lack of insulin.
0215 diabetics who 176
0215 require 163 Post
0216 intervention to 187 Prandial: Source: Brunner &
0216 maintain their 104
0216 blood glucose 104 65 – 140 Suddarth’s Textbook of
0216 within an 142 mg/dl Medical – Surgical Nursing
0216 acceptable 329
range as Eleventh Edition
0216 148
determined by
their physician.
(American
Diabetes
Association)

PHC2: Case Presentation Page 15

 DIAGNOSTIC EXAMINATIONS
DATE NAME OF DIGANOSTIC PURPOSE OF DIAGNOSTIC CONCLUSIONS AND
TAKEN PROCEDURE PROCEDURE FINDINGS
0214 Ultrasound Ultrasound imaging is a Multiple Cholelithiasis,
noninvasive medical test that
normal liver, biliary duct,
helps physicians diagnose and
treat medical conditions. It pancreas & spleen
produces a picture of the
organs and other structures
in the upper abdomen.

Source: American College of

Radiology

VII. Review of Anatomy & Physiology

What is the pancreas?
A simple answer is that the pancreas is an oblong
flattened gland located deep in the abdomen.
Where is the pancreas?
The pancreas is located deep in the abdomen,
sandwiched between the stomach and the
spine. It lies partially behind the stomach.
The other part is nestled in the curve of
the duodenum (small intestine). To
visualize the position of the pancreas,
try this: Touch the thumb and
"pinkie" finger of your right hand
together, keeping the other three fingers
together and straight. Then, place your hand
in the center of your belly just below your
lower ribs with your fingers pointing to the
left. Your hand will be at the approximate level of your pancreas.
Because of the pancreas' deep location, tumors are rarely palpable (able to be felt by pressing
on the abdomen.) It also explains why many symptoms of pancreatic cancer often do not
appear until the tumor grows large enough to interfere with the function of nearby structures
such as the stomach, duodenum, liver, or gallbladder.

PHC2: Case Presentation Page 16

VIII. Readings
Innovation In Diabetes Care: New Ways For People To Take Insulin; New Compounds Under
Development
Pharmaceutical companies are exploring new and different ways of enabling people who need
to take insulin to control their diabetes, according to a report issued today by the Association of
the British Pharmaceutical Industry (ABPI).

At the same time, the report reveals that more than 50 new compounds to combat the
condition are in various stages of development.

Companies are actively researching delivery methods that include:

-- Inhaled insulin powder.
-- Liquid insulin inhaler system.
-- Insulin spray, to be delivered as a fine mist to the mouth. -- At least two types of oral insulin,
using different delivery technologie
-- Transdermal patch.

"The discomfort of self-injection is thought to deter many people with diabetes from starting
insulin treatment that they may need. This has led companies to explore alternative methods of
'delivering' the medicine to patients," said Dr Richard Barker, Director General of the ABPI.

"Diabetes has been diagnosed in as many as two million people in the UK, with many more
believed to have the condition but not yet diagnosed. While it can be kept relatively stable in
the majority of patients, it does require careful attention to regulating the condition, both
through lifestyle changes and medication."

Type 1 diabetes occurs when the body's immune system attacks and destroys cells in the
pancreas that make insulin, a vital hormone that regulates glucose in the body. It forms about
ten per cent of the total number of diabetes cases.

Type 2 diabetes typically emerges in middle or later life because of growing resistance to the
action of insulin, often related to the development of obesity. At first, there are often no clear
symptoms, which is why so many people are thought to be undiagnosed. In its advanced stages,
type 2 diabetes may need to be treated with insulin injections, like type 1.

"The UK-based pharmaceutical industry is putting great effort into finding new and improved

PHC2: Case Presentation Page 17

answers to both types of diabetes, with large numbers of potential medicines at various stages
of development, and there are some exciting prospects for finding alternatives to injections,"
said Dr Barker.

"This area exemplifies the value of progressive, incremental innovations in bringing costly, long-
term conditions under control."

The new delivery methods that are being researched, together with further details about the
condition and the developments in the pipeline, are detailed in a new booklet, Target Diabetes,
published by the ABPI.

The many different types of medicine under development include new compounds that reduce
insulin resistance, others that reduce glucose release into the blood, and a synthetic version of
a naturally occurring hormone found in the venom of the Gila monster, a poisonous lizard found in
the south-western USA and Mexico.

IX. Bibliography:
1. http://health.msn.com/medical-tests/articlepage.aspx?cp-documentid=100070105
2. http://en.wikipedia.org/wiki/Blood_sugar
3. http://www.medicalnewstoday.com/articles/35436.php
4. Medlineplus.com
5. Brunner & Suddarth’s Textbook of Medical – Surgical Nursing Eleventh Edition

PHC2: Case Presentation Page 18