Professional Documents
Culture Documents
Introduction
In the Philippines, were this study conducted, particularly clients in the Hospicio
de San Jose with diabetes mellitus are present. The Hospicio de San Jose (Originally
1778 by Husband and Wife Don Francisco Gomez Enriquez and Dona Barbara Versoza.
It was first built in Pandacan, Manila then to Intramuros, Binondo, Nagtahan and
Echague and Finally to its present location in 1810. It is a Catholic Welfare Institution
that is the home to Orphans, abandoned and special children and the elderly
considered as a high risk because of their lifestyle and eating attitudes or habits. As we
all know that all clients with diabetes mellitus have problems of excessive intake of food
The queries now lie on how to prevent, cure and care for clients with this
disease. Questions like Isnt the client aware of this matter already?, Isnt the patient
aware of this disease?, and What are the attitudes and beliefs of patient suffering from
this ailment?. It is in this light that the researcher chose to make a study and delve
further into the awareness on diabetes mellitus of selected clients in Hospicio de San
Jose. It is a significant disease because of its deleterious effects on the quality of life of
those affected: It is estimated that by the year 2020, more than 233 million worldwide
will suffer from Type II Diabetes. And for the Philippines the estimate is 3.98 million in
that year.
elevated blood sugar level. It is the result of defective insulin secretion, action or both.
The resulting chronic hyperglycemia is associated with damage to, and subsequent
dysfunction of various organs, especially the eyes, nerves, heart and blood vessels.
systematic disease caused by an imbalance between the insulin supply and the insulin
demand. Insulin is produced by the pancreas and normally maintains blood glucose
level. In diabetes Mellitus, either there is enough insulin, or the insulin that is produced
is ineffective, resulting in a high blood glucose level. Diabetes also causes disturbances
of protein and fat metabolism. These abnormalities are associated with micro and
Diabetes develops when either the pancreas is not producing enough of the
hormone, insulin, to metabolize glucose, or when the insulin fails to act on the receptor
cells in the blood. When blood glucose rises above a certain level, it spills over into the
urine. The condition, which amt be hereditary, affects roughly three percent of men and
two percent of women: up to half of the affected population may not have been
diagnosed.
Through there is no cure for diabetes mellitus, proper insulin therapy and other
modes with the correct diet, enable most patients to live virtually normal lives with
damage of the vision from the rupture of the blood vessel in the eyes as well as
restricted blood flow to the limbs, which may lead to gangrene and subsequent
amputation. Diabetes mellitus is also associated with the risk of coronary heart disease
which is two to three times higher in men and four to five percent higher in women
Improper treatment of the disease can lead to coma and death, which was the
usual outcome before the discovery of insulin in 1921. Fifty years ago, about thirty
percent of pregnancies among women with diabetes mellitus ended in stillbirth or death
of the child within the weeks of birth, as well as a higher percentage of abnormalities.
Today, the figure on stillbirths is far lower with the perinatal mortality rate (total of
stillbirth plus death in the first four weeks of life) of 5.6 percent, compared with 1.4
percent for the general population. Babies of mothers with diabetes tend to be larger
and have an increased risk for complications, such as breathing problems and
of fluid and fats. This is because of the inability of the body to break down the
develop boils and skin infection. About half of the people affected are diagnosed for
some years until the high blood glucose levels are detected in samples of blood or urine
The aim of the treatment in all types of diabetes is to keep the blood glucose
therapy. Prescribed diets involve ensuring that the meals and snacks are so timed that
leading to eventual collapse and possibly coma. It is vital for such patients to swallow
glucose in the blood because of lack of insulin treatment. Unless quickly treated in the
automatic drug injector attached to the body. Small pen sized injectors containing a
cartridge of insulin can be carried in the pocket for ease and treatment.
Non insulin dependent diabetes mellitus also known as Type 2 and is the
commonest form of the disease condition. Formerly known as adult onset diabetes, it
usually affects people aged forty and progresses gradually. In this type, the pancreas
has not ceased to produce insulin, but the quantity is insufficient, or the hormone is not
stimulating the glucose intake in muscles and tissues required for energy. The result is
diabetes mellitus tends to run in the family. Other risk factors such as increasing age,
developed countries.
combination with tablets that reduce the amount of blood glucose. There are two main
types of blood glucose reducing drug which are: a. sulfunyreas working mainly by
stimulating the pancreas islet cells known as the Islet of Langerhans to produce more
insulin, and b. biguanides that increase the effectiveness of insulin on cells. Eventually,
The aim is to maintain blood glucose at the level that is as normal as possible
and to prevent obesity, thus lowering the attendant risk of cardiovascular disease.
Acarbose, the first group in the drugs called alpha-glucosidase inhibitors, was
introduced for treating non insulin dependent diabetes mellitus in 1993. By restricting
the action of alpha-glucosidase, which helps digest sugar and starch in the intestine,
Future approaches to diabetes mellitus that are being explored, include various
insulin delivery systems to speed up body uptake; drugs that protect the pancreatic islet
cells from autoimmune attack; transplant of islet cells or pancreas; and an artificial
pancreas.
Diabetes is a serious disease; People with diabetes are at two times higher risk
for heart attack and stroke, and seventeen times prone to develop kidney disease. Fifty
leading cause of new cases of blindness. It also accounts for twenty five percent (25%)
of new cases of end stage renal disease. And seventy five percent (75%) of diabetic
Diabetes is a costly disease. Ironically ten percent will spend for diabetic care
and ninety percent treatment for the complication. The following illustrates this reality
about the disease: A. Direct cost of care and prevention of disease, and B. Indirect cost
intangible cost like stress, pain, anxiety and loss of quality of life.
Patients with diabetes are at 1.5 times greater risk of hospitalization because of
amputation. Patient with diabetic complications like heart and kidney disease and
stroke, blindness, amputation were hospitalized at an average of 2.8 percent day longer
than the non-diabetic patient with the same problem. The annual cost of blood glucose
management of an in-patient with diabetes is very high, per person per year for patient
seeking additional level of glucose control. It cost hundred thousand per year to achieve
Cost is not only financial but includes psychological cost of everyday living as
well. These are the fees for the diabetologist, ophthalmologist, podiatrist and dietician.
More fees for the laboratory examination, purchase of drugs, blood glucose meter and
stripes and in addition expenses for issuances and diabetes education. A person with
diabetes face psychological problems like job discrimination; and their lifestyle is limited
and restricted.
Diabetes is a continual and added expenses responsibility for self care. It also
imposes extra effort and expenses from the families and the community. The cost of
diabetes is very widespread and growing. Adding up the cost means accounting for the
direct cost to people with diabetes and families, the indirect cost to society and the
with diabetes are predicted to be in Asia. The population of most countries is aging.
the number of people living together. Many individuals have limited access to adequate
health care, and many countries are unable to provide it universally. Access to health
care in Asia and Oceania varies both within and between the countries in the region.
Diabetes is very high in priorities of health care plan in China, Singapore, Malaysia,
Taiwan, Hong-kong and Australia. It has low priority in the Philippines, Korea, and Fiji.
health as continuum from wellness to illness and speaks of an optimal state of wellness.
diseased state of the system. Neuman offers a general proposition that the healthier
the system, the lower the reaction to stress. The prevention of disequilibrium or illness
replication of this Neumans System Model application. The main agenda is wellness or
the body equilibrium, wherein the researcher of this study aims to assess the level of
clients disease awareness and its prevention, therefore by preparing them how to
prevent complication.
conceptualized as prevention focused and the action of the nurse as reconstitution. She
reaction has occurred. In order to prevent the disease like diabetes the patient should
consult a doctor, have complete examination of the blood and urine like fasting blood
2. Secondary Prevention, when the stressor invasion has occurred and action is
taken to prevent the state of equilibrium from progressing to the point at which basic
of lifestyle, b. stop smoking or drinking too much, c. avoidance of foods containing high
sugar, d. taking of the proper diet and doing proper exercises to prevent from other
complications.
by stressors to restore the system of equilibrium to optimal wellness or its stable state.
The whole family is affected, so the patient needs support coming from the other family
members. Intervention at more than one level of prevention may take place
concomitantly. For instance, the nurse may offer assistance at the tertiary level in terms
Neumans model also includes to discuss the client system, where an individual
from the internal and external environment. Neumans systems perspective was chosen
Neuman clearly discusses the process wherein the disease can be prevented.
The theory also replicates the internal and external environment or the milieu itself that
directly affects the disease process, along which similarly the study is being conducted.
Conceptual Framework
aspects related to their disease, diabetes mellitus. These diabetic clients are currently in
essential for health professionals to be better informed so that they may provide better
The system model which guided the researcher in conducting this study is
Systems model has two equally important features which are the structure and
process. The system consists of subsystems. Each system and each subsystem is
complete in itself. As an open system, the human system accepts input from outside
which processes the inputs in a phase called throughput, and explores it in a phase
called output. Equilibrium is the goal of the system. Change (input, throughput, and
output) is a feature of the process and the end product (output) is necessarily different
from what is entered into the system (input). Neuman describes a person as an open
The first column contains the Input, which is concerned with the respondents
demography as a. age, b. gender, c. civil status, and d. length of having the disease.
Furthermore the Input includes also the current data on awareness of diabetes clients
with regard to the nature of disease, diet, wound care, blood glucose monitoring,
exercise, and medication, b. awareness of diabetes clients when grouped according
gender, c. plan of actions that may evolve to help the diabetic client patients be aware
in the first column being utilized to conclude the projected outcome of the study as
This study deals with the disease awareness of diabetes clients in the Hospicio
de San Jose.
1. age,
2. gender,
following areas:
a. nature of disease,
b. diet,
c. wound care,
e. exercise, and
f. medication
gender?
4. What plan of action may be formulated to help the diabetes clients and
I. Demographic
profile of the
respondents in
terms of:
a. nature of
disease, Databank on
b. age, the respondents
c. gender, profile and the
d. civil status, & level of disease
e. length of awareness of
having the diabetes clients
disease.
in the Hospicio
de San Jose thru:
a. questionnaire,
b. survey,
c. interview,
II. Awareness of d. statistical
diabetic clients evaluation, and
with regards to: e. presentation Action Plan
a. nature of of the analyzed
disease, calculated data.
b. diet,
c. wound care,
d. blood
glucose
monitoring, &
e. exercise, and
f. medication.
The study attempt to determine the awareness of clients with Diabetes Mellitus
The researcher conducts this study among diabetic mellitus clients at Hospicio de
Patients are not only limited in any division, wherein 3 female and 3 male
diabetic client is the prime subject of the study. There is no limitation in terms, whether
what type of diabetes mellitus, age, and condition of the client (Physically fit and/or
unfit) they have, as well as they are cooperative and knowledgeable about their disease
The study attempt to determine the awareness of female and male diabetic
clients treatment to attain quality life and awareness needed by the clients.
clients in Hospicio de San Jose; is clearly aimed to make aware of care of the
person suffering from this disease. It is important for the patients to learn as
the diabetic nurses can better plan and implement the needed care for them.
the awareness of individual clients before nurses could implement a certain task
Researcher would come out the reality but it is not enough, considering
Positively speaking the result of the study help them to fully furnish the program
implementation. Future research will add on the present finding for better
made and the guidelines being tested should be to fully utilized. Resources being
used become productive so that the findings provide the directions of the
program.
Definitions of Terms
The following terms used in the current study are concretely defined
study:
Action Plan. It refers to the suggested action plan resulting from the evaluation
Clients. It refers to the one who receives an in-house care in the Hospicio de
San Jose.
marked by insulin deficiency, excess sugar in the blood and urine. It also refers to a
diabetes mellitus awareness from the health practitioner to the clients of the Hospicio
de San Jose. It also concerned their alertness and responsiveness to the disease.
Footcare. It refers to the way were the clients care their foot, and or either
diabetic foot.
regarding diabetes mellitus disease in this present time of study. It will categorize as
Medication. It refers to the way were the clients take their diabetes mellitus
medications.
Nature of Disease. It refers to the signs and symptoms were the client
Quality Life. It refers to the feature of life free from any diseases or at least
training seminars locally to provide insights and clear direction as to the dimension of
the study. This chapter has been prepared with the following topics subtopics; related
local studies related foreign Studies related local literature and related foreign literature.
FOREIGN LITERATURE
Nimencio Nocodemus Jr, from Minnesota, U.S.A. (2013) notes that the Diabetes
Control Complication Trial and the Stockholmn Study have conclusively demonstrated
that improving blood glucose control in patients with diabetes mellitus, reduces the risk
and the blood glucose goals modified if necessary to reduce the risk.
patient. Several variations of intensive treatment program can be used, with no definite
superiority of one treatment method over the other. Individualization is the key to
success. Each program has the same general principles. Regular insulin is used to
control the postprandial glucose excursion and a slow infusion of regular insulin by a
pump or injected, intermediate or long acting is used to balance fasting blood glucose
In addition to reducing blood glucose, treatment goals should include those for
bodyweight, blood lipid, blood pressure, exercise, and monitoring frequency. Insulin
Eric Nagourney (2013) observed that millions of Americans once given clean bills
of health may now qualify for diagnosis of a condition known as prediabetes. The
American Diabetes Association released the new guidelines for the doctors to use when
looking for the problem. There are two main methods to assess whether a person has
prediabetes. One, patients fast overnight and then their blood is drawn in the morning
and the glucose levels are tested. With the other method, patients are given the
morning test and are retested after drinking a sugar solution. The new guidelines lower
the acceptable level of blood glucose to one hundred milligrams a deciliter from one
hundred ten.
is considered a serious condition because almost everyone develops diabetes for the
first time. Moreover, recent research has shown that even before full scale diabetes
occurs, prediabetics may suffer damage to the heart and circulatory system. The new
guidelines are important, according to some experts because after the doctor learns
that their patients are predaibetic, they can take steps to prevent the condition from
persons weight that correlate with the risk of heart disease and other diseases of such
nature, is the waist circumference. This shows the location of fat in the body is more
important that the degree of overweight itself. In predicting ones susceptibility to have
another disease, the amount of visceral or intra-abdominal fat can be gauge by simply
measuring the waistline. This is independent of the total body weight. If the body
weight index were close to one normal susceptibility to having type 2 diabetes mellitus
and heart disease is increased when the waistline is above the healthy values.
almost universally thought that insulin resistance was caused by primary genetic factors
and the impaired insulin secretion was secondary to the beta cell exhaustion after a
year of compensatory hyper secretion. This concept has now been challenged by the
recognition that impaired beta cell function can be detected earlier than resistance in
insulin release. It was also observed that type 2 diabetes can occur without insulin
resistance, but not without impaired insulin secretion; that weight loss in obese patient
can normalize insulin sensitivity but not impaired insulin secretion. The most of the
insulin resistance in type 2 diabetes seems to be accounted for the obesity, especially
central obesity, glucose toxicity, physical inactivity and high fat diet. Despite the fact
that insulin resistance appears as the mainly acquired defects, mathematical analyses
indicated that it contributed as much as impaired beta cell function to impairing glucose
tolerance. Therefore both insulin resistance and impaired insulin secretion are important
therapeutic targets.
Type 2 Diabetes. These agents stimulates beta-cell insulin secretion by acting on high
affinity beta-cell receptors and promoting target cell sensitivity to glucose, the new oral
metabolized, with long duration of action. It lower blood glucose in the same manner as
other sulfonylureas, by inhibiting the pancreatic cell, thus stimulating the release of
insulin.;
He explained that diabetes starts out in a genetically prone individual with one hundred
percent insulin sensitivity, and whose insulin secretion is one hundred percent efficient.
The development of the disease can be triggered by a change in the persons diet or
eating habits and reduce physical activity, which result in decreased insulin sensitivity.
At this early stage, the beta-cells of the pancreas, which are responsible for secreting
insulin, can overcome the higher demand by hyper secretions within normal ranges.
Frequently, diagnosis is made past this stage, when insulin sensitivity has become
receptor, and plasma half-life. Professor Rosak compares the glucose lowering effect,
noting that the peak and beyond understanding of therapeutic action is comparable for
the drugs.
Allane Hernandez (2012) from the original article Physical fitness and risk factor
for type 2 diabetes, assessed the relationship between the changes in maximal oxygen
uptake and sub maximal maker of aerobic fitness to changes in risk factor for
cardiovascular disease and type 2 diabetes following the twenty weeks endurance
training program.
Because of the changing way of life in modern society, sedentariness and obesity
have become serious and growing problems worldwide. Physical inactivity and obesity
are not only associated with a member of health related risk factor but also,
independent risk factor type-2 diabetes. There is good evidence that regular physical
activity has protective effect against several chronic disease including coronary heart
anxiety. Recently, lifestyle intervention, including regular physical activity and dietary
modification, have been shown to reduce the risk of progressing from impaired glucose
tolerance to type-2 diabetes and also been shown to improve several risk factors.
Physical activity may protect against in part through reduction of risk and other
associated with lower weight and, particularly lower visceral fat accumulation, higher
HDL cholesterol and lower triglyceride level, lowers the blood pressure and improves
the insulin sensitivity. Based on interventional and epidemiological evidence, the Center
for Disease Control and Prevention and the American College of Sport Medicine
Yoshita Yajima M.D. Ph. D. (2012) Professor, Internal Medicine, says diabetes is
a lifelong disease. But this does not mean that the diabetes is hopeless. Diabetes can
be controlled. A person with this disease can continue to live a productive, happy life.
Whereas for NIDDM/ Type II diabetic patient can be controlled entirely through diet,
weight reduction and adequate physical activity. But most NIDDM/Type II do not
respond very well to this regimen, and also requires oral antidiabetic drugs known as
oral hypoglycemic.
Further, some NIDDM/Type II diabetic patients find diet exercise and even anti
diabetic drugs are not enough to control their blood sugar level. They require insulin for
the best management of their diabetes. The long-term goals of diabetic therapy are to
minimize, delay or entirely prevent complication and to let diabetic patient live a normal
life. Diabetic patients who develop diabetes after the age of forty have had the disease
for five years or less and who have never taken insulin respond best to oral anti diabetic
drugs. Sixty to seventy percent if NIDDM/Type II diabetic patients respond well to oral
anti diabetic drugs, but never respond to what and need insulin. There is still another
group who does well at first but gradually stops responding. These patients eventually
need insulin.
Allan J Jarber (2013) said the epidemic proportion reached by the obesity and
type 2 diabetes represent remarkable challenge to the medical community which has
been trained and to treat the heart disease rather than to prevent, even the context of
primary prevention to estimate the risk on the basis in the presence of classical risk
factor. As type 2 diabetes is recognized the risk factor it is important understand which
feature of diabetes are responsible for this markedly increased risk factor.
FOREIGN STUDIES
J. Rosenstock M.D.S.L. Schwartz M.D. and C.Clark M.D. (2016) observed that
insulin treatment can improve and maintain glycemic control, thus preventing long term
complications in type 2 diabetes mellitus. Most patients with this type of diabetes,
experience progressive b-cell dysfunction and will require insulin therapy, either alone,
or in combination with oral agents, for satisfactory glycemic control. The novel
two argines are added to the b-chain and glycine is substituted for asparagines at the
Kare Creason Sorensen (2013) presented the data on the beta cells dysfunction
studies in both Mexican American and Pima Indians have shown that insulin secretory
defects and insulin sensitivity defects confer equal relative risk of development of
diabetes in person with apparently normal glucose tolerance. Recent data that Pima
goups shows in the normogycemic subject that progress to diabetes during a five year
period have easily and coincidentally decreased in insulin sensitivity and insulin
match the declining sensitivity. Failing islets secrete specific markers that provide clues
on the pathogenesis of their progressive destruction. Amyloid fibrils may be toxic to islet
cells, leading to beta cell apoptosis and replacement of the islets by amyloid. This is
likely to be as final common pathway fro beta cell loss in the type 2 diabetes
Dr. Diana Chau and Steven V. Edelman (2013) in the fall issue of Clinical
Diabetes noted Goals of therapy for the elderly diabetic patients should include the
evaluation of their functional status, Life expectancy, social and financial support, and
their own desires for treatment. A full geriatrics assessment performed before
establishing any long term therapy may aid in identifying potential problems that could
significantly impair the success of a given therapy. Often, elderly patients have
depression, and difficult social issues that need to be addressed. The population of the
elderly is increasing and more attention should be paid to the complex needs of the
Professor Sir Frank Snoek (2008) observed that we are heading for one of the
biggest health catastrophes that the world has ever seen. People with Impaired Glucose
Type 2 diabetes constitutes about eighty to ninety five percent of all diabetes
cases recorded in developed countries, and account for higher percentages in the
increasing urbanization, dietary changes, reduced physical activity, and other unhealthy
occurring in both developed and emerging nations, where it is the most prevalent in
urban areas. The risk of developing type 2 diabetes is also clearly linked to increasing
prevalence of obesity.
Professor Perre Levebvre (2009) said that is action is not taken now to stop the
rise in diabetes, there is significant risk that government and social security systems
may fail to ensure the appropriate care to the millions who will be affected by diabetes
in 2025. Moreover by promoting diabetes prevention, we will ensure that those millions
who already have diabetes will not face the nightmare of regression in the quality of
care they deserve while, on the contrary, there is great need in many parts of the world
to improve it.
important because of the key factors that induce a variety of risk factors simultaneously
in one individual. The key factors may directly relate the vascular changes. He added,
the primary or genetic insulin resistance is very rare and most insulin resistant state is
induced visceral obesity. Visceral obesity accumulates the key factors that are located at
LOCAL LITERATURE
Medical center. Teaching is not a new role for nurse In Nursing history health teaching
is focused about sanitation housing and care for sick in the hospital and community
today education and training preventive health practices and health promotion are
Our teaching nurse being a member of the health care team usually spends more
time patients or client than other team members. This contact provides in her the
opportunity to develop rapport and build a trust relationship with the patient and
he/she is able to complete the assessment of an individual patient learning needs and
Hard work and dedication are pre-requisites for a nurse to become diabetic nurse
Trinidad said anything worthwhile is usually challenging and requires hard work
leadership should be a positive force and could lead by setting achievement goals for
Diabetes care is complicated. It is expensive .it requires that the person with the
diabetes be knowledgeable have good cognitive and motor skills be able to solve
the education is increasing commitment and participation of the patient in the teaching
/learning process and the follow-up care teaching nurse are greatly involved in this
task.
Sanirose S. Orbita (2011) a clinical and sport nutritionist said that diet could be
very complex maintaining diet one can accept and stick to will always be a challenge for
patients the doctor and the nutritionist with the proliferation and accessibility of diet
the patient is left in the quandary. Dieticians have to present the diet in away the
patient will understand complying this in itself is a huge task. To prevent information
overload, focus should be on the most important and relevant information based on
patients lifestyle.
The following strategies for patient, doctor and dietician to promote diet
week. Initially, following the diet four times a week may promote better adherence.
Later this can increase a commitment. Short-term goals can lead to long-term
successes.
Augusto D. Litonjua, M.D. (2013) observed that increasing body weights bodes
ill for many persons, because this also increases the risks for other diseases such as
type 2 diabetes mellitus and heart diseases among others. Body weight is measured in
term of the body mass index, which is the weight in kilogram divided by the height in
meters squared. Using the Asia Pacific Guidelines, obesity means that for a woman,
thirty five percent of the weight is fat; while in man being obese indicates that thirty
Grace Delos Santos, M.D. (2011), noted that abnormalities of insulin secretion
occur early in the pathogenesis of type 2 diabetes. Most of the time the abnormalities
are present when the diagnosis is made. Oral administration of drugs aimed at
diabetes. At present, benzoic acid is used, and the d-phynylalamine derivatives added
to this class of medication the group of medicines that stimulate insulin secretion.
consequent rise in cytosolic calcium dependent regulatory protein responsible for the
Marcelo A. Lim, M.D. (2011) also observed that the weight gain precedes the
development of diabetes. He also inferred that the weight gain leads to increasing
insulin resistance, until finally the output of insulin from the beta cell is unequal to the
demand. The scenario gives beta cells dysfunction a secondary role to weight gain and
insulin resistance in the pathogenesis of the type 2 diabetes. However, ranging from
the results of epidemiologic survey of metabolic and molecular studies, suggest that the
beta cell dysfunction may play a role in the development of type 2 diabetes and ever for
Dr. Rosa Allyn Sy (2008) from Cardinal Santos Medical Center, noted the
educational tool for health care professionals while counseling patients on healthy
eating habits. Just a year ago. The Philippine Association for the Study of Overweight
and Obesity (PASOO) supported by the president and other officer and members of the
Board of Directors conceptualized the Filipino Pyramid Guide. Similar to a food guide, it
is intended to help diabetes educators illustrate more clearly which activities would be
beneficial to their patients. The activity pyramid guide uses simple and easy action
words or instructions like habitually, often. Regularly and Minimal to indicate activities
that would provide the most benefit in terms if cardiovascular and metabolic health.
Included in the guide is the number of calories burned per minute per kilogram of body
weight of the person performing the activity. The base of the pyramid includes
activities, part of our daily routines, when performed habitually or daily routines, when
performed habitually or daily for a minimum of 30 minutes, even ten minutes at a time
So if one is diabetic, obese, with poor sugar control and have never engaged in
any form of exercise before, activities like walking, climbing the stairs, or doing
household chores may be a good start. It is important to note that for beginners, the
amount of cumulative activity time is more important than the specific type and manner
of activity. Aerobic exercises like jogging, brisk walking, swimming, aerobic dancing and
recreational activities like ballroom dancing, badminton, tennis, etc., burn more calories
per millimeter per body weight and are advised for those who want to lose more
weight. To get the most benefit from the activity, it has easy action words or
instructions which can be done 3 -5 times a week for at least 30 45 minutes. These
activities will improve cardiovascular endurance. The Filipino Pyramid Activity Guide is
intended to be a guide that should help everyone selects an activity that best fits his
lifestyle and health needs. Just thirty minutes of the different activities over the course
Tina Abotiz Yulo (2012), Fitness Instructress and columnist of the Philippine Daily
Inquirer wrote As a diabetic you already know that exercising regularly is an important
part of keeping your lifestyle. There are new and exciting trends for you to choose
from.
Tae Bo is also called aerobics kickboxing. Tae Bo is not a wise choice if one has
not exercised before. And even if one were relatively fit, one needs to join a beginners
class. Kickboxing uses explosive movements one is not used to do, Gradual progression
is very important if one wants to stay free from injury. Be aware that kickboxing
this type of exercise may not be appropriate because even if wearing gloves and the
bags and your sparing partners are padded, one hand and feet still take a beating.
Pilates, those machine-based exercise programs develops the trunk and leg
muscles in a gentle, non-impact but challenging manner. One will not get any
cardiovascular benefits strength and flexibility. A good teacher will offer modification for
beginners. The arms are probably the place to inject since they are not used as much
Tai Chi. This is an all around, gentle form of exercise that is suitable for almost
everyone. It can lower the blood pressure, increase the muscular endurance in the legs,
improve balance and coordination and relieves stress. Even though it is not stressful on
the feet, one should also check the blister and small cuts as standard procedure.
practiced. Some positions put pressure on hand and feet, so always do a thorough
Andrew Delos Angeles (2007), Food Technologist from Bureau of Food and
Drugs wrote an article on Diabetes Mellitus and herbal supplements which have been
New drugs have also been developed intended to affect the organ responsible for the
development of the disorder. Most of these drugs mimic the insulin secreting bet-cell of
the pancreas. The net effect would be imitating the action of insulin or serum glucose.
Other than drug, there are new products that somehow approximate the action
these new drugs have against diabetes mellitus and its accompanying complication
Glucose homeostasis is the basic principle of this health product mode of action. As
food supplements or food products, their main function is to assist in the proper
nourishment of the human body. This is merely to assure its proper nourishment and
nothing more. However, there is no guarantee in using these products, based on some
laboratory results to prevent or even cure disease as viewed by some physician and
researchers.
Murallo, (2013) wrote that patients which diabetes tend to have higher levels of
low-density lipoprotein or very bad cholesterol that clog up the arteries. They also tend
to have high level of triglycerides, the sidekicks of bad cholesterol, and low levels of
high density lipoprotein or good cholesterol, the kind that help clean the artery.
Most patients with type 2 diabetes are overweight and harbor excess fat. These
fat cells may release a bunch of nasty factors such as tumor necrosis factors that can
promote not just atherosclerosis, but swelling, or inflammation in the blood vessel and
blood clots, all of which increase the risk of cardiovascular disease. She added that
these patients likewise have a higher chance of having high blood pressure which also
Jesus Sarol, (2013) observed that the importance of self monitoring of blood
glucose per se is not a cure for diabetes, the method is meant to increase patients
awareness of blood glucose levels to empower them to make the necessary treatment
optimally, but this approach can only be done through the guidance of a health
demonstrated that improving blood glucose control in patients with diabetes mellitus
reduces the risk of developing retinopathy, neuropathy, and nephropathy. The
Likewise, Eric Nagourney contributes the two main methods to assess whether a
person has prediabetes. One, patients fast overnight and then their blood is drawn in
the morning and the glucose levels are tested. With the other method, patients are
given the morning test and are retested after drinking a sugar solution.
persons weight that correlate with the risk of heart disease and other diseases of such
lifelong disease. But this does not mean that the diabetes is hopeless. Diabetes can be
J. Rosenstock M.D.S.L. Schwartz M.D. and C.Clark M.D. observed that insulin
treatment can improve and maintain glycemic control, thus preventing long term
Center. Teaching is not a new role for nurse thus, the role of nurses in awaking
diabetes clients.
Augusto D. Litonjua, M.D. observed that increasing body weights bodes ill for
many persons, because this also increases the risks for other diseases such as type 2
All the above literature and studies presented in this research study are directly
related and help the readers understand and awaking them for future references.
CHAPTER III
RESEARCH METHODOLOGY
The chapter presents the research design, and the methods and/or procedures
utilized in gathering and validating as well as aid in the analysis of the data collected in
this study. This chapter also represents the sources of the data, the number of
respondents from the data collected, the instruments to be used for data collection,
the way in which data for data collected, and the way in which the data will be treated
statistically.
Research Design
Manalaysay, et. Al (2014), it is the designed to determine the extent to which different
variables are related to each other in the population of interest. The critical
the awareness on diabetes mellitus of diabetic clients at Hospicio de San Jose when
they are grouped according to gender as expressed in the problem statement and
hypothesis.
Locale and Population
The focus of this study is 6 adult diabetes patients who are admitted and
underlying care of the Hospicio de San Jose. The respondents will be selected using the
following criteria:
in the research.
4. The client, by no means has any pre arranged clients education program with
Research Instrument
The researcher selected 6 clients by purposive sampling and who are admitted
from the period of study. This purposive sampling simplified the number of respondents
translated in Filipino words so that the client understands carefully and for their
convenience in answering.
Data Gathering
office and securing permission to conduct the study, the following are the steps
questionnaire, the selected five respondents will not be included in the actual
c. After testing, the researcher consults the adviser and finalized the
questionnaire.
The data gathered from the respondents were subjected to the following
statistical treatment:
a. The frequency of the responses for each item was determined by the
computation of the numbers of the respondents who made a check as a particular item
to determine the profile of the respondents; a simple percentage was used through this
formula: P= f x 100
-------
N
Where:
P= Percentage
= the sum of
F = frequency
N = number of respondents
b. The weighted mean will be computed and the weighted frequency for each
item will be determined by multiplying the frequency for each item by the weighted
mean of the said item in the instrument using the Likert five point numerical scales. The
rating scale used in answering the questionnaires and its interpretation is as follows:
However the final interpretations from the over-all mean of the tabulated
frequencies of the respondents regarding level of awareness is interpreted using the
following scale:
The summation of the weighted mean frequencies was determined by adding the
entire weighted mean for a particular item in the questionnaire, likewise the average
The weighted mean of the weighted frequencies was computed through this
formula:
WM = wf
f
Where:
WM = Weighted Mean
wf = Summation of Weighted Frequencies
f = Sum of Frequencies of the computed
weighted mean
X2 = 2
Where:
X2 = Chi-Square
O = Observed Frequency
E = Expected frequency
CHAPTER IV
This chapter deals with the presentation, analysis and interpretation of data
1.1 age,
1.2 gender,
1.3 civil status,
1.4 educational attainment, and
1.5. Length of having the disease?
Table 1
Respondents According to Age
AGE Female % Male % COMBINE %
Table 1 shows the breakdown of all the respondents according to age. With a
total frequency of six (6), half or 50% percent are female which are equal to the male
Diabetic clients belong to the higher age bracket due to the reason that the
disease usually affects those who are not so active anymore with activities. Being at
their present age, their movements become slower and their physical health prone to
sickness and their location where they are being cared of.
Table 2
Respondents According to Gender
GENDER Female % Male % COMBINE %
Table 2 shows the summary of all the respondents according to gender. There
present illness.
Table 3
There are two (2) or 33.3% married respondents, one (1) or 16.6% is separated and
This only shows that the clients of Hospicio de San Jose accept whatever their
statuses are.
Table 4
72 College units.
Table 5
Table 5 displays the number of years the diabetes client have been suffering
from the disease. Four (4) or 66.6% of them are within 16 to 20 years of having the
disease now, while only two (2) or 33.3% for 26 years and above.
Estimating the ages of the respondents in Table 1 and relating it in the above
table (Table 5), we may conclude that most of diabetic clients may have had diabetes
way back at the age of thirty (30) to forty (40) years old.
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
disease. With a weighted mean of 4.17 with verbal interpretation of most often
meaning that the respondents are highly aware , respondents noticed that they urinate
more than the usual. Respondents also feel thirsty and hungry based on the weighted
mean of 4.3. The lowest weighted mean for this category is 3.8 or often even though
they are also highly aware, hence, the respondents also encountered blurring of
vision
First and foremost, the clients must be reminded of the nature of the disease
they are suffering from. They must familiarize themselves with the usual symptoms like
blurring of visions, sweating, thirst and hunger to name a few, so that they will know
what to expect in the event that they may experience one of these.
Table 7
Respondents Level Of Awareness According
to Diet
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
to the survey, respondents occasionally eat all the food they want as long as there are
medicines, and that they limit food intake rich in carbohydrates such as rice, bread and
etc. with a weighted mean of 283. Likewise the over-all mean of 2.6 indicates that the
very important, such that a client must consult a dietician or a diabetic educator to
guide them and educate them on the correct mix-and-match of foods not detrimental to
their health.
Table 8
Respondents Level Of Awareness According
to Foot care
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
reveals that the clients are not giving attention on their foot like changing socks
regularly and wearing proper Footwear. This entails on the weighted mean of the
survey responses of 1.49 meaning that the respondents are low aware.
Table 9
Respondents Level Of Awareness According
to Blood Glucose Monitoring
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
presented in Table 9. On this table revealed over-all mean of 1.99 indicates that the
respondents were moderately aware. It also shows that respondents seldom check their
blood glucose with a weighted mean of 1.66. They also seldom monitor their blood
glucose at least twice a day based on the weighted mean of 1.66. But it was found out
that the respondents occasionally monitor their blood glucose four times a day
especially when they are sick based on the weighted mean of 2.6.
Table 10
Respondents Level Of Awareness According
to Exercise
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
10. Findings show that the respondents seldom sees nurse educator and doctor
therefore that they are seldom clarify the benefits of doing the exercise regimen
meaning to say that the respondents are (wm= 1.66) moderately aware on this
program. They also said that they seldom perform exercise as long as they have time.
Exercise is a physical activity that is encouraged to all diabetic clients to do. This
activity, if done regularly, makes the body stronger and resistant to further disease
complications.
Table 11
Respondents Level Of Awareness According
to Medication
Legend:
INTERPRETATION INTERPRETATION
WEIGHT MEAN RANGE WEIGHTED MEAN OVERALL WEIGHTED MEAN
5 4.50 - 5.00 Always (A) Highly Aware (HA)
4 3.50 - 4.49 Most Often (MO) Highly Aware
3 2.50 - 3.49 Occasionally (O) Moderately Aware (MA)
2 1.50 - 2.49 Seldom (S) Moderately Aware
1 1.00 - 1.49 Not at All (NA) Low Aware (LA)
an interval time. If taken properly, at a correct dosage and time, the condition of the
client will improved. It is just up to the client to comply with the requirements of the
prescribed medication.
It shows that respondents occasionally drink the medicine as instructed (WM = 2.33),
3. How do the levels of disease awareness of the diabetic clients differ when
they are grouped according to gender ?
Table 12
Significant Difference Between the Level of Awareness When Grouped
According to Gender
Male Female
Mean 2.89 2.81
Variance 0.15 0.17
Df 10
t Stat 0.34
P-value 0.74
t Critical two-tail 2.23
Table 12 displays the result of t-test between the level of awareness of the
respondents when grouped according to gender. The p-value of 0.74 is less the 0.05
level of significance. It may be concluded that the level of awareness of the female is
The study was focused on the diabetes clients in Hospicio de San Jose,
researcher decided to include all the present clients for more intensive campaigned
due to the extensiveness of the disease, and it will be prevented at Hospicio de San
General Objective: Top provide a safe and positive environment wherein diabetic patients can
live normal life
Problem Specific Strategy/Activity Person Time Expected Outcome
Objective Involved Frame
Commu- To provide Promote open Communication
nication effective by:
Barrier communi- 1. Asking client in each visit Physician End of A better understanding of diabetes
cation what concern they have about Consultation prevention & control
between Diabetes.
physician,
client,
caregiver
and nurse 2. Review the short term goal Client A closer doctor and clients relationship
agreed on the initial visit.
General Objective: Top provide a safe and positive environment wherein diabetic patients can
live normal life
Problem Specific Strategy/Activity Person Time Expected Outcome
Objective Involved Frame
Ignora- To increase Health Education Plans and
nce of the level of Program:
Comp- awareness on
1. Conduct lectures in the unit
the effects
lication complication including all health workers and Health
significant others (as referred) Carriers , & As needed Increased awareness level of client on
of diabetes
the effect of emotions
clients
This chapter presents the summary description of the conducted of the study
and its findings, the conclusions based on the analysis of the data gathered and some
This study dealt with the level of awareness on diabetes among clients in
Summary of Findings
1.1 age,
1.2 gender,
1.3 civil status,
1.4 educational attainment, and
1.5. Years of having the disease?
1.1. Age & Gender. 6 or 100% are belong to 61 years old and above are
respondents responses in terms of age, half or 50% percent are female which are equal
1.3. Civil Status. Two (2) or 33.3% with same percentage for married and
widower respondents plus one (1) or 16.6% with same percentage in separated and
2.1 Nature of Disease. The Hospicio de San Jose clients respondents are highly
aware in the nature of Diabetes Mellitus resulted from their a weighted mean of 4.17
(Table 6).
2.2. Diet. Respondents occasionally eat all the food they want as long as there
are medicines, and that they limit food intake rich in carbohydrates such as rice, bread
and etc. with a weighted mean of 283. Likewise the over-all mean of 2.6 indicates that
2.3. Foot care. Weighted mean of 1.49 meaning that the Hospicio de San Jose
respondents are low aware in terms of foot care and they did not giving attention on
2.4. Blood Glucose Monitoring. On over-all mean of 1.99 indicates that the
(Table 9).
2.5. Exercise. The respondents are moderately aware of the program, even
though they are seldom doing an exercise and clarify the benefits from nurse and
(Table 11).
The level of awareness of the respondents is the same even when they are
grouped by gender.
Conclusions
The framework of the study reflects the different indicators of level awareness as
Looking closely into the profile of the respondents, there are all belong to the
age of 61- above. Male respondents composed of 50 % which is equal the number of
female respondents. Thirty three point three percent (33.3%) on both married and
separated respondents and mostly, they came from High school level.
On the data presented and interpreted in the level of awareness of the
respondents in the different areas, they are equally interpreted as moderately aware
medications, exercise, blood glucose monitoring, diet and highly aware on their nature
Subsequently, by merely looking at the data presented, one can say that there is
grouped by gender.
Recommendations
1. Hospicio de San Jose should continue its noble work of delivering quality client
2. Hospicio de San Jose and its affiliates should provide clients continuous
by the other health institutions and/or other health centers to facilitate proper health
6. The result of this study may be integrated in Nursing Curriculum for the
A. BOOKS
Rizza, Robert S., Medical Clinic of North America DM, Phildelphia W.B.
Sauders Company, 2012
B. THESIS/DISSERTATION
C. Manual , Journal
Sy, Rosa Allyn., The common sense guide to weight loss, Diabetes
Watch, 2008
Trinidad, Susan., Noghtingales Pride: Teaching in Nurses Action:
Diabetes Watch. 2012
D. Website
www.diabetes.org/diabetescare
www.diabetesphil.org
www.diabetes/20mellitus.html
E. Others
Direction: Please accomplish the questionnaire by checking the items that best describe your
answer
1. Age
_______ 20-25 years old ________ 46-50 years old
_______ 26-30 years old ________ 51-55 years old
_______ 31-40 years old ________ 56-60 years old
_______ 41-45 years old ________ 61- above
2. Gender
_______ male ________ female
3. Civil Status
_______single ________ widower
_______married ________ separated
4. Educational Attainment
Direction: Mark or Check (/) corresponds to your understanding and the things you do your
diabetes. Used the scale below for your answer.
(Lagyan ng tsek ang sagot na malapit o tumpak sa iyong kaalaman sa dapat gawin ng isang diabetiko.
Gamitin sa pagsagot ang panuto sa ibaba )
5 Palagi Always
4 Madalas Most Often
3 Paminsan - minsan Occasionally
2 Bihira Seldom
1 Hindi Not at all
A NATURE OF DISEASE 5 4 3 2 1
ITEMS
1 I urinate more than unusual
(Naiihi ako ng mas madalas sa iba)
2 I feel thirsty and hungry.
(Pakiramdam ko ay laging uhaw at gutom)
3 My wound doesnt heal naturally.
(Yung sugat ko ay hindi madaling gumaling)
4 I encountered blurring of my vision.
(Nanlalabo na ang aking mata)
B DIET 5 4 3 2 1
ITEMS
1 I eat all the foods I wants as long as there is medicines.
(Kinakain ko ang lahat ng gusto kong kainin basta
umiinom ako ng gamot)
2 I go after to the approved diet that my diabetic educator
teaches.
(Sinusunod ko ang ipinayo nilang diet para sa akin)
3 I do limit food intake rich in carbohydrates such as rice,
bread and etc.
(Di ko nililimitahan and mga pagkaing sagana sa
carbohydrates tulad ng kanin, tinapay at ida pa)
C FOOTCARE 5 4 3 2 1
ITEMS
1 I regularly go to the parlor for my pedicure
(Lagi akong pumupunta sa parlor para magpapedicure)
2 I frequently check my foot if there is any calluses
(Lagi kong tinitingnan ang aking paa kung may mga
kalyo, corns, at saka blisters)
3 I go to the doctor if I have lacerate wound
(Lagi akong pumupunta sa doctor kapag ako ay may
sugat)
D. BLOOD GLUCOSE MONITORING 5 4 3 2 1
ITEMS
1 I check my blood glucose if I have signs and symptoms of
hypoglycaemia
(Kumukuha ako ng blood glucoe kapag nakakaramdam ng
sintomas ny hypoglycaemia)
2 I monitor my blood glucose four times a day when I sick
so as to avoid any untoward complication that may
happen
(Tinitinganan ko and blood glucose apat na beses sa isang
araw kapag ako ay may sakit para maiwasan and
anumang komplikasyon)
3 I monitor my blood glucose at least twice a day
(Minomonitor ko ang blood glucose kahit dalawang beses
isang araw)
E EXERCISE 5 4 3 2 1
ITEMS
1 I ask my doctors advice before doing the exercise
program.
(Kumukunsulta ako sa doctor bago magsimulang
magehersisyo)
2 The diabetic nurse educator and doctor clarify the benefits
of doing the exercise regimen.
(Ipinapaliwanag ng diabetic nurse educator at doctor ang
kahalagahan ng ehersisyo)
3 I perform exercise as soon as I have time.
(Nag eehersisyo lang ako pag may oras)
F MEDICATION 5 4 3 2 1
ITEMS
1 I dont drink my medicine when my blood sugar is
controlled.
(Hindi ako umiinom ng gamut kapag mababa ang aking
blood sugar)
2 I drink my medicine as instructed.
(Iniinom ko ang gamut ayon sa ipinayo ng aking doctor)
3 I seek consolation to a diabetic nurse educator and to the
doctor if experience sign and symptoms of hypoglycaemia
after drinking medication given.
(Kumunsulta ako sa isang diabetic nurse educator at
doctor kapag nararamdaman ko ang mga sintomas ng
hypoglycaemia)