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CHAPTER I
INTRODUCTION
Background of the Study
Diabetes mellitus is one of the major chronic
diseases which affect millions of people worldwide. It is
a metabolic disorder characterized by glucose
intolerance. This systemic disease is caused by an
imbalance between insulin supply and insulin demand. It
is one of the serious, complex chronic diseases, which
tend to accelerate degenerative changes throughout the
body by widespread vascular changes in the large blood
vessels and the micro-vessels if not treated properly. It
affects mostly adults from the age of 25 years to 74
years, although it also affects children as young as 3
years old. Two types of diabetes mellitus are identified,
type I and type II. About 5-10% of people with diabetes
have type I and 90-95% have type II (Smeltzer & Bare
1992).
The outcome of diabetes mellitus depends almost
entirely on the patients self-management. Health
professionals have a major responsibility in assisting
patients to gain the necessary knowledge, skills and
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attitudes for self-management (Phipps, Long & Woods
1987).
Diabetes mellitus currently affects an estimated 11
million people in the United States. About 500,000 new
cases of diabetes are diagnosed annually. It is prevalent
in the elderly, though studies indicate that even
children are affected. Diabetes is a leading cause of new
blindness among 25-74 year olds in the United States and
the third leading cause of death, mostly because of the
high rate of coronary artery diseases which are a
complication of diabetes mellitus (Smeltzer & Bare 1992).
The incidence of diabetes mellitus in South Africa for
children is 0.07-3.5 per 10 000 population (Smeltzer &
Bare 1992). It was estimated in 1996 that 0.5 million
people suffered from diabetes mellitus in South Africa
(Working Group of the National Diabetes Advisory Board
1997).
The aim of the treatment of diabetes mellitus is to
achieve blood glucose levels as close to the non-diabetic
state as feasible. Patients must take responsibility for
their own care and should therefore acquire the knowledge
and technical skills to monitor urine and blood glucose,
recognize and prevent hypoglycemia or hyperglycemia and
complications (Matwa, Chabeli, Muller & Levitt 2003).
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The control of diabetes mellitus can be better
maintained if patients adhere to a prescribed treatment
regimen (Lewis & Collier 1992). According to Coates
(1994), patients may monitor their blood glucose levels
by testing the urine or blood, though recently blood
testing is preferred to urine testing because the latter
is known to be inaccurate and may not warn the diabetic
of impending hypoglycemia. Patients can monitor
themselves at home using reagent strips or a glucose
meter. Monitoring of glucose at home enables patients to
check the glucose level regularly and to use the results
to decide on the management of their diabetes
complications. Complications become a reality when
treatment is not adhered to and this can be due to lack
of knowledge. According to Hamera (1992) research results
of studies done on diabetes mellitus reveal only the
positive aspects of the disease, e.g., a positive
attitude about having diabetes, and ignore the negative
aspects. The experience is therefore not representative.
For a sample to be representative, both positive and
negative aspects should be included.
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Statement of the Problem
As Community Health Nursing (CHN) affiliates in
Barangay 9, Tigbauan Iloilo, we applied the concept of
metabolism to include glucose metabolism. Diabetes
Mellitus is one illness included in this concept. Based
on the case findings (epidemiology), we have surveyed
several cases of adults aging forty (40) years old and
above diagnosed of diabetes, some claimed to have a
maintenance medication and others are saying they have
diabetes but have neglected to have follow-ups with their
doctor as well as monitoring of their blood sugar level.
It seems that this serious disease or illness is being
taken for granted. As nursing students, aware of the
severe complications of diabetes we would like to find
out if how informed are these adult residents about this
illness. Thus, this study will focus on the knowledge of
diabetes mellitus among the residents of Barangay 9,
Tigbauan, Iloilo.
Specifically, this study will answer the following
questions:
1. What is the level of knowledge on diabetes mellitus
among residents when taken as a whole and when
categorize according to age, gender, educational
attainment and monthly family income?
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2. Is there as a significant difference in the level of
knowledge on diabetes mellitus among residents when
categorize according to age, gender, educational
attainment and monthly family income?
Objectives of the Study
This study aims to determine the knowledge of
residents about diabetes mellitus in Brgy. 9, Tigbauan,
Iloilo.
Specifically, this study aims to determine:
1. The level of knowledge on diabetes mellitus among
residents when taken as a whole and when categorize
according to age, gender, educational attainment and
monthly family income.
2. If there is a significant difference in the level of
knowledge on diabetes mellitus among residents when
categorize according to age, gender, educational
attainment and monthly family income.
Hypotheses
In consonance with the study, this hypothesis will
be tested, that there is no significant difference in the
level of knowledge on diabetes mellitus among residents
when categorize according to age, gender, educational
attainment and monthly family income.
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Definition of Terms
For clarity of meaning, the following terms are
defined as to how they are used in this study.
Knowledge. The fact or condition
of knowing something with familiarity gained through
experience or association; the fact or condition of being
aware of something (meriam-webster.com).
In this study, this refers to the familiarity gained
or a condition of being aware to the disease, diabetes
mellitus of the adult residents in Barangay 9, Tigbauan,
Iloilo.
Resident. One who resides in a particular place
permanently or for an extended period
(thefreedictionary.com)
In this study, residents refer to an adult
population in barangay 9, Tigbauan, Iloilo ages forty
(40) and above and the respondents of this investigation
or study.
Diabetes Mellitus. Is a metabolic disorder
characterized by glucose intolerance, a systemic disease
caused by an imbalance between insulin supply and insulin
demand (Smeltzer & Bare 1992).
In this study, diabetes mellitus refers to a
metabolic disorder or disease which the researchers would
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like to find out if how well the respondents of this
study are informed.
Barangay. Is the smallest administrative division in
the Philippines (encyclopedia.thefreedictionary.com)
In this study, barangay refers to Barangay 9,
Tigbauan, Iloilo, the place where we affiliate for our
Community Health Nursing (CHN) practice and the research
locale of this study.
Significance of the Study
Residents. The result of this study will provide
criteria as to whether their knowledge is adequate or not
about Diabetes Mellitus. In such, this could be a
baseline in providing the amount of health teachings and
health interventions in order to improve or augment
information regarding the disease being studied.
Community. The result of this study can provide the
community with considerable basis on certain knowledge
related to improving prevention strategies and cure of
the disease and promotion of health.
Family. Knowing that the disease is hereditary, the
result of this study can be a guide as they go through
their daily activities and everyday experiences. It can
shed a light and to give them a sense of living with the
people who are sick of Diabetes Mellitus just as them.
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Health Workers. The result of this study will serve
as a baseline for these workers where to improve or where
to strengthen health care delivery among their
constituents in the community and specifically with
Diabetes Mellitus that ranks number 2 among the leading
cause of morbidity.
Scope and Limitation of the Study
A descriptive research design will be used in this
study. The study will be limited to the adult residents
of Barangay 9, Tigbauan, Iloilo aging forty (40) and
above.
The dependent variable of this study will be the
knowledge on diabetes mellitus of the residents while the
independent variable will be age, gender, educational
attainment and monthly family income.
This study will be conducted on the first semester
of the school year 2013-2014.
The sample population of this study will be computed
using the Slovins formula and a simple random technique
will be used to determine the respondents of the study.
The researchers will use a researchers-made
questionnaire to determine the level of knowledge on
diabetes mellitus of the residents of the selected
barangay.
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Statistical computations will be computed using
Statistical Package for Social Sciences (SPSS) software.
For the descriptive data analysis the mean and the
standard deviation will be used and for the inferential
analysis, the t-test will be used for a two-category
variable and analysis of variance (ANOVA) for more than
two categories of variables.
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CHAPTER II
Review of Related Literature
Diabetes Mellitus
Diabetes mellitus, or simply diabetes, is a group of
metabolic diseases in which a person has high blood
sugar, either because the pancreas does not produce
enough insulin, or because cells do not respond to the
insulin that is produced (Shoback et al, 2007). Diabetes
mellitus has several long-term complications and thus
plays a major role in increasing morbidity and mortality
in the patients.
It is defined as "a clinical syndrome characterized
by hyperglycemia in the fasting state, due to absolute or
relative deficiency of insulin or defect in its receptors
or other abnormalities" ( Kahn, et al, 2005).
It comprises a heterogeneous group of disorders,
which arise in many different ways, but all are
associated with a variable degree of hyperglycemia, with
or without glucosuria. The condition is incurable and is
often associated with disabilitating complications
particularly in patients with a poor diabetic control.
The deficiency in insulin or inefficiency of its action
has a major effect on almost all metabolic pathways of
carbohydrate, proteins, lipids, minerals and water
http://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Insulinhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Blood_sugarhttp://en.wikipedia.org/wiki/Pancreashttp://en.wikipedia.org/wiki/Insulin -
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metabolism. Metabolic derangements associated with
diabetes have resulted in its classification as a `major
metabolic syndrome'. Long-standing derangements result in
structural and hence functional changes in the cells of
the body and often cause permanent or irreversible
damage, which lead to various complications of diabetes
mellitus including biochemical, functional, symptomatic
and morphological alterations (Porte, et al, 2003).
Historical Background
Historical reviews report that the first mention of
diabetes as a condition causing `polyuria' was first made
about 1500 B.C. in Papyrus Eber's found at Luxor in
Egypt. A report from China indicated that the urine of
diabetic patients was so sweet that dogs were attracted
to it and a little later, around 400 B.C., the sweetness
was referred to as "honey urine". Around the sixth
century AD, the association between excessive indulgence
in food and drinks and the development of diabetes led to
its description as the "disease of the rich". It was
Aretaeus of Cappedocia (about 81-138 AD) who gave the
name `diabetes', which is a Greek word meaning "to run
through a siphon", since the polyuria state associated
with diabetes was well known. The first suggestion that
glucose was first elevated in blood before it was
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a `substance' from the pancreas of dogs by Banting and
Best in 1921 for which they got the Noble Prize (LeRoith,
2004). This substance had a hypoglycaemic effect and was
later named "Insulin". In 1960, Sanger elucidated the
chemical structure of insulin and Yallow and Berson, by
which minute quantities of insulin could be detected
(Lack, E. E., 2003), introduced the Radioimmunoassay
(RIA). Large scale preparation of insulin was initiated
and pancreas from different animals was used for this
purpose. For over a decade the hog, bovine or porcine
insulin was widely used for the treatment of diabetes
mellitus and different oral hypoglycemic were introduced.
More recently, since the advent of recombinant DNA
technology, insulin preparation has taken a new turn and
now using the human proinsulin gene, introduced into a
bacterial plasmid, large quantities of human insulin are
prepared and purified and used for treatment of diabetic
patients. In the same way, during the last two and a half
decades tremendous progress has been made in almost all
aspects of diabetes including diagnosis, immunological
and genetic aspects and treatment (Kahn et al, 2005).
However, despite tremendous efforts several fields still
remain unveiled and there is still no cure for this
condition.
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Classification of Diabetes Mellitus
Several attempts have been made to classify diabetes
mellitus and various classification systems have existed.
However, the most widely accepted is the World Health
Organization (W.H.O.) classification (WHO, 2012) which
was originally proposed by Irvine, later adopted by the
National Diabetes Data Group and was later updated in
1985.
There are three main types of diabetes mellitus
(UCSF Medical Center).
Type 1 DM results from the body's failure to produce
insulin, and presently requires the person to inject
insulin or wear an insulin pump. This form was
previously referred to as "insulin-dependent diabetes
mellitus" (IDDM) or "juvenile diabetes".
Type 2 DM results from insulin resistance, a
condition in which cells fail to use insulin properly,
sometimes combined with an absolute insulin
deficiency. This form was previously referred to as
non insulin-dependent diabetes mellitus (NIDDM) or
"adult-onset diabetes".
The third main form, gestational diabetes occurs
when pregnant women without a previous diagnosis of
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diabetes develop a high blood glucose level. It may
precede development of type 2 DM.
Insulin-Dependent Diabetes Mellitus
Insulin-dependent diabetes mellitus (IDDM), commonly
referred to as type-I diabetes, is a condition caused
when an autoimmune response induces the death of insulin-
secreting b cells in the pancreas. Insulin is the
protein that is responsible for transporting glucose
(secreted by pancreatic a cells) from the blood into the
cells, where the glucose is metabolized for energy.
When b cells are killed the body has no way of producing
insulin, so glucose levels in the blood are unable to be
controlled, leading to hyperglycemia, or high blood
glucose level. Longterm complications of hyperglycemia
include cardiovascular, kidney, and eye diseases, as well
as various nervous system disorders (diabetes.com, 2000).
Causes
IDDM tends to run in families, and there is
substantial evidence that genetics plays a significant
role in causing the disease. However, studies have shown
that the concordance rate for IDDM among monozygotic
twins is less than 50 percent, meaning that environmental
factors must also play a significant role (Tisch and
McDevitt, 2002). The fact that both environment and
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Although IDDM susceptibility has an apparent genetic
origin, what exactly is responsible for stimulating the
autoimmune response remains unclear. The most common
examples of the various possible external factors that
have been shown to trigger a response leading to IDDM
include:
Viruses Strong correlations between IDDM and
exposure to certain viruses such as those causing
German measles, mumps, and certain variants of
Polio, especially at a young age, suggest that these
viruses can stimulate a b cell autoimmune response.
It is possible that these viruses induce activation
and proliferation of T cells specific for a viral
epitope that mimics a protein unique to b cells,
therefore causing armed T cells to respond to
the b cell autoantigens (Diabetes.com, 2000).
Drugs and chemicals Pyriminil (rat poison) and
pentamidine, a drug used to treat pneumonia, are
among several synthetic chemicals and drugs that
have been shown to induce IDDM (Diabetes.com, 2000).
Cows milk Although it remains controversial, one
theory suggests that exposure to cows milk during
infancy can induce an autoantibody response to p69,
a protein often expressed by b cells. Expression of
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p69 on b cells can be induced by IFN-g, which could
be present due to a viral infection. This theory
therefore works in conjunction with the virus
theory, claiming that infant exposure to cow's milk
elicits antibodies capable of attacking b cells
later in life following a viral infection (Fauci et
al, 2008).
Pathogenesis
The two distinctive features of IDDM are the
infiltration of pancreatic islets by macrophages and
lymphocytes, a condition known as insulitis, and the
presence of auto antibodies in the serum (Le Roith, et
al, 2004). Both of these events serve as markers for the
prediabetic phase of IDDM.
More than a dozen islet-cell proteins that elicit
antibody responses in type-I diabetics have been
identified, and the presence of these auto antigens
(and/or their corresponding auto antibodies) serve as
important diagnostic tools for early identification of
IDDM. Among the apparently more significant auto
antigens are:
37k antigen--The antibodies to this auto antigen are
found in over half of all type-I diabetics, and
these auto antibodies are unique to diabetes and are
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not found in patients suffering from other
endocrine-related autoimmune diseases.
b-granule antigen--This auto antigen has not been
completely identified yet, but it is known the be
the target for the Th1 T cell clones derived from
NOD mice.
P69
Insulin
GAD--Glutamic acid decarboxylase (GAD) exists in two
isoforms of 65kD (GAD65) and 67kD (GAD67).
Insulin and GAD are the two evidently self-reactive
proteins that have been studied most in depth since both
of these autoantigens consistently indicate autoimmune
activity in the pancreatic islets (Von Herath, 2001).
However, although the identification of autoantibodies in
the serum has been valuable to the study of which
proteins are involved in b cell autoimmunity, the precise
role of these antibodies in the pathogenesis of IDDM
remains unclear. Therefore, a greater emphasis has been
placed on studying the cell-mediated (T cell) rather than
the humoral (antibody) response. This shift in focus has
led to the discovery that many of these autoantigens,
including GAD and insulin, are targeted not only by
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autoantibodies, but also by T cells (Le Roith, et al,
2004).
Non-Insulin Dependent Diabetes Mellitus
Genetics
NIDDM is known to occur more often in some families
than others. Recent advances have led to a better
understanding of how insulin is produced and released
have led to the discovery of several genes that cause
diabetes in a small proportion of affected families. A
major effort is now underway to discover the other genes
that cause diabetes in the majority of patients
(csua.berkeley.edu).
Researchers have announced that they have identified
mutations in at least 3 genes involved in the subset of
Type 2 called MODY (Maturity - Onset - Diabetes of the
Young), which tends to be diagnosed prior to age 25, and
there are some mitochondrial disorders implicated in some
types of Type 2 diabetes, but the cause for the majority
of people with Type 2 diabetes does not seem well-
understood (csua.berkeley.edu).
Aging and obesity are commonly identified risk
factors for diagnosis of Type 2 diabetes but these are
correlations not causes; we do know that it is a
genetically- or congenitally-based disease and that
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predisposing genes are necessary. In fact, the
correlation among identical twins for Type 2 diabetes is
virtually 100% (csua.berkeley.edu).
Diet
Hyperinsulinemia exists in childhood in populations
at high risk for NIDDM. Stimulated by obesity, upper body
obesity, and physical inactivity, insulin resistance
develops, accompanied by impaired glucose tolerance. The
pressure of the NIDDM risk factors continues this process
of insulin resistance/hyperinsulinemia/hyperglycemia,
until glucose toxicity to the beta cell results in
inability to secrete sufficient insulin, resulting in
decompensated fasting hyperglycemia" (csua.berkeley.edu)
Other Environmental Factors
A number of researchers, particularly those in the
U.K., have been reporting on interesting epidemiological
studies of Type 2 diabetics, which suggest that prenatal
environment may have a significant role in the causation
of Type 2 diabetes, as well as hypertension. More than 20
studies have shown that lightweight babies, babies who
are long and thin at birth, or those who are short and
have disproportionately small bellies grow into adults
with high blood pressure, elevated cholesterol, high
blood sugar levels, and increased risk of dying from
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cardiovascular disease. In one study of 15,000 adults in
Hertfordshire, men who weighed less than 2.5 kg (5.5 lbs)
at birth were found to have 3 times the incidence of Type
2 diabetes than men born weighing more than 4.5 kg (9.9
lbs). Several hypotheses have been developed about this
idea, including that maternal glucocorticoids reprogram
the fetal hormone system, or that maternal deprivation at
the end of pregnancy when the liver is forming affects
its development and leads to NIDDM (csua.berkeley.edu)
Pathophysiology of Diabetes Mellitus
The pathophysiology of all types of diabetes is
related to the hormone insulin, which is secreted by the
beta cells of the pancreas. In a healthy person, insulin
is produced in response to the increased level of glucose
in the bloodstream, and its major role is to control
glucose concentration in the blood. What insulin does is,
allowing the body cells and tissues to use glucose as a
main energy source. Also, this hormone is responsible for
conversion of glucose to glycogen for storage in the
muscles and liver cells. This way, sugar level is
maintained at a near stable amount.
In a diabetic person, there is an abnormal
metabolism of insulin hormone. The actual reason for this
malfunction differs according to the type of diabetes.
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not responding to insulin as they do in a healthy person.
Since the body cells and tissues are resistant to
insulin, they do not absorb glucose; instead it remains
in the bloodstream. Thus, the Type 2 diabetes is also
characterized by elevated blood sugar. It is commonly
manifested by middle-aged adults (above 40 years). As
insulin is not necessary for treatment of Type 2
diabetes, it is known as Non-insulin Dependent Diabetes
Mellitus (NIIDM) or Adult Onset Diabetes.
The third type of diabetes is called Gestational
diabetes. As the term clearly suggests, it is exhibited
by pregnant women. Over here, high level of blood glucose
is caused by hormonal fluctuations during pregnancy.
Usually, the sugar concentration returns to normal after
the baby is born. However, there are also instances, in
which it remains high even after childbirth. This is an
indication for increased risks of developing diabetes in
the near future.
As already mentioned, the symptoms and effects of
all the three forms of diabetes are similar. The
noticeable symptoms include increased thirst
(polydipsia), increased urination (polyuria), and
increased appetite (polyphagia). Other diabetes signs and
symptoms include excessive fatigue, presence of sugar in
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the urine (glycosuria), body irritation, unexplained
weight loss, and dehydration. Elevated blood sugar and
glycosuria are interrelated; when sugar amount in the
blood is abnormally high, the reabsorption by proximal
convoluted tubule is reduced, thereby retaining some
glucose in the urine (buzzle.com).
Risk Factors
There are many studies show that obesity,
hypertension and lifestyle factors suchas diet, physical
activity, smoking and drinking habits are related to
diabetes.
According to the study among people age 20 years and
over in Oman, the overall prevalence of diabetes was
11.6% and varied according to urban or rural residence,
age, marital status, educational level, smoking status,
measure of obesity, cholesterol and systolic blood
pressure. The prevalence of hypertension is 21.1 (Al-
Moosa et al., 2006).
Signs and Symptoms
Lack of insulin causes hyperglycemia responsible for
most of the signs and symptoms. Hypoglycemia occurs in
Diabetics due to medications and inappropriate dietary
habits.
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Frequent urination. Water retention is an important
function of kidney. Water retention is co-related with
the absorption of glucose and sodium. In Diabetes there
is excess Glucose excretion in urine, condition termed
as Glycosuria. Hence there is also excess excretion of
water, resulting in increased urine output known
as Polyuria.
Increased thirst. Naturally as there is increased
water loss, there is increased requirement for water
consumption to avoid dehydration. It is known
as Polydipsia.
Extreme hunger. Insulin redistributes glucose from
blood to the tissues. Hence in Diabetes there
is decreased availability of glucose to cells and tissues
as most of the glucose is present in blood. Other neural
mechanisms are responsible for hunger. This increased
appetite is known as Polyphagia.
Other nonspecific symptoms like lethargy, gastric
symptoms like nausea, vomiting may also occur sometimes.
Most diabetics also have co-existing entities like
Hypertension, Thyroid Disorders etc. It is important to
note that many diabetics (especially type II patients)
have prolonged symptom free periods as we said before.
Symptom free periods correlate with good control over
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blood glucose level and proper diet. Hence these two
things form an important part of therapy.
Complications
Type 1 and type 2 diabetes are chronic, life-long
conditions that require careful monitoring and control.
Without proper management they can lead to very high
blood sugar levels which can result in long term damage
to various organs and tissues.
Cardiovascular disease. Affects the heart and blood
vessels and may cause fatal complications such as
coronary heart disease (leading to heart attack) and
stroke. Cardiovascular disease is the major cause of
death in people with diabetes, accounting in most
populations for 50% or more of all diabetes fatalities,
and much disability.
Kidney disease. Can result in total kidney failure
and the need for dialysis or kidney transplant. Diabetes
is an increasingly important cause of renal failure, and
indeed has now become the single most common cause of end
stage renal disease, i.e. that which requires either
dialysis or kidney transplantation, in the USA2, and in
other countries.
Nerve disease. Can ultimately lead to ulceration and
amputation of the toes, feet and lower limbs. Loss of
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The initial approach to the older adult with
diabetes mellitus requires assessment of the patient's
current medical status and estimated life expectancy.
Motivation and commitment of the patient and family also
play a large role in determining what level of treatment
is appropriate. Support services available in the
community and financial status should also be considered
(health.am).
Oral Hypoglycemic Agents. Increasingly, therapy for
type 2 diabetes builds on diet and exercise and has
become more mechanistically focused. Single or
combination chemotherapy is used. A significant amount of
improvement can be expected with improved therapy.
Currently, 54% of elderly diabetic patients have
hemoglobin A1clevels above normal and 27%of the total had
A1c levels greater than 8. Thus, nearly a quarter has
"poor" control. Current best practices require a normal
hemoglobin A1c, certainly less than 7. For those
individuals in whom the demands of therapy are too great,
medication side effects are too great, or access to
monitoring is not possible, a reduction in expectations
and greater complication rates will be higher.
Medications currently available can promote insulin
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secretion, increase insulin sensitivity, or slow the
digestion/processing of complex carbohydrates.
Diet. Diet alone has varying degrees of success.
Elderly patients with diabetes are able to improve
diabetes control with diet and weight loss. However, they
may find it difficult to adhere to a strict dietary
regimen and maintain weight loss. Older adults with
mobility problems may find exercise to increase caloric
expenditure impossible. If dramatic dietary restriction
is employed to reduce weight, nutrient and vitamin
deficiencies may develop. Aggressive dietary management
cannot be recommended under these circumstances. Other
considerations specific to older adults may limit the
effectiveness of dietary therapy.
A diabetic diet is relatively high in carbohydrates
(50%-60% of total calories), low in fat (30% of total
calories from fat, with 10% saturated fat, 10%
polyunsaturated fat, and 10% monosaturated fat), and
moderate in protein (~20% of total calories). If
malnourished or chronically ill, the elderly patient
should increase protein and energy intake. Vitamin and
mineral supplements are indicated when caloric intake
falls below 1000 kilocalories per day.
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People suffering from diabetes mellitus are at
greater risk of contracting colorectal cancer.
They found that diabetes was associated with an
increased risk of colon cancer in both men and women.
However, the risk of rectal cancer was 20 percent higher
in men.
This data suggests that diabetes mellitus is an
independent risk factor for colon and rectal cancer, and
people with diabetes should be aware of the risk of
contracting colon cancer and follow their doctor's advice
and screen themselves for the cancer.
The researchers have also recommended that the
doctors be aware of an increased colorectal cancer risk
in patients who smoke and are obese; more so, in fact,
than the ones who have diabetes.
A study related to the current study entitled The
New-Onset Diabetes: How to Tell the Difference between
Type 1 and Type 2 Diabetesby Largay (2012). The result
showed that with the increase in the incidence of type 2
diabetes in children and adolescents and of type 1
diabetes in adults, making a correct diagnosis has become
more challenging. Type 1 diabetes results from autoimmune
destruction of the pancreatic -cells that produce
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insulin and can occur at any age (ECDC, 2003). When it
occurs in adults, type 1 diabetes can progress to total
insulin deficiency at different rates. The slowly
progressive form is known as LADA (sometimes called type
1.5 diabetes). There is also a more rapidly progressive
form that mimics type 1 diabetes seen in children.
Diabetic ketoacidosis (DKA) is a common feature but
may not be present early in the presentation, occurring
in only 1725% of those with new-onset diabetes
(Wolfsdorf et al, 2006).
Patients with LADA appear to have a lower prevalence
of the metabolic syndrome. While comparing patients with
new-onset type 1 and type 2 diabetes, one study 5 found
those with LADA had a lower BMI, lower triglycerides and
total cholesterol, higher HDL, and a lower prevalence of
hypertension than those with type 2 diabetes. At
diagnosis, fasting C-peptide levels were lower in LADA
than in type 2 diabetes, perhaps confirming the typical
observation of little or no response to oral agents and
the need for insulin earlier in the course of the
disease.
Antibody testing can assist in diagnosis. Autoimmune
antibodies associated with type 1 diabetes include GAD-
65, islet cell antibodies (ICAs), insulinoma-associated
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course of the trial. Although it is common for background
therapy to change during the course of a relatively long
outcomes trial, trials that test strategies rather than
specific therapies have the additional problem of
therapeutic approaches changing over time. Both
revascularization strategies employed in BARI 2D evolved
during the course of the trial, with higher use of drug-
eluting stents and greater use of minimally invasive
surgical techniques as the trial progressed.
Although they stop short of requiring that drugs
that improve glycemic control actually reduce
cardiovascular risk, which is a worthy if not elusive
goal, these new requirements are aimed at ensuring that
drugs that improve glycemic control do not result in
cardiovascular harm.
A study related to the current study entitled,
Prevention of Type 2 Diabetes Mellitus by Changes in
Lifestyle among Subjects with Impaired Glucose Tolerance
by Tuomilehto et al (2009). This study provides evidence
that type 2 diabetes can be prevented by changes in the
lifestyles of both women and men at high risk for the
disease. The overall incidence of diabetes was reduced by
58 percent. Our estimate of the effect of the
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relatively small reduction in weight in the prevention of
diabetes.
It is possible to achieve primary prevention of type
2 diabetes by means of a nonpharmacologic intervention
that can be implemented in a primary health care setting.
According to our results, 22 subjects with impaired
glucose tolerance must be treated in this way for one
year or 5 subjects for five years to prevent one case
of diabetes.
A study related to the current study entitled,
Infections in Diabetes Mellitus by Schaberg (2008).
According to the study, individuals with diabetes can
have any infection that affects the general population.
However, people with diabetes are at increased risk of a
variety of specific infectious complications. Infections
associated with either increased frequency or severity
among individuals with diabetes include mucormycosis;
cystitis; complicated urinary tract infections, including
pyelonephritis; intrarenal abscesses; perinephric
abscesses; pneumonia; lower-extremity soft tissue
infection, including polymicrobial gangrene;
emphysematous cholecystitis; and malignant otitis
externa.
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The most dramatic example of the interaction of
angiopathy, acidosis, and poor glycemic control in
infection is mucormycosis. Mucormycosis is a severe
infection caused by fungi of the order Mucorales. These
fungi are ubiquitous and are often found on decaying
matter, such as moldy bread. Patients with diabetes are
at particular risk of a form of the disease known as
rhinocerebral mucormycosis.
This infection is thought to be caused by inhalation
of the spore forms of the organisms, which are presumed
to then lodge in the nasal tissue. The spores
subsequently germinate and invade adjacent tissue, with a
particular tropism for blood vessels. The orbit and
central nervous system can subsequently become affected.
The infection usually presents with facial or ocular
pain. Fever and symptoms of sinusitis may be present.
About 50% of patients are in diabetic ketoacidosis (DKA)
at the time of presentation.
Urinary tract infections are also more common among
patients with diabetes. Women with diabetes are at a
particularly increased risk of urinary tract infection.15
Upper tract infection has been shown to be significantly
more common in patients with diabetes. E. coli is the
most common causative organism, followed by other gram-
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negative bacteria. Because of the high incidence of often
unsuspected upper tract infection, a 7- to 14-day course
of therapy has been recommended for treatment of cystitis
among patients with diabetes.
Pyelonephritis is clearly more common in patients
with diabetes. It is treated similarly to pyelonephritis
in nondiabetic patients. Other renal infections that are
more common in individuals with diabetes include renal
carbuncles (intrarenal abscesses caused by the
hematogenous spread of S. aureus), renal corticomedullary
abscesses (intrarenal foci of infection associated with
reflux and obstruction caused by the same organisms that
typically cause pyelonephritis), and the rare but
devastating emphysematous pyelonephritis, associated with
gas formation within the kidney
The latter infection is usually caused by E. coli or
other gram-negatives and is typically detected by a
routine X-ray of the abdomen. A combination of surgery
and medical therapy is usually required. Perinephric
abscesses are caused either by the rupture of intrarenal
abscesses into tissue surrounding the kidney or by the
hematogenous or lymphatic deposition of organisms into
that tissue. Gram-negative organisms such as E. coli are
the most common reported causative bacteria. However, a
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wide variety of organisms, such as S. aureus, fungi,
anaerobes, and mycobacteria, have been reported as
causes.
Diabetes is very clearly associated with these
infections. Underlying renal pathology, such as
vesicovesicular reflux and obstructive uropathies, are
also strongly associated with these abscesses.
Local Studies
A study related to the current study entitled,
Philippine cardiovascular outcome study-diabetes mellitus
(PHILCOS-DM): A cohort study of the eight-year incidence
of Diabetes Mellitus in NCR, Region 3 and Region 4 by
Velandria et al (2008). The study determined the 8-year
incidence of diabetes mellitus (DM) and impaired fasting
glucose (IFG), and the current prevalence of DM, IFG, and
impaired glucose tolerance (IGT), among respondents of
the 1998 Food and Nutrition Research Institute 5th
National Nutrition Survey (FNRI-NNS) in the
National Capital Region (NCR), Region 3, and Region 4 of
the Philippines.
It was a descriptive cohort study. A community-based
study including all previous respondents of the 1998
FNRI-NNS survey in NCR, Region 3, and Region 4. Out of
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the previous 1,316 individuals in the 3 areas of the 1998
FNRI-NNS data, a total of 1,085 respondents were included
in the Philippine Cardiovascular Outcome Study (PhilCOS,
2007) with a response rate of 82 percent. The study
determined the 9-years incidence rate of DM and IFG, and
the 2006 If prevalence of DM, IFG, and IGT of the cohort.
The 8-years incidence of DM using fasting Wood
glucose (FBG) was 9 percent, and of IFG was 10 percent.
The prevalence of DM was 19 percent (combined FBG, 2H PG,
and interview). The prevalence of IFG was 9 percent based
on the cut-off IFG level of 110-125mg/dL. However, using
the newer cut-off level of 100-125mg/dL, the prevalence
of IFG increased to 30 percent. The prevalence of IGT was
25 percent.
The PhilCOS-DM has reported the first 8-year
incidence rate of DM and IFG in NCR, Region 3, and Region
4. PhilCOS-DM also determined significant proportions of
DM, IFG, and IGT in the cohort that warrant early
aggressive intervention for prevention and management.
An experimental study related to the current study
entitled, The Effect of Momordica Charantia Capsule
Preparation on Glycemic Control in Type 2 Diabetes
Mellitus by Dans et al (2009). This is the first
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randomized controlled trial to shed light on the issue
concerning the hypoglycemic effects of M. charantia. The
investigators targeted a 1% decline in A1c at the outset
with an estimated power of 88%. With the observed decline
of 0.24%, the achieved power was only 11%. For this
reason, we are unable to make a definite conclusion about
the effectiveness of M. charantia. However, the results
of this study can be used estimate the sample size for
bigger studies. It is a randomized, double-blind,
placebo-controlled trial was conducted between April and
September 2004 at the outpatient clinics of the
Philippine General Hospital. The trial included 40
patients, 18 years old and above, who were either newly
diagnosed or poorly controlled type 2 diabetics with A1c
levels between 7% and 9%. On top of the standard therapy,
the patients were randomized to either M. charantia
capsules or placebo. The treatment group received two
capsules of M. charantia three times a day after meals,
for 3 months. The control group received placebo at the
same dose. The primary efficacy endpoint was change in
the A1c level in the two groups. The secondary efficacy
endpoints included its effect on fasting blood sugar,
serum cholesterol, and weight. Safety endpoints included
effects on serum creatinine, hepatic transaminases
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(Alanine aminotransferase/ALT and Aspartate
aminotransferase/AST), sodium, potassium, and adverse
events.
A study related to the current study entitled,
Metabolic Syndrome in the Philippine General Population:
Prevalence and Risk for Atherosclerotic Cardiovascular
Disease and Diabetes Mellitus by Morales et al (2008).
The prevalence of MS in the general population in the
Philippines in 2003 to 2004 for adults aged 20 years and
above, representing 42.6 million Filipinos, varied
significantly depending on the criteria used. Using the
clinical definitions, namely the original NCEP-ATP III
and that modified by the AHA/NHLBI, the prevalence of MS
in the Philippines in 2003 was 11.9% and 18.6%,
respectively. The 1998 survey utilized capillary blood
analyzed with a Cholestec LDX desktop unit whereas the
2003 survey used venous blood analysed by a validated
Cobas-Mira machine located in a central laboratory.
There have been many controversial issues and
debates on MS. The main ones concern the definition and
criteria for the diagnosis, the underlying aetiology and
pathogenesis, the prevalence rates, predisposition to
atherosclerotic cardiovascular disease and DM and the
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specific treatment. At the present time, diagnosing MS
allows clinicians to identify and stratify individuals
with these risk factors. It must be stressed that all
cardiovascular risk factors should be treated
individually and aggressively and that treatment should
be based on evidence-based approaches to the management
of the individual components.
In conclusion, the MS is common in the adult
Filipino population. The most prevalent components are
low HDL-C and abdominal obesity. In the population
surveyed, the MS had robust predisposition to DM, to
stroke and, by the IDF definition alone, to MI as well.
A study related to the current study entitled, Type
2 Diabetes and Metabolic Syndrome in Filipina-American
Women a High-risk Nonobese Population by Araneta et al
(2008). In this study, community-dwelling Filipina-
American women had a sixfold higher risk of diabetes and
nearly a threefold risk of the metabolic syndrome
compared with community-dwelling Caucasian women from the
same county. This higher prevalence was not explained by
differences in education, parity, body size, fat
distribution, and percentage of body fat, behaviors, or
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Several recent studies have shown that the reference
(wild-type) allele at several of the IL4R SNPs examined
here is associated with atopic asthma and increased IgE
levels (Sandford et al, 2000; Howard et al, 2002). Thus,
it appears that the same alleles at IL4R SNPs confer an
increased risk for a canonical Th1 (T1D) and Th2 (atopic
asthma) disease. If true, these associations argue
against an effect on Th1/Th2 balance mediated by
polymorphism in the IL4R gene and suggest instead that
these variations may influence some aspect of immune
regulation and homeostasis in both Th1 and Th2 pathways
and possibly B cell activation, as well. Conceivably, the
observed patterns of disease association reflect the
effect of IL4R polymorphisms on the balance between the
activation of Th1 and Th2 cells and that of T regulatory
cells. Finally, the extent of risk for T1D may be
determined by specific combinations of variants at the
IL4R locus and at the genes encoding its two ligands, IL4
and IL13.
Theoretical Framework
This study was guided by Orems conceptual model of
nursing. Orems model includes three related theories:
theory of self-care, theory of self-care deficit, and
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general or specific self-care requisites, thus persons
who are in a stage of self-care deficit may need nursing
help. Nurses will design a nursing system to meet an
individuals self-care deficit or to develop the
individuals self-care agency.
In helping the individuals to develop self-care
agency, nurses exercise their nursing agency through
social, interpersonal and professional technological
systems. The organized efforts of nurses are called
nursing systems, which consist of three types: wholly
compensatory, partly compensatory and supportive
educative.
In the supportive-educative nursing system, an
individuals self-care agency is, for the most part,
adequate in meeting self-care requisites.
Nurses only provide support for the maintenance of the
individuals self-care, or education to further develop
their self-care agency.
Diabetes mellitus is a chronic disease that affects
bio psychosocial and economic factors. It is necessary
for patients to develop self-care management abilities
and integrate self-care activities in their daily lives.
A person who is diabetes is able to meet self-care
requisites to control his/her blood glucose levels. Nurse
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can enhance patients perceived self-care efficacy to a
high level and thereby increase self-confidence and
motivation in behavior modification through the
continuous development of self-care agency.
Therefore, a supportive-educative nursing system, by
using methods such as teaching, guiding, supporting, and
providing a developmental environment, make important
contributions to self-care agency, thereby increasing the
ability to control the disease.
In summary, Orems conceptual model of nursing was
used to guide this study. Helping methods were
systematically blended and emphasized both of the group
process and the individual process. The nurse is a
resource for patients and should use effective
instruction media to increase patients learning. All the
methods are based on a good relationship between the
nurse and patient.
This supportive-educative program should increase
self-care agency as reflected by an increase in self-
confidence in performing self-care, and improve control
of blood glucose and body mass index, which reflect a
good diabetic control.
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Chapter III
Methodology
Research Design
The researcher will use the Descriptive research
design in the conduct of this study. Descriptive research
design is a scientific method that involves observing and
describing the behavior of a respondent without
influencing in anyway (Shuttleworth, 2008). It will be
used to describe the characteristics of the variables of
the study.
Identification of the Respondents
The participants of the study will be the adult
residents ages forty (40) and above residing at Brgy. 9,
Tigbauan, Iloilo. The sample size will be computed using
the Slovins formula and a simple random technique will
be used to determine the respondents of the study.
Data gathering Instrument
A researcher-made questionnaire will be used as the
main data-gathering instrument for this study. It will
consist two parts. Part I will contain the demographic
data such as the respondents name, age, educational
attainment, gender and monthly family income.
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The survey questionnaire will be divided into two
parts. First, it contains of the respondents profile
data. Part II will be the questionnaire about the
knowledge level of the respondents in Diabetes Mellitus.
Validity and Reliability of the Questionnaire
To test for the validity of the instrument, the
questionnaire will be subjected for face and content
validation of three (3) experts wherein critiquing and
corrections will be made and will then be reproduced and
distributed personally to the respondents.
Reliability is a measure of how well the study
actually measures what it is supposed to measure. This
will be done by administering the instrument to ten (10)
adults to test for the reliability in order to see if the
same results will be obtained.
Data gathering procedure
In gathering data, the researcher will ask
permission from the Dean to conduct study outside of the
school. Write a letter to Barangay Captain informing that
the researchers choose his barangay as research locale. A
schedule will be set for the administration of the
instrument. The researcher will personally administer the
questionnaire and retrieve after making sure that no
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questions are left unanswered.
Statistical Data Analysis
Data gathered from this investigation will be
subjected to certain computer-processed statistical
tests.
Mean. The obtained mean scores will be used to
ascertain the knowledge of the residents of Brgy. 9,
Tigbauan Iloilo on Diabetes Mellitus.
Standard Deviation. The SD will be used to
determine the dispersion of the mean.
t-test for independent sample. The t-test will be
employed to determine the significance of the differences
in the two-level categories of variables with
significance level at 0.05 alpha.
Analysis of Variance (ANOVA). The ANOVA will be
used to determine the significance of differences in the
three or more level categories of the variables with the
significance level set at 0.05 alpha.
All statistical computations will be computer-
processed through Statistical Package for the Social
Sciences (SPSS) software.
For scoring and statistical interpretation, the
respondents will indicate their answers by placing a
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ST. THERESE MTC-CollegesLa Fiesta Site
M.H Del Pilar St. Molo, Iloilo City
DIABETES MELLITUS: KNOWLEDGE OF RESIDENTS AT BARANGAY 9, TIGBAUAN, ILOILO
PART I
A. Personal Data Information
Name (Optional):_________________________________________
Age: _______ Gender: _______
Educational Attainment: _________________________________
Monthly Family Income: __________________________________
Instruction: Please check the appropriate column that correspond your
choice.( Palihog butang sang tsek sa idalum sang inyo sabat.)
Strongly Agree (1)-means that the respondents believe that the statement is
absolutely true.
(Ang buot hambalon nagapati kamo sang bug-os nga ang pamangkot tama gid ka
matuod.)
Agree (2) - means that the respondents believe that the statement is
true.
(Ang bout hambalon nagapati kamo nga ang pamangkot matuod.)
Disagree (3) - means that respondents believe that the statement is false.
(Ang buot hambalon nagapati kamo nga ang pamangkot hindi matuod.)
Strongly Disagree (4)- means that the respondents believe that the statement
is very unlikely to be true.
( Ang buot hambalon nagapati kamo sang bug-os nga ang pamangkot hindi gid
matuod.)
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PART II
QUESTIONS
StronglyAgree (1)
Agree(2)
Disagree(3)
StronglyDisagree
(4)
The following are signs andsymptoms of Diabetes Mellitus.
Ang mga masunod amo ang mga
senyales kag sintomas sang
diabetes.
1.) Frequent urination. Pirmi gaihiihi
2.) Excessive hunger.
Permi gina gutom.
3.) Increased thirst.
Permi gina uhaw.
4.) Extreme fatigue.
Sobra nga pagkakapoy
5.) Irritability.
Pagka-iritable.
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Etiology/Causes
Kabangdanan sang sakit.
6.)The body failed to produce
insulin.Ang aton lawas wala naga pagwa
sang insulin.
7.)The body cells fail to use the
insulin properly.
Ang cells sang aton lawas indi
makagamit maayo sang insulin
8.)Impaired glucose intolerance as
a result of hormonal changes
during pregnancy.(gestational
diabetes)
Ang kabangdanan sang diabetes
sa nagabusong amo ang pagbaylo
sang pag usar sang glucose sang
aton cells.
9.) Increased age contribute to
the risk of Diabetes Mellitus.
Ang pagtaas sang edad amo ang isa
ka kabangdanan sang Diabetes
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Prevention.
Ang Pag Tapna.
10.) Avoid sugary beverages at
home as much as possible.
Likawan ang tanan nga
mga matam-is nga ilimnon sa
sulod sang balay.
11.) Limit fatty food intake.
Limitahan ang mga matambok nga
pagkaun.
12.) Exercise regularly.
Mag ehersisyo kada adlaw.
13.) Daily insulin injections are
required as prescribed.
Ang reseta sang pag.painsulin
injection sa adlaw-adlaw nga tanan
kinahanglanon gid.
14.) Maintenance oral medication
should not be neglected.
Ang pag-inom sang
maintenance nga bulong para sa
diabetes hindi gid dapat
paglipatan.
15.) Seek a medical advice for a
diabetic diet.
Mag bisita sa sentro para ma
hatagan sang ihibalo kon ano nga
mga pagka-on ang naga kadapat sa
mga tao nga may diabetes.
16.) Decrease physical activity to
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lessen fatigability.
Buhinan ang mga pisikal nga
aktibidades para hindi matam-an
sang kakapoy.
17.) In persons with diabetic
lesions, daily cleansing should be
done.
Kinahanglan limpyohan adlaw-adlaw
ang mga pilas nga resulta sang
diabetes.
18.) A person with diabetes should
be extra careful not to cause
injury to the skin.
Ang tao nga may diabetes
kinahanglan gid nga mag andam nga
hindi mapilasan ang iya panit.
19.) Seek immediate medical
consultation for any injury to the
skin.
Kon mapilasan, mag
pakonsulta gilayon sa doctor
20.) Regular monthly monitoring of
blood glucose level is very
important for people with
diabetes.
Kinahanglan mag pa check-up
sang glucose (sugar)kada bulan ang
mga tao nga may diabetes.