Neurogenic DI -This is a form of Diabetes Insipidus that is characterized by a problem in the hypothalamus section of the brain. It results in the damage of the pituitary gland and thus disrupts the usual storage and release of ADH.
- Describe the 3 types of diabetes Insipidus.
Nephrogenic DI – This result when Kenney’s can’t to respond to ADH any longer. It is characterized by the production of large volume of dilute urine because kidney tubules fail to respond to vasopressin and therefore unable to absorb filtered water back into the body (Stadler, 2013)..
Polydipsic DI – This is characterized by large production of urine. Primary cause is the damage of thirst regulating organs in the hypothalamus thus resulting in drinking a lot of fluids and hence the high production of urine.
Tests measure Glucose, urine specific gravity, serum electrolytes, urine osmolarity, ADH levels and urinary sodium. Urine specific gravity of 1.005 or a lower value and urine osmolarity lower than 200 mOsm/kg is an indication of Diabetes Insipidus.
- What lab values would you expect to see with each type?
Plasma osmolarity is normally greater than 287 mOsm/kg. Water deprivation is performed in some ambiguous clinical tests. Testing is most accurate when the patient is dehydrated as it allows ADH to be at its highest concentration during the testing period. Water deprivation should always be considered as part of the process this gives the most accurate results.
Neurogenic DI results from kidneys not responding to ADH appropriately. Desmopressin isn’t an option. Low salt diet with just enough water to avoid dehydration is the prescription.
- Describe the causes/potential causes of each type and how the treatment varies between the 3 types and why
Polydipsic DI can be caused by mental illness and has no treatment other than decreasing the amount of fluid intake. If the condition is caused by mental illness, mental illness can be treated as the solution to the condition (Bilous & Donnelly, 2010).
Nephrogenic DI – The defect may be due to genetic disorder or kidney disorder. Some drugs like lithium or antiviral medications such as foscarnet can cause nephrogenic diabetes insipidus.
Generally, treatment of diabetes insipidus can be done by using synthetic hormone called desmopressin which can be administered through injection, oral or nasal spray.
The red flag symptoms of Diabetes insipidus is when someone loses more than 3% of their weight before test, shock collapse of circulatory
- What would indicate a “red flag “symptom in any of them and require urgent treatment
BMI has a relationship with insulin resistance and diabetes. For people who are obese, the amount of non-esterified fatty acids, hormones, cytokines, glycerol, proinflammatory markers and substances involved in the making of insulin resistance increases. Weight gain is thus central foundation to Type 1 and Type 2 Diabetes.
- Explain how his obesity contributes to the beta cell dysfunction seen with Type 2 DM
- Explain how GLP 1 receptor agonists improve glucose control in the diabetic patient.
- What are the pros can cons of dipeptidyl peptidase IV (DPP-IV) inhibitors versus GLP 1 receptor
GLP-1 has been researched for the treatment of Type 2 Diabetes since incretin effect is low or absent for people with type 2 diabetes mellitus. GLP-1 receptor activation on β-cells results in higher level of insulin biosynthesis in β-cell, resistance to β-cell apoptosis, β-cell proliferation and survival in both human and rodents despite hypoglycemia risk being minimized since exocytosis and insulin production occurs in a glucose reliant process.
The two therapies have good safety and reliability historical usage with minimal interaction with a number of medications that are commonly prescribed in T2DM. Dipeptidyl peptidase 4 (DPP IV) enzymes break down incretin and enzymes inhibiting drugs increase the levels of incretin. The gliptins and other drugs are incretin agonists used for the treatment of type 2 diabetes. The two classes are tolerated, GLP-1 RA being associated with nausea and DPP-IV associated with some infections and headaches (Stadler, 2013).
Stadler, K. (2013). Oxidative stress in diabetes. In Diabetes(pp. 272-287). Springer, New York, NY.
Bilous, R., & Donnelly, R. (2010). Handbook of diabetes. John Wiley & Sons.