People today use Diabetes to discuss a “sugar” problem. While this is true, it is not the only factor that describes Diabetes. There are actually four types of diabetes, and only two of them describe a “sugar” problem. These four types of Diabetes are Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus, Central Diabetes Insipidus, and Nephrogenic Diabetes Insipidus.
Type 1 Diabetes Mellitus is an autoimmune disease in which pancreatic alpha cells stop producing insulin. Insulin’s job in our bodies is to push sugar (glucose) out of the bloodstream and into our body’s organs (liver, muscle, and fat tissue) for storage and use as energy later. Type 1 patients present to physicians as thin young men with increased thirst and urination. Medications used to treat this are various types of insulin (Lispro, NPH, Glargine, etc.) depending on their short or long term effects.
Type 2 Diabetes Mellitus is a metabolic disorder in which pancreatic alpha cells decrease insulin production. This allows more sugar to remain in the bloodstream, causing detrimental damage to various organs in the body if not caught early or controlled with 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 through poor lifestyle choices, such as an inadequate diet. Medications used to treat this disease include metformin, sulfonylureas, and alpha-glucosidase inhibitors.
Central diabetes insipidus is a neurogenic disease in which the hypothalamus in the brain does not produce any antidiuretic hormone (ADH), which is also known as vasopressin. This hormone is stored in the hindbrain pituitary until it is used by the kidneys for water reabsorption. ADH controls the concentration of urine that is excreted from the body, but if it is not produced, our body 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 hormone replacement with artificial Desmopressin.
Nephrogenic diabetes insipidus is a pathologic disorder in which receptors in the collecting ducts of the kidneys do not respond to ADH. This problem prevents the kidneys from concentrating the urine, causing the release of very dilute urine. Patients present with excessive thirst and urination that cause severe dehydration. The causes of this acquired disease can be the use of lithium or electrolyte imbalance. This condition can be treated with a diet low in sodium and protein, as well as diuretics, such as hydrochlorothiazide and amiloride.
So the next time you see someone claiming to be diabetic, ask them, “What type of diabetes do you have?” Then you will know what is wrong with them and how to treat them.
