People today use Diabetes to discuss a “sugar” problem. Even though this is true, it is not the only factor describing Diabetes. There are actually four kinds of Diabetes, and just two of these describe a “sugar” problem. These four types of Diabetes are Diabetes Mellitus type 1, Diabetes Mellitus type 2, Central Diabetes Insipidus and Nephrogenic Diabetes Insipidus.
Diabetes Mellitus type 1 is an autoimmune disease where pancreatic alpha cells stop making Insulin. Insulin’s function in our bodies is to push sugar (glucose) out of the bloodstream into our body organs (liver, muscles, and adipose tissue) to store for energy use later. Type 1 patients present to doctors as thin youths with an increase in thirst and urination. Medications used to treat this are various types of Insulin (Lispro, NPH, Glargine, etc.) dependent on its short or long lasting effects.
Diabetes Mellitus type 2 is a metabolic disorder where the pancreatic alpha cells decrease the production of Insulin. This allows more sugar to remain in the bloodstream causing detrimental damage to various organs in the body if not detected early or controlled by proper diet, exercise, and medication. These patients present to physicians as obese adults with increased hunger, thirst, and urination. This disease can be hereditary or acquired by poor lifestyle choices, such as improper diet. Medications used to treat this disease include Metformin, Sulfonylureas, and alpha-Glucosidase Inhibitors.
Central Diabetes Insipidus is a neurogenic disease where the hypothalamus in the brain does not make any anti-diuretic hormone (ADH), which is also known as vasopressin. This hormone is stored in the posterior pituitary of the brain until it is used in the kidneys for reabsorption of water. ADH controls the concentration of urine that is excreted from the body, but if it is not made, our bodies cannot reabsorb water, so we will produce very dilute urine. This acquired disorder can be caused by trauma to the brain or is idiopathic. Patients present dehydrated with excessive thirst and urination. Treatment is replacement of the hormone with artificial Desmopressin.
Nephrogenic Diabetes Insipidus is a pathological disorder where the receptors at the collecting tubules in the kidneys do not respond to ADH. This problem prevents the kidneys from concentrating urine causing the release of very dilute urine. Patients present with excessive thirst and urination causing severe dehydration. Causes of this acquired disease can be lithium use or electrolyte imbalance. This condition can be treated with a low sodium and low protein diet, as well as with diuretics, such as Hydrochlorothiazide and Amiloride.
So the next time you here a person who claims they are a diabetic, ask them, “What kind of Diabetes do you have?” Then you will know what is wrong with them and how to treat them.