DM and Diabetes Insipidus
Content
Diabetes Melitus and Diabetes Insipidus
Written by : Amelya Lesmana 030.09.011
Faculty of Medicine risa!ti "ni#ersity $010
%ontent :
&ac!'round %)apter 1 *Diabetes Mellitus Definition +at)op)ysiolo'y , %auses -ymptoms %omplication %)apter $ *Diabetes Insipidus Definition +at)op)ysiolo'y -ymptoms %omplication %)apter 3 * Diabetes Melitus and Diabetes Insipidus %)apter 0 *%onclusion &iblio'rap)y reatment , Medication reatment , Medication
(i 1 1 1 10 10 11 1. 1. 1. 1/ 19 $0 $$
$3
$0
&ac!'round
Many people still assume t)at diabetes is a disease of a parent or a
disease arisin' only because of )eredity. In fact1 e#ery person can )a#e diabetes1 bot) youn' and old1 includin' you. Accordin' to data of W231 Indonesia ran!s 0t) lar'est in t)e number of patients 4it) Diabetes Mellitus in t)e 4orld. In t)e year $000 alone1 t)ere are about 5.6 million Indonesian people 4it) diabetes. 2o4e#er1 in $006 t)e estimated number of diabetics in Indonesia rose s)arply to 10 million people1 in 4)ic) 50 percent are a4are of ne4 diabetes1 and amon' t)em only about 30 percent for treatment re'ularly. It is unfortunate t)at many diabetics 4)o do not reali7e t)ey suffer from a disease t)at more commonly referred to diabetes or diabetes. )is may be due to t)e lac! of information about diabetes in t)e community especially t)e symptoms. Most cases of diabetes type $ diabetes is caused by )eredity. &ut )eredity alone is not enou') to cause a person affected by diabetes because t)e ris! is only 58. It turned out t)at type $ diabetes is more common in people sufferin' from obesity due to obesity or from )is lifestyle.
%)apter 1 Diabetes Melitus Definition
(i
Diabetes mellitus is a disease in 4)ic) t)e concentration of 'lucose 9simple su'ar: in t)e blood is )i') because t)e body can not release or use insulin ade;uately. Insulin is a )ormone released by t)e pancreas1 4)ic) is responsible for maintainin' normal blood su'ar le#els. Insulin put su'ar into cells so it can produce ener'y or stored as ener'y reser#es. +at)op)ysiolo'y , %auses Glucose Metabolism <ner'y is re;uired for t)e normal functionin' of t)e or'ans in t)e body. Many tissues can also use fat or protein as an ener'y source but ot)ers1 suc) as t)e brain and red blood cells1 can only use 'lucose. =lucose is stored in t)e body as 'lyco'en. )e li#er is an important stora'e site for 'lyco'en. =lyco'en is mobili7ed and con#erted to 'lucose by 'luconeo'enesis 4)en t)e blood 'lucose concentration is lo4. =lucose may also be produced from non*carbo)ydrate precursors1 suc) as pyru#ate1 amino acids and 'lycerol1 by 'luconeo'enesis. It is 'luconeo'enesis t)at maintains blood 'lucose concentrations1 for e(ample durin' star#ation and intense e(ercise. The endocrine pancreas The pancreas has both endocrine and exocrine functions. The endocrine tissue is grouped together in the islets of Langerhans and consists of four different cell types each with its own function. Alp)a cells produce glucagon. &eta cells produce proinsulin. Proinsulin is the inactive form of insulin that is converted to insulin in the circulation. Delta cells produce somatostatin. F or PP cells produce pancreatic polypeptide. Regulation of insulin secretion Insulin secretion is increased by elevated blood glucose concentrations, gastrointestinal hormones and eta adrenergic stimulation. Insulin secretion is inhibited by catecholamines and somatostatin.
1 The role of insulin and glucagon in glucose Insulin and 'luca'on 4or! syner'istically to !eep blood 'lucose concentrations normal.
*
insulin metabolism
*
'luca'ons metabolism
Diabetes Melitus type 1 : autoimmune diseases are 'enetically determined by symptoms t)at ultimately to4ards a 'radual process of destruction imunolo'ic cells t)at produce insulin.
)e cause of type 1 diabetes is still not fully understood. -ome t)eori7e t)at type 1 diabetes is 'enerally a #irally tri''ered
autoimmune response in 4)ic) t)e immune system>s attac! on #irus infected cells is also directed a'ainst t)e beta cells in t)e pancreas. )e autoimmune attac! may be tri''ered by reaction to an infection1 for e(ample by one of t)e #iruses of t)e %o(sac!ie #irus family or =erman measles1 alt)ou') t)e e#idence is inconclusi#e. In type 11 pancreatic beta cells in t)e Islets of Lan'er)ans are destroyed or dama'ed production. sufficiently to effecti#ely abolis) endo'enous insulin )is etiolo'y distin'uis)es type 1>s ori'in from type $. It
s)ould also be noted t)at t)e use of insulin in treatin' a patient does >>not>> mean t)at patient )as type 1 diabetes? t)e type of diabetes a patient )as is determined only by t)e cause@fundamentally by 4)et)er t)e patient is insulin resistant 9type $: or insulin deficient 4it)out insulin resistance 9type 1:. )is #ulnerability is not s)ared by e#eryone1 for not e#eryone infected by t)e suspected or'anisms de#elops type 1 diabetes. )is )as su''ested presence of a 'enetic #ulnerability and t)ere is indeed an obser#ed in)erited tendency to de#elop type 1. It )as been traced to particular 2LA 'enotypes1 t)ou') t)e connection bet4een t)em and t)e tri''erin' of an auto*immune reaction is still poorly understood. -ome researc)ers belie#e t)at t)e autoimmune response is influenced by antibodies a'ainst co4>s mil! proteins. A lar'e retrospecti#e controlled study publis)ed in $006 stron'ly su''ests t)at infants 4)o 4ere ne#er breastfed )ad a ris! for de#elopin' type 1 diabetes t4ice t)at of infants 4)o 4ere breastfed for at least t)ree mont)s. )e mec)anism is not fully understood. Ao
connection )as been establis)ed bet4een autoantibodies1 antibodies to co4>s mil! proteins1 and type 1 diabetes. A subtype of type 1 9identifiable by t)e presence of antibodies a'ainst beta cells: typically de#elops slo4ly and so is often confused 4it) type $. In addition1 a
small proportion of type $ cases manifest a 'enetic form of t)e disease called maturity onset diabetes of t)e youn' 9M3DB:. Citamin D in doses of $000 I" per day 'i#en durin' t)e first year of a c)ild>s life )as been connected in one study in Aort)ern Finland 94)ere intrinsic production of Citamin D is lo4 due to lo4 natural li')t le#els: 4it) an /08 reduction in t)e ris! of 'ettin' type 1 diabetes later in life. )e causal connection1 if any1 is obscure. ype 1 diabetes 4as pre#iously !no4n as Du#enile diabetes because it is one of t)e most fre;uent c)ronic diseases in c)ildren? )o4e#er1 t)e maDority of ne4*onset type 1 diabetes is seen in adults. -cientific studies t)at use antibody testin' 9'lutamic acid decarbo(ylase antibodies 9=ADA:1 islet cell antibodies 9I%A:1 and insulinoma* associated 9IA*$: autoantibodies: to distin'uis) bet4een type 1 and type $ diabetes demonstrate t)at most ne4*onset type 1 diabetes is seen in adults. A $00/ boo!1 E ype 1 Diabetes in Adults: +rinciples and +racticeF 9Informa 2ealt)care1 $00/: says t)at adult*onset type 1 autoimmune diabetes is t4o to t)ree times more common t)an classic c)ild)ood*onset autoimmune diabetes. In type 1 diabetes1 t)e body does not produce insulin. Insulin is a )ormone t)at is needed to con#ert su'ar 9'lucose:1 starc)es and ot)er food into ener'y needed for daily life. -ome su''est t)at deficiency of Citamin D3 9one of se#eral related c)emicals 4it) Citamin D acti#ity: may be an important pat)o'enic factor in type 1 diabetes independent of 'eo'rap)ical latitude1 and so of a#ailable sun intensity. -ome c)emicals and dru's preferentially destroy pancreatic cells. +yrinuron 9Cacor1 A*3*pyridylmet)yl*A>*p*nitrop)enyl urea:1 a rodenticide introduced in t)e "nited -tates in 19.61 selecti#ely
destroys pancreatic beta cells1 resultin' in type 1 diabetes after accidental or intentional in'estion. Cacor 4as 4it)dra4n from t)e ".-. mar!et in 19.91 but is still used in some countries. Ganosar is t)e trade name for strepto7otocin1 an antibiotic and antineoplastic a'ent used in c)emot)erapy for pancreatic cancer? it also !ills beta cells1 resultin' in loss of insulin production. 3t)er pancreatic problems1 includin' trauma1 pancreatitis or tumors 9eit)er mali'nant or beni'n:1 can also lead to loss of insulin production. )e e(act causes of type 1 diabetes are not yet fully understood1 and researc) on t)ose mentioned1 and ot)ers1 continues. In December !""#, researchers from Toronto $ospital for %ic& 'hildren published research that shows a lin& between type ( diabetes and the immune and nervous system. )sing mice, the researchers discovered that a control circuit exists between insulin* producing cells and their associated sensory +pain*related, nerves. It-s being suggested that faulty nerves in the pancreas could be a cause of type ( diabetes.
Diabetes
Melitus
Type
2
:
formerly
called
adult*onset
or
noninsulindependent diabetes1 is t)e most common form of diabetes. +eople can de#elop type $ diabetes at any a'e1 e#en durin' c)ild)ood. )is form of diabetes usually be'ins 4it) insulin resistance1 a condition in 4)ic) fat1 muscle1 and li#er cells do not use insulin properly. At first1 t)e pancreas !eeps up 4it) t)e added demand by producin' more insulin. In time1 )o4e#er1 it loses t)e ability to secrete enou') insulin in response to meals. +eople 4)o are o#er4ei')t and inacti#e are more li!ely to de#elop type $ diabetes. reatment includes ta!in' diabetes medicines1 ma!in' 4ise food c)oices1 e(ercisin' re'ularly1 controllin' blood pressure and c)olesterol1 and ta!in' aspirin daily@for some.
Insulin resistance means t)at body cells do not respond appropriately 4)en insulin is present. "nli!e type 1 diabetes mellitus1 insulin resistance is 'enerally Hpost*receptorH1 meanin' it is a problem 4it) t)e cells t)at respond to insulin rat)er t)an a problem 4it) t)e production of insulin. 3t)er important contributin' factors:
•
increased )epatic 'lucose production 9e.'.1 from 'lyco'en *I 'lucose con#ersion:1 especially at inappropriate times 9typical cause is deran'ed insulin le#els1 as t)ose le#els control t)is function in li#er cells:
•
decreased insulin*mediated 'lucose transport in 9primarily: muscle and adipose tissues 9receptor and post*receptor defects: impaired beta*cell function@loss of early p)ase of insulin release in response to )yper'lycemic stimuli
•
)is is a more comple( problem t)an type 11 but is sometimes easier to treat1 especially in t)e early years 4)en insulin is often still bein' produced internally. ype $ may 'o unnoticed for years before dia'nosis1 since symptoms are typically milder 9e'1 no !etoacidosis1 coma1 etc: and can be sporadic. 2o4e#er1 se#ere complications can result from improperly mana'ed type $ diabetes1 includin' renal failure1 erectile dysfunction1 blindness1 slo4 )ealin' 4ounds 9includin' sur'ical incisions:1 and arterial disease1 includin' coronary artery disease. )e onset of type $ )as been most common in middle a'e and later life1 alt)ou') it is bein' more fre;uently seen in adolescents and youn' adults due to an increase in c)ild obesity and inacti#ity. A type of diabetes called M3DB is increasin'ly seen in adolescents1 but t)is is classified as a diabetes due to a specific cause and not as type $ diabetes. Diabetes mellitus type $ is of un!no4n etiolo'y 9i.e.1 ori'in:. Diabetes mellitus 4it) a !no4n etiolo'y1 suc) as secondary to ot)er diseases1 !no4n 'ene defects1 trauma or sur'ery1 or t)e effects of dru's1 is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause. <(amples include diabetes mellitus suc) as M3DB or t)ose caused by )emoc)romatosis1 pancreatic insufficiencies1 or certain types of medications 9e.'.1 lon'*term steroid use:. Accordin' to %D%1 about $3.613 million people in t)e "nited -tates1 or /8 of t)e population1 )a#e diabetes. )e total pre#alence of diabetes increased 13.58 from $005*$00.. It is t)ou')t t)at only $08 of diabetes is no4 undia'nosed1 do4n from an estimated 308 in $005 and from t)e pre#iously estimated 508 in ca 1995. About 90J958 of all Aort) American cases of diabetes are type $1 and about $08 of t)e population o#er t)e a'e of 65 )as diabetes mellitus type $. )e fraction of type $ diabetics in ot)er parts of t)e 4orld
#aries substantially1 almost certainly for en#ironmental and lifestyle reasons1 t)ou') t)ese are not !no4n in detail. Diabetes affects o#er 150 million people 4orld4ide and t)is number is e(pected to double by $0$5.. About 55 percent of type $ are obese @c)ronic obesity leads to increased insulin resistance t)at can de#elop into diabetes1 most li!ely because adipose tissue 9especially t)at in t)e abdomen around internal or'ans: is a 9recently identified: source of se#eral c)emical si'nals to ot)er tissues 9)ormones and cyto!ines:. 3t)er researc) s)o4s t)at type $ diabetes causes obesity as an effect of t)e c)an'es in metabolism and ot)er deran'ed cell be)a#ior attendant on insulin resistance. 2o4e#er1 'enetics play a relati#ely small role in t)e 4idespread occurrence of type $ diabetes. Diabetes mellitus type $ is often associated 4it) obesity1 )ypertension1 ele#ated c)olesterol 9combined )yperlipidemia:1 and 4it) t)e condition often termed Metabolic syndrome 9it is also !no4n as -yndrome K1 Lea#an>s syndrome1 or %2A3-:. -econdary causes of Diabetes mellitus type $ are: acrome'aly1 %us)in'>s syndrome1 t)yroto(icosis1 p)eoc)romocytoma1 c)ronic pancreatitis1 cancer and dru's.
-ymptoms
ype 1 diabetes si'ns and symptoms can come on ;uic!ly and may include:
•
Increased thirst and frequent urination. As e(cess su'ar builds up in your bloodstream1 fluid is pulled from your tissues. )is may lea#e you t)irsty. As a result1 you may drin! @ and urinate @ more t)an usual.
•
Extreme hunger. Wit)out enou') insulin to mo#e su'ar into your cells1 your muscles and or'ans become depleted of ener'y.
)is tri''ers intense )un'er t)at may persist e#en after you eat. Wit)out insulin1 t)e su'ar in your food ne#er reac)es your ener'y*star#ed tissues.
•
eight loss. Despite eatin' more t)an usual to relie#e )un'er1 you may lose 4ei')t @ sometimes rapidly. Wit)out t)e ener'y su'ar supplies1 your muscle tissues and fat stores may simply s)rin!.
•
!atigue. If your cells are depri#ed of su'ar1 you may become tired and irritable.
•
"lurred #ision. If your blood su'ar le#el is too )i')1 fluid may be pulled from your tissues @ includin' t)e lenses of your eyes. )is may affect your ability to focus clearly.
ype $ diabetes symptoms may de#elop #ery slo4ly. In fact1 you can )a#e type $ diabetes for years and not e#en !no4 it. Loo! for:
•
Increased thirst and frequent urination. As e(cess su'ar builds up in your bloodstream1 fluid is pulled from t)e tissues. )is may lea#e you t)irsty. As a result1 you may drin! @ and urinate @ more t)an usual.
•
Increased hunger. Wit)out enou') insulin to mo#e su'ar into your cells1 your muscles and or'ans become depleted for ener'y. )is tri''ers intense )un'er.
•
eight loss. Despite eatin' more t)an usual to relie#e )un'er1 you may lose 4ei')t. Wit)out t)e ability to use 'lucose1 t)e body uses alternati#e fuels stored in muscle and fat. %alories are lost as e(cess 'lucose is released in t)e urine.
•
!atigue. If your cells are depri#ed of su'ar1 you may become tired and irritable. "lurred #ision. If your blood su'ar is too )i')1 fluid may be pulled from t)e lenses of your eyes. to focus clearly. )is may affect your ability ype $ diabetes
•
•
$lo%&healing sores or frequent infections. affects your ability to )eal and resist infections.
•
'reas of dar(ened s(in. -ome people 4it) type $ diabetes )a#e patc)es of dar!1 #el#ety s!in in t)e folds and creases of t)eir bodies @ usually in t)e armpits and nec!. )is condition1 called acant)osis ni'ricans1 may be a si'n of insulin resistance.
%omplications
- Heart and blood #essel disease. Diabetes dramatically increases your ris! of #arious cardio#ascular problems1 includin' coronary artery disease 4it) c)est pain 9an'ina:1 )eart attac!1 stro!e1 narro4in' of t)e arteries 9at)erosclerosis: and )i') blood pressure. In fact1 about 65 percent of people 4)o )a#e diabetes die of some type of )eart or blood #essel disease1 accordin' to t)e American 2eart Association. * )er#e damage *neuropathy+. <(cess su'ar can inDure t)e 4alls of t)e tiny blood #essels 9capillaries: t)at nouris) your ner#es1 especially in t)e le's. )is can cause tin'lin'1 numbness1 burnin' or pain t)at usually be'ins at t)e tips of t)e toes or fin'ers and 'radually spreads up4ard. +oorly controlled blood su'ar could cause you to e#entually lose all sense of feelin' in t)e affected limbs. Dama'e to t)e ner#es t)at control di'estion can cause problems 4it) nausea1 #omitin'1 diarr)ea or constipation. For men1 erectile dysfunction may be an issue. & ,idney damage *nephropathy+. )e !idneys contain millions of tiny blood #essel clusters t)at filter 4aste from your blood. Diabetes
can dama'e t)is delicate filterin' system. -e#ere dama'e can lead to !idney failure or irre#ersible end*sta'e !idney disease1 re;uirin' dialysis or a !idney transplant. * Eye damage. Diabetes can dama'e t)e blood #essels of t)e retina 9diabetic retinopat)y:1 potentially leadin' to blindness. Diabetes also increases t)e ris! of ot)er serious #ision conditions1 suc) as cataracts and 'laucoma. * !oot damage. Aer#e dama'e in t)e feet or poor blood flo4 to t)e feet increases t)e ris! of #arious foot complications. Left untreated1 cuts and blisters can become serious infections. -e#ere dama'e mi')t re;uire toe1 foot or e#en le' amputation. * $(in and mouth conditions. Diabetes may lea#e you more susceptible to s!in problems1 includin' bacterial and fun'al infections. =um infections also may be a concern1 especially if you )a#e a )istory of poor dental )y'iene. * -steoporosis. Diabetes may lead to lo4er t)an normal bone mineral density1 increasin' your ris! of osteoporosis. * .regnancy complications. 2i') blood su'ar le#els can be dan'erous for bot) t)e mot)er and t)e baby. )e ris! of miscarria'e1 stillbirt) and birt) defects are increased 4)en diabetes isn>t 4ell controlled. For t)e mot)er1 diabetes increases t)e ris! of diabetic !etoacidosis1 diabetic eye problems 9retinopat)y:1 pre'nancy*induced )i') blood pressure and preeclampsia. * /earing problems. 2earin' impairments occur more often in people 4it) diabetes.
reatment , Medication
reatment for type 1 diabetes is a lifelon' commitment to:
• • • •
a!in' insulin <(ercisin' re'ularly and maintainin' a )ealt)y 4ei')t <atin' )ealt)y foods Monitorin' blood su'ar
Types of insulin are many and include rapid*actin' insulin1 lon'* actin' insulin and intermediate options. <(amples are re'ular insulin 92umulin L1 Ao#olin L1 ot)ers:1 insulin isop)ane 92umulin A1 Ao#olin A:1 insulin lispro 92umalo':1 insulin aspart 9Ao#oLo':1 insulin 'lar'ine 9Lantus: and insulin detemir 9Le#emir:. Dependin' on your needs1 your doctor may prescribe a mi(ture of insulin types to use t)rou')out t)e day and ni')t. 'n inhaled insulin 9<(ubera: 4as pre#iously a#ailable1 but t)e manufacturer stopped sellin' t)e dru' because too fe4 people 4ere usin' it. -ince it 4as ta!en off t)e mar!et1 t)is dru' )as been lin!ed to an increased number of lun' cancers in people 4it) a )istory of smo!in'. 2o4e#er1 because t)e additional number of lun' cancer cases is so small1 it>s not clear if t)ere>s a lin! to t)e medication. If you used <(ubera and )a#e a )istory of smo!in'1 discuss t)ese concerns 4it) your doctor. %urrently1 t)e only options for 'ettin' insulin into t)e body are inDection or insulin pump infusion. Insulin can>t be ta!en orally to lo4er blood su'ar because stomac) en7ymes interfere 4it) insulin>s action. Insulin in0ections can be done usin' a fine needle and syrin'e or an insulin pen a de#ice t)at loo!s li!e an in! pen1 e(cept t)e cartrid'e is filled 4it) insulin. -ther medications are sometimes prescribed as 4ell1 suc) as:
•
.ramlintide *$ymlin+. An inDection of t)is medication before you eat can slo4 t)e mo#ement of food t)rou') your stomac) to curb t)e s)arp increase in blood su'ar t)at occurs after meals.
•
1o%&dose aspirin therapy. Bour doctor mi')t prescribe lo4* dose aspirin t)erapy to )elp pre#ent )eart and blood #essel disease.
•
/igh blood pressure medications. <#en if you don>t )a#e )i') blood pressure1 your doctor may prescribe medications !no4n as an'iotensin*con#ertin' en7yme 9A%<: in)ibitors or an'iotensin II receptor bloc!ers 9AL&s:1 because t)ese medications can )elp !eep your !idneys )ealt)y in addition to lo4erin' blood pressure. It>s recommended t)at people 4it) diabetes )a#e blood pressure less t)an 130M/0 millimeters of mercury 9mm 2':.
•
2holesterol&lo%ering drugs. As 4it) )i') blood pressure dru's1 your doctor may not 4ait until your c)olesterol is ele#ated before )e or s)e prescribes c)olesterol*lo4erin' a'ents !no4n as statins. %)olesterol 'uidelines are more a''ressi#e for people 4it) diabetes because of t)e ele#ated )eart disease ris!. )e American Diabetes Association recommends t)at lo4*density lipoprotein 9LDL1 or HbadH: c)olesterol be belo4 100 m'MdL and t)at )i')*density lipoprotein 92DL1 or H'oodH: c)olesterol be o#er 50 m'MdL. ri'lycerides1 anot)er type of blood fat1 are ideal 4)en t)ey>re less t)an 150 m'MdL.
•
.ancreas transplant. Wit) a successful pancreas transplant1 you 4ould no lon'er need insulin. &ut pancreas transplants aren>t al4ays successful @ and t)e procedure poses serious ris!s. Bou 4ould need a lifetime of potent immune*suppressin'
dru's to pre#ent or'an reDection.
)ese dru's can )a#e serious
side effects1 includin' a )i') ris! of infection and or'an inDury. &ecause t)e side effects can be more dan'erous t)an t)e diabetes1 pancreas transplants are 'enerally reser#ed for t)ose 4it) #ery difficult*to*control diabetes.
•
Islet cell transplantation. Lesearc)ers also are e(perimentin' 4it) islet cell transplantation1 4)ic) pro#ides ne4 insulin* producin' cells from a donor pancreas. Alt)ou') t)is e(perimental procedure )as met 4it) problems in t)e past1 ne4 tec)ni;ues and better dru's to pre#ent islet cell reDection may impro#e its future c)ance for success. 2o4e#er1 islet cell transplantation still re;uires t)e use of immune*suppressin' medications1 and Dust as it did 4it) its o4n natural islet cells1 t)e body often destroys transplanted islet cells1 ma!in' t)e time off insulin s)ort*li#ed. Additionally1 a sufficient supply of islet cells isn>t a#ailable for t)is treatment to become more 4idespread.
•
$tem cell transplant. In a $00. &ra7ilian study1 a small number of people ne4ly dia'nosed 4it) type 1 diabetes 4ere able to stop usin' insulin after bein' treated 4it) stem cells made from t)eir o4n blood. Alt)ou') stem cell transplants @ 4)ic) in#ol#e s)uttin' do4n t)e immune system and t)en buildin' it up a'ain @ can be ris!y1 t)e tec)ni;ue may one day pro#ide an additional treatment option for type 1 diabetes.
reatment for type $ diabetes re;uires a lifelon' commitment to:
• • • •
&lood su'ar monitorin' 2ealt)y eatin' Le'ular e(ercise +ossibly1 diabetes medication or insulin t)erapy
Diabetes
medications
and
insulin
therapy
-ome people 4)o )a#e type $ diabetes can mana'e t)eir blood su'ar 4it) diet and e(ercise alone1 but many need diabetes medications or insulin t)erapy. )e decision about 4)ic) medications are best depends on many factors1 includin' your blood su'ar le#el and t)e presence of any ot)er )ealt) problems. Bour doctor mi')t e#en combine dru's from different classes to )elp you control your blood su'ar in se#eral different 4ays.
•
Diabetes medications. 3ften1 people 4)o are ne4ly dia'nosed 4ill be prescribed metformin 9=lucop)a'e:1 a diabetes medication t)at lo4ers 'lucose production in t)e li#er. Bour doctor 4ill also recommend lifestyle c)an'es1 suc) as losin' 4ei')t and becomin' more acti#e. Alon' 4it) metformin1 ot)er oral or inDected medications can be used to treat type $ diabetes. -ome diabetes medications stimulate your pancreas to produce and release more insulin. -till ot)ers bloc! t)e action of en7ymes t)at brea! do4n carbo)ydrates or ma!e your tissues more sensiti#e to insulin. In addition to diabetes medications1 your doctor mi')t prescribe lo4*dose aspirin t)erapy as 4ell as blood pressure and c)olesterol lo4erin' medications to )elp pre#ent )eart and blood #essel disease.
•
Insulin therapy. -ome people 4)o )a#e type $ diabetes need insulin t)erapy as 4ell. &ecause normal di'estion interferes 4it) insulin ta!en by mout)1 insulin must be inDected.
Insulin in0ections in#ol#e usin' a fine needle and syrin'e or an insulin pen inDector @ a de#ice t)at loo!s li!e an in! pen1 e(cept t)e cartrid'e is filled 4it) insulin. 'n insulin pump also may be an option. )e pump is a de#ice
about t)e si7e of a cell p)one 4orn on t)e outside of your body. A tube connects t)e reser#oir of insulin to a cat)eter t)at>s inserted under t)e s!in of your abdomen. A tubeless pump t)at uses disposable pods to )old t)e insulin and a 4ireless de#ice to tell t)e pump 4)at to do is also a#ailable. A small cat)eter from t)e pod is automatically inserted under t)e s!in1 and t)e pod can be 4orn on t)e abdomen1 lo4er bac!1 t)i')s or upper arms. W)ic)e#er insulin pump you use1 it can be pro'rammed to dispense specific amounts of insulin automatically. It can also be adDusted to deli#er more or less insulin dependin' on meals1 acti#ity le#el and blood su'ar le#el. Types of insulin are many and include rapid*actin' insulin1 lon'*actin' insulin and intermediate options. <(amples include insulin lispro 92umalo':1 insulin aspart 9Ao#oLo':1 insulin 'lar'ine 9Lantus: and insulin detemir 9Le#emir:. Dependin' on your needs1 your doctor may prescribe a mi(ture of insulin types to use t)rou')out t)e day and ni')t.
%)apter $ Diabetes Insipidus
Definition
Diabetes insipidus 9DI: may be central or nep)ro'enic. %entral diabetes insipidus is c)aracteri7ed by decreased secretion of
antidiuretic )ormone 9AD2:1 also !no4n as ar'inine #asopressin 9AC+:1 t)at results in polyuria and polydipsia by diminis)in' t)e patient>s ability to concentrate urine. Diminis)ed or absent AD2 can be t)e result of a defect in one or more sites in#ol#in' t)e )ypot)alamic osmoreceptors1 supraoptic or para#entricular nuclei1 or t)e supraoptico)ypop)yseal tract. In contrast1 lesions of t)e posterior pituitary rarely cause permanent diabetes insipidus because AD2 is produced in t)e )ypot)alamus and still can be secreted into t)e circulation. Aep)ro'enic diabetes insipidus is c)aracteri7ed by a decrease in t)e ability to concentrate urine due to a resistance to AD2 action in t)e !idney. Aep)ro'enic diabetes insipidus can be obser#ed in c)ronic renal insufficiency1 lit)ium to(icity1 )ypercalcemia1 )ypo!alemia1 and tubulointerstitial disease? rarely1 diabetes insipidus may be )ereditary.
Pathophysiology
<lectrolyte and #olume )omeostasis is a comple( mec)anism t)at balances t)e body>s re;uirements for blood pressure and t)e main electrolytes sodium and potassium. In 'eneral1 electrolyte re'ulation precedes #olume re'ulation. W)en t)e #olume is se#erely depleted1 )o4e#er1 t)e body 4ill retain 4ater at t)e e(pense of deran'in' electrolyte le#els. )e re'ulation of urine production occurs in t)e )ypot)alamus1 4)ic) produces AD2 in t)e supraoptic and para#entricular nuclei. After synt)esis1 t)e )ormone is transported in neurosecretory 'ranules do4n t)e a(on of t)e )ypot)alamic neuron to t)e posterior lobe of t)e pituitary 'land 4)ere it is stored for later release. In addition1 t)e
)ypot)alamus re'ulates t)e sensation of t)irst in t)e #entromedial nucleus by sensin' increases in serum osmolarity and relayin' t)is information to t)e corte(. )e main effector or'an for fluid )omeostasis is t)e !idney. AD2 acts by increasin' 4ater permeability in t)e collectin' ducts and distal con#oluted tubule1 specifically it acts on proteins called a;uaporins 4)ic) open to allo4 4ater into t)e collectin' duct cells. t)us concentratin' t)e urine. )is increase in permeability allo4s for reabsorption of 4ater into t)e bloodstream1
-ymptoms
•
<(cessi#e t)irst
o o
May be intense or uncontrollable May in#ol#e a cra#in' for ice 4ater
•
<(cessi#e urine #olume
<(cessi#e urination and e(treme t)irst 9especially for cold 4ater and sometimes ice or ice 4ater: are typical for DI. -ymptoms of diabetes insipidus are ;uite similar to t)ose of untreated diabetes mellitus1 4it) t)e distinction t)at t)e urine is not s4eet as it does not contain 'lucose and t)ere is no )yper'lycemia 9ele#ated blood 'lucose:. &lurred #ision is a rarity. -i'ns of de)ydration may also appear in some indi#iduals since t)e body cannot conser#e muc) 9if any: of t)e 4ater it ta!es in. )e e(treme urination continues t)rou')out t)e day and t)e ni')t. In c)ildren1 DI can interfere 4it) appetite1 eatin'1 4ei')t 'ain1 and 'ro4t) as 4ell. )ey may present 4it) fe#er1 #omitin'1 or diarr)ea. Adults 4it) untreated DI may remain )ealt)y for decades as lon' as
enou') 4ater is consumed to offset t)e urinary losses. 2o4e#er1 t)ere is a continuous ris! of de)ydration and loss of potassium.
%omplication
Diabetes insipidus can cause your body to retain an inade;uate amount of 4ater to function properly1 and you can become de)ydrated. De)ydration can cause:
• • • • • • • •
Dry mout) Muscle 4ea!ness Lo4 blood pressure 9)ypotension: 2ypernatremia -un!en appearance to your eyes Fe#er or )eadac)e1 or bot) Lapid )eart rate Wei')t loss insipidus can also cause an electrolyte imbalance.
Diabetes
<lectrolytes are minerals in your blood @ suc) as sodium1 potassium and calcium @ t)at maintain t)e balance of fluids in your body. <lectrolyte imbalance can cause symptoms1 suc) as )eadac)e1 fati'ue1 irritability and muscle pains.
reatment , Medication
& 2entral diabetes insipidus. &ecause t)e cause of t)is form of diabetes insipidus is a lac! of anti*diuretic )ormone 9AD2:1 treatment is usually 4it) a synt)etic )ormone called desmopressin. Bou can ta!e desmopressin as a nasal spray1 oral tablets or by inDection. )e synt)etic )ormone 4ill eliminate t)e increase in urination. For most people 4it) central DI1 desmopressin is a safe and effecti#e treatment. If t)e condition is caused by an abnormality in t)e pituitary 'land or )ypot)alamus 9suc) as a tumor:1 your doctor 4ill first treat t)e abnormality. If you )a#e central DI1 be sure to replace any fluid t)at you do lose? )o4e#er1 4)ile you>re ta!in' desmopressin1 drin! fluids or 4ater only 4)en you>re t)irsty. )is is because t)e dru' pre#ents e(cess 4ater e(cretion1 4)ic) means your !idneys are ma!in' less urine and are less responsi#e to c)an'es in body fluids. In mild cases of central DI1 increased 4ater inta!e may be all t)at you need. Bour doctor may su''est a certain amount of 4ater inta!e @ usually more t)an $.6 ;uarts 9about $.5 liters: a day @ to ensure proper )ydration. & )ephrogenic diabetes insipidus. )is condition is t)e result of
your !idneys not properly respondin' to AD21 so desmopressin is not a treatment option. Instead your doctor may prescribe a lo4*salt diet to )elp reduce t)e amount of urine your !idneys ma!e. Bou>ll also need to be sure to drin! enou') 4ater to a#oid de)ydration. )e dru' )ydroc)lorot)ia7ide1 used alone or 4it) ot)er medications1 may impro#e symptoms. Alt)ou') )ydroc)lorot)ia7ide is a diuretic 9usually used to increase urine output:1 in some cases it can reduce urine output for people 4it) nep)ro'enic DI.
If
symptoms
from
nep)ro'enic
diabetes
insipidus
are
due
to
medications you>re ta!in'1 stoppin' t)ese medicines may )elp? )o4e#er1 don>t stop ta!in' any medication 4it)out tal!in' 4it) your doctor first. & 3estational diabetes insipidus. reatment for most cases of
'estational DI is 4it) t)e synt)etic )ormone desmopressin. In rare cases1 an abnormality in t)e t)irst mec)anism causes 'estational DI. In t)ese rare cases1 doctors don>t prescribe desmopressin.
%)apter 3 Diabetes Melitus , Diabetes Insipidus
Diabetes mellitus and diabetes insipidus is different but bot) are similar because t)e same symptoms t)at cause t)irst and fre;uent urination. %omplaints and t)e main symptoms of diabetes insipidus 9DI: are polyuria and polydipsia. )e amount of fluid you drin! or t)e production of urine per $0 )ours is #ery lar'e1 reac)in' 50*10 liters. Diabetes mellitus 9DM: is a syndrome 4it) disturbance of normal metabolism of carbo)ydrates1 fats1 and proteins due to lac! of insulin secretion or decreased tissue sensiti#ity to insulin. DI and DM )ad t)e same symptoms1 namely polyuria. +olyuria contained in t)e #arious states1 alt)ou') t)e DI is a cause t)at often occurs. )ere are 10 appeals in t)e dia'nosis of polyuria t)an DI1 suc) as uncontrolled diabetes and t)e use of certain dru's. +olyuria al'orit)m consists of se#eral sta'es before reac)in' t)e dia'nosis of DI. -tep one is to !no4 t)e urine osmolality. )e ne(t step if t)e #alue is N$50 m3sm M L and +AAI 100 mmol M L1 t)e dia'nosis of DI 4as found. &ut if your urine osmolality obtained only N$50 m3sm M L1 t)e dia'nosis is obtained only polidipsi. Mec)anism of polyuria and polydipsia are closely related. )e )i') blood 'lucose le#els cause se#ere de)ydration in t)e body cells due to osmotic pressure1 4)ic) causes fluid in t)e cell e(it. )e e(it of 'lucose in t)e urine 4ill cause a state of osmotic diuresis. )e o#erall effect is a #ery lar'e loss of fluid in t)e urine. &ecause of t)at t)en arises polydipsia. Diabetes insipidus distin'uis)ed 4it) diabetes melitus t)rou') 4)ic) urine 'lucose testin' in diabetes insipidus does not occur 'lucosuria
%)apter 0 %onclusion
Diabetes Insipidus is not t)e same as diabetes mellitus 9Hsu'arH diabetes:. Diabetes Insipidus resembles diabetes mellitus because t)e symptoms of bot) diseases are increased urination and t)irst. 2o4e#er1 in e#ery ot)er respect1 includin' t)e causes and treatment of t)e disorders1 t)e diseases are completely unrelated. -ometimes diabetes insipidus is referred to as H4aterH diabetes to distin'uis) it from t)e more common diabetes mellitus or Hsu'arH diabetes.
Leferences :
1. -)ils1 Maurice <. -)i!e1 Mos)e. Loss1 A %at)arine. %aballero1 &enDamin. %ousins1 Lobert O. $006. Modern Nutrition in Health and Disease, 10th Edition. +)iladelp)ia: Lippincott Williams and Wil!ins. $. =uyton1 Art)ur %. 2all1 Oo)n <. $00.. Medical +)ysiolo'y e(tboo! <dition 11t). Oa!arta: <=%. .. MedscapePs %ontinually "pdated Leference. Diabetes Insipidus. )ttp:MMemedicine.medscape.comM.accessed Ouly1 3t) $010 0. )e Medical Ae4s. Diabetes Insipidus. )ttp:MM444.ne4s* medical.netM)ealt)MDiabetes*Insipidus* reatment.asp(. accessed Ouly1 3t) $010 5. )e Medical Ae4s. Diabetes Melitus +lus. ype 1. )ttp:MM444.ne4s* Insipidus. medical.netMQta'RM ype*1*Diabetes. accessed Ouly1 3t) $010 6. Medline Diabetes )ttp:MM444.nlm.ni).'o#MmedlineplusMencyMarticleM0003...)tm. accessed Ouly1 3t) $010 .. /. Medica Mayo %linic. -tore. ype $ Diabetes Diabetes Melitus. Melitus. )ttp:MMmedicastore.comMDiabetes. accessed Ouly1 3t) $010 )ttp:MM444.mayoclinic.comM)ealt)Mtype*$*diabetesMD-005/5. accessed Ouly 3t) $010
Written by : Amelya Lesmana 030.09.011
Faculty of Medicine risa!ti "ni#ersity $010
%ontent :
&ac!'round %)apter 1 *Diabetes Mellitus Definition +at)op)ysiolo'y , %auses -ymptoms %omplication %)apter $ *Diabetes Insipidus Definition +at)op)ysiolo'y -ymptoms %omplication %)apter 3 * Diabetes Melitus and Diabetes Insipidus %)apter 0 *%onclusion &iblio'rap)y reatment , Medication reatment , Medication
(i 1 1 1 10 10 11 1. 1. 1. 1/ 19 $0 $$
$3
$0
&ac!'round
Many people still assume t)at diabetes is a disease of a parent or a
disease arisin' only because of )eredity. In fact1 e#ery person can )a#e diabetes1 bot) youn' and old1 includin' you. Accordin' to data of W231 Indonesia ran!s 0t) lar'est in t)e number of patients 4it) Diabetes Mellitus in t)e 4orld. In t)e year $000 alone1 t)ere are about 5.6 million Indonesian people 4it) diabetes. 2o4e#er1 in $006 t)e estimated number of diabetics in Indonesia rose s)arply to 10 million people1 in 4)ic) 50 percent are a4are of ne4 diabetes1 and amon' t)em only about 30 percent for treatment re'ularly. It is unfortunate t)at many diabetics 4)o do not reali7e t)ey suffer from a disease t)at more commonly referred to diabetes or diabetes. )is may be due to t)e lac! of information about diabetes in t)e community especially t)e symptoms. Most cases of diabetes type $ diabetes is caused by )eredity. &ut )eredity alone is not enou') to cause a person affected by diabetes because t)e ris! is only 58. It turned out t)at type $ diabetes is more common in people sufferin' from obesity due to obesity or from )is lifestyle.
%)apter 1 Diabetes Melitus Definition
(i
Diabetes mellitus is a disease in 4)ic) t)e concentration of 'lucose 9simple su'ar: in t)e blood is )i') because t)e body can not release or use insulin ade;uately. Insulin is a )ormone released by t)e pancreas1 4)ic) is responsible for maintainin' normal blood su'ar le#els. Insulin put su'ar into cells so it can produce ener'y or stored as ener'y reser#es. +at)op)ysiolo'y , %auses Glucose Metabolism <ner'y is re;uired for t)e normal functionin' of t)e or'ans in t)e body. Many tissues can also use fat or protein as an ener'y source but ot)ers1 suc) as t)e brain and red blood cells1 can only use 'lucose. =lucose is stored in t)e body as 'lyco'en. )e li#er is an important stora'e site for 'lyco'en. =lyco'en is mobili7ed and con#erted to 'lucose by 'luconeo'enesis 4)en t)e blood 'lucose concentration is lo4. =lucose may also be produced from non*carbo)ydrate precursors1 suc) as pyru#ate1 amino acids and 'lycerol1 by 'luconeo'enesis. It is 'luconeo'enesis t)at maintains blood 'lucose concentrations1 for e(ample durin' star#ation and intense e(ercise. The endocrine pancreas The pancreas has both endocrine and exocrine functions. The endocrine tissue is grouped together in the islets of Langerhans and consists of four different cell types each with its own function. Alp)a cells produce glucagon. &eta cells produce proinsulin. Proinsulin is the inactive form of insulin that is converted to insulin in the circulation. Delta cells produce somatostatin. F or PP cells produce pancreatic polypeptide. Regulation of insulin secretion Insulin secretion is increased by elevated blood glucose concentrations, gastrointestinal hormones and eta adrenergic stimulation. Insulin secretion is inhibited by catecholamines and somatostatin.
1 The role of insulin and glucagon in glucose Insulin and 'luca'on 4or! syner'istically to !eep blood 'lucose concentrations normal.
*
insulin metabolism
*
'luca'ons metabolism
Diabetes Melitus type 1 : autoimmune diseases are 'enetically determined by symptoms t)at ultimately to4ards a 'radual process of destruction imunolo'ic cells t)at produce insulin.
)e cause of type 1 diabetes is still not fully understood. -ome t)eori7e t)at type 1 diabetes is 'enerally a #irally tri''ered
autoimmune response in 4)ic) t)e immune system>s attac! on #irus infected cells is also directed a'ainst t)e beta cells in t)e pancreas. )e autoimmune attac! may be tri''ered by reaction to an infection1 for e(ample by one of t)e #iruses of t)e %o(sac!ie #irus family or =erman measles1 alt)ou') t)e e#idence is inconclusi#e. In type 11 pancreatic beta cells in t)e Islets of Lan'er)ans are destroyed or dama'ed production. sufficiently to effecti#ely abolis) endo'enous insulin )is etiolo'y distin'uis)es type 1>s ori'in from type $. It
s)ould also be noted t)at t)e use of insulin in treatin' a patient does >>not>> mean t)at patient )as type 1 diabetes? t)e type of diabetes a patient )as is determined only by t)e cause@fundamentally by 4)et)er t)e patient is insulin resistant 9type $: or insulin deficient 4it)out insulin resistance 9type 1:. )is #ulnerability is not s)ared by e#eryone1 for not e#eryone infected by t)e suspected or'anisms de#elops type 1 diabetes. )is )as su''ested presence of a 'enetic #ulnerability and t)ere is indeed an obser#ed in)erited tendency to de#elop type 1. It )as been traced to particular 2LA 'enotypes1 t)ou') t)e connection bet4een t)em and t)e tri''erin' of an auto*immune reaction is still poorly understood. -ome researc)ers belie#e t)at t)e autoimmune response is influenced by antibodies a'ainst co4>s mil! proteins. A lar'e retrospecti#e controlled study publis)ed in $006 stron'ly su''ests t)at infants 4)o 4ere ne#er breastfed )ad a ris! for de#elopin' type 1 diabetes t4ice t)at of infants 4)o 4ere breastfed for at least t)ree mont)s. )e mec)anism is not fully understood. Ao
connection )as been establis)ed bet4een autoantibodies1 antibodies to co4>s mil! proteins1 and type 1 diabetes. A subtype of type 1 9identifiable by t)e presence of antibodies a'ainst beta cells: typically de#elops slo4ly and so is often confused 4it) type $. In addition1 a
small proportion of type $ cases manifest a 'enetic form of t)e disease called maturity onset diabetes of t)e youn' 9M3DB:. Citamin D in doses of $000 I" per day 'i#en durin' t)e first year of a c)ild>s life )as been connected in one study in Aort)ern Finland 94)ere intrinsic production of Citamin D is lo4 due to lo4 natural li')t le#els: 4it) an /08 reduction in t)e ris! of 'ettin' type 1 diabetes later in life. )e causal connection1 if any1 is obscure. ype 1 diabetes 4as pre#iously !no4n as Du#enile diabetes because it is one of t)e most fre;uent c)ronic diseases in c)ildren? )o4e#er1 t)e maDority of ne4*onset type 1 diabetes is seen in adults. -cientific studies t)at use antibody testin' 9'lutamic acid decarbo(ylase antibodies 9=ADA:1 islet cell antibodies 9I%A:1 and insulinoma* associated 9IA*$: autoantibodies: to distin'uis) bet4een type 1 and type $ diabetes demonstrate t)at most ne4*onset type 1 diabetes is seen in adults. A $00/ boo!1 E ype 1 Diabetes in Adults: +rinciples and +racticeF 9Informa 2ealt)care1 $00/: says t)at adult*onset type 1 autoimmune diabetes is t4o to t)ree times more common t)an classic c)ild)ood*onset autoimmune diabetes. In type 1 diabetes1 t)e body does not produce insulin. Insulin is a )ormone t)at is needed to con#ert su'ar 9'lucose:1 starc)es and ot)er food into ener'y needed for daily life. -ome su''est t)at deficiency of Citamin D3 9one of se#eral related c)emicals 4it) Citamin D acti#ity: may be an important pat)o'enic factor in type 1 diabetes independent of 'eo'rap)ical latitude1 and so of a#ailable sun intensity. -ome c)emicals and dru's preferentially destroy pancreatic cells. +yrinuron 9Cacor1 A*3*pyridylmet)yl*A>*p*nitrop)enyl urea:1 a rodenticide introduced in t)e "nited -tates in 19.61 selecti#ely
destroys pancreatic beta cells1 resultin' in type 1 diabetes after accidental or intentional in'estion. Cacor 4as 4it)dra4n from t)e ".-. mar!et in 19.91 but is still used in some countries. Ganosar is t)e trade name for strepto7otocin1 an antibiotic and antineoplastic a'ent used in c)emot)erapy for pancreatic cancer? it also !ills beta cells1 resultin' in loss of insulin production. 3t)er pancreatic problems1 includin' trauma1 pancreatitis or tumors 9eit)er mali'nant or beni'n:1 can also lead to loss of insulin production. )e e(act causes of type 1 diabetes are not yet fully understood1 and researc) on t)ose mentioned1 and ot)ers1 continues. In December !""#, researchers from Toronto $ospital for %ic& 'hildren published research that shows a lin& between type ( diabetes and the immune and nervous system. )sing mice, the researchers discovered that a control circuit exists between insulin* producing cells and their associated sensory +pain*related, nerves. It-s being suggested that faulty nerves in the pancreas could be a cause of type ( diabetes.
Diabetes
Melitus
Type
2
:
formerly
called
adult*onset
or
noninsulindependent diabetes1 is t)e most common form of diabetes. +eople can de#elop type $ diabetes at any a'e1 e#en durin' c)ild)ood. )is form of diabetes usually be'ins 4it) insulin resistance1 a condition in 4)ic) fat1 muscle1 and li#er cells do not use insulin properly. At first1 t)e pancreas !eeps up 4it) t)e added demand by producin' more insulin. In time1 )o4e#er1 it loses t)e ability to secrete enou') insulin in response to meals. +eople 4)o are o#er4ei')t and inacti#e are more li!ely to de#elop type $ diabetes. reatment includes ta!in' diabetes medicines1 ma!in' 4ise food c)oices1 e(ercisin' re'ularly1 controllin' blood pressure and c)olesterol1 and ta!in' aspirin daily@for some.
Insulin resistance means t)at body cells do not respond appropriately 4)en insulin is present. "nli!e type 1 diabetes mellitus1 insulin resistance is 'enerally Hpost*receptorH1 meanin' it is a problem 4it) t)e cells t)at respond to insulin rat)er t)an a problem 4it) t)e production of insulin. 3t)er important contributin' factors:
•
increased )epatic 'lucose production 9e.'.1 from 'lyco'en *I 'lucose con#ersion:1 especially at inappropriate times 9typical cause is deran'ed insulin le#els1 as t)ose le#els control t)is function in li#er cells:
•
decreased insulin*mediated 'lucose transport in 9primarily: muscle and adipose tissues 9receptor and post*receptor defects: impaired beta*cell function@loss of early p)ase of insulin release in response to )yper'lycemic stimuli
•
)is is a more comple( problem t)an type 11 but is sometimes easier to treat1 especially in t)e early years 4)en insulin is often still bein' produced internally. ype $ may 'o unnoticed for years before dia'nosis1 since symptoms are typically milder 9e'1 no !etoacidosis1 coma1 etc: and can be sporadic. 2o4e#er1 se#ere complications can result from improperly mana'ed type $ diabetes1 includin' renal failure1 erectile dysfunction1 blindness1 slo4 )ealin' 4ounds 9includin' sur'ical incisions:1 and arterial disease1 includin' coronary artery disease. )e onset of type $ )as been most common in middle a'e and later life1 alt)ou') it is bein' more fre;uently seen in adolescents and youn' adults due to an increase in c)ild obesity and inacti#ity. A type of diabetes called M3DB is increasin'ly seen in adolescents1 but t)is is classified as a diabetes due to a specific cause and not as type $ diabetes. Diabetes mellitus type $ is of un!no4n etiolo'y 9i.e.1 ori'in:. Diabetes mellitus 4it) a !no4n etiolo'y1 suc) as secondary to ot)er diseases1 !no4n 'ene defects1 trauma or sur'ery1 or t)e effects of dru's1 is more appropriately called secondary diabetes mellitus or diabetes due to a specific cause. <(amples include diabetes mellitus suc) as M3DB or t)ose caused by )emoc)romatosis1 pancreatic insufficiencies1 or certain types of medications 9e.'.1 lon'*term steroid use:. Accordin' to %D%1 about $3.613 million people in t)e "nited -tates1 or /8 of t)e population1 )a#e diabetes. )e total pre#alence of diabetes increased 13.58 from $005*$00.. It is t)ou')t t)at only $08 of diabetes is no4 undia'nosed1 do4n from an estimated 308 in $005 and from t)e pre#iously estimated 508 in ca 1995. About 90J958 of all Aort) American cases of diabetes are type $1 and about $08 of t)e population o#er t)e a'e of 65 )as diabetes mellitus type $. )e fraction of type $ diabetics in ot)er parts of t)e 4orld
#aries substantially1 almost certainly for en#ironmental and lifestyle reasons1 t)ou') t)ese are not !no4n in detail. Diabetes affects o#er 150 million people 4orld4ide and t)is number is e(pected to double by $0$5.. About 55 percent of type $ are obese @c)ronic obesity leads to increased insulin resistance t)at can de#elop into diabetes1 most li!ely because adipose tissue 9especially t)at in t)e abdomen around internal or'ans: is a 9recently identified: source of se#eral c)emical si'nals to ot)er tissues 9)ormones and cyto!ines:. 3t)er researc) s)o4s t)at type $ diabetes causes obesity as an effect of t)e c)an'es in metabolism and ot)er deran'ed cell be)a#ior attendant on insulin resistance. 2o4e#er1 'enetics play a relati#ely small role in t)e 4idespread occurrence of type $ diabetes. Diabetes mellitus type $ is often associated 4it) obesity1 )ypertension1 ele#ated c)olesterol 9combined )yperlipidemia:1 and 4it) t)e condition often termed Metabolic syndrome 9it is also !no4n as -yndrome K1 Lea#an>s syndrome1 or %2A3-:. -econdary causes of Diabetes mellitus type $ are: acrome'aly1 %us)in'>s syndrome1 t)yroto(icosis1 p)eoc)romocytoma1 c)ronic pancreatitis1 cancer and dru's.
-ymptoms
ype 1 diabetes si'ns and symptoms can come on ;uic!ly and may include:
•
Increased thirst and frequent urination. As e(cess su'ar builds up in your bloodstream1 fluid is pulled from your tissues. )is may lea#e you t)irsty. As a result1 you may drin! @ and urinate @ more t)an usual.
•
Extreme hunger. Wit)out enou') insulin to mo#e su'ar into your cells1 your muscles and or'ans become depleted of ener'y.
)is tri''ers intense )un'er t)at may persist e#en after you eat. Wit)out insulin1 t)e su'ar in your food ne#er reac)es your ener'y*star#ed tissues.
•
eight loss. Despite eatin' more t)an usual to relie#e )un'er1 you may lose 4ei')t @ sometimes rapidly. Wit)out t)e ener'y su'ar supplies1 your muscle tissues and fat stores may simply s)rin!.
•
!atigue. If your cells are depri#ed of su'ar1 you may become tired and irritable.
•
"lurred #ision. If your blood su'ar le#el is too )i')1 fluid may be pulled from your tissues @ includin' t)e lenses of your eyes. )is may affect your ability to focus clearly.
ype $ diabetes symptoms may de#elop #ery slo4ly. In fact1 you can )a#e type $ diabetes for years and not e#en !no4 it. Loo! for:
•
Increased thirst and frequent urination. As e(cess su'ar builds up in your bloodstream1 fluid is pulled from t)e tissues. )is may lea#e you t)irsty. As a result1 you may drin! @ and urinate @ more t)an usual.
•
Increased hunger. Wit)out enou') insulin to mo#e su'ar into your cells1 your muscles and or'ans become depleted for ener'y. )is tri''ers intense )un'er.
•
eight loss. Despite eatin' more t)an usual to relie#e )un'er1 you may lose 4ei')t. Wit)out t)e ability to use 'lucose1 t)e body uses alternati#e fuels stored in muscle and fat. %alories are lost as e(cess 'lucose is released in t)e urine.
•
!atigue. If your cells are depri#ed of su'ar1 you may become tired and irritable. "lurred #ision. If your blood su'ar is too )i')1 fluid may be pulled from t)e lenses of your eyes. to focus clearly. )is may affect your ability ype $ diabetes
•
•
$lo%&healing sores or frequent infections. affects your ability to )eal and resist infections.
•
'reas of dar(ened s(in. -ome people 4it) type $ diabetes )a#e patc)es of dar!1 #el#ety s!in in t)e folds and creases of t)eir bodies @ usually in t)e armpits and nec!. )is condition1 called acant)osis ni'ricans1 may be a si'n of insulin resistance.
%omplications
- Heart and blood #essel disease. Diabetes dramatically increases your ris! of #arious cardio#ascular problems1 includin' coronary artery disease 4it) c)est pain 9an'ina:1 )eart attac!1 stro!e1 narro4in' of t)e arteries 9at)erosclerosis: and )i') blood pressure. In fact1 about 65 percent of people 4)o )a#e diabetes die of some type of )eart or blood #essel disease1 accordin' to t)e American 2eart Association. * )er#e damage *neuropathy+. <(cess su'ar can inDure t)e 4alls of t)e tiny blood #essels 9capillaries: t)at nouris) your ner#es1 especially in t)e le's. )is can cause tin'lin'1 numbness1 burnin' or pain t)at usually be'ins at t)e tips of t)e toes or fin'ers and 'radually spreads up4ard. +oorly controlled blood su'ar could cause you to e#entually lose all sense of feelin' in t)e affected limbs. Dama'e to t)e ner#es t)at control di'estion can cause problems 4it) nausea1 #omitin'1 diarr)ea or constipation. For men1 erectile dysfunction may be an issue. & ,idney damage *nephropathy+. )e !idneys contain millions of tiny blood #essel clusters t)at filter 4aste from your blood. Diabetes
can dama'e t)is delicate filterin' system. -e#ere dama'e can lead to !idney failure or irre#ersible end*sta'e !idney disease1 re;uirin' dialysis or a !idney transplant. * Eye damage. Diabetes can dama'e t)e blood #essels of t)e retina 9diabetic retinopat)y:1 potentially leadin' to blindness. Diabetes also increases t)e ris! of ot)er serious #ision conditions1 suc) as cataracts and 'laucoma. * !oot damage. Aer#e dama'e in t)e feet or poor blood flo4 to t)e feet increases t)e ris! of #arious foot complications. Left untreated1 cuts and blisters can become serious infections. -e#ere dama'e mi')t re;uire toe1 foot or e#en le' amputation. * $(in and mouth conditions. Diabetes may lea#e you more susceptible to s!in problems1 includin' bacterial and fun'al infections. =um infections also may be a concern1 especially if you )a#e a )istory of poor dental )y'iene. * -steoporosis. Diabetes may lead to lo4er t)an normal bone mineral density1 increasin' your ris! of osteoporosis. * .regnancy complications. 2i') blood su'ar le#els can be dan'erous for bot) t)e mot)er and t)e baby. )e ris! of miscarria'e1 stillbirt) and birt) defects are increased 4)en diabetes isn>t 4ell controlled. For t)e mot)er1 diabetes increases t)e ris! of diabetic !etoacidosis1 diabetic eye problems 9retinopat)y:1 pre'nancy*induced )i') blood pressure and preeclampsia. * /earing problems. 2earin' impairments occur more often in people 4it) diabetes.
reatment , Medication
reatment for type 1 diabetes is a lifelon' commitment to:
• • • •
a!in' insulin <(ercisin' re'ularly and maintainin' a )ealt)y 4ei')t <atin' )ealt)y foods Monitorin' blood su'ar
Types of insulin are many and include rapid*actin' insulin1 lon'* actin' insulin and intermediate options. <(amples are re'ular insulin 92umulin L1 Ao#olin L1 ot)ers:1 insulin isop)ane 92umulin A1 Ao#olin A:1 insulin lispro 92umalo':1 insulin aspart 9Ao#oLo':1 insulin 'lar'ine 9Lantus: and insulin detemir 9Le#emir:. Dependin' on your needs1 your doctor may prescribe a mi(ture of insulin types to use t)rou')out t)e day and ni')t. 'n inhaled insulin 9<(ubera: 4as pre#iously a#ailable1 but t)e manufacturer stopped sellin' t)e dru' because too fe4 people 4ere usin' it. -ince it 4as ta!en off t)e mar!et1 t)is dru' )as been lin!ed to an increased number of lun' cancers in people 4it) a )istory of smo!in'. 2o4e#er1 because t)e additional number of lun' cancer cases is so small1 it>s not clear if t)ere>s a lin! to t)e medication. If you used <(ubera and )a#e a )istory of smo!in'1 discuss t)ese concerns 4it) your doctor. %urrently1 t)e only options for 'ettin' insulin into t)e body are inDection or insulin pump infusion. Insulin can>t be ta!en orally to lo4er blood su'ar because stomac) en7ymes interfere 4it) insulin>s action. Insulin in0ections can be done usin' a fine needle and syrin'e or an insulin pen a de#ice t)at loo!s li!e an in! pen1 e(cept t)e cartrid'e is filled 4it) insulin. -ther medications are sometimes prescribed as 4ell1 suc) as:
•
.ramlintide *$ymlin+. An inDection of t)is medication before you eat can slo4 t)e mo#ement of food t)rou') your stomac) to curb t)e s)arp increase in blood su'ar t)at occurs after meals.
•
1o%&dose aspirin therapy. Bour doctor mi')t prescribe lo4* dose aspirin t)erapy to )elp pre#ent )eart and blood #essel disease.
•
/igh blood pressure medications. <#en if you don>t )a#e )i') blood pressure1 your doctor may prescribe medications !no4n as an'iotensin*con#ertin' en7yme 9A%<: in)ibitors or an'iotensin II receptor bloc!ers 9AL&s:1 because t)ese medications can )elp !eep your !idneys )ealt)y in addition to lo4erin' blood pressure. It>s recommended t)at people 4it) diabetes )a#e blood pressure less t)an 130M/0 millimeters of mercury 9mm 2':.
•
2holesterol&lo%ering drugs. As 4it) )i') blood pressure dru's1 your doctor may not 4ait until your c)olesterol is ele#ated before )e or s)e prescribes c)olesterol*lo4erin' a'ents !no4n as statins. %)olesterol 'uidelines are more a''ressi#e for people 4it) diabetes because of t)e ele#ated )eart disease ris!. )e American Diabetes Association recommends t)at lo4*density lipoprotein 9LDL1 or HbadH: c)olesterol be belo4 100 m'MdL and t)at )i')*density lipoprotein 92DL1 or H'oodH: c)olesterol be o#er 50 m'MdL. ri'lycerides1 anot)er type of blood fat1 are ideal 4)en t)ey>re less t)an 150 m'MdL.
•
.ancreas transplant. Wit) a successful pancreas transplant1 you 4ould no lon'er need insulin. &ut pancreas transplants aren>t al4ays successful @ and t)e procedure poses serious ris!s. Bou 4ould need a lifetime of potent immune*suppressin'
dru's to pre#ent or'an reDection.
)ese dru's can )a#e serious
side effects1 includin' a )i') ris! of infection and or'an inDury. &ecause t)e side effects can be more dan'erous t)an t)e diabetes1 pancreas transplants are 'enerally reser#ed for t)ose 4it) #ery difficult*to*control diabetes.
•
Islet cell transplantation. Lesearc)ers also are e(perimentin' 4it) islet cell transplantation1 4)ic) pro#ides ne4 insulin* producin' cells from a donor pancreas. Alt)ou') t)is e(perimental procedure )as met 4it) problems in t)e past1 ne4 tec)ni;ues and better dru's to pre#ent islet cell reDection may impro#e its future c)ance for success. 2o4e#er1 islet cell transplantation still re;uires t)e use of immune*suppressin' medications1 and Dust as it did 4it) its o4n natural islet cells1 t)e body often destroys transplanted islet cells1 ma!in' t)e time off insulin s)ort*li#ed. Additionally1 a sufficient supply of islet cells isn>t a#ailable for t)is treatment to become more 4idespread.
•
$tem cell transplant. In a $00. &ra7ilian study1 a small number of people ne4ly dia'nosed 4it) type 1 diabetes 4ere able to stop usin' insulin after bein' treated 4it) stem cells made from t)eir o4n blood. Alt)ou') stem cell transplants @ 4)ic) in#ol#e s)uttin' do4n t)e immune system and t)en buildin' it up a'ain @ can be ris!y1 t)e tec)ni;ue may one day pro#ide an additional treatment option for type 1 diabetes.
reatment for type $ diabetes re;uires a lifelon' commitment to:
• • • •
&lood su'ar monitorin' 2ealt)y eatin' Le'ular e(ercise +ossibly1 diabetes medication or insulin t)erapy
Diabetes
medications
and
insulin
therapy
-ome people 4)o )a#e type $ diabetes can mana'e t)eir blood su'ar 4it) diet and e(ercise alone1 but many need diabetes medications or insulin t)erapy. )e decision about 4)ic) medications are best depends on many factors1 includin' your blood su'ar le#el and t)e presence of any ot)er )ealt) problems. Bour doctor mi')t e#en combine dru's from different classes to )elp you control your blood su'ar in se#eral different 4ays.
•
Diabetes medications. 3ften1 people 4)o are ne4ly dia'nosed 4ill be prescribed metformin 9=lucop)a'e:1 a diabetes medication t)at lo4ers 'lucose production in t)e li#er. Bour doctor 4ill also recommend lifestyle c)an'es1 suc) as losin' 4ei')t and becomin' more acti#e. Alon' 4it) metformin1 ot)er oral or inDected medications can be used to treat type $ diabetes. -ome diabetes medications stimulate your pancreas to produce and release more insulin. -till ot)ers bloc! t)e action of en7ymes t)at brea! do4n carbo)ydrates or ma!e your tissues more sensiti#e to insulin. In addition to diabetes medications1 your doctor mi')t prescribe lo4*dose aspirin t)erapy as 4ell as blood pressure and c)olesterol lo4erin' medications to )elp pre#ent )eart and blood #essel disease.
•
Insulin therapy. -ome people 4)o )a#e type $ diabetes need insulin t)erapy as 4ell. &ecause normal di'estion interferes 4it) insulin ta!en by mout)1 insulin must be inDected.
Insulin in0ections in#ol#e usin' a fine needle and syrin'e or an insulin pen inDector @ a de#ice t)at loo!s li!e an in! pen1 e(cept t)e cartrid'e is filled 4it) insulin. 'n insulin pump also may be an option. )e pump is a de#ice
about t)e si7e of a cell p)one 4orn on t)e outside of your body. A tube connects t)e reser#oir of insulin to a cat)eter t)at>s inserted under t)e s!in of your abdomen. A tubeless pump t)at uses disposable pods to )old t)e insulin and a 4ireless de#ice to tell t)e pump 4)at to do is also a#ailable. A small cat)eter from t)e pod is automatically inserted under t)e s!in1 and t)e pod can be 4orn on t)e abdomen1 lo4er bac!1 t)i')s or upper arms. W)ic)e#er insulin pump you use1 it can be pro'rammed to dispense specific amounts of insulin automatically. It can also be adDusted to deli#er more or less insulin dependin' on meals1 acti#ity le#el and blood su'ar le#el. Types of insulin are many and include rapid*actin' insulin1 lon'*actin' insulin and intermediate options. <(amples include insulin lispro 92umalo':1 insulin aspart 9Ao#oLo':1 insulin 'lar'ine 9Lantus: and insulin detemir 9Le#emir:. Dependin' on your needs1 your doctor may prescribe a mi(ture of insulin types to use t)rou')out t)e day and ni')t.
%)apter $ Diabetes Insipidus
Definition
Diabetes insipidus 9DI: may be central or nep)ro'enic. %entral diabetes insipidus is c)aracteri7ed by decreased secretion of
antidiuretic )ormone 9AD2:1 also !no4n as ar'inine #asopressin 9AC+:1 t)at results in polyuria and polydipsia by diminis)in' t)e patient>s ability to concentrate urine. Diminis)ed or absent AD2 can be t)e result of a defect in one or more sites in#ol#in' t)e )ypot)alamic osmoreceptors1 supraoptic or para#entricular nuclei1 or t)e supraoptico)ypop)yseal tract. In contrast1 lesions of t)e posterior pituitary rarely cause permanent diabetes insipidus because AD2 is produced in t)e )ypot)alamus and still can be secreted into t)e circulation. Aep)ro'enic diabetes insipidus is c)aracteri7ed by a decrease in t)e ability to concentrate urine due to a resistance to AD2 action in t)e !idney. Aep)ro'enic diabetes insipidus can be obser#ed in c)ronic renal insufficiency1 lit)ium to(icity1 )ypercalcemia1 )ypo!alemia1 and tubulointerstitial disease? rarely1 diabetes insipidus may be )ereditary.
Pathophysiology
<lectrolyte and #olume )omeostasis is a comple( mec)anism t)at balances t)e body>s re;uirements for blood pressure and t)e main electrolytes sodium and potassium. In 'eneral1 electrolyte re'ulation precedes #olume re'ulation. W)en t)e #olume is se#erely depleted1 )o4e#er1 t)e body 4ill retain 4ater at t)e e(pense of deran'in' electrolyte le#els. )e re'ulation of urine production occurs in t)e )ypot)alamus1 4)ic) produces AD2 in t)e supraoptic and para#entricular nuclei. After synt)esis1 t)e )ormone is transported in neurosecretory 'ranules do4n t)e a(on of t)e )ypot)alamic neuron to t)e posterior lobe of t)e pituitary 'land 4)ere it is stored for later release. In addition1 t)e
)ypot)alamus re'ulates t)e sensation of t)irst in t)e #entromedial nucleus by sensin' increases in serum osmolarity and relayin' t)is information to t)e corte(. )e main effector or'an for fluid )omeostasis is t)e !idney. AD2 acts by increasin' 4ater permeability in t)e collectin' ducts and distal con#oluted tubule1 specifically it acts on proteins called a;uaporins 4)ic) open to allo4 4ater into t)e collectin' duct cells. t)us concentratin' t)e urine. )is increase in permeability allo4s for reabsorption of 4ater into t)e bloodstream1
-ymptoms
•
<(cessi#e t)irst
o o
May be intense or uncontrollable May in#ol#e a cra#in' for ice 4ater
•
<(cessi#e urine #olume
<(cessi#e urination and e(treme t)irst 9especially for cold 4ater and sometimes ice or ice 4ater: are typical for DI. -ymptoms of diabetes insipidus are ;uite similar to t)ose of untreated diabetes mellitus1 4it) t)e distinction t)at t)e urine is not s4eet as it does not contain 'lucose and t)ere is no )yper'lycemia 9ele#ated blood 'lucose:. &lurred #ision is a rarity. -i'ns of de)ydration may also appear in some indi#iduals since t)e body cannot conser#e muc) 9if any: of t)e 4ater it ta!es in. )e e(treme urination continues t)rou')out t)e day and t)e ni')t. In c)ildren1 DI can interfere 4it) appetite1 eatin'1 4ei')t 'ain1 and 'ro4t) as 4ell. )ey may present 4it) fe#er1 #omitin'1 or diarr)ea. Adults 4it) untreated DI may remain )ealt)y for decades as lon' as
enou') 4ater is consumed to offset t)e urinary losses. 2o4e#er1 t)ere is a continuous ris! of de)ydration and loss of potassium.
%omplication
Diabetes insipidus can cause your body to retain an inade;uate amount of 4ater to function properly1 and you can become de)ydrated. De)ydration can cause:
• • • • • • • •
Dry mout) Muscle 4ea!ness Lo4 blood pressure 9)ypotension: 2ypernatremia -un!en appearance to your eyes Fe#er or )eadac)e1 or bot) Lapid )eart rate Wei')t loss insipidus can also cause an electrolyte imbalance.
Diabetes
<lectrolytes are minerals in your blood @ suc) as sodium1 potassium and calcium @ t)at maintain t)e balance of fluids in your body. <lectrolyte imbalance can cause symptoms1 suc) as )eadac)e1 fati'ue1 irritability and muscle pains.
reatment , Medication
& 2entral diabetes insipidus. &ecause t)e cause of t)is form of diabetes insipidus is a lac! of anti*diuretic )ormone 9AD2:1 treatment is usually 4it) a synt)etic )ormone called desmopressin. Bou can ta!e desmopressin as a nasal spray1 oral tablets or by inDection. )e synt)etic )ormone 4ill eliminate t)e increase in urination. For most people 4it) central DI1 desmopressin is a safe and effecti#e treatment. If t)e condition is caused by an abnormality in t)e pituitary 'land or )ypot)alamus 9suc) as a tumor:1 your doctor 4ill first treat t)e abnormality. If you )a#e central DI1 be sure to replace any fluid t)at you do lose? )o4e#er1 4)ile you>re ta!in' desmopressin1 drin! fluids or 4ater only 4)en you>re t)irsty. )is is because t)e dru' pre#ents e(cess 4ater e(cretion1 4)ic) means your !idneys are ma!in' less urine and are less responsi#e to c)an'es in body fluids. In mild cases of central DI1 increased 4ater inta!e may be all t)at you need. Bour doctor may su''est a certain amount of 4ater inta!e @ usually more t)an $.6 ;uarts 9about $.5 liters: a day @ to ensure proper )ydration. & )ephrogenic diabetes insipidus. )is condition is t)e result of
your !idneys not properly respondin' to AD21 so desmopressin is not a treatment option. Instead your doctor may prescribe a lo4*salt diet to )elp reduce t)e amount of urine your !idneys ma!e. Bou>ll also need to be sure to drin! enou') 4ater to a#oid de)ydration. )e dru' )ydroc)lorot)ia7ide1 used alone or 4it) ot)er medications1 may impro#e symptoms. Alt)ou') )ydroc)lorot)ia7ide is a diuretic 9usually used to increase urine output:1 in some cases it can reduce urine output for people 4it) nep)ro'enic DI.
If
symptoms
from
nep)ro'enic
diabetes
insipidus
are
due
to
medications you>re ta!in'1 stoppin' t)ese medicines may )elp? )o4e#er1 don>t stop ta!in' any medication 4it)out tal!in' 4it) your doctor first. & 3estational diabetes insipidus. reatment for most cases of
'estational DI is 4it) t)e synt)etic )ormone desmopressin. In rare cases1 an abnormality in t)e t)irst mec)anism causes 'estational DI. In t)ese rare cases1 doctors don>t prescribe desmopressin.
%)apter 3 Diabetes Melitus , Diabetes Insipidus
Diabetes mellitus and diabetes insipidus is different but bot) are similar because t)e same symptoms t)at cause t)irst and fre;uent urination. %omplaints and t)e main symptoms of diabetes insipidus 9DI: are polyuria and polydipsia. )e amount of fluid you drin! or t)e production of urine per $0 )ours is #ery lar'e1 reac)in' 50*10 liters. Diabetes mellitus 9DM: is a syndrome 4it) disturbance of normal metabolism of carbo)ydrates1 fats1 and proteins due to lac! of insulin secretion or decreased tissue sensiti#ity to insulin. DI and DM )ad t)e same symptoms1 namely polyuria. +olyuria contained in t)e #arious states1 alt)ou') t)e DI is a cause t)at often occurs. )ere are 10 appeals in t)e dia'nosis of polyuria t)an DI1 suc) as uncontrolled diabetes and t)e use of certain dru's. +olyuria al'orit)m consists of se#eral sta'es before reac)in' t)e dia'nosis of DI. -tep one is to !no4 t)e urine osmolality. )e ne(t step if t)e #alue is N$50 m3sm M L and +AAI 100 mmol M L1 t)e dia'nosis of DI 4as found. &ut if your urine osmolality obtained only N$50 m3sm M L1 t)e dia'nosis is obtained only polidipsi. Mec)anism of polyuria and polydipsia are closely related. )e )i') blood 'lucose le#els cause se#ere de)ydration in t)e body cells due to osmotic pressure1 4)ic) causes fluid in t)e cell e(it. )e e(it of 'lucose in t)e urine 4ill cause a state of osmotic diuresis. )e o#erall effect is a #ery lar'e loss of fluid in t)e urine. &ecause of t)at t)en arises polydipsia. Diabetes insipidus distin'uis)ed 4it) diabetes melitus t)rou') 4)ic) urine 'lucose testin' in diabetes insipidus does not occur 'lucosuria
%)apter 0 %onclusion
Diabetes Insipidus is not t)e same as diabetes mellitus 9Hsu'arH diabetes:. Diabetes Insipidus resembles diabetes mellitus because t)e symptoms of bot) diseases are increased urination and t)irst. 2o4e#er1 in e#ery ot)er respect1 includin' t)e causes and treatment of t)e disorders1 t)e diseases are completely unrelated. -ometimes diabetes insipidus is referred to as H4aterH diabetes to distin'uis) it from t)e more common diabetes mellitus or Hsu'arH diabetes.
Leferences :
1. -)ils1 Maurice <. -)i!e1 Mos)e. Loss1 A %at)arine. %aballero1 &enDamin. %ousins1 Lobert O. $006. Modern Nutrition in Health and Disease, 10th Edition. +)iladelp)ia: Lippincott Williams and Wil!ins. $. =uyton1 Art)ur %. 2all1 Oo)n <. $00.. Medical +)ysiolo'y e(tboo! <dition 11t). Oa!arta: <=%. .. MedscapePs %ontinually "pdated Leference. Diabetes Insipidus. )ttp:MMemedicine.medscape.comM.accessed Ouly1 3t) $010 0. )e Medical Ae4s. Diabetes Insipidus. )ttp:MM444.ne4s* medical.netM)ealt)MDiabetes*Insipidus* reatment.asp(. accessed Ouly1 3t) $010 5. )e Medical Ae4s. Diabetes Melitus +lus. ype 1. )ttp:MM444.ne4s* Insipidus. medical.netMQta'RM ype*1*Diabetes. accessed Ouly1 3t) $010 6. Medline Diabetes )ttp:MM444.nlm.ni).'o#MmedlineplusMencyMarticleM0003...)tm. accessed Ouly1 3t) $010 .. /. Medica Mayo %linic. -tore. ype $ Diabetes Diabetes Melitus. Melitus. )ttp:MMmedicastore.comMDiabetes. accessed Ouly1 3t) $010 )ttp:MM444.mayoclinic.comM)ealt)Mtype*$*diabetesMD-005/5. accessed Ouly 3t) $010
