Diagnosis: Sepsis secondary to UTI, complicated; Diabetes Mellitus type 2 poorly controlled Pathophysiology Explanation: RISK FACTORS: >Family

History (Maternal side) The risk of type 2 diabetes increases if your parent or sibling has type 2 diabetes >Age (60 years old) The risk of type 2 diabetes increases as you get older, especially after age 45. That's probably because people tend to exercise less, lose muscle mass and gain weight as they age >Sex (Female) Diabetes is more common in women than in men. >Race (Filipino) In the study of Cuasi et.al ,they found out that Filipinos are at higher risk for type 2 DM than the US non- hispanic white population. Although it's unclear why, people of certain races including blacks, Hispanics, American Indians and Asian-Americans are more likely to develop type 2 diabetes than whites are. >Weight (overweight) Being overweight is a primary risk factor for type 2 diabetes. The more fatty tissue you have, the more resistant your cells become to insulin. PRECIPITATING FACTORS: >Non-compliance to medications- The patient is supposed to take Metformin 500 mg as maintenance for Diabetes but she has not complied to it due to financial constraints. NARRATIVE FOR THE DISEASE PROCESS: With the factors mentioned, there is now the development of Insulin Resistance. The primary events are believed to be an initial insensitivity of insulin resulting in peripheral insulin resistance. The body responds to this situation by signaling the pancreas to produce more insulin, and later on there becomes inadequate insulin production from the beta cells to compensate because they are already exhausted. The result is decreased absorption of glucose by the cells which is then causing cellular starvation. The liver perceives that there is not enough glucose for the cells so it tries to compensate by increasing glucose release from the liver from stored glycogen (glycogenolysis). However, the main problem is insulin resistance so it just adds up to the classic finding of high blood sugar. Hyperglycemia causes our blood to become hyperosmolar. High osmolarity causes increased blood viscosity and sluggish blood flow. On of the manifestations is body malaise since there is not enough blood/O2 supply and nutrient absorption of cells. Diabetes can slow down our body's ability to fight infection. High blood sugar (glucose) leads to high levels of sugar in your body's tissues. When this happens, bacteria grow and infections can develop more quickly in people with diabetes. Also, if we have already have an infection, there is diminished ability to fight off the microorganisms since there is sluggish blood flow and supply to organs. Common sites of infection are our bladder, kidneys, vagina, gums, feet, and skin. In the case of the patient, she has developed Urinary tract infection. It was related to the fact that urinary tract is a common site of infection for diabetic persons and facilitated by short urethra in females and other unhygienic practices. Urinary tract infection (UTI) defines a condition in which the urinary tract is infected with a pathogen causing inflammation. Usually, early treatment of infections can prevent more serious complications. However, the patient continued non-adherence to diabetic maintenance therapy. She has not consulted for management of UTI also. Most of these infections are considered uncomplicated and are easily treated, but if they are not addressed, the infection may spread up through the ureters and into the kidneys. Complicated UTI implies infections of urinary tracts, which are anatomically and functionally altered. Abnormal results in urine tests of the patient are confirmatory for this complication. A kidney infection is more dangerous and can lead to permanent kidney damage. In some cases, a urinary tract infection may lead to an infection in the bloodstream (sepsis,septicemia) that can be life-threatening. Sepsis occurs when a serious infection causes the body's normal reaction to infection to go into overdrive. Sepsis is caused by bacteria that make toxins that cause the immune system to attack the body's own organs and tissues. With sepsis, bacteria and the toxins they create cause changes in a person's body temperature, heart rate, and blood pressure, and can result in dysfunction of the body's organs. The patient manifested fever, weakness, cough and increased blood pressure.