CHAPTER I

THE PROBLEM AND ITS BACKGROUND

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

Hospicio General) is located at the Isla de Convalescencia in Manila. It was founded in

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

as well as hereditary tendencies.

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.

Diabetes, as defined by Belchetz (Mosby 2012), is a disease characterized by

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.

Diabetes is a metabolic disorder characterized by glucose intolerance. It is a

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

macro- vascular neuropathic changes.

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

minimal side effects, though their mortality rate is higher.

 Moderate raised blood glucose levels can eventually cause kidney failure and

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

before menopause. The risk of stroke is increased two to three times.

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

hypoglycemia (low blood sugar) at stillbirth.

A common symptom of diabetes mellitus is weight reduction caused by the loss

of fluid and fats. This is because of the inability of the body to break down the

carbohydrates. Other symptoms are passing copious amounts of urine (polyuria),

increased thirst (polydipsia), excessive hunger (polyphagia), disturbances of vision: limb

numbness; genital itching; cessation of menstruation in women; and easy tendency to

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

during medical test.

The aim of the treatment in all types of diabetes is to keep the blood glucose

level as normal as possible by administering insulin, or by providing glucose reduction

therapy. Prescribed diets involve ensuring that the meals and snacks are so timed that

the bodys insulin levels do not become overwhelmed.

Hypoglycemia results from the excessive amount of insulin or sulfonylureas, lack

of food, or excessive exercise. It may occur in non diabetics as a result of insulin

overdose and lack of carbohydrates. Hypoglycemia produces a low-blood-glucose level,

leading to eventual collapse and possibly coma. It is vital for such patients to swallow

some form of sugar quickly following symptoms of sweating, confusion, faintness, or

palpitation. The opposite condition, hyperglycemia, occurs when there is an excess of

glucose in the blood because of lack of insulin treatment. Unless quickly treated in the

hospital, hyperglycemia may lead to coma and death.

Generally, insulin is self administered by patients through injection, or with an

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

a build up of glucose in the blood and urine.

Although the causes of this malfunctioning are unclear, non-insulin dependent

diabetes mellitus tends to run in the family. Other risk factors such as increasing age,

obesity and sedentary lifestyle, probably contribute to its increased incidence in

developed countries.

Non insulin dependent diabetes is controlled initially by diet alone, or in

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,

however, patients may need insulin injection.

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,

acardose can limit an increase in blood glucose levels after eating.

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

percent of non-traumatic amputation occurs in people with diabetes. Diabetes is a

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

death are due to arteriosclerosis.

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

which refers to loss of productivity and income, other costs as in psychosocial or

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

stringent glucose control.

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

direct cost to the health care sector.

An epidemic in diabetes is already underway. More than fifty percent of people

with diabetes are predicted to be in Asia. The population of most countries is aging.

Diabetes is particularly common in aging population and is increasing in proportion to

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.

The costs borne by individuals with diabetes are high.

Theoretical Framework

Neumans System Model (see appendices) is health oriented. It describes

health as continuum from wellness to illness and speaks of an optimal state of wellness.

Equilibrium is a healthy state in the system, and disequilibrium is the unhealthy or

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

is the central focus and goals.

In this instance, diabetic clients at Hospicio de san Jose appeared as a direct

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.

Neumans model provides a central focus in nursing intervention, which is

conceptualized as prevention focused and the action of the nurse as reconstitution. She

identifies three types of nursing intervention and labels them as:

1. Primary Prevention, when a threat to health exists but no stressor invasion

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

sugar and urinalysis.

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

structure becomes threatened. If the patient is diagnosed, as a diabetic he should

already take precautions like a. all medicines should be prescribed by doctors, change

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.

3. Tertiary Prevention which means reconstituting a system seriously impacted

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

of reconstitution of a health state, while applying primary or secondary teaching

intervention in attempts to prevent a recurrence of the disease in the future. Optimal

Stability is the goal of nursing intervention.

Neumans model also includes to discuss the client system, where an individual

or aggregate, is visualized as an open system that experiences stressors developing

from the internal and external environment. Neumans systems perspective was chosen

because of its precise and comprehensive analysis.

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

The study focus on determining the awareness of diabetes clients on important

aspects related to their disease, diabetes mellitus. These diabetic clients are currently in

the Hospicio de San Jose.

Results of several studies suggest that adequate information, education and

support about diabetes contribute significantly to healing the Diabetic patient. It is

essential for health professionals to be better informed so that they may provide better

guidance and support to the family.

The system model which guided the researcher in conducting this study is

depicted in the paradigm shown in Figure 1.

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

system in constant interaction with his/her internal and external environment.

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

of disease. While in throughput or process, it provide information wherein a variables

in the first column being utilized to conclude the projected outcome of the study as

presented in Column 3 (Output).

Statement of the Problem

This study deals with the disease awareness of diabetes clients in the Hospicio

de San Jose.

Specifically it sought to answer the following questions.

1. What is the profile of the respondents in terms of :

1. age,

2. gender,

3. civil status, &

4. length of having the disease

2. What is the level of awareness of the diabetes clients relevant to the

following areas:

a. nature of disease,

b. diet,

c. wound care,

d. blood glucose monitoring,

e. exercise, and

f. medication

3. Is there a significant difference between the disease awareness of

diabetes client in Hospicio de San Jose when grouped according

gender?

4. What plan of action may be formulated to help the diabetes clients and

increase their awareness of the disease?

Hypothesis

There is no significant difference between the awareness of diabetes clients in

Hospicio de San Jose when they group according to gender.

INPUT THROUGHPUT OUTPUT

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.

Paradigm of the Study

Figure 1
Scope and Delimitation of the Study

The study attempt to determine the awareness of clients with Diabetes Mellitus

in Hospicio de San Jose.

The researcher conducts this study among diabetic mellitus clients at Hospicio de

San Jose from the month of August to September 2016.

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

and its process.

Significance of the Study

The study attempt to determine the awareness of female and male diabetic

clients treatment to attain quality life and awareness needed by the clients.

Subsequently, the study benefits the following:

Diabetic Clients. The study being focused on the awareness of diabetic

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

much as he/she can, about in diabetes. Since self care is an enormous

responsibility to gain the optimal wellness, or prevent the onset of diabetes.

Nursing Practitioners. It is pointed out that the present standing of

patients education in terms of diabetes mellitus awareness is very vital,

therefore, focus is on the clients need to improve the present awareness, so that

the diabetic nurses can better plan and implement the needed care for them.

Nurse Educators. Experience is the great education even though education

is a continuous learning. As viewed in nursing practice, it is a must to understand

the awareness of individual clients before nurses could implement a certain task

related to their provision of care to them.

Researcher and Future Researchers. As a result of this study, the

Researcher would come out the reality but it is not enough, considering

different attitudes of or awareness of clients while undergoing treatment.

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

result of awareness building regarding diabetes mellitus.

Government Implementers. The law making body, implementers and

implementation also be benefited in such a way that no useless trial must be

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

operationally so as to provide clarity and easy understanding of the contents of the

study:

Action Plan. It refers to the suggested action plan resulting from the evaluation

of the respondents and other related factors.

Awareness. It refers to clear and certain apprehension of truth, assured

rational conviction about diabetes and is used in the study.

Blood Glucose Monitoring. It refers to the blood monitoring of sugar in the

blood that determines clients conditions (if he/she is diabetic.)

Clients. It refers to the one who receives an in-house care in the Hospicio de

San Jose.

Diabetes Mellitus. It refers to a chronic disease of the pancreatic organ,

marked by insulin deficiency, excess sugar in the blood and urine. It also refers to a

chronic metabolic disorder resulting from a variable interaction of hereditary and

environmental factors characterized by fasting hyperglycemia due to abnormal insulin

secretion or insulin ineffectiveness.

Diabetes Mellitus II. Refers to interplay of heredity factors (diabetes gene)

and environmental factors (obesity, physical, inactivity, nutritional factors, aging,

intrauterine factors) its cause is that patient has insulin resistance.

Diet. It refers to a selected food to be taken by patients for a medical reason.

 Dietician. It refers to a person who computes the diet of a person.

Disease Awareness. It refers to the information dissemination campaign of

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.

Exercise. It refers to physical activity, which helps in maintaining a normal

blood sugar level.

Footcare. It refers to the way were the clients care their foot, and or either

diabetic foot.

Hospicio de San Jose. It refers to non-stock, non-profit caring institution,

wherein the study being pursued.

Hyperglycemia. It refers to an excess sugar in the blood.

Hyperglycemia. It refers to abnormal decrease of sugar in the blood.

Insulin. It refers to a pancreatic hormone that regulates the metabolism of

carbohydrates and fats by controlling the blood glucose level.

Level of Awareness. It refers to the level of awareness of the clients

regarding diabetes mellitus disease in this present time of study. It will categorize as

highly aware, moderately aware and low aware.

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

encountered at time of this study.

Polyphagia. It refers to excessive hunger of one person.

 Polydipsia. It refers to excessive thirst of one person.

Polyuria. It refers to excessive urination especially at night.

Quality Life. It refers to the feature of life free from any diseases or at least

prevented as of the present diabetes mellitus.

 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

The researcher reviewed article, reports journals attended convention and

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

of developing retinopathy, neuropathy, and nephropathy. Each patient should be

carefully evaluated for the appropriateness of institution of an intensive insulin

treatment program. In particular, the risk of severe hypoglycemia must be considered

and the blood glucose goals modified if necessary to reduce the risk.

Successful implementation of an intensive treatment program requires a

competent healthcare team and a knowledgeable and well-motivated cooperative

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

utilization and production.

In addition to reducing blood glucose, treatment goals should include those for

bodyweight, blood lipid, blood pressure, exercise, and monitoring frequency. Insulin

doses should be adjusted based on consistent pattern of blood glucose monitoring

results surrounding the targets.

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.

Prediabetes, the American Diabetes Association says, often causes no symptom,

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

worsening, usually with diet and exercise.

Barter (2011) a Scandinavian physician showed that the only aspects of a

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.

Robert S. Rizza, M.D. (2012) noted that type 2 diabetes is a heterogeneous

disorder in which genetic and environmental factors adversely influence insulin

secretion and insulin sensitivity as to cause hyperglycemia. Until quite recently, it is

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

prediabetic individual normoglycemic first degree relatives an monozygotic twins of type

2 patient. Late hyperinsulinemia can simply be the consequence of impaired early

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.

According to Rosenstock, (2016) sulfonylureas have been used in patient with

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

antidiabetic drug is the result of efforts to develop a drug potential therapeutic

advantage over a second generation. Glimepiride and rapidly absorbed and

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.;

Professor Harold Shryock (2012), Chairman and Director of the Department of

Diabetes and Metabolic Division as C. Von Noorden Clinic, Frankfurt Scahsenhausen,

Germany, observed further, Type II diabetes is a disease with chronic deterioration.

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

markedly reduced and diabetes is overt.

Moreover the therapeutic effect of insulin secretory drugs can be distinguished

from anothet by their attachment to specific receptors, association time to that

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

disease, hypertension, obesity, diabetes, osteoporosis, colon cancer, depression and

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

related factors. In observational and international studies, regular physical activity

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

suggested a thirty-minute or more exercise of moderate intensity physical activity on

most preferably all days of the week.

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

recombinant insulin analog, insulin glargine, is a modification of human insulin by which

two argines are added to the b-chain and glycine is substituted for asparagines at the

twenty-one positions of the insulin molecules.

Kare Creason Sorensen (2013) presented the data on the beta cells dysfunction

in early events in the cascade of metabolic defects leading to diabetes. Longitudinal

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

secretion, whereas the nonprogressor appropriately demonstrate insulin secretion to

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

cognitive impairment, limitation in their activities of daily living, undiagnosed

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

population especially those with type 2 Diabetes Mellitus.

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

Tolerance are at high risk of progressing to type 2 diabetes and developing

cardiovascular disease. About seventy percent of those with Impaired Glucose

Tolerance usually live in developed countries.

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

developing countries, of rapid cultural, and social changes; ageing population,

increasing urbanization, dietary changes, reduced physical activity, and other unhealthy

lifestyle and behavioral pattern. The change in lifestyle is a worldwide phenomenon,

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.

KJ Greeland Rothmann (2013) believes that metabolic syndromes are highly

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

the upper stream of insulin resistant.

LOCAL LITERATURE

According to Susan Trinidad (2012) RN A head nurse education from Makati

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

considered essential components of comprehensive health care.

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

provide continuity throughout the teaching process.

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

every diabetic in your care.

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

problem and be motivated to implement self-management of the disease the goal of

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

information from a number of sources-media information technology family and friend

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

compliance and easy adherence. Emphasize the improvement not perfection. It is

unrealistic to expect a hundred percent compliance to dietary changes everyday of the

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

percent of the weight is fat.

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

stimulating insulin release remains to be a cornerstone in the treatment of type 2

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.

Member depolarization activates voltage dependents calcium channel and the

consequent rise in cytosolic calcium dependent regulatory protein responsible for the

movement of the beta granules to the membranes for exocystosis of insulin.

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

that of obesity and insulin resistance.

LOCAL STUDIES

Dr. Rosa Allyn Sy (2008) from Cardinal Santos Medical Center, noted the

development of different food pyramids worldwide has proven to be an important

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

will provide metabolic efficiency by increasing total energy expenditure.

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

of a day is healthy and rewarding.

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

involves the abdominal muscles as well as arms and legs.

Equipment-Based Kickboxing. This is a real kickboxing using gloves,

punching/kicking bags or even sparing partners. If one ha s a peripheral neuropathy,

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

as abdominal muscles or legs.

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.

Yoga. It can be either gentle or strenuous depending on the kind of yoga

practiced. Some positions put pressure on hand and feet, so always do a thorough

check-up after the workout.

Andrew Delos Angeles (2007), Food Technologist from Bureau of Food and

Drugs wrote an article on Diabetes Mellitus and herbal supplements which have been

observed to help the diabetic such as bittergourd or as it is locally known ampalaya.

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

promote atherosclerosis or the narrowing of the blood vessel.

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

adjustments by way of diet. Behavioral modifications can be likewise be adjusted

optimally, but this approach can only be done through the guidance of a health

professional as it may be hazardous for a patient to titrate medication on his own.

Synthesis of the Study

Nimencio Nocodemus Jr, from Minnesota, U.S.A. Studies have conclusively

demonstrated that improving blood glucose control in patients with diabetes mellitus
reduces the risk of developing retinopathy, neuropathy, and nephropathy. The

information where Nocodemus wants to impart.

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.

Similarly, Barter a Scandinavian physician underscore that the only aspects of a

persons weight that correlate with the risk of heart disease and other diseases of such

nature, is the waist circumference.

Yoshita Yajima M.D. Ph. D. Professor, Internal Medicine, says diabetes is a

lifelong disease. But this does not mean that the diabetes is hopeless. Diabetes can be

controlled. An information that contributed by Yajima.

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

complications in type 2 diabetes mellitus.

According to Susan Trinidad RN a head nurse education from Makati Medical

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

diabetes mellitus and heart diseases among others as under scored.

 Marcelo A. Lim, M.D. also observed that the weight gain precedes the

development of diabetes as mentioned by the previous author.

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

The researcher utilized and applies the descriptive design. According to

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

distinguishing characteristics is the effort to estimate relationship, as distinguish from

simple description. Thus, it determines whether there is a significant difference between

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:

1. The client who is diagnosed with Diabetes Mellitus.

2. The client must be Thirty one years old and above.

3. The client, likewise be male or female, signified his/her intention to contribute

in the research.

4. The client, by no means has any pre arranged clients education program with

regard to diabetes mellitus.

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

by selection. The questionnaire to be administered was arranged structurally and

translated in Filipino words so that the client understands carefully and for their

convenience in answering.

Data Gathering

After forwarding a letter of request to the Hospicio San Jose administrators

office and securing permission to conduct the study, the following are the steps

undertaken by the researcher in gathering data:

 a. The researchers questionnaire has been submitted to research adviser for

checking and comments. Then, upon approval, the researcher conducts a

testing of questionnaire to validate.

b. Conducting a random sampling of the respondents to test the validity of the

questionnaire, the selected five respondents will not be included in the actual

subject of the study.

c. After testing, the researcher consults the adviser and finalized the

questionnaire.

d. Then after administration of questionnaire, retrieval of answered

questionnaire was done and submitted it to the statistician for guidance on

the computation and interpretation.

Statistical Treatment of Data

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:

WEIGHT MEAN RANGE VERBAL INTERPRETATION

5 4.50 - 5.00 Always
4 3.50 - 4.49 Most Often
3 2.50 - 3.49 Occasionally
2 1.50 - 2.49 Seldom
1 1.00 - 1.49 Not at All

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:

WEIGHT MEAN RANGE LEVEL OF AWARENESS

5 4.50 - 5.00 Highly Aware
4 3.50 - 4.49 Highly Aware
3 2.50 - 3.49 Moderately Aware
2 1.50 - 2.49 Moderately Aware
1 1.00 - 1.49 Low Aware

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

weighted mean computed form the evaluated weighted mean.

The weighted mean of the weighted frequencies was computed through this

formula:

Weighted Mean = Summation of Weighted Frequencies

Sum of frequencies

WM = wf
f
Where:

WM = Weighted Mean
wf = Summation of Weighted Frequencies
f = Sum of Frequencies of the computed
weighted mean

c. Significant Difference. The Significant difference in the assessment of

respondents awareness on Diabetes Mellitus who are under care of Hospicio

de San Jose when they group according to gender, as a comparative study

will be tested using the chi-square test formulas shown below:

X2 = 2

Where:
X2 = Chi-Square
O = Observed Frequency
E = Expected frequency
 CHAPTER IV

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

This chapter deals with the presentation, analysis and interpretation of data

gathered following the sequence of the questions in Chapter 1.

STATEMENT OF THE PROBLEM #1

1. What is the profile of the respondents in terms of:

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 %

31-40 years old

41-50 years old
51-55 years old
56-60 years old
61-and above 3 100 3 100 6 100
TOTAL 3 100 3 100 6 100

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

respondents and they are belong to 61 years old and above.

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 %

GENDER 3 100 3 100 6 100

TOTAL 3 100 3 100 6 100

Table 2 shows the summary of all the respondents according to gender. There

are three (3) male and three (3) female respondents.

Basically, the researcher requires conducting equal number of participants

according to gender, to compare their awareness in terms of Diabetes Mellitus as their

present illness.
 Table 3

Respondents According to Civil Status

CIVIL STATUS Femal % Male % COMBINE %

e
Single 1 33.3 1 16.6
Married 2 66.6 2 33.3
Widower 2 66.6 2 33.3
Separated 1 33.3 1 16.6
TOTAL 3 100 3 100 6 100

Table 3 summarized the respondents when grouped according to civil status.

There are two (2) or 33.3% married respondents, one (1) or 16.6% is separated and

only 33.3% or two (2) are widower.

This only shows that the clients of Hospicio de San Jose accept whatever their

statuses are.
 Table 4

Respondents According to Educational Attainment

EDUCATIONAL Female % Male % COMBINE %

ATTAINMENT
Elementary Graduate 1 33.3 1 16.6
High School Level 1 33.3 1 33.3 2 33.3
High School Graduate
With 72 College units 1 33.3 1 33.3 2 33.3
College Graduate 1 33.3 1 16.6
TOTAL 3 100 3 100 6 100

Table 4 presents the frequency of the respondents when grouped according to

educational attainment. There are 33.3% or 2 respondents responses that they are
High School level and the other 2 respondents are belong to an students with 72 units
in college.
It may be noticed that the diabetic clients are mostly high school level and with

72 College units.
 Table 5

Respondents According to Number of Years having

been diagnosed and having the disease

NUMBER OF YEARS Femal % Male % COMBINE %

e
HAVING BEEN
DIAGNOSED AND
HAVING THE
DISEASE
Less than one year
6-10b years
11-15 years
16-20 years 2 66.6 2 66.6 4 66.6
26 years and above 1 33.3 1 33.3 2 33.3
TOTAL 3 100 3 100 6 100

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.

STATEMENT OF THE PROBLEM #2

2. What is the level of awareness of the diabetic relevant to the following

areas:

2.1 nature of disease,

2.2 diet,
2.3 wound care,
2.4 blood glucose monitoring,
2.5 exercise, and
2.6 medication?
 Table 6
Respondents Level Of Awareness According
to Nature of the Disease

ITEMS Female VI Male VI Combined VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I urinate more than 4.3 MO 4.6 A 4.45 HA
unusual
2 I feel thirsty and 4.3 MO 4.3 MO 4.3 HA
hungry
3 My wound doesnt 4.3 MO 4 MO 4.15 HA
heal naturally
4 I encountered 4.6 A 3 O 3.8 HA
blurring of my vision
TOTAL AVERAGE 4.4 MO 3.96 MO 4.175 HA
MEAN

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)

Table 6 depicts the respondents level of awareness according to nature of the

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

ITEMS Female VI Male VI Combine VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I eat the foods I 2 S 3.66 MO 2.83 MA
wants as long as
there is medicines
2 I go after to the 2 S 2.3 S 2.15 MA
approved diet that
my diabetic educator
teaches
3 I do limit food intake 2 S 3.66 MO 2.83 MA
rich in carbohydrates
such as rice, bread
and etc
TOTAL AVERAGE 2 S 3.20 O 2.60 MA
MEAN

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)

Table 7 reveals the respondents level of awareness according to diet. According

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

respondents are moderately aware.

Diabetes is a disease that restricts patients on un-planned food in-take. Diet is

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

ITEMS Female VI Male VI Combine VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I regularly go to the 1.66 S 1 NA 1.33 LA
parlor for my pedicure
2 I frequently check my 1.66 S 1.33 NA 1.49 LA
foot if there is any
calluses
3 I go to the doctor if I 1.66 S 1.66 S 1.66 MA
have lacerated wound
TOTAL AVERAGE 1.66 S 1.33 NA 1.49 LA
MEAN

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)

Table 8 present the respondents level of awareness in terms of foot care

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

ITEMS Female VI Male VI Combine VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I check my blood 1.33 NA 2 S 1.66 MA
glucose if I have
signs and symptoms
of hypoglycaemia
2 I monitor my blood 1.66 S 2.66 O 2.16 MA
glucose four times a
day when I am sick
so as to avoid any
untoward
complication that my
happen
3 I monitor my blood 1.33 NA 3 O 2.16 MA
glucose at least twice
a day
TOTAL AVERAGE 1.44 NA 2.15 S 1.99 MA
MEAN

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)

The respondents level of awareness according to blood glucose monitoring is

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.

Monitoring of blood glucose is a major test done to diabetic clients.

Monitoring at regular intervals should be done.

Table 10
Respondents Level Of Awareness According
to Exercise

ITEMS Female VI Male VI Combine VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I ask my doctors 1.66 S 2 S 1.83 MA
advise before doing
the exercise program
2 The diabetic nurse 1.33 NA 2 S 1.66 MA
educator and doctor
clarify the benefits of
doing the exercise
regimen
3 I perform exercise as 1 NA 2.33 S 1.91 MA
soon as I have time
TOTAL AVERAGE 1.33 NA 2.11 S 1.80 MA
MEAN

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)

The respondents level of awareness in terms of exercise is presented in Table

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

ITEMS Female VI Male VI Combine VI

Respondents Respondents Respondents
weighted weighted weighted
Mean Mean Mean
1 I dont drink my 2 S 1.66 S 2.83 MA
medicine when my
blood sugar is
controlled
2 I drink my medicine as 1.66 S 3 O 2.33 MA
instructed
3 I just drink my 2 S 3 O 2.5 MA
medicines every time I
found to drink it
TOTAL AVERAGE 1.88 S 2.55 O 2.55 MA
MEAN

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)

Medication is a very important to diabetic client. It must be monitored, taken at

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.

Table 11 displays the respondents level of awareness according to medication.

It shows that respondents occasionally drink the medicine as instructed (WM = 2.33),

and they are moderately aware.

STATEMENT OF THE PROBLEM #3

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 same as the level of awareness of the male.

STATEMENT OF THE PROBLEM #4

4. What plan of action may be formulated to help the diabetes clients

increase their awareness of disease awareness?

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

Jose, the following are:

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.

3. Review the daily self- Caregiver

management plan & steps for
patient implementation.

4. Continue teaching & Nurse

reinforcing key educational
messages.
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
Lack of To Health Education Plans and
informa- developed Program:
tion health 1. Conduct ward visits/ follow Physician & One Month A positive health behavior & better
education up and recording of new cases. Nurse Duration understand-ing of diabetes prevention &
program control
that will
improve the
attitudes & 2. Schedule lectures in different Caregivers Probably Increased positive behavior
practices of department. twice a
diabetes month as
clients needed

3. Distribution of reading Preferably

materials relevant to the twice a
management of disease. month as
needed

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

2. Film showing in the unit

center regarding the illness and
its complication (as referred).
 CHAPTER V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

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

recommendations based on the important points of the entire research.

This study dealt with the level of awareness on diabetes among clients in

Hospicio de San Jose.

Summary of Findings

The result of the study shows that:

STATEMENT OF THE PROBLEMS

1. What is the profile of the respondents in terms of:

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

to the male (Table 1 and 2)

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

single respondents (Table 3).

 1.4. Educational Attainment. 33.3% or 2 respondents responses that they
are High School graduate same as 2 respondents that are belong to students with 72
units in college (Table 4).
1.5. Years of Having the Disease. Four (4) or 66.6% of the respondents
responses that they have the disease for more than 16 to 20 years now, while the other
33.3% or 2 respondents have the disease for 26 years more.
2. What is the level of awareness of the diabetic relevant to the following
areas?

2.1 nature of disease,

2.2 diet,
2.3 foot care,
2.4 blood glucose monitoring,
2.5 exercise, and
2.6 medications?

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

the respondents are moderately aware (Table 7).

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

changing socks regularly and wearing proper Footwear (Table 8).

2.4. Blood Glucose Monitoring. On over-all mean of 1.99 indicates that the

respondents were moderately aware the importance of blood glucose monitoring

because they seldom check their blood glucose as resulted on a weighted mean of 1.66

(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

doctors from the weighted mean of 1.66. (Table 10).

2.6. Medications. The respondents moderately aware (wm = 2.33) in terms of

medication as cleared, on their occasional drinking of medication as instructed

(Table 11).

3. Is there a significant differences between the level of awareness of the

diabetic clients differ when they are grouped according to gender?

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

perceived by the respondents.

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

of disease, hence they are low aware on foot care.

Subsequently, by merely looking at the data presented, one can say that there is

no significant difference among the level of awareness of the respondents when

grouped by gender.

Recommendations

Looking at the summary of findings and conclusions, the following

recommendations are presented:

1. Hospicio de San Jose should continue its noble work of delivering quality client

care in all ages needed their services.

2. Hospicio de San Jose and its affiliates should provide clients continuous

seminars and updating of awareness emphasizing importance of footcare, diet, blood

glucose monitoring, exercise, medication, as well as , its possible complication when

required health regimen is followed strictly.

3. The results of this study may be published in nursing professional magazines

and journals for disseminations of the findings.

4. The diabetes awareness program prepared by the researcher may be adopted

by the other health institutions and/or other health centers to facilitate proper health

teaching to diabetic clients.

 5. A similar study may be conducted in another research venue to substantiate

the findings of the present study.

6. The result of this study may be integrated in Nursing Curriculum for the

enhancement of Diabetes program.

 BIBLIOGRAPHY

A. BOOKS

Belchetz, Paul., Diabetes and Endocrinology, Mosby, 2013

Fauci, Anthony., Harrisons Principles of internal Medicine, 14th Ed. Vol.

2, 2010

Last, M.J., A Dictionary of Epidemiology, 2nd Ed. Oxford University

Press, New York, 2015

Litonjua, Augusto., Type 2 Diabetes Management for Health Care

Professionals. 1st Ed. Johnson and Johnson, 2013

Rothmann, K.J., Greenland S., Modern Epidemiology 2nd Ed. Lippincott

Raven Publisher, Phildelphia 2013

Sorensen, Kare Creason., Medical Surgical Nursing., J.B. Lippincott,

2013 Revised Edition

Rizza, Robert S., Medical Clinic of North America DM, Phildelphia W.B.
Sauders Company, 2012

Shryock, Harold, Modern Medical Guide, 2012

B. THESIS/DISSERTATION

Murallo, Carolyn., The Relationship between Patients Acceptance and

the Knowledge, Skill and Attitude toward Diabetes, Master
Thesis Arellano University, 2013

C. Manual , Journal

Barter, Philip., The Metabolic Syndrome in daily Practice. Mets in sight,

2011
Chua, Diana et.al., Treating the atherosclerotic junk in Diabetes,
August 2013

Delos Angeles, Andrew., Diabetes Mellitus and Herbal Supplement.

Health new Diabetes: Killing me Sweetly, 2007

Delos Santos, Grace., Insulin Secretageous. Scribbling Publication

UERMMC Institutes for Diabetes Studies on Diabetes Foundation, 2011

Harber, Allan J., Cardiovascular risk Factor with Type 2 Diabetes

American Family Physician, 2013

Hernandez, Allan., The Benefits of Exercise. Health New Diabetes:

Killing me Sweetly, 2012

Levebvre, Perre., Diabetes Stop the Rise. Diabetes Watch, 2009

Lim, Marcelo., Role of Beta-Cell Dysfunction in the Pathogens of Type 2

Diabetes. Scribbling Publication, 2011

Orbita, Sanirose A, Diabetes and Nutrition Health and Home

Magazine, HH Publishing, Makati City, Philippines 2011

Nagourney, Eric., Wider Net for Diabetic Disorder. 2013

Nocodemus, Nimencio Jr., Self Monitoring Blood Glucose In Non

Insulin requiring Type 2 Diabetes Mellitus., Diabetes Watch,
2013

Rosentock, Julio., Safe and Efficious Glucose Control with Glemipiride

Diabetes Watch, 2013

Sarol, Jesus Diabetic Watch Glucose Monitoring FHQ Magazine.,

RBP Publishing, Makati City, 2013

Snoek, Frank., Physiological Aspect of Type 2 Diabetes Screening

International Monitor, 2008

Sy, Rosa Allyn., The common sense guide to weight loss, Diabetes
Watch, 2008
Trinidad, Susan., Noghtingales Pride: Teaching in Nurses Action:
Diabetes Watch. 2012

Yajima. Yoshitada., Diabetes, how we can treat it?., 2012

Yulo, Tina Aboitiz Diabetic Campaign; Stress and Action Physical

Fitness Magazine, ARQ Zebra Publishing, Bulacan Bulacan, 2012

D. Website

www.diabetes.org/diabetescare
www.diabetesphil.org
www.diabetes/20mellitus.html

E. Others

Encyclopedia and Britanica, Inv. 1994 2001 edition

Encyclopedoa Encarta 2000 Edition
QUESTIONNAIRE
AWARENESS ON DIABETES AMONG CLIENTS IN THE HOSPICIO DE SAN
JOSE: BASIS FOR ACTION PLAN

Part I Demographic profile

Part I: Demographic Profile

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

_______ Elementary Graduate

_______ High School Graduate
_______ with 72 College Units
_______ College Graduate
_______ with masteral Units
_______ Masteral Degree
_______ with Doctoral Units
_______ Doctoral Degree

5. Number of years Having Been Diagnosed and Having the Disease

_______ less than one year
_______ 1 5 years _______ 6 10 years
_______ 11 15 years _______ 16 20 years
_______ 26 and above

Part II Disease Awareness on Diabetes Clients

The following statement are Awareness on Diabetes Clients in Hospicio de San Jose.

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)