Introduction This introduction is mainly focused on how a patient adapts to live with type two diabetes in everyday life. What activities are taken and what measures can be taken in order to be able to control the disease. Further along the assignment we will also discuss the treatment, education and measures that can be taken. The patient is given a false name (Mrs Caruana). Necessary measures have been taken to protect the privacy and confidentiality of the patient. The patient is always a unique person and should be treated with respect and dignity irrespective of the age, gender or political views (Maltese code of ethics for nurses and midwifes, 1997). From this story we can also identify the importance of taking care of ourselves. It also very evident, the importance of the multidisciplinary team working together to be able to achieve the best results possible for the patient. A multidisciplinary team is a team that consists of nurses, psychologists, social workers, occupational therapists, counsellors, care workers and others. They all have different area of studies and they combine their skills together. They meet on a regular basis so as to see the progress of the patient (Mitchell G.K et al, 2008). Pathophysiology Diabetes mellitus is a persistent high blood glucose levels. They can be associated with either pancreas dysfunction, insulin deficiency or ineffective insulin secretion and action. It can also be inherited from another family member with history of diabetes mellitus (WHO, 2018). Insulin is a hormone made by the pancreas which allows the body to use glucose from carbohydrates in food that we eat for energy. Insulin helps keeps the sugar level from getting high blood glucose (hyperglycaemia) or low blood glucose (hypoglycaemia). (Hess – Fischl A, 2014). In Mrs Caruana’s case the blood sugar levels where always above 25.0mmol/I from when she was tested first for diabetes. Her relatives were very worried. Mrs Caruana would not be able to take care of herself alone since she was suffering from diabetes and dementia. She needed constant monitoring. The normal reading for a person without diabetes is 3.9 – 5.5mmol/I, while for someone with diabetes it will be 4.4 – 7.2mmol/I. There is also a long -term glucose test called the Haemoglobin or HbA1c. This is expressed as a percentage. For a non -diabetic patient it should be less than 5.7% while for a person with diabetes it is 7.0% or less (Spero D, 2016). Types of diabetes There are three main types of diabetes: Type 1 diabetes It is an autoimmune disease that affects the regulation of the blood. Antibodies that are produced by the immune system of the person destroys the producing cells in the pancreas. Obviously than the pancreas fails to produce insulin. Blood sugar will increase and would not be able to be delivered to the brain and muscles, without insulin. People with type 1 diabetes can no longer produce insulin of their own so they start taking doses of insulin via injections as prescribed by the doctor. They must than watch the amount of insulin they inject with their diet. They have to make sure that the carbohydrates intake matches the insulin dose (Oberg E, 2016) Type 2 diabetes Type 2 diabetes is the most common type of diabetes. Insulin resistance is no the common factor for this type of diabetes. One can have type 2 diabetes but will not be insulin resistance. One can have a form of type 2 diabetes where the body does not produce enough insulin. It develops in adults and most often in obese individuals which is characterised by hyperglycaemia. It will than result in the body being unable to compensate with increased production of insulin. In people with this type of diabetes, the body cells have become resistant to insulin (Capetta A, 2017). In our case Mrs Caruana had to administer insulin injections to regulate her readings since oral hypoglycaemic agents were not able to control it. Type 2 diabetes can be hereditary. If someone from the family had this condition before it means that one is at a greater risk. Genes also play an important role in diabetes type 2. Some may have a genetic mutation that may make the susceptible to type 2. Lack of exercise can also be a cause of diabetes type 2 since physical activity have many benefits and will greatly influence how the body uses insulin.Being obese makes it also more likely to develop it. One will become insulin resistance and that will lead to other health problems (Leontis M.L, 2017). Normally patients with this type of diabetes are not dependant on insulin but in cases where the blood glucose readings are unstable insulin injections may be administered. Type 3 diabetes (Gestational diabetes) This type of diabetes occurs during pregnancy. It is when a woman who never had diabetes before, have high blood levels during pregnancy. According to the centres for control and disease prevention, 2014, gestational diabetes is as high as 9.2%. The placenta that supports the baby includes a hormone that helps the baby to develop. These same hormones tend to obstruct the mother’s insulin in her body. Insulin resistance makes it hard for the mother’s body to use insulin as she may need up to three times insulin. Without enough insulin glucose cannot leave the blood to be changed, so glucose ends up in the blood causing high levels (American Diabetes Association, 2016). As seen in Mrs Caruana’s case. She developed gestational diabetes during pregnancy and those who develop it during pregnancy are at higher risk of developing type 2 diabetes when they are older. Pregnant women who developed gestational diabetes during their first pregnancy are more prone to develop it during the second and third pregnancy also (Mann D, 2010). According to Sullivan W, that among all the medications available to treat medical conditions, prednisolone, similar steroids and thiazide diuretics have the most profound effect on metabolism. They tend to increase high blood sugar levels (Sulluvan W, 2014). Statistics According to the Wealth Health Organization the number of people with diabetes have increased by 317 from 1980 – 2014. Diabetes among adults over 18 years of age has also increased by 3.8%. In 2015, it was estimated that there were 1.6 million deaths caused by diabetes and another 2.2 million in 2012. Approximately half of all the deaths in connection with diabetes have occurred before the age of 70 and it is assumed that diabetes will be the seventh leading death cause in 2030 (WHO, 2017). According to the European Health Interview Service (EHIS), prevalence of diabetes was 8%, and 6% of the population were taking oral medication for diabetes (Department of Health Information and Research, 2008). Signs and Symptoms and Risk Factors of Diabetes Anyone is at risk of developing diabetes. Type 1 diabetes can be inherited from previous family members and type 2 diabetes is ore related to obesity and uncontrolled diet. In our case Mrs Caruana never took care of what she eats so she ended up diabetic. Ever since she was diagnosed with dementia she rarely wanted to go out and stood away from any walking exercise even though her husband and other family members encouraged her to do so. Oldroyd J and Heald A, (2005) states that Asia and Africa are the regions at a greatest risk of diabetes. The top three countries with the maximum prevalence of diabetes are India, China and USA. African Americans are 77% higher risk of getting diabetes than White Americans. For Asian Americans diabetes is already the fifth leading death cause (Burns J, 2018). Some other risk factors that can lead to diabetes are family history, obesity, infections, pancreas disease, ethnic backgrounds, age and insulin resistance (WebMD, 2016). As very well described by Gardener. A (2017), diabetes is a ”silent killer”. This is because symptoms can be mistreated very easily. Some signs and symptoms of diabetes are Polydipsia which means excessive thirst, polyuria which means frequent urination, polyphagia which means increased hunger, numbness in hands and feet and lethargy (Brunner and Suddarth, 2014) How to monitor for diabetes? Readings of a person with normal blood sugar ranges from 4.0 to 7.0mmol/I (National Healthcare Group, 2012). When an HbA1c is done, it does not instantly measure the glucose levels. The result is affected by how high or low blood glucose levels tend to be over a period of 2-3 months (Diabetes.co.uk, 2012). Self -monitoring is important because it puts the person checking it in charge. It is important to take note of then numbers and if a necessary action is needed, a General Practitioner (GP), should be informed immediately (Aloma. K.R,2009). Mrs Caruana’s relatives were always encouraging her to go and have blood tests but she always took her health for granted apart from forgetting.