Introduction of Diabetes Mellitus and Diabetes Insipidus
Diabetes mellitus and diabetes insipidus are clinical entities that have been well described for years, but only recently have their pathophysiologic nature and long-term management been defined. Until a century ago, little was known about the course of these diseases or their underlying mechanisms. The present review will discuss a pathophysiologic model of these diseases, focusing on current concepts that are used to understand the treatment of patients and the progression of disease in affected individuals.
Although they share the same first name and some of the symptoms, diabetes insipidus and diabetes mellitus are completely different diseases. They cause different problems and they have different treatments. In this topic, we will explain a bit about both of the diseases and then move on to what the primary differences between them are.
Diabetes mellitus is general diabetes that most of the population suffer from. It involves several conditions on how your body turns food into energy. When you eat carbohydrates, your body turns the food into a sugar called glucose and the hormone insulin regulates the flow of glucose in your bloodstream. If there is a low level of insulin secretion in your body, then your blood glucose levels will increase which leads to a condition called high blood sugar. It can cause serious health problems and if not controlled can be life-threatening. It comes in different forms
Prediabetes: It is a condition when your blood glucose levels are higher than usual but not so high that it can be diagnosed as diabetes
Type I Diabetes: This is also called insulin-dependent diabetes and is an auto-immune condition where your body attacks your pancreas with antibodies. Thus the pancreas is damaged which results in low levels of insulin secretion and high levels of blood glucose. This condition can damage the blood vessels of eyes and kidneys. The treatment involves injecting insulin into the fatty tissue under the skin with the help of syringes and insulin pens.
Type II Diabetes: It is also referred to as non-insulin-dependent diabetes. It is observed mostly in people suffering from obesity. In this condition, the patient’s body produces insulin but it is not enough to control blood glucose levels. It causes the same health complications as type 1 diabetes. The only way to keep this type of diabetes in control is to lead a healthy life; eating right, exercising and keeping a healthy weight.
Gestational Diabetes: Pregnancy can cause insulin resistance. If this leads to diabetes then doctor’s call it gestational diabetes. It is usually spotted in middle or late pregnancy. Gestational diabetes should be controlled as it poses a risk for the fetus. The new-born baby might gain weight after birth and face trouble breathing. The treatment includes meal planning for the mother, daily exercise, taking insulin and keeping weight under control.
Characteristics of Diabetes Mellitus
Diabetes mellitus (DM) is a disease characterized by hyperglycemia that results from defects in insulin secretion or insulin action. In particular, the body's inability to respond normally to insulin has been viewed as being fundamental in the pathogenesis of DM.
DM is commonly characterized by hyperglycemia, with an average fasting plasma glucose level between 7.8 and 11.1 mmol/L and a 2-h glucose level greater than 11.1 mmol/L; however, asymptomatic hyperglycemia, mild hyperglycemia, and mild hyperglycemia associated with impaired fasting glucose have also been observed. These abnormal glucose values are often accompanied by high insulin secretion and resistance in peripheral tissues, and severe cases are associated with small amounts of insulin secretion and resistance in the liver.
More recently, hyperglycemia has been associated with an increase in the natural killer cell activity as assessed by binding to insulin-IgG complexes. This finding has been noted in the groups with DM, and in those who have had a successful induction of remission from DM; the findings have been attributed to an increased number of circulating insulin-IgG complexes. Insulin is normally secreted into the extracellular compartment by pancreatic ß-cells in response to a glucose challenge. When there is insulin resistance, this glucose-sensing mechanism is compromised and hyperglycemia occurs despite normal insulin secretion and activity. In these individuals, insulin resistance and hyperglycemia are a result of an inability to appropriately regulate glucose homeostasis in peripheral tissues. Hyperglycemia may also result from postprandial hyperinsulinemia (especially when there is a delay in carbohydrate absorption), although this represents a relatively uncommon form of diabetes.
Insulinomas most patients with insulinomas present with acute pancreatitis. However, a significant proportion of these patients have no objective findings on physical examination and are diagnosed by the patient's physician from indirect signs (weight loss and vague complaints). About 1% of patients have no objective laboratory findings and are diagnosed by direct history and/or physical examination.
The majority of these patients are male. Presenting signs can be acute pancreatitis, diabetes, acromegaly, and other disorders of growth. The most common presenting sign is recurrent hypoglycemia (or diabetic ketoacidosis), which often occurs in patients with large hypersecreting islet cells and few remaining normal-functioning beta cells. Unconsciousness and death may occur without warning if no treatment is given. Fortunately, the prognosis for this condition is excellent if intervention is instituted promptly.
Diabetes Insipidus
Diabetes insipidus is a condition where your kidney produces abnormally large volumes of dilute and odourless urine. The kidneys of an affected patient can pass up to 20 litres of urine. As a result, the patient would have to drink large amounts of fluid. There are four types of diabetes insipidus:
Central: The reason behind central diabetes insipidus is damage to a person’s hypothalamus or the pituitary gland which results in abnormal production, storage and release of vasopressin. The issue causes the kidneys to remove excess fluid from the body.
Nephrogenic: The causes of this type of diabetes insipidus are gene mutation or inherited gene changes which lead to the kidneys not functioning normally. Some of the symptoms are low potassium and high calcium levels in the blood.
Dipsogenic: A defect in the thirst mechanism located in the brain's hypothalamus causes this type of diabetes insipidus which increases the thirst and the liquid intake of a person. It also suppresses vasopressin and increases the passing of urine.
Gestational: This happens during pregnancy.
The general symptoms of diabetes insipidus are:
Thirst
Nausea
Dry skin
Fatigue
Dizziness etc.
The treatments for diabetes mellitus include hormonal therapy, medication to balance mineral levels in the body and living a healthy life.
Differences Between Diabetes Mellitus and Insipidus
Each disease has its own set of specific characteristics. The following table lists those differences.
Diabetes Insipidus vs Diabetes Mellitus
FAQs on Difference between Diabetes Mellitus and Diabetes Insipidus
1. How is diabetes mellitus diagnosed?
There are several ways diabetes mellitus can be diagnoses
Urine analysis: Patients with diabetes mellitus will have increased glucose levels in urine. However multiple tests should be done for accurate results.
Blood tests: fasting blood glucose test, haemoglobin A1C test, oral glucose tolerance tests are some of the ideal tests for confirmation of diabetes mellitus.
Screening: Screening is done for patients affected with type II diabetes who show no symptoms. It is recommended for children who are obese and also overweight adults.
2. What type of hormone treatment is used for diabetes insipidus?
A man-made hormone called desmopressin is used to treat diabetes insipidus. It replaces the missing ADH hormone and decreases urination. The hormone works by increasing water permeability in renal tubular cells and decreases urine volume and increases urine concentration.
3. What are the three major signs of diabetes mellitus?
The three major signs of diabetes mellitus are:
Polydipsia: This corresponds to increased thirst.
Polyuria: Increase in urination
Polyphagia: Increase in appetite leading to binge eating.
These are also known as the three P’s and they often but not always occur together.
4. How is diabetes insipidus diagnosed?
A common test is ‘water deprivation. It takes several hours and the patient is not allowed to drink any fluid on the day of the test. Initial blood and urine tests are carried out to measure the salt levels and the concentration in both.
At hourly intervals, the tests are repeated along with checking blood pressure, weight and the amount of urine passed.
If the blood sodium or concentration levels rise above the normal range along with low urine concentration, then it is likely that the patient has been diagnosed with diabetes insipidus.
5. What are the complications of diabetes?
Diabetes complications may be various and some of them are listed below:- Blindness, Heart attack, Kidney failure, Amputation of the limbs, Death from heart attack or stroke. Because of these complications, diabetes is more dangerous than any other chronic illness. In Children: Birth weight is affected. They may develop foot deformities, retinopathy and kidney failure, In Elderly: Wearing-off of cognitive functions. Diabetes is very dangerous for your health. Diabetic coma is one of the most dreaded complications of diabetes. Patients having diabetes mellitus may have unconsciousness, resulting from sudden decrease in blood sugar levels, followed by failure of all organs of metabolism.
6. What is insulin?
Insulin is a hormone produced by the pancreas which helps in the absorption of sugar from the blood into cells. Insulin is normally found in blood plasma and is the major metabolic hormone of carbohydrate metabolism. Its main functions are to maintain normal levels of glucose in the blood, to initiate the process of gluconeogenesis (the synthesis of glucose from non-carbohydrate substances), and to stimulate amino acid release from muscle proteins which are used as fuel. Insulin administration to the bloodstream acts by controlling the concentrations of glucose, glycogen, fat and amino acids in the blood, which in turn affects the concentration of oxygen in the blood, pH, and the tissue-specific levels of insulin receptor sites on target cells.
7. What is the role of high blood sugar on obesity?
When the blood sugar levels are controlled, the energy from food is used directly by the body for energy production or stored as fat. Obesity occurs when there is an imbalance between the amount of energy entering the body and the energy being used for various processes. It has been long known that the level of blood sugar, which is controlled by insulin, and the amount of fat being stored in the body are intimately linked. high blood sugar is the final and most important step in the development of a serious diabetic condition. At least two studies have suggested that inflammation caused by high levels of circulating free fatty acids (FFA) may be implicated in the pathogenesis of diabetes.
8. What is the connection between insulin and obesity?
Insulin lowers blood sugar levels in two ways: It stimulates cells to take up glucose from the blood and it stimulates fat cells to store fat. When high levels of insulin occur, they stimulate the storage of fat in many tissues. The most important effect of insulin on fat cell metabolism is to increase the activity of lipoprotein lipase (LPL), which causes triglycerides and cholesterol esters to be released from their cellular storage sites. This causes them to be broken down by the liver and absorbed into the bloodstream.
9. What is the connection between obesity and diabetes?
Obesity occurs when the body has an excess of adipose tissue. At the same time, type II diabetes develops when a person does not produce enough insulin to regulate blood sugar levels. Therefore, people who are obese and have diabetes will likely have higher blood sugar levels than the normal weight population.the connection between diabetes and obesity is The main lifestyle factor associated with the development of type II diabetes is overweight and obesity, which often occurs together with eating a western diet (high in fat and sugar) and a sedentary lifestyle.
