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Chapter I THE PROBLEM AND THE REVIEW OF RELATED LITERATURE Introduction

Diabetes mellitus is a disease in which the pancreas produces insufficient amounts of insulin, or in which the body’s cells fail to respond appropriately to insulin. There are two types of diabetes mellitus, the type I and the type II. This study focuses on the type II diabetes mellitus since it accounts mostly of the cases compared to type I Diabetes Mellitus.

Diabetes

Mellitus

Type

II

is

a

non-communicable

lifestyle disease. It is also a chronic metabolic disease in

which

the

body cannot effectively

use

the

insulin

it

produces. Thus, it leads to an increased concentration of glucose in the blood (hyperglycemia). In this case, the disease is expected to affect the patient’s quality life. It demands a lot to the lifestyle, poses debilitating and life threatening complications and has significant effect on the well-being of the patient.

The managements for diabetes mellitus and its related

health risk factors are often highly complex and require

considerable

patient

education

and

frequent

medical

monitoring

to

prevent

the

occurrence

of

severe

2

complications. This disease has long-term complications, such as retinopathy, neuropathy, heart disease,nephropathy, and stroke, which have a detrimental effect to the quality of life.

With the following complications, it is important for the patient to learn how to cope up to its effect. Coping

mechanism is a way of patient on how to deal with the

consequences

of

their

disease.

Many

people

have

a

characteristic way of coping with situation based on their personality. People who cope well tend to believe that they can personally influence what happens to them. They usually

make

more optimistic and persevere

even under extremely

adverse circumstances. Most significantly, they choose the

appropriate

strategies to

cope with

the situations they

have. In opposite, people who cope poorly with the situation

tend to have somewhat opposite behaviour, such as being pessimistic and lower self-esteem.

As of 2011, the estimated number of adults living with diabetes has soared to 366 million, representing 8.3% of the global adult population. This number is expected to increase to 522 million people by 2030, or 9.9% of adults, which equates to approximately three more people with diabetes every ten seconds.

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In

most

countries,

Diabetes

is

now

among

the

five

leading causes of death. Indeed, here in the Philippines it

is

one

among

the

top

ten leading

causes of mortality.

Besides, it ranks as the ninth (9 th ) top killer disease

nowadays.

It

is

also

alarming to

know

that recently

according

to

World Health Organization

(WHO), diabetes

deaths

will

double

between

2005

and

2030

in developing

countries including the Philippines.

Those data show that Diabetes Mellitus incidence are

not just rampant internationally nationality.

but

also

in

our

own

With

the

above

problem, the researchers decided

to

conduct a study to find out the coping mechanism of the respondents with the common effects of diabetes mellitus type II. With these, it would be helpful in the prevention of the occurrence of further complications of the disease.

Review of Related Literature

Included

in

this

section are

related studies

about

diabetes mellitus, Type 2 diabetes mellitus and its impact

on

the

different

aspects

of

life

such

as

physical and

psychological/emotional, the coping strategies of patients with Type 2 diabetes mellitus and as well as the ways of

prevention and treatment.

4

It

is generally

believed that

the

prevalence

of

Diabetes Mellitus is increasing worldwide and it represents a large burden for patients and society. Diabetes Mellitus must be considered a major public health problem however it

does not stop those people who have this disease in living their life. People with diabetes have to live their life, and deal with whatever life throws at them. Most authors defined diabetes mellitus or better known

just

as "diabetes"

as

a chronic disease associated with

abnormally high levels of the sugar glucose in the blood.

Diabetes

is

due

to

one

of

two

mechanisms:

(1)

Inadequate

production

of insulin (which

is

made

by

the pancreas and lowers blood glucose) or (2) Inadequate

sensitivity of cells to the action of insulin. The two main types of diabetes correspond to these two mechanisms and are called insulin-dependent (type I) and non-insulin-dependent

(type

II)

diabetes.

(Retrieved

from:

on February 24, 2012)

According

to

Barbara

L.

Bullock

and

Reet

L.

Henze

(2000), the prevalence of DM increases with age.

Over 10 %

of individuals over the age of 65 have DM as compared with

0.8% of individuals younger than 38. greater in women (55%) than men (45%).

The incidence is also

5

In type II diabetes, there is no insulin or not enough

of

it.

In

type

II

diabetes, there

is generally enough

insulin but the cells upon it are not normally sensitive to its action. Type II Diabetes Mellitus accounts mostly of the cases compared to Type I Diabetes Mellitus. Diabetes Mellitus type II is known to be a chronic

disease

that

mainly

affects

the

metabolism

of

sugar.

According to

Brunner

&

Suddarth’s (2010)

Textbook of

Medical-Surgical Nursing 12th edition, the two main problems in type II diabetes are insulin resistance and impaired

insulin

secretion.

Thus,

it

leads

to

decreased tissue

sensitivity to insulin. With type II diabetes, the body either resists the effects of insulin — a hormone that

regulates the movement of sugar into cells — or does not produce enough insulin to maintain a normal glucose level. (Retrieved from: http://www.mayoclinic.com/health/type-2- diabetes/DS00585 on March 3, 2012) Diabetes mellitus type II is a metabolic disorder that is characterized by high blood glucose in the context

of insulin

(Retrieved

relative insulin deficiency from:

6

In addition,

type

II

diabetes is

characterized by

chronic hyperglycemia with disturbances of carbohydrate,

fat, and protein metabolism resulting

from

defects

in

insulin secretion, insulin action, or both.

(Retrieved

from: http://www.staff.ncl.ac.uk/ on February 29, 2012).

Type II diabetes, the most common type of diabetes is

multifactorial.

It

is

due

to

the

inheritance

of

susceptibility genes

plus

environmental

factors

such

as obesity. Obesity, in turn, clearly is multifactorial in

causation.

(Retrieved

from:

http://www.medterms.com/script/main on March 3, 2012.

Type II diabetes is primarily be seen in middle-aged adults (40-65 years old), and be in contrast to type I

diabetes, which

is

usually

diagnosed

at

a

much earlier

stage. (Retrieved from: http://www.diabetes.co.uk/type2- diabetes.html on March 8, 2012) However, Cases of type 2 diabetes is already increasing in children throughout the country. One problem that is thought to be causing the increase in obesity rates is the misconception that many parents have of “puppy fat“, i.e. the belief that extra fat on young children is healthy, and that they will eventually shed the fat as they grow older. The fact is, puppy fat is something that babies have. From the time children are on their feet and walking they should not be carry excess fat,

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and certainly not at the age of 4 years and over. (Retrieved from : http://www.motleyhealth.com/lose-weight/the-puppy- fat-myth-and-child-obesity on March 8, 2012). In addition, Type II diabetes was once rare in children

and adolescents but has recently become more common. About 15% of people older than 70 have type 2 diabetes. People of certain racial and ethnic backgrounds are at increased risk of developing type 2 diabetes: blacks, Native Americans, and Hispanics who live in the United States have a twofold to threefold increased risk. Type 2 diabetes also tends to run

in

families.

(Retrieved

from:

Generally, type II diabetes develops more slowly than type I diabetes. As a result, some people can be diagnosed

with type II diabetes (and some other diabetes types) years after they first developed the condition. In some cases, diabetes may only be diagnosed after noticing the signs of diabetic complications that is a serious position. Untreated, type II diabetes can be life threatening. Higher blood sugars over a period of time allow diabetic

complications

to

set

in,

such

as

diabetic retinopathy,

kidney disease, and cardiovascular disease (heart disease).

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People with type II diabetes may not have any symptoms for years or decades before they are diagnosed. Symptoms may be subtle. Increased urination and thirst are mild at first

and

gradually worsen

over weeks

or months.

Eventually,

people feel extremely fatigued, are likely to develop

blurred vision, and may become dehydrated. (Retrieved from:

People with type II diabetes often do not have any symptoms. When symptoms do occur, they are often ignored

because

they

may

not

seem serious.

Symptoms

in

type

I

diabetes usually come on much more suddenly and are often severe. Common symptoms of diabetes include excessive thirst and appetite, increased urination (sometimes as often as every hour), unusual weight loss or gain, fatigue, nausea perhaps vomiting, blurred vision, in women, frequent vaginal infections, in men and women, yeast infections, dry mouth, slow-healing sores or cuts and itching skin, especially in

the groin or vaginal area.

If a person with diabetes is

having weakness or fainting spells; experiencing a rapid

heartbeat, trembling, and excessive

sweating;

and

feel

9

irritable,

hungry,

or

suddenly drowsy.

He/she could

be

developing hypoglycemia -- low blood sugar that can occur

with

diabetes

treatment.

(Retrieved

from

:

on September 18, 2012)

People with type II diabetes are especially at risk for

hypoglycemia,

which

is

also called

low

blood

sugar

or

insulin shock. This may be caused by insufficient intake of food, too much exercise or excessive alcohol intake. One of the most common causes of hypoglycemia is injecting too much

insulin.

Usually the condition

is

manageable, though

occasionally

it

can

be

severe

or

even

life-threatening,

particularly if the patient fails to recognize the symptoms.

Managing diabetes as effectively as possible to increase

insulin sensitivity can greatly reduce

the

risk

of

hypoglycemia.

It is also essential to manage exercise and

food intake responsibly, as directed by a doctor.

Mild hypoglycemia is common among people with type II diabetes. Severe episodes are rare, even among those who are taking insulin. However, everyone who is controlling glucose levels should be aware of warning symptoms. Persons with diabetes at highest risk for severe hypoglycemia are those who have a previous history of the disorder or those who

10

develop

"hypoglycemia

unawareness."

(Retrieved

from:

Based on a study conducted by Wim JC de Grauw, Eloy H van de Lisdonk, Robert RA Behr, Willem HEM van Gerwen, Henk JM van den Hoogen and Chris van Weel (1999), “The physical fitness of type II diabetes mellitus patients was clearly impaired. Functional health status decreased significantly

with

the

presence

of

co-morbidity

in

particular

cardiovascular

co-morbidity and

a

longer

duration

of

diabetes. Cardiovascular co-morbidity turns out to be not

only a predominant factor in the decreased life expectancy

of

type

II diabetes mellitus patients:

it

impairs the

patient's functional health status long before as well.”

In

people with

diabetes, stress

can

change blood

glucose levels in two ways: (1) People under stress may not take good care of themselves; they may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals. (2) Stress hormones may also alter blood glucose levels directly. Scientists have studied the effects of stress on glucose levels in animals and people. Diabetic mice under physical or mental stress have elevated glucose levels. The effects in people

11

with type I diabetes are more mixed. While most people's glucose levels go up with mental stress, others' glucose

levels can go down. In people with type II diabetes, mental stress often raises blood glucose levels. Physical stress,

such

as

illness

or injury,

causes higher blood glucose

levels in people with either type of diabetes. Some sources of stress are never going to go away, no matter what you do. Having diabetes is one of those. Still, there are ways to reduce the stresses of living with diabetes. Support groups can help. Knowing other people in the same situation helps those with diabetes feel less alone. They can also learn

other

people's

hints

for

coping

with

problems. Making

friends

in

a

support

group

can

lighten

the

burden

of

diabetes-related stresses. Dealing directly with diabetes

care

issues

can

also

help.

(Retrieved

Living

with

type

2

diabetes

may sometimes

cause

a

person discouraged. Some emotional

highs

and

lows

are

normal,

but

it’s

necessary to

recognize when

emotional

changes signal unusual stress so that a person with DM

can

begin to find ways to cope with it.

In regards with stress brought by diabetes, there are general guidelines for managing it: (1) Stay active. It can

12

improve blood sugar levels as well as mood; (2) Meditate. Short periods of quiet reflection can improve one’s ability to cope with stress; (3) Be positive or avoid negative thoughts; (4) Laugh. Laughter may lower blood pressure and reduce stress hormones; (6) Consider yoga. This form of full-body stretching can help someone feel calm; (7) Get plenty of sleep. Sleep loss may lead to weight gain and may interfere with body’s ability to use insulin; (8)Make sure to have a good support network.

(Retrieved

from:

Depression is

the most common psychiatric disorder

witnessed in the diabetic population. Depression and anxiety

can

interfere

with

the

health care

of individuals with

diabetes. Diabetic individuals with depression or anxiety

are at greater risk for being noncompliant with medical

treatment

and

for

developing

medical

complications,

according to a review of studies in the May/June 1999 issue

of "Diabetes and Metabolism Research Reviews." “Those with diabetes may experience depression and

anxiety. A study published in the June 2001 issue of

"Diabetes

Care" investigated

the

rates

of diabetes

and

depression, finding that having diabetes doubles the odds of

13

being depressed and women with diabetes are more likely to have depression than men with diabetes. Diabetic individuals also have higher levels of anxiety, as noted in the December 2002 edition of "The Journal of Psychosomatic Research." (Retrieved from: www.livestrong.com/article/94222-mental- social-effects- diabetes / on March 8, 2012) “While complications could be understood to ‘upset’

people and the more of them the more ‘upset’ they may cause, there is an additional effect of duration of diabetes. The longer the duration the greater the distress – this would mean that depression and anxiety is not simply linked to initial adjustment problems to having diabetes but it is not clear from this component of the study why people with longer duration of diabetes seem to be more depressed and anxious. Factors such as age, education (and occupational status, which was not included in the regression analyses due to its 81 correlation with education), and the perceived effort expended on dealing with all chronic conditions were not found to be predictors of distress in this group in the

presence

of

the

effects of complications

and diabetes

duration. “ (Retrieved from: http://www.chronicillness.org.au/downloads /Diabetesanddepression.pdf on January 27, 2012.)

14

According to Richard M. Weil, MEd, CDE (2000), it’s no

coincidence that the rate of Type II diabetes is rising. The two are strongly related: The heavier people are, the more

likely

they

are

to develop diabetes.

So

strong

is

the

connection between obesity and diabetes that a new word,

“diabesity,” has been coined by the medical community. (The first diabesity conference was held in Virginia in March

2001.)

It’s also no coincidence that Type II diabetes and

obesity are on the rise at a time when physical inactivity

is commonplace. People who are physically inactive tend to

be heavier than people who are active, and they tend to have

more diabetes too.

While the rises in obesity and Type II

diabetes show no signs of slowing any time soon, research

suggests that something can be done to increase the number of people who are physically active and to decrease the

number

who

develop

obesity

and

Type

II

diabetes. This

article offers suggestions to help individuals make informed decisions about losing weight and becoming more physically

active. Despite the risks associated with type II diabetes, most people can lead active lives and continue to enjoy the foods and activities that they previously enjoyed. Diabetes

does

not

mean

an

end

to "special

occasion" foods like

birthday

cake,

and

most

people

with

diabetes

can

enjoy

15

exercise

in

almost

any

form.

(Retrieved

from:

on

March 9, 2012) Managing diabetes can seem like an overwhelming task, particularly for the newly diagnosed patient. Many diabetics

struggle to cope with the requirements and this can lead to depression. Diabetes is a unique disease because people diagnosed with it must be responsible for the majority of their own

care.

There

are

a

lot

of

areas

to

cover. Insulin,

medication, blood glucose monitoring, diet, and exercise are all important parts of diabetes management that must be incorporated into people’s lifestyle who have this. Nutrition is very important in managing diabetes. Being overweight or obese can also make managing diabetes more difficult. Losing weight, even 5-7% of total body weight, can greatly improve glucose control, and overall health. Monitoring blood glucose levels is an extremely important part of diabetes management. But most importantly, blood glucose monitoring lets a person know if his/her levels are too high or too low. Exercise is also an important way to manage diabetes. Not only can physical activity helps to achieve beneficial weight loss, but it can lower blood sugar

16

and

help

cells

accept

insulin

more

efficiently.

When

a

person

has diabetes,

excess weight

can

make

his/her

condition more difficult to control. Fat cells are more resistant to insulin than lean muscle cells, so having too

much body fat makes it that much harder to use the insulin that body makes. Maintaining a healthy weight is key to

managing

diabetes.

(Retrieved from:

http://diabetes.about.com/od/doctorsandspecialists/u/coping withdiabetes.htm on September 18, 2012) According to Mc Culloch (2001,) “For most people, the

first

few

months

after

being

diagnosed

are

filled with

emotional

highs

and

lows.

If

a

person

has

just

been

diagnosed with diabetes, hi/her family should use this time

to learn as much as possible so that caring for diabetes

(including

testing

blood

sugar,

going

to

medical

appointments, and taking medications) becomes

a

part

of

his/her daily routine.”

However,

basing

on

Birgitta Sandén-Eriksson, PhD

(2000) “Diabetes had little impact on daily living and it affected the individual more than the family. The emotional relationship between the patients and their diabetes was

relaxed

and

strong

but

they still

felt

high

levels

of

independence, freedom, and safety. As expected, the social

situation changed with increasing

age.

The

number

of

17

subjects still at work and the number of households with

children

decreased and

the number

of old-age pensioners

increased.” According to Diana Rodriguez (2011), “Having type II

diabetes changes

one’s

life

and

can

certainly affect

relationships. Diabetes

attention

and focus,

management which may

be

requires

There

is

a

a

lot

of

need

to

carefully monitor the food that a person with diabetes eats and check his/her blood sugar frequently throughout the day.

Even

a relationship, dating life

if

person

is

not currently

in

a

long-term

diabetes

can

have

an

impact

on

his/her

(Retrieved

from:

diabetes-and-relationships.aspx March 8, 2012) In addition, a person with diabetes either Type I or

Type II should talk to a doctor or nurse about resources that are available for medical as well as psychological support. These may include group classes, meetings with a nutritionist, social worker, or nurse educator, and other

educational

resources such

as

books,

web

sites,

or

magazines.

(Retrieved

from:

18

Type

2

diabetes

is

a

serious health condition.

Following pre-diabetes or metabolic

type

2

diabetes

can

potentially

be

avoided

through diet and exercise. Such a diagnosis can be viewed as

a useful, if urgent, wake up call. If resistance to insulin

increases, people with type 2 diabetes may need to take oral anti-diabetic medications, or take insulin to keep their

blood

sugar

levels

stable.

(Retrieved

from:

March

02,

2012)

Coping

has

been

defined

as

a

response

aimed

at

diminishing the physical, emotional and psychological burden

that

is

linked

to

stressful life

events

and

daily

hassles Coping is understood to be adaptational activity that involves effort. It is the element of effort which enables us to draw the distinction between coping and ready-

made adaptational

devices

such

as

reflexes.

Coping

constitutes constantly changing cognitive, behavioural and

emotional efforts

to manage particular

external and/or

internal demands that are appraised as taxing or exceeding

the resources of the individual.

Coping with the implications of one's diabetes related problems could be a difficult and often lifelong process.

19

Patients may cope by adjusting their social role to fit the demands and challenges associated with the illness, or they may cope by trying to reframe their experiences viewing the situation in a more positive light. Accepting the reality of

the

diagnosis and

developing a positive attitude

toward

treatment is thought to be critical for successful coping

and recovery.

Retrieved October 02,2012)

(

from:

Healthy coping

and managing negative

emotions are

central to diabetes self management, all of which influence health and quality of life. Depression and other negative emotions can make diabetes worse, and problems with diabetes can worsen emotional health. Mediating both of these is self management.

Problem-solving skills that are central to diabetes self management are also central to managing emotions. For example, if people set a goal to increase their physical activity — maybe something as simple as walking five days a

week — and they meet that goal, the achievement helps their

emotions, and

the

physical activity

helps

both

their

emotions and their diabetes.

20

In

addition

to

the

above

mentioned,

there

are

key

skills for healthy coping which

are – (1) Problem-solving

and

goal setting

— appraising

problems and

challenges,

generating alternatives for dealing with them, testing those

alternatives, and assessing results, (2)

Social skills,

including

how

to

express one’s

feelings and

choices

effectively, (3) Cognitive skills and (4) Stress management

skills like relaxation and meditation.

(Retrieved from:

25.pdf on September 03, 2012)

Treatment typically includes diet

modification and

control,

regular

and

appropriate exercise, home blood

in

some

and/or insulin

cases,

oral

medication

(Retrieved

from:

2012)

Recently a number of new and effective treatments have

become

available, such

as Byetta,

Victoza and Bydureon.

Maintaining good control of blood glucose levels is vital in reducing the risk of diabetic complications. If you are

overweight, weight loss can often help to improve the extent

of

diabetes

symptoms.

(Retrieved

from

21

2012).

Conceptual Framework:

Input

Type Ii

Diabetes

Mellitus

Patients

-Profile

Age: 31-

85

Gender

Figure

Process Output Information Baseline data gathering on the patients’ -Floating of questionnaires coping mechanisms to the
Process
Output
Information
Baseline data
gathering
on the
patients’
-Floating of
questionnaires
coping
mechanisms to
the common
effects of
Diabetes
Mellitus Type

II

: Interrelationships among input, process and

output. The IOP represents the profile of the respondents

with

diabetes

mellitus

type

II

as

the

input.

A

self-

developed structured questionnaire

was

utilized

as

the

process to obtain the output which is the common effects of

diabetes

mellitus

and

the

coping

mechanisms of

the

respondents.

 

Statement of the Problem:

 

The

research study generally aims

to determine

common

the

patients’

coping

mechanisms

to

the

effects

of

22

Diabetes Mellitus Type II. The research study specifically

aims to answer the following:

  • 1 What is the profile of the respondents in terms of the following

    • 1 Age

    • 2 Gender

    • 3 Year of diagnosis

  • 2 What are the common effects of Type II DM to the respondents?

  • 3 What are the coping mechanisms of the respondents on the effects of DM Type II in terms of

    • 1 Psychological

    • 2 Spiritual

    • 3 Physical

    • 4 Socioeconomic

    Statement of the Hypothesis:

    1. The more effective the patient’s coping mechanism,

    the lesser the complication of diabetes mellitus type 2 that

    may occur.

    2.

    The

    lesser

    the complication

    of

    the

    diabetes

    mellitus, the better quality of life of the patients.

    23

    Significance of Study:

    The

    results

    of

    this

    study

    on

    the patients’ coping

    mechanism to the common effects or complications of Diabetes

    Mellitus type II will be essential to the following:

    The Nursing Administrators. The results of this study

    will make them aware about the scenario so that they can

    make ways to improve their conditions like implementing

    health programs providing education to the community people

    regarding the prevention and rehabilitation of the disease.

    The Nursing Institutions. The results of this study

    will help them point the most common complication involved

    in having a Diabetes Mellitus Type II. With this, they are

    able to focus on that identified human aspect which have the

    greatest impact to the respondents’ life and intervene.

    The selected respondents. The results of this study

    will help them manage the impact of Diabetes Mellitus to

    their lives and able to cope with the long term consequence

    of their illness.

    The future researchers. The results of the study will

    serve

    as

    guide and encouragement

    for

    them

    to

    further

    research, improve and investigate for changes and updates

    for this study.

    24

    Scope and Delimitation:

    This study is primarily focused on the patients’ coping

    mechanisms to the common effects of Diabetes Mellitus type

    II. Assessment is limited to the awareness of the chosen

    respondents regarding the effects or complications of type

    II Diabetes Mellitus and the different measures they take to

    cope with it. This research is also limited with the number

    of respondents which were randomly selected from Lutheran

    Clinic and Divine Mercy Wellness Center. The research is

    further limited to a time frame period of two semesters and

    it is strictly conducted within the City of Tuguegarao.

    Definition of Terms:

    Diabetes

    mellitus

    -

    It

    is

    simply referred

    to

    as

    diabetes.

    It is a group of metabolic diseases in which

    a person has high blood sugar, either because the body

    does not produce enough insulin, or because cells do not

    respond to the insulin that is produced.

    Diabetes

    mellitus

    type

    1

    -

    This

    results from

    autoimmune destruction of insulin-

    producing beta

    cells of the pancreas.[2] The subsequent lack

    of

    25

     

    insulin

    leads

    to

    increased

    blood

    and

    urine

    glucose. Diabetes mellitus type 2 - It is a

    metabolic

    disorder

    that

    is

    characterized by

    high

    blood

    glucose in the context of insulin resistance and

    relative insulin deficiency. Insulin- It is a hormone produced by the pancreas which

    is

    central

    to

    regulating

    carbohydrate

    and

    fat

    metabolism in the body.

    Insulin

    causes

    cells

    in

    the

    liver, muscle, and fat tissue

    to take up glucose

    from the blood, storing it as glycogen

    in

    the

    liver

    and muscle. Hyperglycaemia -or high blood sugar, is a condition in

    which an excessive amount of glucose circulates in the

    blood plasma. Coping mechanisms -Coping mechanisms are the methods

    used to cope with stress, including illness. It is an

    adaptation to environmental stress that is based as

    conscious or

    unconscious choice and

    that enhances

    control over behaviour or gives psychological comfort.

    Patient’s

    coping

    mechanism -

    It

    is

    a

    set

    of

    behaviour or practice of patient for

    management

    of

    his/her Type

    II Diabetes Mellitus including

    appropriate behavior related to health

    care

    professionals, investigations and treatment.

    26

    Common effects - A change or changed state occurring as

    a direct result of action by somebody or something else

    that frequently occurs. Common effects of Type II Diabetes Mellitus - These are

    the usual complications that are experienced by patient

    with type II diabetes mellitus. Psychological-directed toward the will or toward

    the mind specifically in its cognitive function. Spiritual - Relating to or affecting the human

    spirit or soul as opposed to material or physical

    things. Physical-

    Body,

    the

    physical structure of

    an

    organism. Social-economic - refers to a characteristic of

    living organisms as applied

    to

    populations’

    humans and other animals. It always refers

    to

    the interaction of organisms with other organisms

    and to their collective co-existence, irrespective

    of whether they are aware of it or not, and

    irrespective of whether the interaction is

    voluntary or involuntary. And also, how patients

    use their resources for their treatment.

    27

    CHAPTER II

    RESEARCH METHODOLOGY AND PROCEDURES

    This chapter provides a view on the research methods

    and procedures undertaken by the researchers in the conduct

    of the study.

    Research Design

    The study used quantitative approach. Specifically, the

    study

    use

    descriptive

    survey

    method

    in

    gathering

    information.

    The

    purpose of descriptive

    studies

    is

    to

    observe, describe, and document aspects of a situation as it

    naturally occurs and sometimes to serve as a starting point

    for

    hypothesis

    generation

    or

    theory

    development.

    Descriptive survey typically seeks to ascertain respondents’

    perspectives or experiences on a specified subject in a

    predetermined structured manner. In this particular study,

    the

    researchers

    aim

    to determine

    the

    patients’ coping

    mechanisms to the common effects of Diabetes Mellitus Type

    II. Also, the researchers aim to determine if

    there is a

    significant relationship between the

    effects

    and coping

    mechanisms.

    Respondents of the Study

    28

    Respondents

    came

    from

    the

    two

    of

    the

    clinical

    institutions within Tuguegarao City that caters to Diabetic

    patients namely Lutheran Clinic and Divine Mercy Wellness

    Center. The survey was conducted with 12 and 10 patients at

    Lutheran

    Clinic

    and

    Divine

    Mercy

    Wellness

    Center

    respectively. Random sampling was being used in getting the

    respondents from both institutions specifically, fish bowl

    technique. The patient’s age, gender and length of incurring

    the disease was being considered in the study.

    Instrumentation

    The researchers designed a four pages questionnaire to

    be used in collecting the necessary data for this study. The

    first part consists of instructions on why and how the

    respondents

    will

    answer

    the

    tool.

    It

    also

    contains the

    biographic data of the patient (name, age, date of birth,

    gender,

    marital status,

    cellphone number,

    educational

    attainment, year of diagnosis, latest blood glucose level).

    The second page contains the most common listed effects of

    Diabetes Mellitus while the third and fourth pages contain

    the different coping mechanisms observed by patients.

    In these questionnaires, the researchers used closed

    ended questions wherein the respondent will have to put

    check on the space provided labeled from a range of 1-5 on

    29

    the common effects; 1 if strongly disagree,2 if disagree, 3

    if agree, 4 if strongly agree, 5 if very strongly agree; and

    1-4 on the complications of DM type II; 1 if never (never

    experienced),2 if seldom ( have experienced it at least once

    a month),3 if sometimes ( have experienced it at least

    weekly),

    4

    if

    always

    (have

    experienced it

    everyday)

    depending on their chosen answers.

    They were also assured that their replies are to be

    treated strictly confidential

    since all items in the

    questionnaires pertains to the respondents personal opinions

    of thoughts believing they are requested to answer in all

    honesty and genuineness

    QUESTIONNAIRE:

    ITEM

    POSITIVE

     

    COPING

    ITEM

    NEGATIVE

     

    COPING

    MECHANISMS

     

    MECHANISMS

     
     

    PSYCHOLOGICAL

     

    1

    I

    feel

    good

    about

    my

    2

    My

    level

    of

    stress

    is

    general health.

     

    high.

     

    3

    I am trying to cope with

    4

    I feel discouraged with

    the

    complications

    of

    my

    diabetes

    treatment

    diabetes.

     

    plan.

     

    5

    My

    diabetes

    does

    not

    6

    I worry about the future

    interfere

    with

    other

    and

    the

    possibility of

    30

     

    aspects of my life.

     

    serious complications.

     

    7

    I

    struggle

    with making

    8

    • I have feelings of guilt

    changes

    in

    my

    life

    to

    on having the disease

     

    care for my diabetes.

     

    9

    I

    am

    confident

    in

    my

    10

    • I can’t

    accept

    my

    ability

    to

    make dietary

    diabetes.

     

    changes.

     
     

    SPIRITUAL

     

    1

    I

    can

    still

    manage

    to

    2

    • I was not able to attend

    attend

     

    spiritual

    mass regularly.

     

    activities

    such

    as

     

    rosary.

     

    3

    My faith increases.

     

    4

    • I am

    not

    praying

     

    anymore.

    6

    I

    can

    still

    join

    and

    5

    • I blame God for having

    support religious groups

    the disease.

     
     

    (missionary activities of

     

    nuns and priests).

     

    8

    I

    believe

    that

    God

    will

    7

    • I consider my disease as

    help me to overcome this

    a punishment of God.

     

    challenge.

       

    10

    I

    still look myself as a

    9

    • I lost hope.

     

    beautiful

    creation

    of

     

    God.

     
     

    PHYSICAL

     

    1

    I

    have

    undergone

    an

    eye

    2

    • I was

    not

    able

    to

    fit

    examination.

     

    physical

    activity into

     

    my daily routine (e.g.,

    • I take elevators instead

    31

     

    of stairs).

     

    3

    I

    start

    a

    low-

    4

    I

    feel

    tired

    and

    carbohydrate diet 9fruits

    restless during work or

    and vegetables).

     

    while walking, climbing

     

    upstairs.

     

    5

    I

    exercise continuously

    6

    I did not practice oral

    for at least 20 minutes.

    care regularly (brushing

    teeth every after meal,

    use of mouth wash).

     

    7*

    (FOR SMOKERS)

     

    I

    stop

    9

    I

    am

    not

    performing

    smoking.

     

    wound care when I have

     

    injury.

     

    8*

    (FOR SMOKERS) I decrease

    11

    I

    am

    not

    taking

    my

    the no. of sticks that I

    prescribed

    medications

    smoke.

     

    on regular basis and I

     

    am

    not

    monitoring my

    blood

    glucose

    and

    cholesterol regularly.

    10

    I

    wash

    my

    feet,

       

    remembering

    to

    dry

    between my toes.

     

    12

    I

    am

    eating

    5

    servings

       

    per

    day

    of

    fruits

    and

    vegetables.

     

    13*

    (FOR

    ALCOHOLICS)

    I

    stop

       

    drinking

     

    alcohol

    beverages.

     

    14*

    (FOR ALCOHOLICS) I limit

     

    32

     

    drinking

     

    alcoholic

       

    beverages.

     
     

    SOCIO-ECONOMIC

     

    1

    I

    have

    a

    wide

    family

    2

    My

    family’s

    income

    support system.

    mostly

    goes

    to

    my

     

    treatment

    with

    the

    disease.

     

    3

    I

    still

    have

    a positive

    4

    I

    believe

    that

    my

    outlook about life.

     

    scheduled routine check-

     

    ups

    are

    burden

    to

    our

    financial status.

     

    5

    I still find time to talk

    6

    I

    spend

    my

    time

    just

    and

    communicate with

    my

    staying in the house.

    loved ones.

       

    7

    I

    still

    attend

    8

    Seeking help from health

    gatherings/parties like I

    professionals is costly.

    used to do.

     

    9

    My

    loved

    ones, friends,

    10

    I

    can’t

    afford

    to

    buy

    and

    even

    co-workers

    the prescribed diabetic

    understand that diabetes

    medications.

     

    does

    not

    hinder

    me

    from

     

    fulfilling

     

    my

    responsibilities

    despite

    some precautions.

    Data Gathering Procedure

    33

    The researchers sought permission

    to

    the resident

    doctors of each clinical institution.

    In

    Divine Mercy

    Wellness Center, Dr. Abigail Lejos Cureg, and in Lutheran

    Clinic, Dr. Joseph Richard Pagela Guzman through a letter

    noted by the Mrs. Josephine Lorica PhD. adviser and Dr.

    Elizabeth Baua, Dean of School of Health Sciences inclusive

    of the floating of questionnaires. The questionnaires were

    being distributed personally to 22 patients having type II

    DM patients.

    The answered questionnaires were retrieved,

    collated and interpreted.

    Data Analysis

    The

    data

    gathered through the questionnaires

    were

    subjected to statistical treatment

    using

    the following

    statistical tools:

    Frequency and percentage distribution

    was

    used

    to

    determine the profile variables and reader usage. Weighted

    mean

    was

    used

    to

    determine the

    common

    effects

    or

    complications of Type II DM to the patients in terms of

    their coping mechanism (physical, psychological, socio-

    economic, sexual and spiritual aspects).

    To further understand the value of weighted means, the

    range below was used:

    34

    I.COMMON EFFECTS OR COMPLICATIONS

    OF

    TYPE

    II DIABETES

    MELLITUS

    Range

    Descriptive Interpretation

    • 5 very strongly agree

    • 4 strongly agree

    • 3 agree

    • 2 disagree

    • 1 strongly disagree

    II.COPING MECHANISMS

    • 4 always (have experienced it everyday)

    • 3 sometimes (have experienced it at least weekly)

    • 2 seldom (have experienced it at least once a month)

    • 1 never (never experienced)

    After getting the mean of the coping mechanism, the

    positive and negative coping mechanisms were ranked from 1-4

    with corresponding points to evaluate

    the

    most

    utilized

    coping mechanism by the respondents. For rank one (1)-four

    (4) points, rank two (2)- three (3) points, rank three (3)-

    two (2) points, rank four (4)- one (1) point.

    35

    CHAPTER III

    PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

    This chapter includes the results and discussion of

    this said research study. It contains the profile of the

    respondents along with the means and percentages of the data

    collected

    and

    questionnaires.

    collated

    after

    the

    retrieval

    of

    Profile of the Respondents

    Table 1.1: Age of the Respondents

    AGE

    Number of Respondents

    Percentage

    1(31-35)

    1

    5%

    2(36-40)

    1

    5%

    3(41-45)

    2

    9%

    4

    (46-50)

    4

    18%

    5

    (51-55)

    1

    5%

    6(56-60)

    1

    5%

    7

    (61-65)

    3

    14%

    8

    (66-70)

    1

    5%

    9

    (71-75)

    3

    14%

    10

    (76-80)

    1

    5%

    11

    (81-85)

    4

    18%

     

    TOTAL

    22

    100%

    Interpretation: This table shows that majority of the

    respondents comprised of those with ages ranging from 46-50

    (middle-aged adults) and from 81-85 (late adulthood) with a

    percentage of 18%. This then is followed by the ages ranging

    36

    from 61-65 41-45 with a percentage of 9%. Lastly, the least

    number of respondents are with ages ranging from ages 31-35,

    36-40, 51-55, 56-60, 66-70 and 76-80 with a percentage of 5

    %.

    Therefore,

    this study

    shows that

    patients that

    are

    mostly affected with Diabetes Mellitus are those in middle

    and late adulthood.

    Table 1.2: Gender of the Respondents

    Gender

    Female

    Percentage

    1(Female)

    16

    73%

    2(Male)

    6

    27%

    Total

    22

    100%

    Interpretation: This table shows that majority of the

    respondents comprised of female patients, 16 out of the 22

    respondents with the percentage of 73%.

    In conclusion, this research shows results that women

    are more affected than men.

    (Barbara L. Bullock and Reet L. Henze (2000))

    Table 1.3: Disease Span of the Respondents

    37

    Disease span (year)

    Frequency

    Percentage

    (1-5)

    14

    64%

    (6-10)

    5

    23%

    (11-15)

    2

    9%

    (16-20)

    1

    5%

    Total

    22

    100%

    Interpretation: This table shows that the majority of

    the respondents were diagnosed with Type 2 Diabetes Mellitus

    for about 1 to 5 years with the percentage of 64%.

    Then it

    is

    followed by

    the disease

    span

    of

    6-10

    years

    with

    a

    percentage of 23%, followed by a disease span of 11-15 years

    with the percentage of 9%

    and lastly the least no. of

    respondents have the disease span of about 16-20 years with

    the percentage of 5%.

    Table 2.1 Mean scores of the Common Effects of Diabetes

    Mellitus Type II to the Respondents

    Rank

    Common Effects of DM type II

    Mean

    • 1 Qa1

    3.7727

    • 2 Qa2

    3.6818

    • 3 Qa3

    3.6364

    • 4 Qa4,Qa20,Qa26

    3.5000

    • 5 Qa6,Qa17

    3.4091

    • 6 Qa12,Qa30

    3.2727

    • 7 Qa19

    3.1818

    • 8 Qa7,Qa25

    3.0455

    • 9 Qa9

    3.0000

    • 10 Qa5,Qa27

    2.9545

    • 11 Qa22

    2.9091

    38

    • 12 Qa8,Qa28

     

    2.8636

    • 13 Qa11

     

    2.8182

    • 14 Qa10

     

    2.7727

    • 15 Qa23

     

    2.6818

    • 16 Qa18

     

    2.5455

    • 17 Qa15,Qa29

     

    2.4091

    • 18 Qa31

     

    2.3636

    • 19 Qa14,Qa16

     

    2.3182

    • 20 Qa32

     

    2.2857

    • 21 Qa13,Qa21,Qa24

     

    2.2273

    • 22 Qa33

     

    1.8182

    • 23 Qa35

     

    1.8750

    • 24 Qa34

     

    1.6875

    Interpretation:

    The

    table

    shows

    the

    ranking of

    the

    identified common effects of diabetes mellitus type II to

    the respondents. Question number 1 has the highest mean

    which is 3.7727. It was followed by Question number 2 with a

    mean of 3.618. Then Question number 3 with a mean of 3.6364.

    Then followed by question number 4, 20 and 26 with a mean of

    3.5000. Question number 6 and 17 with a mean of 3. 4091.

    Question number 12 and 30 with a mean of 3.2727. It was

    followed by Question number 19 with a mean of 3.1818. Then,

    Question number 7 and 25 with a mean of 3. 0455. Question

    number 9 with a mean of 3.0000. Question number 5 and 27

    with a mean of 2.9545. These was followed by question number

    22 with a mean of 2.9091, then number 8 and 28 with a mean

    of 2.8636. question number 11 has a mean of 2.8182, question

    number 10 has a mean of 2,7727. Then question number 23 has

    39

    a mean of 2.6818. It was followed by question number 18

    which has a mean of 2.5455, then question number 15 and 29

    with 2.4091 mean. These were followed by question 31 with

    2.3636 mean and 14 and 16 with 2.3182. This was followed by

    question number 32 with a mean of 2.2857. Then question

    number 13, 21 and 24 with a mean of 2.2273. a mean of 1.8182

    in question number 33 and 1.8750 and question number 35.

    Question number 34 has the least mean in the questions

    regarding

    the common

    effects of

    the

    DM

    Type

    2

    to

    the

    respondents.

    Table 3.1 Mean of the Answers With Regards to the

    Questions on the Category of Psychological Coping Mechanism

     

    Psychological Coping Mechanism

     

    Positive

    Negative

    PsyCM

    Mean

    PsyCM

    Mean

    Qb1.1

    3.0909

    Qb1.2

    2.5455

    Qb1.3

    3.5909

    Qb1.4

    2.3636

    Qb1.5

    2.6818

    Qb1.6

    3.0455

    Qb1.7

    3.0909

    Qb1.8

    2.4545

    Qb1.9

    3.3182

    Qb1.10

    2.2727

     

    Weighted

    Weighted mean

    3.1545

    mean

    2.5364

    Interpretation: The table shows that the weighted mean

    for the positive Psychological Coping Mechanism is 3.1545,

    40

    Table 3.2 Mean of the Answers With Regards to the

    Questions on the Category of Spiritual Coping Mechanism.

     

    Spiritual Coping Mechanism

     
     

    Negative

    Positive SCM

    Mean

    SCM

    Mean

     

    3.318

    2.181

    Qb2.1

    2

    Qb2.2

    8

     

    3.500

    2.000

    Qb2.3

    0

    Qb2.4

    0

     

    3.136

    1.450

    Qb2.6

    4

    Qb2.5

    0

     

    3.681

    1.500

    Qb2.8

    8

    Qb2.7

    0

     

    3.954

    1.545

    Qb2.10

    5

    Qb2.9

    5

     

    3.518

    Weighted

    1.735

    Weighted mean

    2

    mean

    5

    Interpretation: The table shows that the weighted mean

    for the positive Psychological Coping Mechanism is 3.5182,

    while the negative Psychological Coping Mechanism is 1.7355.

    Table 3.3 Mean of the Answers With Regards to the

    Questions on the Category of Physical Coping Mechanism.

     

    Physical Coping Mechanism

    P

    M

    N

    M

    o

    e

    e

    e

    s

    a

    g

    a

    i

    n

    a

    n

    t

    t

    41

    i

     

    i

     

    v

    v

    e

    e

    P

    P

    h

    h

    y

    y

    C

    C

    M

    M

     

    2

     

    2

    Q

    .

    Q

    .

    b

    6

    b

    5

    3

    3

    3

    9

    .

    6

    .

    0

    1

    4

    2

    9

     

    3

     

    1

    Q

    .

    Q

    .

    b

    4

    b

    1

    3

    5

    3

    3

    .

    4

    .

    6

    3

    5

    4

    4

     

    2

     

    1

    Q

    .

    Q

    .

    b

    9

    b

    5

    3

    5

    3

    0

    .

    4

    .

    0

    5

    5

    6

    0

     

    2

     

    1

    Q

    .

    Q

    .

    b

    1

    b

    6

    3

    0

    3

    3

    .

    0

    .

    6

    7

    0

    9

    4

     

    2

    Q

    1

    Q

    .

    b

    .

    b