Diabetes Insipidus:
A deficiency of circulating antidiuretic hormone (ADH), or (vasopressin),
or because the kidneys are not responding properly to the presence of ADH.
It affects both sexes, and more common in childhood or early adulthood.
In uncomplicated diabetes insipidus, the prognosis is good. With
adequate water replacement, patients usually lead normal lives. In
cases complicated by an underlying disorder, such as metastatic cancer,
the prognosis varies.
Diabetes insipidus is marked by frequent urination, as frequently as
every half hour, all day and night. Resulting in the need to keep
drinking – huge quantities.
Cause: Diabetes insipidus may be familial, acquired, or
idiopathic. It can be acquired as the result of intracranial neoplastic
or metastatic lesions. other causes may include hypophysectomy or
other neurosurgery; head trauma, which damages the neurohypophyseal structures;
infection; granulomatous disease; and vascular lesions.
Symptoms:
Extreme polyuria (frequent urination) usually 4 to 16 liters/day of
dilute urine, but sometimes as much as 30 liters/day with low specific
gravity (less than 1.005)
Extreme thirst and increase fluid intake
Fatigue (in severe cases)
Dehydration – may have increase heart rate, low blood pressure, dry
mouth, eyes may appear sunken, lack of tears, weight loss, confusion
and irritability
Treatment:
Until the underlying cause of diabetes insipidus can be identified and
eliminated, administration of various forms of vasopressin or of a vasopressin
stimulant can control fluid balance and prevent dehydration.
Chlorpropamide may be prescribed to stimulate ADH secretion.
Call your doctor if you have the above symptoms and or signs of dehydration
as soon as possible.
Diabetes Mellitus
Diabetes mellitus: A chronic insulin deficiency
or resistance, diabetes mellitus is marked by disturbances in carbohydrate,
protein, and fat metabolism. Diabetes is a major risk factor for
myocardial infarction, cerebrovascular accident, renal failure, and peripheral
vascular disease. It is also the leading cause of new blindness in
adults.
Diabetes mellitus occurs in two forms: insulin-dependent
diabetes mellitus (IDDM) also called: Type I, or juvenile-onset
diabetes and the more prevalent non insulin-dependent
diabetes mellitus (NIDDM), also called Type II, or maturity-onset
diabetes.
Type I diabetes: Usually occurs before age 30 (although
it may occur at any age). The patient is usually thin and will require
exogenous insulin and dietary management to achieve control.
Type II diabetes: usually occurs in obese adults
after age 40 and is most frequently treated with diet and exercise, may
also requires hypoglycemic drugs. Treatment may also include insulin
therapy.
In diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar nonketotic
coma (HHNC), dehydration may cause hypovolemia and shock. Long-term
effects of diabetes may include retinopathy, nephroopathy, artherosclerosis,
and peripheral and autonomic neuropathy. Peripheral neuropathy usually
affects the legs and may cause numbness.
Cause: Both Types I and II are of unknown cause but may
be hereditary.
Type I appears to be an autoimmune disease and is strongly associated
with human leukocyte antigens (HLA) DR 3 and 4. It may also be associated
with certain viral infections.
Type II is associated with impaired insulin secretion, peripheral insulin
resistance, and increased basal hepatic glucose production. Other
associated factors include obesity; insulin antagonists such as excess
counter regulatory hormones and phenytoin; oral contraceptives; and pregnancy.
Symptoms:
Fatigue
Polyuria (frequent urination) related to hyperglycemia
Polydipsia (excessive thirst)
Dry mucous membranes
Poor skin turgor
Type II, weight loss and polyphagia (excessive ingestion of food)
Treatment:
Effective treatment attempts to normalize blood glucose levels and prevent
complications.
Type I – Insulin replacement that mimics normal pancreatic function.
Current means of insulin replacement include mixed, split doses of rapid
(short-onset) with intermediate – or long-onset insulin injected usually
twice a day (varies according to doctors orders); premeal injections of
rapid insulin with intermediate -onset injections at bedtime; and continuous
subcutaneous insulin infusion (insulin pump) (NOTE – this is a example,
all medications should be prescribed and follow your doctors orders)
Pancreas transplantation, is still experimental.
Diabetic therapy also requires a diet carefully planned to meet nutritional
needs, to control blood glucose levels, and to reach and maintain appropriate
body weight.
For the obese diabetic patient, weight reduction is a dietary goal.
In Type I, the calorie allotment may be high, depending on growth
stage and activity level. To be successful, however, the diet must
be followed consistently, and meals must be eaten at regular times.
Type II diabetes may require oral hypoglycemics. These medications
stimulate endogenous insulin production and may also increase insulin sensitivity
at the cellular level.