UNIVERSITY OF CAGAYAN VALLEY
College of Health
College Avenue, Tuguegarao City 3500
Annex Campus: Dr. Matias P. Perez Sr. Bldg.
Phone/Fax (078) 844 8981
A CASE PRESENTATION OF 58-YEAR-OLD PATIENT WITH DIABETES MELLITUS TYPE 2
PRESENTED BY:
DESIRIE ALCABEDOS BACUYAG
APRIL JOY AYSON BADUA
JOAN TUMANGUIL BULUAN
ZYRYLLE L. CABANTING
PATRICK ISRAEL CAMAYANG
ARLIE NICOLE CLEMENTE
ANALOU AGANA MONTEFALCON
VYONCEY JEAN ORENCIA TUCJANG
General objectives:
This case study will serve as a guide for Nursing students, to provide a knowledge and understanding
about a patient who is diagnosed with Diabetes Mellitus Type 2
Specific Objectives:
To be able to define what is all about Diabetes Mellitus Type 2
To discuss anatomy and physiology of the related disease.
Enumerate the different signs and symptoms of Diabetes Mellitus Type 2
Trace the pathophysiology of the disease process
To establish essential nursing intervention to be implemented for the patient’s wellness.
To learn new skills as well as hone our ongoing clinical skills required in the management of the
patient with Diabetes Mellitus Type 2
Definition of Terms
Diabetes Mellitus Type 2 (T2DM) is a chronic metabolic disorder characterized by the presence of
persistent hyperglycemia resulting from two primary defects: insulin resistance and impaired insulin
secretion. In this condition, the body's cells become less responsive to the action of insulin (insulin
resistance), and the pancreas fails to produce sufficient insulin to overcome this resistance.
Glucagon is a peptide hormone produced by the alpha cells of the islets of Langerhans in the pancreas. It
plays a vital role in maintaining blood glucose levels, especially during periods of fasting or low blood sugar
(hypoglycemia), by acting as a counter-regulatory hormone to insulin.
Glycosuria is the presence of glucose in the urine, which typically occurs when the blood glucose level
exceeds the renal threshold for glucose reabsorption. Insulin is a peptide hormone produced by the beta cells
of the islets of Langerhans in the pancreas. It plays a central role in regulating blood glucose levels and
maintaining energy balance in the body.
Langerhans refers to islets of Langerhans, which are clusters of specialized cells located within the
pancreas. These clusters play a crucial role in regulating blood glucose levels through the secretion of
hormones.
Polyuria is a condition characterized by excessive urination, typically defined as the production of more
than 3 liters of urine per day in adults, although this threshold can vary. It is a symptom, not a disease in
itself, and often indicates an underlying medical condition or disturbance in the body's fluid balance.
Polydipsia is the medical term for excessive thirst or an abnormal, insatiable desire to drink fluids. It is
typically a symptom of an underlying condition or imbalance in the body's fluid regulation system.
Polyphagia is the medical term for excessive hunger or an abnormally increased appetite. It is often
associated with conditions where the body’s normal regulatory mechanisms for hunger and satiety are
disrupted, leading to an overwhelming desire to eat more than usual.
INTRODUCTION
Diabetes Mellitus Type 2 (T2DM) is a chronic metabolic disorder characterized by insulin resistance
and impaired insulin secretion, leading to hyperglycemia. It is the most common form of diabetes, accounting
for 90-95% of all diabetes cases worldwide. The prevalence of T2DM has been steadily increasing due to
lifestyle changes, urbanization, and aging populations, posing a significant public health challenge.
This disease is associated with various risk factors, including genetic predisposition, obesity, physical
inactivity, and dietary habits. Beyond hyperglycemia, T2DM is linked to a range of complications, such as
cardiovascular disease, neuropathy, nephropathy, and retinopathy, which substantially impact quality of life
and healthcare systems globally.
Studying T2DM involves understanding its pathophysiology, identifying risk factors, developing
preventive strategies, and exploring therapeutic interventions to mitigate its progression and complications.
This research is crucial for advancing personalized medicine and improving outcomes for individuals living
with this condition.
In this introduction, we aim to provide a comprehensive overview of T2DM's etiology, pathogenesis,
and the current state of research, emphasizing the importance of addressing this growing global health
concern.
Diabetes Mellitus Type 2 (T2DM) is a significant public health concern in the Philippines, reflecting
both global trends and unique local challenges. Characterized by insulin resistance and progressive beta-cell
dysfunction, T2DM contributes to the growing burden of non-communicable diseases (NCDs) in the country.
The prevalence of T2DM in the Philippines has been steadily increasing, driven by lifestyle changes,
urbanization, and genetic predisposition among Filipinos.
Cultural factors, dietary habits rich in refined carbohydrates and saturated fats, and limited access to
healthcare services in rural and underserved areas exacerbate the situation. T2DM is further complicated by
poor awareness, delayed diagnosis, and limited adherence to treatment, leading to high rates of complications
such as cardiovascular disease, neuropathy, nephropathy, and retinopathy.
The study of T2DM in the Philippines is crucial to understanding the interplay between genetic,
environmental, and socio-economic factors contributing to the disease. Research is needed to design
culturally appropriate preventive measures, improve early detection, and develop cost-effective management
strategies tailored to the Filipino population.
This introduction seeks to provide a framework for studying T2DM in the Philippine context,
highlighting the urgent need for targeted interventions to address this escalating public health issue and
improve the quality of life for Filipinos affected by the disease.
ANATOMY AND PHYSIOLOGY OF THE PANCREAS
The pancreas is a long, slender organ, most of which is located posterior to the bottom half of the stomach.
Although it is primarily an exocrine gland, secreting a variety of digestive enzymes, the pancreas also has
endocrine cells. Its pancreatic islets—clusters of cells formerly known as the islets of Langerhans—secrete
the hormones glucagon, insulin, somatostatin, and pancreatic polypeptide (PP).
Pancreas endocrine function involves the secretion of insulin (produced by beta cells) and glucagon (produced by
alpha cells) within the pancreatic islets. These two hormones regulate the rate of glucose metabolism in the body. The
micrograph reveals pancreatic islets.
Cells and Secretions of the Pancreatic Islets
The pancreatic islets each contain four varieties of cells:
The alpha cell produces the hormone glucagon and makes up approximately 20 percent of each islet.
Low blood glucose levels stimulate the release of glucagon.
The beta cell produces the hormone insulin and makes up approximately 75 percent of each islet.
Elevated blood glucose levels stimulate the release of insulin.
The delta cell accounts for four percent of the islet cells and secretes the peptide hormone
somatostatin. Recall that somatostatin is also released by the hypothalamus, stomach and intestines.
An inhibiting hormone, pancreatic somatostatin inhibits the release of both glucagon and insulin.
The pancreatic polypeptide cell (PP cell) accounts for about one percent of islet cells and secretes the
pancreatic polypeptide hormone. It is thought to play a role in appetite, as well as in the regulation of
pancreatic exocrine and endocrine secretions. Pancreatic polypeptide released following a meal may reduce
further food consumption; however, it is also released in response to fasting.
Regulation of Blood Glucose Levels by Insulin and Glucagon
Glucose is utilized in cellular respiration as a fuel for cells of the body. The body derives glucose from the
breakdown of the carbohydrate-containing foods and drinks we consume. Glucose not immediately taken up
by cells for fuel can be stored by the liver and muscles as glycogen, or converted to triglycerides and stored
in the adipose tissue. Hormones regulate both the storage and the utilization of glucose as required. Receptors
located in the pancreas sense blood glucose levels, and subsequently the pancreatic cells secrete glucagon or
insulin to maintain appropriate blood glucose.
Glucagon
Receptors in the pancreas can sense the decline in blood glucose levels, such as during periods of fasting or
during prolonged labor or exercise. In response, the alpha cells of the pancreas secrete the hormone glucagon,
which has several effects:
Glucagon stimulates the liver to convert its stores of glycogen back into glucose. This response is known as
glycogenolysis. The glucose is then released into the circulation for use by cells throughout the body.
Glucagon stimulates the liver to take up amino acids from the blood and convert them into glucose. This
response is known as gluconeogenesis.
Glucagon stimulates lipolysis, the breakdown of stored triglycerides into free fatty acids andglycerol. Some
of the free glycerol released into the bloodstream travels to the liver, which converts the glycerol into
glucose. This is also a form of gluconeogenesis.
Taken together, these actions increase blood glucose levels. The activity of glucagon is regulated through a
negative feedback mechanism; rising blood glucose levels inhibit further glucagon production and secretion.
Homeostatic Regulation of Blood Glucose
Levels: Blood glucose concentration is
tightly maintained between 70 mg/dL and
110 mg/dL. If blood glucose concentration
rises above this range, insulin is released,
which stimulates body cells to remove
glucose from the blood. If blood glucose
concentration drops below this range,
glucagon is released, which stimulates body
cells to release glucose into the blood.
Insulin
The primary function of insulin is to facilitate the uptake of glucose into body cells. Red blood cells, as well
as cells of the brain, liver, kidneys, and the lining of the small intestine, do not have insulin receptors on their
cell membranes and do not require insulin for glucose uptake. Although all other body cells do require insulin
if they are to take glucose from the bloodstream, skeletal muscle cells and adipose cells are the primary
targets of insulin.
The presence of food in the intestine triggers the release of gastrointestinal tract hormones such as glucose-
dependent insulinotropic peptide (previously known as gastric inhibitory peptide). This is in turn the initial
trigger for insulin production and secretion by the beta cells of the pancreas. Once nutrient absorption occurs,
the resulting surge in blood glucose levels further stimulates insulin secretion.
Precisely how insulin facilitates glucose uptake is not entirely clear. However, insulin appears to activate a
tyrosine kinase receptor, triggering the phosphorylation of many substrates within the cell. These multiple
biochemical reactions converge to support the movement of intracellular vesicles containing facilitative
glucose transporters to the cell membrane. In the absence of insulin, these transport proteins are normally
recycled slowly between the cell membrane and cell interior. Insulin triggers the rapid movement of a pool of
glucose transporter vesicles to the cell membrane, where they fuse and expose the glucose transporters to the
extracellular fluid. The transporters then move glucose by facilitated diffusion into the cell interior.
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
Diabetes Type 2 is a problem where the hormone insulin, which is normally secreted by the pancreas does
not actually work properly. The pancreas is an organ sitting behind the stomach that secretes many things for
digestion but also produces and secretes hormones important for metabolism. One of these hormones is
insulin, produced in response to high blood glucose. For example, after we eat, glucose enters our blood,
stimulating the pancreas to produce insulin. Before continuing with the pathophysiology of diabetes, it is
important to understand what normally happens and how insulin works. In a normal scenario, the pancreas
produces insulin in response to high blood glucose levels. Insulin targets different organs, such as the liver,
adipose tissue (fat), and skeletal muscle, by binding to insulin receptors or insulin-sensitive proteins with the
sole purpose of decreasing blood glucose levels. The binding of insulin to its receptor triggers a cascade of
events within a cell, leading to increased glucose uptake from circulation. This is done by producing more
glucose channels or transporters on the surface of cells, allowing glucose to move from the blood into the
cells.
Insulin also promotes glucose storage. In the liver, insulin stimulates glycolysis and glycogenesis to store
glucose as glycogen. Insulin also stimulates glucose to be stored as fat, which is subsequently transported to
adipose tissue. In Type 2 Diabetes, there is insulin resistance, meaning the receptors that insulin works on do
not function properly or effectively. As a result, insulin does not work effectively on the liver, adipose tissue,
and skeletal muscle, leading to prolonged high blood glucose levels. Insulin resistance occurs due to various
factors, including genetics, family predisposition, unhealthy eating habits, and obesity.
Because of insulin resistance, glucose cannot be taken up by these organs, causing high blood glucose levels.
The pancreas responds by secreting more insulin, but this does not change the underlying insulin sensitivity.
With persistent high blood glucose, glucose travels to the kidneys and is secreted, a condition called
glucosuria. Glucosuria results in osmotic diuresis, where glucose drags water with it, causing frequent
urination (polyuria). This leads to loss of water and electrolytes, resulting in dehydration and a hyperosmolar
state, a medical emergency. Dehydration stimulates thirst, leading to polydipsia. Insulin resistance can also
cause polyphagia, the urge to eat more, as organs signal they are not receiving enough glucose.
Prolonged dehydration can lead to renal failure due to decreased blood flow to the kidneys. Insulin resistance
also impairs glucose storage in the liver, which may instead release more glucose in an attempt to supply the
organs needing it. Prolonged insulin resistance eventually causes the beta cells in the pancreas, which
produce insulin, to atrophy. This exacerbates the condition, and individuals with diabetes may eventually
require insulin injections to compensate.
A. Biographic Data
Name. VN
Sex: Male
Age: 58 years old
Address: Piat, Cagayan
Religion: Roman Catholic
Status: Single
Source of Information: the patient himself
B. Chief Complaint
The patient says “nakaramdam ako ng panghihina noon October 02, 2024 at hindi ako makalad ng
maayos”
C. History of Present Illness
The patient was diagnosed of Diabetes Mellitus Type 2 at Divine Wellness Medical Center on October
05, 2024.
D. Past History
The disease was known to VN as he stated that he has been diagnosed before at Cagayan Valley
Medical Center. He would always feel weak and unable to walk in the morning and sometimes during
the day. The unfortunate times for VN would be feeling weak throughout the day. He describes that
his muscles won’t just work like they used to. He is unable to walk in proper pacing and he couldn’t
do jumps or runs at all. He used to go to his farm as it is the main income of the family but he is not
able to go anymore because of this struggle. VN also stated that he is challenged to sleep properly at
night and that would only get 3 hours of sleep and wake up due to feeling uncomfortable of feeling
weak.
E. Family History of Illness
VN is not the first to have T2DM but also his cousin and his late aunt.
F. Lifestyle
G. Before the disease was known for VN, he lives his life in a comfortable way as they supply the family
needs through farming, they own a lot in somewhere in Piat, Cagayan. He would wake up early in the
morning to start his way to the farm and would take breaks during snack and lunch periods, also goes
home after sunset. He would have heavy meals during lunch and soft drinks for snacks. He stated that
he would always appreciate pandesal for meryenda. After daylight, he would gather with his friends
and drink alcohol such as beer and brandy which after he goes home for dinner and have another
intake of heavy meals. He later realized that this habit goes for almost everyday and that he’s being
reminded by his wife if he could quit these habits to prevent future health problems. VN has been
living this way since his 40s and stated that he wishes to have listened to those who have reminded
him of what future may bring and have changed the way he lives.
H. Social Data
Nobody would gladly accept this type of life challenge as it requires a volume amount of money to
attain the prime of health. VN expressed that he somehow can manage the financial circumstance his
family is facing as he has savings and some of his family members are earning. The help of the
government programs for hospital bills and drug maintenance is huge he considers.
I. Psychological Data
VN is a cheerful and supportive husband and a father to his family as he still plays the vital role of
manhood. In his early days, he would hangout with his friends and his families. He shows positive
personality in his lifetime as he sends his children to school and has a daughter graduate from college
with a bachelor’s degree. He is mindful that he lacks the extent of being a father but he keeps his faith
in his family that he is doing great.