dm and diabetes insipidus

8/13/2019 DM and Diabetes Insipidus

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Diabetes Melitus and Diabetes Insipidus

Written by :

Amelya Lesmana030.09.011

Faculty of Medicine risa!ti "ni#ersity

$010

%ontent :


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&ac!'round (i

%)apter 1 1

*Diabetes Mellitus

Definition 1

+at)op)ysiolo'y , %auses 1

-ymptoms 10

%omplication 10

reatment , Medication 11

%)apter $ 1

*Diabetes Insipidus

Definition 1

+at)op)ysiolo'y 1

-ymptoms 1/

%omplication 19

reatment , Medication $0

%)apter 3 $$

* Diabetes Melitus and Diabetes Insipidus

%)apter $3

*%onclusion

&iblio'rap)y $

&ac!'round

Many people still assume t)at diabetes is a disease of a parent or a


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disease arisin' only because of )eredity. In fact e#ery person can)a#e diabetes bot) youn' and old includin' you.Accordin' to data of W2 Indonesia ran!s t) lar'est in t)e numberof patients 4it) Diabetes Mellitus in t)e 4orld. In t)e year $000 alonet)ere are about 5.6 million Indonesian people 4it) diabetes.

2o4e#er in $006 t)e estimated number of diabetics in Indonesia roses)arply to 1 million people in 4)ic) 50 percent are a4are of ne4diabetes and amon' t)em only about 30 percent for treatmentre'ularly.

It is unfortunate t)at many diabetics 4)o do not reali7e t)ey sufferfrom 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)ecommunity 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 diabetesbecause t)e ris! is only 58. It turned out t)at type $ diabetes is morecommon in people sufferin' from obesity due to obesity or from )islifestyle.

(i

%)apter 1Diabetes Melitus

Definition


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Diabetes mellitus is a disease in 4)ic) t)e concentration of 'lucosesimple su'ar in t)e blood is )i') because t)e body can not release oruse insulin ade;uately. Insulin is a )ormone released by t)e pancreas4)ic) is responsible for maintainin' normal blood su'ar le#els. Insulinput su'ar into cells so it can produce ener'y or stored as ener'y

reser#es.

+at)op)ysiolo'y , %auses

Glucose Metabolism


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* insulin metabolism

* 'luca'ons metabolism


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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


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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 infection

for e(ample by one of t)e #iruses of t)e %o(sac!ie #irus family or

=erman measles alt)ou') t)e e#idence is inconclusi#e. In type 1

pancreatic beta cells in t)e Islets of Lan'er)ans are destroyed or

dama'ed sufficiently to effecti#ely abolis) endo'enous insulin

production. )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 type $ or insulin deficient

4it)out insulin resistance type 1.

)is #ulnerability is not s)ared by e#eryone 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 'enotypes 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. o

connection )as been establis)ed bet4een autoantibodies antibodies

to co4>s mil! proteins and type 1 diabetes. A subtype of type 1

identifiable by t)e presence of antibodies a'ainst beta cells typically

de#elops slo4ly and so is often confused 4it) type $. In addition a
http://www.news-medical.net/health/What-is-Diabetes.aspxhttp://www.news-medical.net/health/What-is-Diabetes.aspx


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small proportion of type $ cases manifest a 'enetic form of t)e disease

called maturity onset diabetes of t)e youn' MDB.

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 ort)ern Finland 4)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 connection if any is obscure.

ype 1 diabetes 4as pre#iously !no4n as u#enile diabetes because it

is one of t)e most fre;uent c)ronic diseases in c)ildren? )o4e#er t)e

maority of ne4*onset type 1 diabetes is seen in adults. -cientific

studies t)at use antibody testin' 'lutamic acid decarbo(ylase

antibodies =ADA islet cell antibodies I%A and insulinoma*

associated IA*$ 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! Eype 1 Diabetes in Adults: +rinciples and

+ractice Informa 2ealt)care $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 diabetes t)e body

does not produce insulin. Insulin is a )ormone t)at is needed to

con#ert su'ar 'lucose starc)es and ot)er food into ener'y needed

for daily life.

-ome su''est t)at deficiency of Citamin D3 one 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 latitude and so

of a#ailable sun intensity.

-ome c)emicals and dru's preferentially destroy pancreatic cells.

+yrinuron Cacor *3*pyridylmet)yl*>*p*nitrop)enyl urea a

rodenticide introduced in t)e "nited -tates in 196 selecti#ely


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destroys pancreatic beta cells resultin' in type 1 diabetes after

accidental or intentional in'estion. Cacor 4as 4it)dra4n from t)e ".-.

mar!et in 199 but is still used in some countries. Ganosar is t)e trade

name for strepto7otocin an antibiotic and antineoplastic a'ent used in

c)emot)erapy for pancreatic cancer? it also !ills beta cells resultin' in

loss of insulin production. t)er pancreatic problems includin'

trauma pancreatitis or tumors eit)er mali'nant or beni'n can also

lead to loss of insulin production.

)e e(act causes of type 1 diabetes are not yet fully understood and

researc) on t)ose mentioned and ot)ers 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.


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Diabetes Melitus Type 2 : formerly called adult*onset or

noninsulindependent diabetes is t)e most common form of diabetes.

+eople can de#elop type $ diabetes at any a'e e#en durin' c)ild)ood.

)is form of diabetes usually be'ins 4it) insulin resistance a condition

in 4)ic) fat muscle and li#er cells do not use insulin properly. At first

t)e pancreas !eeps up 4it) t)e added demand by producin' more

insulin. In time )o4e#er 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 medicines ma!in' 4ise food c)oices e(ercisin' re'ularly

controllin' blood pressure and c)olesterol 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 mellitus insulin

resistance is 'enerally Hpost*receptorH 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.

t)er important contributin' factors:

increased )epatic 'lucose production e.'. from 'lyco'en *

'lucose con#ersion especially at inappropriate times typical

cause is deran'ed insulin le#els as t)ose le#els control t)is

function in li#er cells

decreased insulin*mediated 'lucose transport in primarily

muscle and adipose tissues receptor and post*receptor defects

impaired beta*cell function@loss of early p)ase of insulin release

in response to )yper'lycemic stimuli


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)is is a more comple( problem t)an type 1 but is sometimes easier

to treat especially in t)e early years 4)en insulin is often still bein'

produced internally. ype $ may 'o unnoticed for years before

dia'nosis since symptoms are typically milder e' no !etoacidosis

coma etc and can be sporadic. 2o4e#er se#ere complications can

result from improperly mana'ed type $ diabetes includin' renal

failure erectile dysfunction blindness slo4 )ealin' 4ounds includin'

sur'ical incisions and arterial disease includin' coronary artery

disease. )e onset of type $ )as been most common in middle a'e and

later life 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 MDB is increasin'ly seen in adolescents 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 i.e. ori'in. Diabetes

mellitus 4it) a !no4n etiolo'y suc) as secondary to ot)er diseases

!no4n 'ene defects trauma or sur'ery or t)e effects of dru's is more

appropriately called secondary diabetes mellitus or diabetes due to a

specific cause.


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#aries substantially almost certainly for en#ironmental and lifestyle

reasons 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 diabetes most li!ely

because adipose tissue especially t)at in t)e abdomen around internal

or'ans is a recently identified source of se#eral c)emical si'nals to

ot)er tissues )ormones and cyto!ines. t)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#er 'enetics play a relati#ely small role in t)e

4idespread occurrence of type $ diabetes. Diabetes mellitus type $ is

often associated 4it) obesity )ypertension ele#ated c)olesterol

combined )yperlipidemia and 4it) t)e condition often termed

Metabolic syndrome it is also !no4n as -yndrome K ea#an>s

syndrome or %2A-. -econdary causes of Diabetes mellitus type $

are: acrome'aly %us)in'>s syndrome t)yroto(icosis

p)eoc)romocytoma c)ronic pancreatitis 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 bloodstream fluid is pulled from your tissues.)is may lea#e you t)irsty. As a result you may drin! @ and

urinate @ more t)an usual.

Extreme hunger.Wit)out enou') insulin to mo#e su'ar into

your cells your muscles and or'ans become depleted of ener'y.


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)is tri''ers intense )un'er t)at may persist e#en after you eat.

Wit)out insulin 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'er

you may lose 4ei')t @ sometimes rapidly. Wit)out t)e ener'y

su'ar supplies your muscle tissues and fat stores may simply

s)rin!.

!atigue.If your cells are depri#ed of su'ar you may become

tired and irritable.

"lurred #ision.If your blood su'ar le#el is too )i') 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 fact 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 bloodstream fluid is pulled from t)e tissues.

)is may lea#e you t)irsty. As a result you may drin! @ and

urinate @ more t)an usual.

Increased hunger.Wit)out enou') insulin to mo#e su'ar into

your cells 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'er

you may lose 4ei')t. Wit)out t)e ability to use 'lucose 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.


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!atigue.If your cells are depri#ed of su'ar you may become

tired and irritable.

"lurred #ision. If your blood su'ar is too )i') fluid may be

pulled from t)e lenses of your eyes. )is may affect your ability

to focus clearly.

$lo%&healing sores or frequent infections.ype $ diabetes

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! #el#ety s!in in t)e folds and creases of

t)eir bodies @ usually in t)e armpits and nec!. )is condition

called acant)osis ni'ricans may be a si'n of insulin resistance.

%omplications

- Heart and blood #essel disease. Diabetes dramatically increases

your ris! of #arious cardio#ascular problems includin' coronary artery

disease 4it) c)est pain an'ina )eart attac! stro!e narro4in' of t)e

arteries at)erosclerosis and )i') blood pressure. In fact about 65

percent of people 4)o )a#e diabetes die of some type of )eart or

blood #essel disease accordin' to t)e American 2eart Association.

* )er#e damage *neuropathy+.


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can dama'e t)is delicate filterin' system. -e#ere dama'e can lead to

!idney failure or irre#ersible end*sta'e !idney disease re;uirin'

dialysis or a !idney transplant.

* Eye damage.Diabetes can dama'e t)e blood #essels of t)e retina

diabetic retinopat)y potentially leadin' to blindness. Diabetes also

increases t)e ris! of ot)er serious #ision conditions suc) as cataracts

and 'laucoma.

* !oot damage.er#e dama'e in t)e feet or poor blood flo4 to t)e

feet increases t)e ris! of #arious foot complications. Left untreated

cuts and blisters can become serious infections. -e#ere dama'e mi')t

re;uire toe foot or e#en le' amputation.

* $(in and mouth conditions. Diabetes may lea#e you more

susceptible to s!in problems includin' bacterial and fun'al infections.

=um infections also may be a concern especially if you )a#e a )istory

of poor dental )y'iene.

* -steoporosis.Diabetes may lead to lo4er t)an normal bone mineral

density increasin' your ris! of osteoporosis.

* regnancy complications. 2i') blood su'ar le#els can bedan'erous for bot) t)e mot)er and t)e baby. )e ris! of miscarria'e

stillbirt) and birt) defects are increased 4)en diabetes isn>t 4ell

controlled. For t)e mot)er diabetes increases t)e ris! of diabetic

!etoacidosis diabetic eye problems retinopat)y 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:


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a!in' insulin

s not clear if t)ere>s a lin! to t)e medication. If you

used s action.

Insulin in0ectionscan be done usin' a fine needle and syrin'e or an

insulin pen a de#ice t)at loo!s li!e an in! pen e(cept t)e cartrid'e is

filled 4it) insulin.

-ther medicationsare sometimes prescribed as 4ell suc) as:


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ramlintide *$ymlin+. An inection 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.

o%&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. t )a#e

)i') blood pressure your doctor may prescribe medications

!no4n as an'iotensin*con#ertin' en7yme A%s recommended t)at people 4it)

diabetes )a#e blood pressure less t)an 130/0 millimeters of

mercury mm 2'.

holesterol&lo%ering drugs. As 4it) )i') blood pressure

dru's 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 LDL or HbadH c)olesterol be belo4 100 m'dL and

t)at )i')*density lipoprotein 2DL or H'oodH c)olesterol be o#er

50 m'dL. ri'lycerides anot)er type of blood fat are ideal 4)en

t)ey>re less t)an 150 m'dL.

ancreas transplant. Wit) a successful pancreas transplant

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'


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dru's to pre#ent or'an reection. )ese dru's can )a#e serious

side effects includin' a )i') ris! of infection and or'an inury.

&ecause t)e side effects can be more dan'erous t)an t)e

diabetes pancreas transplants are 'enerally reser#ed for t)ose

4it) #ery difficult*to*control diabetes.

Islet cell transplantation.esearc)ers also are e(perimentin'

4it) islet cell transplantation 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 past ne4

tec)ni;ues and better dru's to pre#ent islet cell reection may

impro#e its future c)ance for success. 2o4e#er islet cell

transplantation still re;uires t)e use of immune*suppressin'

medications and ust as it did 4it) its o4n natural islet cells t)e

body often destroys transplanted islet cells ma!in' t)e time off

insulin s)ort*li#ed. Additionally 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 study 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!y 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'

e'ular e(ercise

+ossibly diabetes medication or insulin t)erapy


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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 alone but many need diabetes medications or

insulin t)erapy. )e decision about 4)ic) medications are best

depends on many factors 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.ften people 4)o are ne4ly dia'nosed

4ill be prescribed metformin =lucop)a'e a diabetesmedication t)at lo4ers 'lucose production in t)e li#er. Bour

doctor 4ill also recommend lifestyle c)an'es suc) as losin'

4ei')t and becomin' more acti#e.

Alon' 4it) metformin ot)er oral or inected 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 medications 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) insulin must be inected.


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antidiuretic )ormone AD2 also !no4n as ar'inine #asopressin AC+

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

osmoreceptors supraoptic or para#entricular nuclei or t)e

supraoptico)ypop)yseal tract. In contrast 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.

ep)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. ep)ro'enic diabetes insipidus can be obser#ed in c)ronic

renal insufficiency lit)ium to(icity )ypercalcemia )ypo!alemia and

tubulointerstitial disease? rarely diabetes insipidus may be )ereditary.

Pathophysiology

s re;uirements for blood pressure and t)e main

electrolytes sodium and potassium. In 'eneral electrolyte re'ulation

precedes #olume re'ulation. W)en t)e #olume is se#erely depleted

)o4e#er 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)alamus 4)ic)

produces AD2 in t)e supraoptic and para#entricular nuclei. After

synt)esis 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 addition t)e


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)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 tubule specifically it acts on proteins called a;uaporins

4)ic) open to allo4 4ater into t)e collectin' duct cells. )is increase

in permeability allo4s for reabsorption of 4ater into t)e bloodstream

t)us concentratin' t)e urine.

-ymptoms


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enou') 4ater is consumed to offset t)e urinary losses. 2o4e#er 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 properly and you can become

de)ydrated. De)ydration can cause:

Dry mout)

Muscle 4ea!ness

Lo4 blood pressure )ypotension

2ypernatremia

-un!en appearance to your eyes

Fe#er or )eadac)e or bot)

apid )eart rate

Wei')t loss

Diabetes insipidus can also cause an electrolyte imbalance.


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& entral diabetes insipidus. &ecause t)e cause of t)is form of

diabetes insipidus is a lac! of anti*diuretic )ormone AD2 treatment is

usually 4it) a synt)etic )ormone called desmopressin. Bou can ta!e

desmopressin as a nasal spray oral tablets or by inection. )e

synt)etic )ormone 4ill eliminate t)e increase in urination. For most

people 4it) central DI 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 suc) as a tumor your doctor 4ill first treat t)e

abnormality.

If you )a#e central DI be sure to replace any fluid t)at you do lose?

)o4e#er 4)ile you>re ta!in' desmopressin drin! fluids or 4ater only4)en you>re t)irsty. )is is because t)e dru' pre#ents e(cess 4ater

e(cretion 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 DI 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 about $.5 liters a day @ to ensure

proper )ydration.

& )ephrogenic diabetes insipidus.)is condition is t)e result of

your !idneys not properly respondin' to AD2 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)ia7ide used alone or 4it) ot)er medications

may impro#e symptoms. Alt)ou') )ydroc)lorot)ia7ide is a diuretic

usually used to increase urine output in some cases it can reduce

urine output for people 4it) nep)ro'enic DI.


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If symptoms from nep)ro'enic diabetes insipidus are due to

medications you>re ta!in' stoppin' t)ese medicines may )elp?

)o4e#er 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

cases an abnormality in t)e t)irst mec)anism causes 'estational DI. In

t)ese rare cases doctors don>t prescribe desmopressin.


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%)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 DI are

polyuria and polydipsia. )e amount of fluid you drin! or t)e

production of urine per $ )ours is #ery lar'e reac)in' 50*10 liters.

Diabetes mellitus DM is a syndrome 4it) disturbance of normal

metabolism of carbo)ydrates fats and proteins due to lac! of insulinsecretion or decreased tissue sensiti#ity to insulin. DI and DM )ad t)e

same symptoms namely polyuria. +olyuria contained in t)e #arious

states 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 DI 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 msm L and

+A 10 mmol L t)e dia'nosis of DI 4as found. &ut if your urine

osmolality obtained only N$50 msm L 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 pressure 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


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%)apter

%onclusion

Diabetes Insipidus is not t)e same as diabetes mellitus Hsu'arH

diabetes. Diabetes Insipidus resembles diabetes mellitus because

t)e symptoms of bot) diseases are increased urination and t)irst.

2o4e#er in e#ery ot)er respect includin' t)e causes and treatment of

t)e disorders 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.


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eferences :

1. -)ils Maurice

dm and diabetes insipidus

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