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Chapter 1

Introduction
Background of the Study
Diabetes is a condition where the amount of glucose in your blood is too high
because the body cannot use it properly. This is because your pancreas doesnt produce
any insulin, or not enough insulin, to help glucose enter your bodys cells or the insulin
that is produced does not work properly (known as insulin resistance). Diabetes develops
when glucose cant enter the bodys cells to be used as fuel.
There are two main types of diabetes: Type 1 Diabetes and Type 2 Diabetes. This
happens when either: There is no insulin to unlock the cells (Type 1 Diabetes) or there is
not enough insulin or the insulin is there but not working properly (Type 2 Diabetes). The
causes of Type 1 Diabetes are the lack of insulin due to the destruction of insulinproducing beta cells in the pancreas, heredity plays an important part in determining who
is likely to develop Type 1 Diabetes, and environmental factors, such as foods, viruses,
and toxins, may play a role in the development of Type 1 Diabetes, but the exact nature of
their role has not been determined. The causes of Type 2 Diabetes is caused by a
combination of factors, including insulin resistance, a condition in which the bodys
muscle, fat, and liver cells do not use insulin effectively, ethnic group (most prevalent in
Caucasian, especially those with backgrounds in Northern European regions, such as
Scandinavia), genes play a significant part in susceptibility to Type 2 Diabetes, having
certain genes or combinations of genes may increase or decrease a persons risk for

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developing the disease, physical inactivity and obesity are strongly associated with the
development of Type 2 diabetes, insulin resistance is a common condition in people who
are overweight or obese, have excess abdominal fat, and are not physically active, and an
abnormal increase in glucose production by the liver also contributes to high blood
glucose levels.
The one who are most likely to have Type 1 Diabetes are children to young adults.
The one who are most likely to have Type 2 Diabetes are middle-aged to older people
who are most likely to be overweight or obese. The disease, once rare in youth, is
becoming more common in overweight and obese children and adolescents, history of
giving birth to a baby weighing more than 9 pounds, high blood pressure (140/90 or
above) or being treated for high blood pressure, and a high-density lipoprotein (HDL), or
good, cholesterol below 35 milligrams per decilitre (mg/dL), or a triglyceride level above
250 mg/dL. Scientists think genetic susceptibility and environmental factors are the most
likely triggers of type 2 diabetes.
The symptoms of having diabetes are excessive thirst, frequent urination, weight
loss, fatigue, visual disturbances (such as blurred vision), itchy skin (particularly around
the genitals), increase hunger, slow healing of sores or frequent infections, areas of
darkened skin, tingling in your hands and feet, sexual dysfunction, and nausea and
vomiting.
There is no known cure for diabetes at this time; however, there are treatments for
it. Controlling of blood sugar (glucose) levels is the major goal of diabetes treatment, in
order to prevent complications of the disease. Type 1 Diabetes is managed with insulin as

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well as dietary changes and exercise. Type 2 Diabetes may be managed with non-insulin
medications, insulin, weight reduction or dietary changes. The choice of medication for
Type 2 Diabetes is individualized, taking into account: the effectiveness and side effect
profile of each medication, the patients underlying health status, any medication
compliance issues, and cost to the patient or health-care system. Medications for Type 2
Diabetes can work in different ways to reduce blood glucose levels. They may: increase
insulin sensitivity, increase glucose excretion, decrease absorption of carbohydrates from
the digestive tract, or work through other mechanisms. Medications for Type 2 Diabetes
are often used in combination. Different methods of delivering insulin include: syringes,
pre-filled pens, and insulin pumps.
Proper nutrition is a part of any diabetes care plan. There is no one specific
diabetic diet that is recommended for all individuals. Pancreas transplantation is an
area of active study for the treatment of diabetes. The major goal in treating Type 1 and
Type 2 Diabetes is to control blood sugar (glucose) levels within the normal range, with
minimal excursions to low or high levels. Type 1 Diabetes is treated with insulin, exercise
and a diabetic diet. Type 2 Diabetes is treated: First with weight reduction, a diabetic diet
and exercise, and oral medication are prescribed when these measures fail to control the
elevated blood sugars of Type 2 Diabetes. If oral medication becomes ineffective
treatment with insulin is initiated.

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Statement of the Problem


The study sought to determine what diabetes is. Specifically, these studies have the
answers to the following questions:
1.
2.
3.
4.
5.

What is diabetes?
What are the types of diabetes?
Who are more likely to have this disease and what are the treatments for it?
What are the symptoms of having diabetes?
What will be the lifestyle of an individual who has diabetes?

Significance of the Study


The study is significant for the following reasons:

This study is to show awareness of diabetes.


This study will also help to prevent people of having diabetes by sharing the facts

that this thesis holds and by research.


This study will also help people to be able to have a healthy lifestyle by eating

healthy and exercising regularly.


This study can be also be set to be a reminder for everyone to monitor to what

they are eating and controlling their diet.


This study can also be able to reduce the factor of death cause by diabetes and/or
can be able to reduce the potential number of people who might have diabetes in

the future.
This study will also serve as a guide for future or follow up study.

Scope and Delimitations of the Study

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The study was carried out to determine the risk of having diabetes. This shows on
how to maintain a healthy lifestyle when having diabetes. Aims to discover ways to not
happen this risk. Although the thesis has detection of risks of diabetes in general, it will
discuss in the field of doctors who specializes in the study of diabetes in the Philippines.

Chapter 2
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Review of Related Literature


Related Literature
Foreign
Diabetes mellitus is a syndrome in which the complication starts from variable
interaction of heredity or in environmental factors and identified by abnormal insulin
secretion and variety of metabolic and vascular manifestation and its results toward
inappropriately elevated blood glucose levels, thickened capillary basal lamina,
accelerated nonspecific atherosclerosis, and neuropathy (Robbins, 1998).
This kind of syndrome has no distinct etiology, pathogenesis, and has invariable
set of clinical findings, as well as specific laboratory tests or definitive and curative
therapy, although in some point it is nearly always associated with fasting hyperglycemia
and decreased glucose tolerance.
A relative or absolute lack of insulin secrete associated with an excess of
circulating stress hormones (incliding glucagon, catecholamines, and cortiso) is
responsible for inappropriate elevation of blood glucose and associated alternations in
lipid metabolism characterizing the metabolic syndrome (Guyton & Hall, 2000).
Diabetes mellitus increases in risk of coronary heart disease, myocardial
infraction and accelerated development of atherosclerosis as well as high level of serum
lipids and triglycerides. Closely monitoring blood sugar levels in diabetic and checking
blood sugar levels in all patients for the development of increased level is an important

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nursing function. Control of blood sugar levels can greatly reduce risk and slow
development of atherosclerosis (Kozier & Erb, 2004).
The primary objective in this treatment of diabetes mellitus in to achieve the
patients optimal health and nutrition. Whether the treatment of asymptomatic
hyperglycemia decreases morbidity and mortality is unknown, and there is significant
risk of hypoglycemia in elderly patients given oral hypoglycemic agents or insulin
therapy. Therefore, as a result it appears that it is best not to use drug treatment for
glucose intolerance in elderly patients with normal fasting plasma glucose level or
asymptomatic fasting hyperglycemia

Local
Clinical practice guidelines are easy-to-use statements that bring together the best
external evidence (research) and clinical experience for rational decision making about a
specific health problem. These evidence-based guidelines should ideally be costeffective, adapted to the local setting, incorporate patients values in decision making, and
in a developing country like the Philippines, consider issues of equity. In drafting the
guidelines, there was a conscious effort to write it not only for those who could afford the
tests and treatments, but also for those who may neither have access nor financial means.
This CPG used two main methods for guideline development: (1) Guideline adaptation
using the ADAPTE process (ADAPTE, 2007); and (2) de novo development of guideline
statements whenever there are no guidelines on certain issues. The latter is the strategy
used for developing statements regarding the use of alternative methods for diagnosis of
diabetes and herbal medications or alternative medicines for the treatment of diabetes

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mellitus. The rationale for the ADAPTE process is to take advantage of existing
guidelines and reduce duplication of effort, thereby shortening the amount of time needed
for guideline generation. The ADAPTE process provides a systematic approach to
adapting guidelines produced in one setting for use in a different cultural and
organizational context. The process has been designed to ensure that the adapted
guideline not only addresses specific health questions relevant to the context of use but
also is suited to the needs, priorities, legislation, policies, and resources in the targeted
setting. The ADAPTE process has been developed to meet the needs of different user
groups, including guideline developers, health care providers, and policy makers at the
local, national, and international level, as well as groups with lesser or greater resources
interested in developing or implementing guidelines. The process is designed to be
flexible, depending on the application. The transparent and explicit reporting of the
adaptation process if followed will enhance the quality and validity of the adapted
guideline. (ADAPTE, 2007) (Appendix A) Local researches on epidemiology,
prognosis, and clinical trials (for drugs and interventions) on diabetes mellitus will be
included in the review of evidence whenever available. Sources for local literature are the
research database of the Philippines Society of Endocrinology and Metabolism; the list of
abstracts of researches of the Institute for Studies on Diabetes Foundation, Inc (ISDFI);
the Philippine Council for Health Research and Development (PCHRD) HERDIN
database; and the local journal of the Philippine College of Physicians, the Philippine
Journal of Internal Medicine. At the end of this CPG development process, gaps in
research and opportunities for improvement in the way we care for diabetic patients will
be identified.

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Research Paradigm
The research Paradigm that guided this study is shown in figure 1.

Figure 1: Research Paradigm

Operational Definition of the Variable of the Study


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For better understanding the researchers defined the following terms:


1. Hypoglycemia - deficiency of glucose in the bloodstream.
2. Syndrome - is a set of medical signs and symptoms that are correlated with each
other and, often, with a specific disease.
3. Etiology - is the study of causation, or origination.
4. Atherosclerosis - a disease of the arteries characterized by the deposition of
plaques of fatty material on their inner walls.
5. Hyperglycemia - an excess of glucose in the bloodstream, often associated with
diabetes mellitus.
6. Glucagon - is a peptide hormone, produced by alpha cells of the pancreas.
7. Catecholamine - any of a class of aromatic amines that includes a number of
neurotransmitters such as epinephrine and dopamine.
8. Cortisol - is a steroid hormone, in the glucocorticoid class of hormones, and is
produced in humans by the zona fasciculata of the adrenal cortex within the
adrenal gland.

Chapter 3
Research Methodology
This chapter discusses the research methodology used in the study. This chapter
covers all aspects concerning the overall data in the research; including the research

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design and the data gathering procedure which discusses the research locale, number of
respondents and the sampling technique used in the study. It also includes the validated
research instrument given to the respondents, and the statistical treatment used.

Research Design
This section aims to discuss the kind of research design and approach the
researcher used in this study. The researcher used descriptive research which describes
the nature of a situation as it exists at the time of the study and to explore the causes of
particular phenomena (Travers, 1978). A descriptive research also concerns data
gathering from a certain population specifically through a survey questionnaire that had
undergone a series of test for validation and verification from the research adviser.

Data Gathering Procedure


On the second week of February 2016, the researchers interviewed a respondent,
composed of 10 questions. This interview was of course approved by the research adviser
of the researcher. The respondent of the study is a Diabetologists of the University of the
East Ramon Magsaysay Memorial Medical Center, Inc. in Quezon City.
The respondent was a female. The respondent was selected by the researchers which in
their judgment is a representative sample. This type of sampling technique is under the
Non-Probability Sampling, specifically the Purposive/Deliberative Sampling which is
also known as Judgment Sampling.

The Research Instrument

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The researchers came up with a questionnaire that consists of three parts: the
profile of the respondent, and the question. Under the profile of the respondent, the
researchers would be able to determine the respondents gender, and name. The interview
is consists of statements associated with a specific factor that contributes to how to
properly handle your way of living with diabetes.
The researchers used a questionnaires. This scale helped the researchers know
what factor is most likely the reason behind the respondents perception on diabetes. On
the implementation of questionnaires, the factors are not shown and the statements are
rearranged in order to avoid any biases.
As evidence that the research instrument is valid, reliable, and accurate, the
researchers asked for 2 persons, specifically the researchers English and Filipino adviser,
to validate the research instrument. Grammar and some terms indicated in the instrument
were changed and corrected. The evaluators were a big help in making not only the
research instrument, but also the research study a better and improved one.

The researcher used the following instrument in the implementation of the study:

PART I: PROFILE OF THE RESPONDENT


Name:________________________________

todays date:______________________

Sex: __Female__Male

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PART II: SURVEY


Instructions: Read each statement carefully.
Since the patient recently diagnosed with type 2 diabetes,
1. Does having diabetes mean that I am at higher risk for other medical problems?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
2. Should I start seeing other doctors regularly, such as an eye doctor?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

3. How often should I test my blood sugar, and what should I do if it is too high or too
low?
________________________________________________________________________
________________________________________________________________________

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________________________________________________________________________
________________________________________________________________________
4. Are there any new medications that I could use to help manage my diabetes?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
5. Does diabetes mean I have to stop eating the foods I like best?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
6. How can exercise make a difference in my diabetes?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
7. If I'm overweight, how many pounds do I have to lose to make a difference in my
health?
________________________________________________________________________
________________________________________________________________________

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________________________________________________________________________
________________________________________________________________________
8. Are my children at increased risk for the disease?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
9. What is the importance of diet in diabetes?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
10. Do I need to take my medications even on days that I feel fine?
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Statistical Treatment of Data


The data gathered were tabulated, analyzed and interpreted using the following
statistical treatment:

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(F) Frequency- used to show the distribution of respondent according to different


categories.
(P) Percentage- used to ascertain the frequency of occurrence.

P=n/F100

Chapter 4
Presentation and Interpretation of Data
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Interview no. 1-2 with Dr. Araceli A. Panelo


Diabetology
UERMMMCI
60 years old
CHART 1

1. Having diabetes means at high


2. Regular check-up
risk for other medication
Yes, Once a year so that we can
Yes , not only in blood sugar but
monitor your diet and blood
it can also affect your eyes and
sugar.
other complications.

Interview no. 3-4 with Dr. Araceli A. Panelo


CHART 2

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3. Tests of Blood Glucose

4. Other medication to use for diabetes


Low glycemic - Index foods also

It is important to monitor your


blood glucose to know whether it

is high or low.

sensitivity of your body tissues to

High Insulin is the medication that

insulin so that your body uses

will bring blood glucose down the

insulin more effectively.


DPP-4 inhibitors - These

fastest. Someone who uses

medications help reduce blood

mealtime insulin can take

sugar levels, but tend to have a

correction doses to lower blood

may be helpful.
Metformin - improving the

modest effect. They don't cause

glucose.
Low Hypoglycemia - is a condition

weight gain.

characterized by abnormally low


blood glucose. Injectable glucagon
kits are used as a medication to
treat someone with diabetes that
has become unconscious from a
severe insulin reaction.

Interview no. 5-8 with Dr. Araceli A. Panelo


CHART 3

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5. Proper food to be eaten


No sweets, no sugar, low fat or low

6. Exercise makes difference in


diabetes
It can help to low your blood

salt.

sugar and loss weight.

7. Overweight should lose weight


Low as 7% of body weight is better.

8. Are my children has a risk for


the disease
Yes, because it is inherent nor Diet

Interview no. 9-10 with Dr. Araceli A. Panelo


CHART 4

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9. Importance of diet
It is important preventable disease

10. Medications to take even if

and a growing public health

youre feeling fine


Yes every day, the continuous

problem. Epidemiologic and

improvement and do it on time it

interventional studies suggest that

is prescribed

weight loss is the main driving


force to reduce diabetes risk.

Analysis:
According to Dr. Araceli A. Panelo, we must take good care of our health, we
must always have time to exercise. And for those who already have diabetes and for those
who are obese and overweight, they must take good care of themselves, they must have
their check-up regularly and lose some extra weight while living a healthy life.

Chapter 5
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Summary of Findings, Conclusions, Suggestions and


Recommendations
Research Design
This study used descriptive method, survey questionnaire and interview
based on readings. Descriptive research is used to obtain information concerning the
current status of the phenomena to describe what exists with respect to variables or
conditions in a situation. The methods involved range from the interview which describes
the status quo, the correlation study which investigates the relationship between
variables, to developmental studies which seek to determine changes over time.
The researchers used 1 respondent to interview. She was a senior citizen who
was a diabetologist and still on duty in UERMMCI hospital. This study covered month of
December 2015 to February 2016.

Summary of Findings:
1. Chart 1 tells us that if you have Diabetes not only the blood gets affected but also
other parts of your body for example: eyes, liver and etc. and you must always go
to your doctor for regular check-up.
2. Chart 2 tells us that it is important to monitor your blood glucose and make sure
that it is not too high or too low and there are other medication for controlling
diabetes for example: Low glycemic, Metformin, DPP-4 inhibitors and etc.
3. Chart 3 tells us that it is important to monitor the food we eat so that it may
reduce the factor of you having diabetes, we must always exercise regularly

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especially for those who are overweight or obese, and we must take care of our
health because in the future, your children might inherit this disease.
4. Chart 4 tells us that diet is very important to people who have diabetes and if they
are prescribed with medication, they must take it seriously and regularly as the
doctor prescribed.

Conclusion:
Based on this study, people who are diabetic must take good care of their
body and they must take their medication seriously. They must watch their intake of food
to lower the risk of complication to their body and they must exercise for their blood
sugar to be activated and convert it to energy. They must also have a regular check-up
with their doctor for them to have a new diet and/or medication. And for the people who
arent diabetic, they must also be careful with their lifestyle and for their children (both
diabetic) to not to inherit that disease and for those people who arent diabetic they must
watch what their children of what they are eating for the children to not have diabetes.

Suggestions:
1. To eat healthy and exercise
2. To follow what the doctor said and not disobeying his/her rules for medication
and for check-ups.

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Recommendations:
1. (for DOH) To help spread awareness of Diabetes.
2. (for DOH) To help the ones who cannot take care of themselves (PWD, Senior
citizens, poor people, etc.) to have a free check-up.
3. (for DOH) To do a medical service each month for those who have Diabetes
4. (for DOH) To help contribute on researching to find a cure or a better
treatment for diabetes.
5. (for the government) To give funding to projects that are right and jus
especially if the country needs it.

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