Dm Grand Case Pres

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Republic of the Philippines

Southern Luzon State University

College of Allied Medicine

Lucban, Quezon

A.Y 2012-2013

CASE STUDY

DIABETES MELLITUS TYPE II UNCONTROLLED

Nephrolithiasis

Submitted to:

Mr. Marc Oneel Alvarez

(Clinical Instructor)

In Partial Fulfillment

Of the Requirements for the Subject

Related Learning Experience

Submitted by:

Ara Q. Maceda

(BSN IV- Group 2)

September 2012


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CHAPTER I

OBJECTIVES

1. General objective

The objective of this study is to broaden the knowledge of the students about

diabetes mellitus and its complications, and further evaluate the students learning

experience in the previous clinical exposure.

2. Specific objectives

After this study, the students will:

a. State well the learnt information about the disease such as its definition, signs and

symptoms, prevention, cure, and its pathophysiology.

b. Be able to give point of views about their handling experience with this kind of case.

c. Be able to connect the patients present history to his past and family history.

d. Be able to assess if they have used the physical assessment for the patients

properly.

e. Explain the appropriate nursing interventions to be implemented to patients having

diabetes mellitus

f. Evaluate the effectiveness of the nursing care plans that were implemented during

the clinical exposure.

g. State the different actions of the drugs being administered to the patient.

h. Interpret the different laboratory tests whether it is normal or there are abnormal

interpretation


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CHAPTER II

INTRODUCTION OF THE DISEASE

.

The term "diabetes mellitus" refers to a group of diseases that affect how your body uses

blood glucose, commonly called blood sugar.

Glucose is vital to your health because it's an important source of energy for the cells

that make up your muscles and tissues. It's your brain's main source of fuel.

If patient have diabetes, no matter what type, it means that they have too much glucose

in their blood, although the reasons may differ. Too much glucose can lead to serious health

problems.

Chronic diabetes conditions include type 1 diabetes (insulin dependent) and type 2

diabetes (non-insulin dependent). Potentially reversible diabetes conditions include

prediabetes when your blood sugar levels are higher than normal, but not high enough to

be classified as diabetes and gestational diabetes, which occurs during pregnancy.


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CHAPTER III

ANATOMY AND PHYSIOLOGY

Endocrine system includes cells, tissues, and organs collectively called endocrine

glands, that secrete hormones into the internal environment.

Hormones are substances that are secreted by the endocrine gland which transported

into the blood, and regulates body mechanisms.

Pancreas is an elongated, somewhat flattened organ posterior to the stomach and

behind the parietal peritoneum. It consists of two major types of secretory tissues. This

organization reflects the pancreas dual function as an exocrine gland that secretes digestive

juice and an endocrine gland that release hormones.

Islet of Langerhans (pancreatic islets) include two distinct type of cells the alpha

cells, which secrete the hormone glucagon, and beta cells, which secrete the hormone insulin.

Glucagon stimulates the liver to breakdown glycogen and converts certain

noncarbohydrates, such as amino acids, into glucose, raising blood sugar concentration. It

elevates blood glucose effectively.

Insulin stimulates the liver to form glycogen from glucose and inhibits conversion of

noncarbohydrates into glucose. It also has the special effect of promoting facilitated diffusion of

glucose across cell membranes that have insulin receptors, such as those of cardiac muscles,

adipose tissues, and resting skeletal muscles.

Glyconeogenesis is the formation of glucose from fats and proteins.


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Glycogenolysis is the breakdown of liver glycogen.

Normal Function of Glucagon and Insulin

Control Center

Beta cells secrete insulin

Receptors Effectors

Beta cells detect rise in blood Insulin: promotes movementsGlucose of glucose into certain cells and

stimulates formation of glycogenfrom glucose

Stimulus Response

Rise in blood glucose level Blood glucose drops toward

normal

Too high blood glucoselevel

Response Too low blood glucose levelBlood glucose level rises

towards normal

StimulusDrop in blood glucose level

Normal Blood

Glucose

Concentration


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Effectors Glucagon stimulates cells to

Breakdown glycogen into ReceptorsGlucose Alpha cells detect a drop in blood

glucose

Control Center

Alpha cells secrete glucagon

CHAPTER IV

OVERVIEW OF THE DISEASE

a. REVIEW OF RELATED LITERATURE

Diabetes mellitus is a group of metabolic diseases characterized by high blood

sugar (glucose) levels that result from defects in insulin secretion, or action, or both.

Diabetes mellitus, commonly referred to as diabetes (as it will be in this article) was first

identified as a disease associated with "sweet urine," and excessive muscle loss in the

ancient world. Elevated levels of blood glucose (hyperglycemia) lead to spillage of

glucose into the urine, hence the term sweet urine.

Normally, blood glucose levels are tightly controlled by insulin, a hormone

produced by the pancreas. Insulin lowers the blood glucose level. When the blood

glucose elevates (for example, after eating food), insulin is released from the pancreas to

normalize the glucose level. In patients with diabetes, the absence or insufficient

production of insulin causes hyperglycemia. Diabetes is a chronic medical condition,

meaning that although it can be controlled, it lasts a lifetime.

What is the impact of diabetes?

Over time, diabetes can lead to blindness, kidney failure, and nerve damage.

These types of damage are the result of damage to small vessels, referred to as

microvascular disease. Diabetes is also an important factor in accelerating the hardening

and narrowing of the arteries (atherosclerosis), leading to strokes, coronary heart
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the face of insulin resistance as discussed above. In many cases this actually means the

pancreas produces larger than normal quantities of insulin. A major feature of type 2

diabetes is a lack of sensitivity to insulin by the cells of the body (particularly fat and

muscle cells).

In addition to the problems with an increase in insulin resistance, the release of

insulin by the pancreas may also be defective and suboptimal. In fact, there is a known

steady decline in beta cell production of insulin in type 2 diabetes that contributes to

worsening glucose control. (This is a major factor for many patients with type 2 diabetes

who ultimately require insulin therapy.) Finally, the liver in these patients continues to

produce glucose through a process called gluconeogenesis despite elevated glucose

levels. The control of gluconeogenesis becomes compromised.

Diabetes can occur temporarily during pregnancy. Significant hormonal changes

during pregnancy can lead to blood sugar elevation in genetically predisposed

individuals. Blood sugar elevation during pregnancy is called gestational diabetes.

Gestational diabetes usually resolves once the baby is born. However, 25%-50% of

women with gestational diabetes will eventually develop type 2 diabetes later in life,

especially in those who require insulin during pregnancy and those who remain

overweight after their delivery. Patients with gestational diabetes are usually asked to

undergo an oral glucose tolerance test about six weeks after giving birth to determine if

their diabetes has persisted beyond the pregnancy, or if any evidence (such as impaired

glucose tolerance) is present that may be a clue to the patient's future risk for developing

diabetes.

Manifestations

The early symptoms of untreated diabetes are related to elevated blood sugar

levels, and loss of glucose in the urine. High amounts of glucose in the urine can cause

increased urine output and lead to dehydration. Dehydration causes increased thirst and

water consumption.

The inability of insulin to perform normally has effects on protein, fat and

carbohydrate metabolism. Insulin is an anabolic hormone, that is, one that encourages

storage of fat and protein.

A relative or absolute insulin deficiency eventually leads to weight loss despite an

increase in appetite.

Some untreated diabetes patients also complain of fatigue, nausea andvomiting.
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Patients with diabetes are prone to developing infections of the bladder, skin, and

vaginal areas.

Fluctuations in blood glucose levels can lead to blurred vision. Extremely elevated

glucose levels can lead to lethargy and coma.

Diagnosis

The fasting blood glucose (sugar) test is the preferred way to diagnose diabetes.

It is easy to perform and convenient. After the person has fasted overnight (at least 8

hours), a single sample of blood is drawn and sent to the laboratory for analysis. This

can also be done accurately in a doctor's office using a glucose meter.

Normal fasting plasma glucose levels are less than 100 milligrams per

deciliter (mg/dl).

Fasting plasma glucose levels of more than 126 mg/dl on two or more tests

on different days indicate diabetes.

A random blood glucose test can also be used to diagnose diabetes. A

blood glucose level of 200 mg/dl or higher indicates diabetes.

When fasting blood glucose stays above 100mg/dl, but in the range of 100-

126mg/dl, this is known as impaired fasting glucose (IFG). While patients with IFG do not

have the diagnosis of diabetes, this condition carries with it its own risks and concerns,

and is addressed elsewhere.

Oral Glucose Tolerance Test

Though not routinely used anymore, the oral glucose tolerance test (OGTT) is a

gold standard for making the diagnosis of type 2 diabetes. It is still commonly used for

diagnosing gestational diabetes and in conditions of pre-diabetes, such as polycystic

ovary syndrome. With an oral glucose tolerance test, the person fasts overnight (at least

eight but not more than 16 hours). Then first, the fasting plasma glucose is tested. After

this test, the person receives 75 grams of glucose (100 grams for pregnant women).

There are several methods employed by obstetricians to do this test, but the one

described here is standard. Usually, the glucose is in a sweet-tasting liquid that the
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person drinks. Blood samples are taken at specific intervals to measure the blood

glucose.

Glucose tolerance tests may lead to one of the following diagnoses:

Normal response: A person is said to have a normal response when the

2-hour glucose level is less than 140 mg/dl, and all values between 0 and 2 hours

are less than 200 mg/dl.

Impaired glucose tolerance: A person is said to have impaired glucose

tolerance when the fasting plasma glucose is less than 126 mg/dl and the 2-hour

glucose level is between 140 and 199 mg/dl.

Diabetes: A person has diabetes when two diagnostic tests done on

different days show that the blood glucose level is high.

Gestational diabetes: A woman has gestational diabetes when she has

any two of the following: a 100g OGTT, a fasting plasma glucose of more than 95

mg/dl, a 1-hour glucose level of more than 180 mg/dl, a 2-hour glucose level of

more than 155 mg/dl, or a 3-hour glucose level of more than 140 mg/dl.

Hemoglobin A1c (A1c)

To explain what an hemoglobin A1c is, think in simple terms. Sugar sticks, and

when it's around for a long time, it's harder to get it off. In the body, sugar sticks too,

particularly to proteins. The red blood cells that circulate in the body live for about three

months before they die off. When sugar sticks to these cells, it gives us an idea of how

much sugar is around for the preceding three months. In most labs, the normal range is

4%-5.9 %. In poorly controlled diabetes, its 8.0% or above, and in well controlled patientsit's less than 7.0% (optimal is


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9 240

10 275

Medications

a. Insulin Secretagogs 2nd generation sulfonylureas

Glipizide, Glyburide, Glicazide, Glimepiride (Glucotrol, Glynase,Amaryl)

o Stimulate insulin secretion

o For lean elderly person

o Causes hypoglycemia

b. Meglitinides

Repaglinide (Prandin), Nateglinide (Starlix)o Stimulate insulin secretion for a short interval

o Rapid onset and offset of action

o Used as preprandial agents

o No effect upon fasting glucose

c. Insulin sensitizers

Thiazolidinediones Pioglitazone (Actos), Rosiglitazone (Avandia)

o Improve insulin sensitivity primarily at muscle and adipose tissue

o Liver function should be monitored q 2 months

o Can cause weight gain & edema

o Contraindicated for CHF

d. Biguanide

Metformin

o Improves insulin sensitivity primarily at the liver

o Generally preferred for obese patients

o Often aides weight loss


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o Diarrhea, dyspepsia, nausea are common

o Lactic acidosis is rare

o Contraindicated in renal disease (CR CL


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hospital intensive care unit. Dehydration can be very severe, and it is not unusual to

need to replace 6-7 liters of fluid when a person presents in diabetic ketoacidosis.

Antibiotics are given for infections. With treatment, abnormal blood sugar levels, ketone

production, acidosis, and dehydration can be reversed rapidly, and patients can recover

remarkably well.

Hypoglycemia means abnormally low blood sugar (glucose). In patients with

diabetes, the most common cause of low blood sugar is excessive use of insulin or other

glucose-lowering medications, to lower the blood sugar level in diabetic patients in the

presence of a delayed or absent meal. When low blood sugar levels occur because of

too much insulin, it is called an insulin reaction. Sometimes, low blood sugar can be the

result of an insufficient caloric intake or sudden excessive physical exertion.

The major eye complication of diabetes is called diabetic retinopathy. Diabetic

retinopathy occurs in patients who have had diabetes for at least five years. Diseased

small blood vessels in the back of the eye cause the leakage of protein and blood in the

retina. Disease in these blood vessels also causes the formation of small aneurysms

(microaneurysms), and new but brittle blood vessels (neovascularization). Spontaneous

bleeding from the new and brittle blood vessels can lead to retinal scarring and retinal

detachment, thus impairing vision.

Kidney damage from diabetes is called diabetic nephropathy. The onset ofkidney

disease and its progression is extremely variable. Initially, diseased small blood vessels

in the kidneys cause the leakage of protein in the urine. Later on, the kidneys lose their

ability to cleanse and filter blood. The accumulation of toxic waste products in the blood

leads to the need fordialysis. Dialysis involves using a machine that serves the function

of the kidney by filtering and cleaning the blood. In patients who do not want to undergo

chronic dialysis, kidney transplantation can be considered.

Nerve damage from diabetes is called diabetic neuropathy and is also caused by

disease of small blood vessels. In essence, the blood flow to the nerves is limited,

leaving the nerves without blood flow, and they get damaged or die as a result (a term

known as ischemia). Symptoms of diabetic nerve damage include numbness, burning,

and aching of the feet and lower extremities. When the nerve disease causes a complete

loss of sensation in the feet, patients may not be aware of injuries to the feet, and fail to

properly protect them. Shoes or other protection should be worn as much as possible.

Seemingly minor skin injuries should be attended to promptly to avoid serious infections.

Because of poor blood circulation, diabetic foot injuries may not heal. Sometimes, minor
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foot injuries can lead to serious infection, ulcers, and even gangrene, necessitating

surgical amputation of toes, feet, and other infected parts.

Gangrene

Gangrene is a term that describes dead or dying body tissue(s) that occur

because the local blood supply to the tissue is either lost or is inadequate to keep the

tissue alive. Gangrene has been recognized as a localized area of tissue death since

ancient times. The Greeks used the term gangraina to describe putrefaction (death) of

tissue. Although many laypeople associate the term gangrene with a bacterial infection,

the medical use of the term includes any cause that compromises the blood supply that

results in tissue death. Consequently, a person can be diagnosed with gangrene but

does not have to be "infected."

There are two major types of gangrene referred to as dry and wet. Many cases of

dry gangrene are not infected. All cases of wet gangrene are considered to be infected,

almost always by bacteria. The most common sites for both wet and dry gangrene to

occur are the digits (fingers and toes) and other extremities (hands, arms, feet, and

legs).

CHAPTER V

CASE STUDY PROPER

a. Patients Profile

Case No. 20114643

Name: Patient X

Address: Golden Meadows Subd. Brgy. Bucal Pagbilao, Quezon

Age: 44 years old

Sex: male

Civil Status: Married

Religion: Catholic

Nationality: Filipino

Place of birth: Pagbilao, Quezon
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Date of birth: August 5, 1969

Name of Father: Ferrarin Musa

Name of Mother: Yolanda Musa

Name of Spouse: Lyn Musa

Chief Complaint: Loss of consciousness and vomiting

Admission Date: August 9,2012

Admission Time: 3:30 pm

Admitting Physician: Dr. Lacerna

Final Diagnosis: Diabetes Mellitus type II uncontrolled Nephrolithiasis

b. Physical assessment

General Condition

Conscious and coherent

Afebrile; T=36.0C

With guarding behavior

With episodes of vomiting

Head

With hair equally distributed on the scalp

With good hair texture

Eyes

With whitish sclera With pale conjunctiva

With conjugate eye movements

With pupil equally round and reactive to light accommodation


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Ears

No ear discharges noted

Easily recoil when folded

Nose

Without nasal discharges; No nasal flaring

Mouth and Teeth

With pale and dry lips

With good dentition

Neck

Without palpable mass noted

With palpable carotid pulse

Without distended vein noted upon palpation

Chest and Lungs

With normal chest expansion upon breathing

With clear breath sounds heard on both lung fields upon auscultation

Cardiovascular

Without papitatons noted

With fluctuating blood pressure

With normal cardiac rate and rhythm upon auscultation

Abdomen

With soft and non-tender abdomen upon palpation

With normoactive bowel sounds of 19 BS/min.

Genitourinary

Dysuria


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Voids freely

With increase in frequency of urination

With yellowish urine; moderate in amount

With non-healing scrotal wound with abscess noted

Extremities

With IV inserted at right metacarpal vein

Without redness or swelling on the IV insertion site

With muscle wasting

With Thin and flaccid muscle tone

Limited range of motion

With pale nailbeds

Skin

With fair skin turgor

With poor skin turgor

pallor

Vital signs:

Day 1 Day 2 Day 3

Temperature 36.0C 36.0C 36.4C

Respiration rate 23bpm 18bpm 25bpm

Pulse rate 79bpm 80bpm 73bpm

BP (mmHg) 130/80 110/80 120/80

b. History of Present Illness

The patient was admitted at QMC on September 8,2012 at around 3:30 in the

afternoon. The patient was sent to the hospital due to a episodes of vomiting and

flaccidity of extremities The patient then was brought to the room of choice and


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underwent such procedures. He is continuously taking insulin for the management of her

diabetes. Also, he took medications for treatment of hyperlipidemia.

c. Past Medical History

The patient was a known diabetic. He is taking antidiabetic medications for

several years. He has no known other diseases except from her diabetes. He only

experienced symptoms like fever, cough, colds, etc but they were managed at home.

d. Family Health History

The family has a history of diabetes mellitus and hypertension. Other than that

they have no family history of other chronic diseases like tuberculosis, cancer, etc.

e. Personal and Social History

The patient is a food lover ever since. He loves to eat foods that He wanted. He

also drinks alcoholic beverages occasionally. He is a smoker. He loves to hang out with her

family. He also has a good relationship to her neighbors according to his significant other.

CHAPTER VIII

COURSE IN THE WARD


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At around 3:30 in the afternoon last August 8,2012, a 44 year old, married man

was admitted at Quezon Memorial Center with the chief complaint of loss of consciousness

and vomiting and flaccidity of extremities. He had been examined by Dr. Lacerna and then

decided to be confined for medical management.

DOCTORS ORDER: At the ER, the doctors order was with the patient which

was as follows: Please admit to Medicine ward, diabetic diet, PNSS 1 L x 6 hours

,RBS q 2 ,for stat Na, K and urine ketone ABS, crea, HgbA1c CBC, urinalysis, chest x-

ray, ECG. Included on the doctors order were medications such as fast drip of 300

cc IVF, metroclopramide 1 amp IV now then q 8, Omeprazole 40 mg IVP now, then

refer accordingly.

NURSING ACTIONS: Upon receiving the orders, the nurse at the ER made the

requests for the laboratories and secured consent for hospitalization. Chest xray,ECG,CBC

was done

PATIENTS RESPONSE: The wife signed the consent while the patient

cooperated during the blood extraction of the medical technologist on duty.

After being sent to the room RBS was taken with the reading of 406mg/dl and had

distended bladder with painful urination

DOCTORS ORDER:Give regular insulin 5 units IVP now then RBS after an

hour. Insert foley catheter

NURSING ACTIONS:. The NOD secured consent for catheriization and the

patients relative was instructed to facilitate the impending stat order for Na,K ,

hgba1C,crea with corresponding requests.The SNOD carried out the previous order and an

hour after the administration of the drug, the blood sugar became 213mg/dl.

August 9,2012

The patient was still in unstable condition of glucose tolerance and RBS at

around 6 am is read as Hi

DOCTORS ORDER: continue RBS monitoring IVF to flow is PNSS 1 L x 6

hours for 4 doses and fast drip of 300 cc to resent IVF

NURSING ACTIONS:. The at around 11am the result of CBC and urinalysis hadbeen referred with corresponding results hemoglobin 8.5, WBC 14 000 cumm, RBC in urine

is 4-6 (0-2) WBC over 100 ( )

DOCTORS ORDER: for blood transfusion of 2 u of PRBC with proper

blood typing and crossmatch and administer ciprofloxacin 500 mg 1 tab BID


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NURSING ACTION: The NOD give proper instruction regarding the facilitation of blood and

administered the prescribed dosage and medication

The RBS increased to 490mg/dl at 1pm

DOCTORS ORDER: Regular insulin 5 units SC now

NURSING ACTION: The drug was administered

August 10,2012

RBS result as of 6 am is read as Hi and the result of Na and K has been released with

results of Na- 126.8(135-145) K 3.74 (3.5-5)

DOCTORS ORDER: NaCl 1 tab TID and give Lantus 8 u SC now

NURSING ACTION: The Nod administered the prescribed dosage of meds

August 11,2012

At around 6 am RBS is 353 mg/dl with no alteration in vomiting

DOCTORS ORDER: New orders made were as follows: Start bladder

training and give Regular insulin SC injection 10 units now and decrease the RBS to 6

hours and discontinue metroclopramide

NURSING ACTION: The NOD carried out the orders and explained to the patient

what the doctor said.

PATIENTS RESPONSE: The patient cooperated while administering the drug

subcutaneously and started to have bladder training

At 8:30 pm RBS taken the result was 502mg/dl. The result was then relayed to

MROD

DOCTORS ORDER: The doctor prescribed to start Lantus 10 units SC OD

9pm, Apidra 6 units SC TID premeals and decrease RBS to TID

NURSING ACTION: The NOD administered the drug ordered and started give

Lantus at night

August 12,2012

At around 6am RBS reading is High

DOCTORS ORDER: Regular insulin 10 units IVP now and repeat Na,K

NURSING ACTION: The NOD administered it immediately after carrying out.


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August 13,2012

RBS reading as of 6am is Hi and HgbA1C result is 7.4% (4.2-6.2%)

DOCTORS ORDER: increased Apidra 8 units SC TID premeals

Increase Lantus to 12 units SC OD PNSS 1 L x 8 3 doses

August 14,2012

DOCTORS ORDER: Regular insulin 10 u SC for repeat Na, K now PNSS 1

L x 6 for 4 doses

NURSING ACTION: The NOD gave request for Na,K and administered the

prescribed dosage of meds

August 15,2012

The results of Na is 137.0 (135-145) and K 2.95 (3.5-5)

DOCTORS ORDER: Give ketosteril 600 mg 2 tabs TID and for UTZ KUB

NURSING ACTION: The NOD gave request and proper instruction for the

examination to be done and administered the prescribed dosage of meds.

At around 12 nn RBS 131 mg/dl

DOCTORS ORDER: decrease Apidra to 5 units SC

August 16,2012

Potassium result is 2.95 and hemoglobin result of 9.2 (12-15)

DOCTORS ORDER: Give Kalium Durule 1 tab TID and for BT of 2 units of

PRBC

NURSING ACTION: The NOD facilitate the transfusion of blood

August 17,2012

Patient develops poor skin tugor

August 19,2012

Patient appears pale and weak and depletion of hemoglobin takes place hemoglobin 8 mg/dl so

the NOD facilitate blood transfusion of 1 u of PRBC


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August 20,2012

At around 6 am RBS reading is 367 mg/dl

DOCTORS ORDER: Give Humulin R 6 units Sc now

August 21,2012

RBS taken with result of 378 gm/dl even though apidra was given MROD ordered Regular

insulin 5 units SC now

August 22,2012

Patient develops a loose bowel movement and 5 consecutive passage drooling stool the MROD

ordered diatabs 2 tabs as stat order

August 24,2012

The patient develops swelling and abscess on the scrotal area and refered according to SROD

with order of wound care should be provided and Coamoxiclav 620mg 1 tab

August 25,2012

RBS taken 320 mg/dl regular insulin 6 u SC was given and the last unit of PRBC was

transfused

August 26,2012

RBS 192 mg/dl regular insulin 6 u SC was given

August 27,2012

The result of KUB has an impression of Nephrolithiases, bilateral and the patient

develops the sore on scrotal area

DOCTORS ORDER: for H and H stat and for repeat na, K and give Acalka 1

tab TID and sambong I tab TID and refer to SROD for scrotal abscess

NURSING ACTION: The NOD administered the prescribed meds and refer

accordingly to SROD

August 28,2012


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The SROD seen the client with scrotal abscess and swelling and tenderness

in the area and prescribed tramadol 50 mg I cap TID for reevaluation.

August 31,2012

The physician maintain the client on NPO for CP clearance and for incision

and drainage/ debridement BT 1 u PRBC prior to OR 1 u standby for OR use

NURSING ACTION: The NOD secured consent from the patient after giving

explanations about the procedure. The NOD also referred MROD the patient for CP

evaluation.

PATIENTS RESPONSE: The patient signed the informed consent and

understood the procedure. RBS 252 mg/dl

DOCTORS ORDER: regular insulin 16 units SC todays pre dinner only.

NURSING ACTION: The drug was administered subcutaneously.

PATIENTS RESPONSE: The patient participated effectively during drug

administration.

September 1, 2012

Patients appears sluggish and with pallor still on the process of facilitating BT due to

unavailability

CHAPTER VII

PATHOPHYSIOLOGY

Modifiable Risk Factors: Non-modifiable Risk Factors*Loves eating sweets and fatty foods *Age: 44 years old*engaged in alcohol drinking *Family history of DM: both sidesOccasionally


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*Laceration on the left foot

Destruction of beta cells of islets of Langerhans that secretes insulin

Decrease insulin production

Insulin insufficiency

Glucose cannot go to the cells

Glucose stays at the systemic blood circulation cell starvation

Hyperglycemia polyphagia RBS=406mg/dl

Increase blood glucose level exceeds increase blood increase peripheralOsmolarity renal threshold viscosity vascular resistance

Intracellular fluid glucose exerts high sluggish circulation decrease oxygen &Dehydration osmotic pressure within and proliferation blood supply to

the renal tubules of microorganisms distal extremities

osmotic dieresis occurs infection muscle wastingWBC=14 000/cumm

Polyuria increase decrease wound healing scrotal areaCapillary permeability

Extracellular fluid fever Dehydration glucose in the

Urine; urinalysis:Stimulates thirst Glucose =3+

Center of the brain

Polydipsia; increasethirst

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