K N O W I N G P E R S O N

Mrs. XXX is a 47 year old businesswoman with a 10- year history of Diabetes Mellitus

Type II. She is married with 5 children. She doesn’t smoke nor drink alcoholic beverages.

“I never saw it coming”, says Mrs. XXX. She was ignorant about this chronic and incurable

disease. She never thought that she will be one of those diabetics struggling for a normal and a

healthy life. “Besides, DM is only for the rich it is not even a part of our bloodline”, says Mrs.

XXX. Her father died at the age of 60 due to complications of Peptic Ulcer Disease and none of

her family member even to the third degree of affinity has Diabetes. Her mother is 70 years old

with osteoporosis but still with good memory and can manage her activities of daily living with

minimum assistance. Common diseases that run in the family are liver disease and peptic ulcer.

Before she was diagnosed, she was not aware of the factors that predispose one to DM.

She believed that only genes will set you up for Diabetes and she didn’t know that lifestyle is a

great factor- that this disease kicks in when you gain a lot of weight and you don’t exercise. She

was overweight during her early 30’s with a BMI of 27.5 (h- 5’4 w-160 lbs.). Mrs. XXX’s diet

history reveals excessive carbohydrate. Her normal dinners consist of 2- 3 cups of rice. She

prefers those fatty and salty foods. She also eats eight to ten pieces of fresh fruits per and as

snacks. Her husband has advised her to go for less sodium and less fat but she found them

“boring and tasteless.” And the worst, she will be eating something sweet for dessert and drink

soda to satisfy her thirst. Her life cycle is just gaining weight with less to no exercise at all. At the

age of 36 she gave birth to her youngest child who is considered according to her doctor as a

large baby. A day after she had undergone Bilateral Tubal Ligation. A year after she

experienced blurred vision and easy fatigability. She just went to an optometrist for an eyeglass

and ignored the other symptom because she thought that it is only due to stress. She also

experienced the frequent feeling of thirstiness and frequent urination especially at night but still

no further action was taken. A month after she experienced vaginal itching. This episode

prompted her to seek medical advice. Her friend who is a known a diabetic advised her to go to

a Diabetes Specialist because she has also experienced same symptom before. Following the

advice of her friend, she immediately scheduled an appointment to the nearest Diabetes

Specialist Doctor. Upon questioning, she told her doctor about the entire unusual episode she

had experienced. After thorough assessment and history taking her doctor explained about

vaginal itching and the other factors associated to this. According to the doctor genital itching is

indicative of yeast infection. It is strongly associated with DM based from the other symptoms

given. In diabetes, blood glucose levels can go abnormally high, which can therefore provide

ideal conditions for naturally present yeast to grow and also diminishes the body’s ability to fight

infection. It can also cause high glucose content in the urine – another extremely suitable place

for yeast to thrive. Her feeling of fatigued is due to many factors like dehydration from increased

urination and her body's inability to function properly, since it's less able to use sugar for energy

needs. Her blurred vision is due high levels of blood sugar pull fluid from your tissues, including

the lenses of your eyes. This affects your ability to focus. Further diagnostic exams were done

like urinalysis and random blood sugar test to confirm the diagnosis. All results were positive of

DM. Two consecutive FBS test were than to further confirm the diagnosis and showed abnormal

results. “If I’m not mistaken its 180 and my cholesterol is above 200”, says Mrs. XXX Her doctor

gave her referral to the ophthalmologist for an eye exam. Then she performed physical

examination. As a part, she performed foot exam, checking for both micro vascular and

neuropathic problem. The exam was normal, except for calluses. Her doctor advised her to

wear shoes with larger toe boxes and proper foot care. She did discuss her fears with her doctor

about diabetes leading to amputations, since this had been a major problem in her friend’s

condition. Her doctor used the opportunity to discuss blood glucose management through

monitoring, medical nutrition therapy, and medication. Her doctor stressed the importance of

losing weight and exercise in the management of her disease. Her doctor gave her several

readings about Diabetes Mellitus for her to have an idea about the disease process and its

management. In her case, her doctor prescribed her with Glucophage to be taken thrice a day

for her diabetes. Simvastatin 20 mg was prescribed for her hypercholesteremia to be taken

once a day.

. Once diagnosed, diabetes will become a way of life for the patient and all the people

concern. The diagnosis meant changes not only for her but for the whole family as well. She

became anxious about everything. “I thought this disease will separate me from everyone”, says

Mrs. XXX because food is the main part of social gatherings. She made further research and

readings regarding the disease process. Fortunately, her nephew is a registered nurse so she

confided to him about it. Her nephew told her a lot about Diabetes. She was like enlightened

that time. This made her more determined not to fight but to sway with it. She didn’t let that

incurable disease to stop her enjoy her life. She started to eat a balanced diet. She didn’t

deprive herself too much but she just changed the portion size of her meal and learned to

substitute foods of different kinds. She also started exercising through brisk walking together

with her husband at the nearby Municipal Park every morning. During Sundays she watches

Aerobic dance and follow them through. She lost weight during that time but always within the

normal range because she knows that drastic change may lead to hypoglycemia. She is very

watchful of herself. When she’s on the nail salon, she makes the manicurist aware about her

condition for them to know how to handle her properly. She always finds time to regularly check

her blood sugar level and Hba1c and results were normal but there were times when they

become just above average or on the borderline. On average her FBS result is 90mg/dl and

HbA1c of 6.5%. She rated herself 8/10 in the way she managed herself and her knowledge

about her illness. She’s very thankful of her family who supported her a lot. They sacrificed a

part of them for her to live normally. They participated by sharing the diabetic meal for their

mother and to be a part of her life by reading about Diabetes for them to know more about it and

share to the whole family. Living with a diabetic means a lot of readings for you to understand

fully and live a life like them. It’s better to consider yourself a diabetic so everybody must be

eating as if they have diabetes because it’s a healthy way of living. It’s the best thing that we

can do.

A year after, she was diagnosed with Cholelithiasis “gallstone” and was advised to

undergo surgery. She became anxious because the problem in wound healing of Diabetics. Her

doctor explained the preparations needed to lessen or cut the complications regarding wound

healing to lessen her anxiety. The mode of treatment will depends on the result of her exams.

To fully control her sugar level, she was prescribed with Insulin subcutaneously 10 ‘u’ in the

morning and 20 ‘u’ in the evening before meals. Everything went fine including those diagnostic

exams and clearances. Her sugar level was fully controlled and everything is within normal so

there was no complication after the surgery. Insulin was then change again to Glucophage to

be taken thrice a day for her maintenance.

“Managing DM is not always that easy”, she said. For years, she had a great control

over her illness but sometimes she just can’t get over it. She goes back to her faulty lifestyle

despite her condition. She became lazy at times. Because of that, she experienced episode of

“hot and dry- sugar high”. Her nephew told her about it for her to be aware and to be

knowledgeable of the things she must do when she is feeling this way. When that happens, she

goes to nearby clinic for her blood sugar test. She’s very thankful that she didn’t suffer so called

DKA. There were also times when she feels the need to control her impulses regarding foods

but her dieting is too rigid that made her experienced episode of “cold and clammy need some

candy” when her sugar level became 70 mg/dl. Then she drinks orange juice then eats a

sandwich and again consulted the doctor. Those upsetting times made her realize the important

things she learned before. She needs motivation and advises to keep her going but sometimes,

she becomes weak and fall on faulty lifestyle. Even though, her family is always there to remind

her.

Last February 2013 was her first admission to the hospital with complaints of chest pain,

difficulty of breathing and dizziness. Her blood pressure was 130/ 90 mmHg. Oxygen was

administered via nasal cannula. ECG was done to rule out cardiac problems. CBG of 240 mg/dl

reveals hyperglycemia. Insulin injection was given as ordered. HbA1c was 8%. She was

confined for about 3 days. Upon discharged she was prescribed with Insulin injection 10 ‘u’ in

the morning and 20 ‘u’ in the evening before meals with other drugs for her chest pain and

hypertension. After 3 months she consulted her doctor for a follow up checkup. Her doctor

requested for HbA1c and the result is 7%. She was advised to continue her insulin injection, to

monitor her sugar levels and blood pressure regularly. Until now, her blood pressure and sugar

level is within normal range. They are monitored regularly. If I have time I always checked on

her to have an update regarding her present condition.

R E F L E C T I O N

The encounter I had with my client is an eye opener for me. I had learned about

Diabetes Mellitus throughout college and I encountered cases in the hospital but I guess those

were just snapshots of the real scenario behind. The real thing will be disclosed when you will a

have a close talk with a known diabetic about her life before and after diagnosis. We often look

on the physical short and long term effect of DM and we overlook the emotional side.

Depression is one and great effect that we must deal with. It must be shocking for an individual

having diagnosed with an incurable disease. After being diagnosed, the feeling of vagueness

will be the issue. They don’t know what to do and how to handle things on the right perspective.

Some are denial and continue their bad habits until it’s too late for them. That’s the time when

we have to go into the picture. We should be there to guide them. Programs for Diabetic patient

must be a part of every health institutions from tertiary down to Barangay Health Stations. I

know that there are existing programs but these are not fully implemented or disregarded.

Furthermore, drive against DM must be known to the people even to the lowest stratum of our

society. We must follow the old wise saying, prevention is better than cure.

I always make it a habit to have a walk or to go jogging during my free time.

As a part of the Health Care team, we must provide proper teachings and trainings for

this group. Let us become an instrument for them to become fully aware about their existing

condition and how to manage it. In doing so, we will be promoting self-reliant clients who are

able to manage their conditions and prevent further complications. We must make them vigilant.

There must be combination of exercise and medication to keep DM under control while allowing

them to follow the odd dietary indiscretion in moderation without serious repercussions. We

must let them enjoy life too.

Giving a diabetes lesson entails a lot of reading for it comprises a wide variety of issues

concerning health. There must be an understanding of metabolism and how it affects sugar

level. You must have an idea about foods, its properties, the right amount and spacing needed

between meals and substitutions of food when they want another considering its sugar and

caloric level. There’s also a need to exercise on a regular basis. There must be a balance of

everything. They must keep going. Above all, they have to study themselves- the self-

awareness issue.