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INTRODUCTION

This case study is all about Mr. E.B., a 53 year old man, married, Filipino and a
bus driver who is newly diagnosed with a Type 2 Diabetes Mellitus with a chief
complaint of dizziness, weakness and difficulty in breathing. He was inadvertently
admitted in a tertiary hospital, thus confirming his disease. Below are pertinent data
related to his disease condition:
History of Present Illness
On December 17, 2015, prior to consultation, Mr. EB was experiencing weakness
and he stated that he feels tired easily doing some household chores. He also feels
thirsty and hungry. The night before he decided to go to hospital, he experienced
difficulty of breathing and weakness, which cause him difficulty sleeping. On the
following day at 7:00AM, he sought consultation at De Vera Medical Center, a tertiary
hospital in his locale. And fasting blood sugar results were too high.
During my interview with him via Face Time, he was able to communicate to me
and has no manifestation of hyperglycemia nor hypoglycemia. According to him, he is
on maintenance drug therapy called oral hypoglycemic agents.

PATIENT HISTORY
To get a comprehensive gathering of information, I have used the Gordons
Functional Health pattern when I interviewed Mr. EB. And the results are as follows:

Health Perception/Health Management Pattern


He was a junk food lover mainly potato chips with large amounts of soda with it.
According to Mr. EB, eating nutritious food, exercise and religiously taking of prescribed
medication or what nurses and Doctors advice will keep him healthy.
Self Esteem, Self-Concept/Self Perception Pattern
Mr. EB is a responsible husband and father to his wife and children. He was able
to provide the needs of his family. The client possessed a jolly and fun loving type of
personality. But since his illness started, most of the time, he felt self-pity and worthless.
He is always irritable and angry when he thinks that he was ignored.
Activity/Exercise Pattern
He believes he is an active individual, during his breaks from driving his own bus,
he makes it a point he jogs and bikes every morning. He doesnt have a sedentary
lifestyle since he serves as mechanic too in his own bus company.
Sleep/Rest Pattern
According to him, he has altered sleep pattern. Each day he only had a
maximum of 4 hours of sleep and despite of that he still feels good upon waking up. He
usually sleeps at around 12 midnight and regularly wakes up at around 4 AM.
Nutrition/ Elimination Pattern
Mr. EB usually takes a cup of creamed coffee in his breakfast and he takes
heavy meals more frequently but after eating he usually feels belly pain. He is fond of
drinking soda and eating street foods. He typically drinks more than an 8 glasses of

water per day. He also stated that prior to his illness he weighted 87kgs but at present
he weighs 72kgs. He also noted that he frequently voids with dark yellow color urine
and felt some discomfort when urinating.
Sexual- Reproductive Pattern
Mr. EB admits he is inactive in sexual intercourse due to his present condition.
Though at times he experiences wet dreams sometimes.
Interpersonal/ Role Relationship Pattern
He has 3 children and they were close to each other. Prior to having Diabetes, he
is very active and usually socializes with his neighbors and friends. His family is very
supportive and understanding, now that he is battling with his disease. He noticed he
became dependent to his wife emotionally due to his illness.
Coping and Stress Tolerance
When he was diagnosed of DM Type 2 there have been many changes occurred
that made difficult for him to adjust. He cannot perform the usual activities that he had
before. When patient he is under stress, he prefers to just lock himself in his room until
he falls asleep. When it comes to problem, he tried to calm himself through prayer and
of course with his wife fully supporting him.
Values-Belief Pattern
As a Roman Catholic, he makes sure he always hears mass every Sunday with
his family. But Due to his illness, he wasnt able to go to mass regularly. According to
him, there are many practices that affects his illness.

Personal Habits
He admits he used to maintain a good personal hygiene and had a diet without
restriction. As the driver in his own bus company, he is obliged to work 6 days per week
and was able to help in doing household errands when he gets home. Due to the
nature of his work, he tends to skip meals and resort to drinking carbonated beverages
whenever there is a need. He does not smoke and is an occasional drinker.

PATHOPHYSIOLOGY
Disease Explanation
Diabetes mellitus, or simply, diabetes, is a disease that damages the body when
the blood glucose (sugar) is allowed to remain too high for too many years. Type 2
diabetes, like that of Mr. EB, is the form that used to be called adult-onset diabetes. It is
a lifestyle disease, resulting from excessive weight gain and lack of exercise. The
patient does not lack insulin, but has insensitivity to his own bodys insulin. Treatment is
started with diet and exercise but may ultimately require pills or insulin.
Type 2 diabetes mellitus is a heterogeneous syndrome characterized by
abnormalities in carbohydrate and fat metabolism. The causes of type 2 diabetes are
multi-factorial and include both genetic and environmental elements that affect beta-cell
function and tissue (muscle, liver, adipose tissue, and pancreas) insulin sensitivity.
Although there is considerable debate as to the relative contributions of beta-cell
dysfunction and reduced insulin sensitivity to the pathogenesis of diabetes, it is
generally agreed that both these factors play important roles. However, the mechanisms

controlling the interplay of these two impairments are unclear. A number of factors have
been suggested as possibly linking insulin resistance and beta-cell dysfunction in the
pathogenesis of type 2 diabetes. A majority of individuals suffering from type 2 diabetes
are obese, with central visceral adiposity. Therefore, the adipose tissue should play a
crucial role in the pathogenesis of type 2 diabetes. 1
Signs and Symptoms
There are many signs and symptoms related to diabetes. Signs can be described
as something that is physically seen, while symptoms are observed by the patient.
According to the American Academy of Orthopedic Surgeons, the main symptoms of a
hyperglycemic crisis include rapid, deep respirations, dehydration, a sweet and fruity
odor on the breath, polyuria (excessive urination), polydipsia (excessive thirst),
polyphagia (excessive eating) or varying degrees of unresponsiveness.

Signs

and

symptoms of a hypoglycemic crisis include the following; shallow respirations,


diaphoresis (sweating), altered mental status (aggression, confusion or unusual
behavior), hunger, anxiousness, seizure, fainting, and weakness on one side of the
body or coma.2
Risk Factors
The major risk factors for type 2 diabetes mellitus are the following: 3

Age greater than 45 years (though, as noted above, type 2 diabetes mellitus is

occurring with increasing frequency in young individuals)


Weight greater than 120% of desirable body weight
Family history of type 2 diabetes in a first-degree relative (eg, parent or sibling)

Hispanic, Native American, African American, Asian American, or Pacific Islander

descent
History of previous impaired glucose tolerance (IGT) or impaired fasting glucose

(IFG)
Hypertension (>140/90 mm Hg) or dyslipidemia (HDL cholesterol level < 40
mg/dL or triglyceride level >150 mg/dL)

Causes:
Diabetes occurs when the pancreas doesn't make enough or any of the hormone
insulin, or when the insulin produced doesn't work effectively. In diabetes, this causes
the level of glucose in the blood to be too high. Type II diabetes occurs when the body is
unable to use the insulin that was originally produced. This type of diabetes occurs
when the amount of receptor sites for insulin decreases or there is defect within the
receptor locations. The Type II form is typically linked to obese individuals. 4 What
causes diabetes depends on the type of the disease. Few of the causes of diabetes
include: Genetic predisposition, Poor Diet or Malnutrition Related Diabetes, Obesity and
Fat Distribution, Sedentary Lifestyle, Stress, Infection, pre-existing Hypertension and
increased Serum lipids and lipoproteins.
Treatment:
Since Diabetes mellitus is a multi-organ affliction, Treatment targets on the prevention of
further complications that may arise. Goals of treatment are as follows: 5

Microvascular (ie, eye and kidney disease) risk reduction through control of
glycemia and blood pressure

Macrovascular (ie, coronary, cerebrovascular, peripheral vascular) risk reduction

through control of lipids and hypertension, smoking cessation


Metabolic and neurologic risk reduction through control of glycemia

Meanwhile, approaches in preventing diabetic complications include the following: 6

HbA1c every 3-6 months


Yearly dilated eye examinations
Annual microalbumin checks
Foot examinations at each visit
Blood pressure < 130/80 mm Hg, lower in diabetic nephropathy
Statin therapy to reduce low-density lipoprotein cholesterol

CONCLUSION
Diabetes in any form is not good for health. One of the option to get rid of Type 2
diabetes is to control overweight/extra fat in your body in early ages. And avoid
sedentary lifestyle. Combined with proper exercise and balanced diet, your risk for
adult-onset diabetes may be prevented or minimally decreased. Although there are lot
of factors that causes diabetes but the main things that one needs to control is the
sugar level & junk food level. Nutrition plays a great role in the development of
Diabetes, so its important to stay vigilant on the foods we eat and must take an extra
caution to utilize it properly by leading an active and healthy lifestyle.

CITATIONS:

1. Scheen, AJ. Pathophysiology of Type 2 Diabetes. Acta Clin Belgium, Nov-Dec 2003 <
http://www.ncbi.nlm.nih.gov/pubmed/15068125#>
2. Gulli, Benjamin, Joseph A. Ciatolla, and Leaugeay Barnes. Emergency Care and
Transportation of the Sick and Injured. Sudbury, MA: Jones and Bartlett, 2011. Print.
3. Khardori, R., MD. Type 2 Diabetes Mellitus. Medscape Article. Updated October
2015.
< http://emedicine.medscape.com/article/117853-overview#a4>
4. "Medi-Info.com. Diabetes Mellitus. Medi-Info. Web. 31 Mar. 2012
<http://www.mediinfo.com/diabetes-mellitus/>.
5. Keller DM. New EASD/ADA Position Paper Shifts Diabetes Treatment Goals.
Medscape Medical News. < http://www.medscape.com/viewarticle/771989>
6. [Guideline] American Diabetes Association Professional Practice Committee.
American Diabetes Association clinical practice recommendations: 2013. Diabetes
Care. January 2013. 36 (suppl 1):S1-S110.