Introduction Diabetes Mellitus is one of the fastest serious health problems not only in the country but also

worldwide. It has been in the top 10 leading causes of mortality in the Philippines according to the latest statistics done by the Department of Health. A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements. There are two major classifications of Diabetes. First, the Type 1 diabetes mellitus which results from -cell destruction which usually leads to absolute insulin deficiency. And the Type 2 which results from a progressive insulin secretory defect on the background of assistance. Others include, genetic defects on the -cell and Gestational diabetes mellitus which is diagnosed during the pregnancy.

I. OBJECTIVES This study entails to seek appropriate strategies and management for the resolution of the case, Diabetes Mellitus. Also this study seek to know and investigate a phenomenon within its real life context.

II. METHODOLOGY

III. DATA GATHERING A. Patients Information The patients name is Mrs. Zenaida Hogar, 76 years old. She was admitted last Januray 15, 2012 at Manila Doctors Hospital. She was diagnosed with Type 2 DM, Diabetic Nephropathy. Patients past medical history/illness consists of Hypertension (20 years), Diabetes Mellitus.

B. Anthropometric Data Height Weight BMI BMI Interpretation IBW CBW TER

C. Dietary Assessment

48- Hour Food Recall Food Items Amount Breakfast A.M Snack Lunch P.M Snack Dinner Breakfast A.M Snack Lunch P.M Snack Dinner TOTAL

CHO

CHON

Fat

Kcal

DAY 1

DAY 2

D. Biochemical Data Markers

Test: Hematology

Date: Jan. 15, 2012 Pxs Laboratory Values Normal Value 123-153/L 0.36-0.45 4.10-5.10x101/2L 4.10-5.10x109/2L 0.00-0.01 0.01-0.04 0.2-0.12 0.36-0.66 0.24-0.44 0.02-0.12 150,000-450,000 x10^9/L 12.00-17.00% 80-96 27.50-53.20 pg 33.,40-35.50 g/dl Variance Normal Normal Normal High Normal Normal Low High Low Normal Normal Normal Normal Normal Normal

Hemoglobin Hematocrit RBC WBC Basophil Eosinophil STAB Neutrophil Lymphocytes Monocyte Platelets RDW MCV MCH MCHC

127 0.39 4.60 19.64 0 0.01 0 0.84 0.08 0.07 222 15.1 84.3 27.6 32.7

Capillary Blood Glucose Date 1/15/2012 Time 1240H refused 0500H 0800H 1/16/2012 0900H 1100H 1700H 2100H 0500H 1100H 1700H 2100H 0500H Result 70 mg/dL 54 mg/dL 132 mg/dL 122 mg/dL 144 mg/dL 113 mg/ dL 87 mg/dL 120 mg/dL 92 mg/dL 104 mg/dL 102 mg/dL Pxs Laboratory Values FBS Cholesterol Triglycerides HDL LDL Alkaline Phosphatase 2.70 3 .90 1 1.6 121 Insulin d5050 1/2 vial IV ad. to eat -

1/17/2012 1/18/2012

Normal Value 3.90-5.55 mmol/L 100-200 mg/dL

Variance Low

FLUID INTAKE 1-15-12 INPUT Time 6-2 2-10 10-6 Oral 210 NPO IVF 500 700 Blood TOTAL Parenteral Others Total 710 700 1410 OUTPUT Urine 800 Total 800 800

1-16-12 INPUT Time 6-2 2-10 10-6 Oral 210 420 100 IVF 400 350 Blood TOTAL Parenteral Others Total 610 420 450 1480 OUTPUT Urine 450 450 Total 450

1-17-12 INPUT Time 6-2 2-10 10-6 Oral 210 420 100 IVF 400 350 Blood TOTAL Parenteral Others Total 610 420 450 1480 420 1800 800 OUTPUT Urine Total 420 1800 800 2000

Urinalysis Color: Dark Transparency: Turbid pH: 6.5 Specific Gravity: 1.020 Glucose: (-) Protein: 1.0 g/L Pxs Laboratory Values 8.2 167 136 2.8 100 1.9 .70 53.3 23.80 29.5 0.8:1

Date: 1-16-12 Blood: 80 ery/ L Ketone: (-) Nitrite: (-) Bilirubin: small Urobilirogen: 7.2 mol/L Leukocytes: 20 leu/ L Normal Value 3.0-9.2 mmoL/L 62-115 mmol/L 135-148 mmol/L 3.50-5.30 mmol/L 110 to 250(mEq/day 100 to 300 mg/day 1.5 - 2.5 mg/dL 64-83 g/L 35-50 g/L 29-33 g/L 1.2:1.5 Variance Normal High Normal Low Low Low Low Low Low Normal Low

BUN Creatinine Sodium Potassium Chlorine Calcium Magnesium Total Protein Albumin Globulin A/G ratio

E. Clinical Manisfestations 2 days PTC, patient had fever documented at 38C and had been noticed with a swelling on her right foot.

IV. ASSESSMENT

A. Nutritional Diagnosis

B. Medical Diagnosis Definition

Diabetes mellitus is a kind of metabolic disease that is brought about by either the insufficient production of insulin or the inability of the body to respond to the insulin formed within the system. In response to this, the body also produces symptoms of polyuria or frequent urination, polyphagia or increased hunger and polydipsia or increased thirst. Read on and get to know what is diabetes mellitus and the underlying processes that produce such conditions. The disease can be classified into three different categories: the type 1, type 2 and the gestational diabetes. Diabetes mellitus type 1 is caused by the loss of beta cells found in the islets of Langerhans in the pancreas. Beta cells primarily produce insulin and hence, their loss will lead to huge insulin deficiencies in the body.In most cases, the loss of the beta cells is caused by an autoimmune attack mediated by the bodys own T-cells. Another type of diabetes mellitus is the type 2 diabetes. Type 2 diabetes is generally characterized by the bodys resistance to insulin. This is primarily attributed to the loss of certain insulin receptors in the tissues that are supposed to mediate the entrance of insulin into the bodys cells. This particular kind of diabetes is the most common kind that afflicts most of the reported cases of the disease. Type 2 diabetes usually leads to hyperglycemia which can be treated by a series of medications that can either improve the bodys insulin sensitivity or improve the livers production of insulin in the system.

Drug Name

Frequency

Rationale

Contraindication

Co- amoxiclav

600 mg; q8

treatment of infections cellulites, Painkiller

Renal failure. Pregnancy & lactation. Neonates. Elderly. Active peptic ulcer, cerebrovascular disease, hemorrhagic diatheses, Patients in bronchospasm, angioedema whom

Ketrolac

30 mg IV; q8

Paracetamol

500 mg q4

For fever

Cefepime

1g IV; q12

For low WBC; and Hypersensitivity antibiotic cefepime or cephalosporins For pain

to other

Algesia

q8

Hypersensitivity to codeine or opioids. Acute intoxication w/ alcohol, hypnotics, narcotics Renal insufficiency, hyperkalemia, untreated Addison's disease, constriction of the esophagus Pregnancy

Kalium Durule

IT P.O; TID

For hypokalemia

Losartan

50 mg P.O.; BID

For HTN & diabetic nephropathy in type 2 DM. For HTN

Metroprolol

50 mg P.O; BID

Bronchospasm or asthma, history of obstructive airway disease Sick sinus syndrome.

Catapres Demerol

75 mcg SL 50 mg

HTN

Relief of moderate to Alcohol, narcotic severe pain analgesics