Break down your perception of "Diabetes"

Diabetes is a word that everyone knows, but very few people are aware of more than two types of diabetes, both of which have to do with insulin and and how the body metabolizes sugar. As popularity of these forms of diabetes grow at an exponential rate, awareness of other forms of diabetes decreases. These forms of diabetes, known as Diabetes Insipidus, have nothing to do with insulin or glucose levels, but are just as serious and debilitating as the commonly referred to “Diabetes.”

So what is Diabetes Insipidus? To put it simply, with this condition the body is missing or not responding to a hormone that controls how water is absorbed into the body. Depending on what type of D.I. the body either does not produce any, or enough of the hormone, or the body has normal amounts of this hormone but due to a genetic defect the kidneys are unable to respond to it. People with Diabetes Insipidus have normal sugar levels and do not require insulin.

Without this ADH hormone, the body does not absorb water.

So what happens when the body does not absorb water? All the water a person with DI drinks is immediately expelled from the body without being used. It is as if a person is not drinking any water at all. This leads to severe dehydration, and if left untreated can cause severe disabilities or even death. These conditions cause extreme quantities of urine similar to the more popular “diabetes” but the difference is that if a person were to stop drinking water all together, the urine would not concentrate and eventually darken. This major factor is what we all depend on to know how hydrated our bodies are and in this condition it is missing.

The word origin of DIABETES comes from the Latin meaning to “pass things through.” Later in the 1560’s Latin medical journal became more specific stating “excessive discharge of urine.” (source). With all kinds of Diabetes, the main similarity is that everyone suffers from excess urination. In different types of Diabetes, different electrolytes are affected, because the issues are with different hormones that tell different organs how to work.

To sum things up, there are forms of diabetes that solely have to do with insulin production in the body that metabolizes glucose, and there are forms of diabetes that solely have to do with the anti-diuretic hormone that controls water absorption.

Diabetes Mellitus = sugar

Diabetes Insipidus = hydration

The problem: When you go to just about any “diabetes” website they are only talking about Diabetes Mellitus. Diabetes Insipidus is rarely considered or included when it comes to studies, statistics, spending and fundraising.Typically you will only see type 1 and type 2 diabetes listed when talking about “how many kinds of diabetes exist” but in actuality there are seven types of diabetes broken into two different groups. Mellitus and Insipidus. This website is here to bring light to Diabetes Insipidus, a disease completely overshadowed by type 2 diabetes.

There Are Seven Forms of Diabetes split into two groups.

Insipidus and Mellitus.

Diabetes Insipidus is divided into four groups.

Central Diabetes
Nephrogenic Diabetes
Gestational Diabetes Insipidus
Dipsogenic Diabetes

Diabetes Mellitus is divided into three groups.

Type 1 Diabetes
Type 2 Diabetes
Gestational Diabetes

Diabetes Insipidus

Central Diabetes:

The pituitary gland is responsible for secreting the ADH hormone (also known as Vasopressin or AVP). The amounts of the hormone released to the kidneys tell’s the kidneys how to regulate water within the body. With this form of diabetes, the pituitary gland does not produce, or does not produce enough of the hormone to help the body regulate water in the body. People with this form of Diabetes are able to take a synthetic version of the hormone to assist in regulation of water into the body. This condition is treated by an Endocrine specialist. If excess diluted urine is found along with higher sodium levels (high sodium means you are dehydrated), with normal sugar levels, a blood test to measure amounts of this ADH hormone in the blood stream can be performed. If there are lower than normal amounts of the hormone, or none at all this is how they typically diagnose Central Diabetes Insipidus. This form of DI can be genetic, but could also be caused by abnormalities in the brain, brain injury or some medications. If a person responds to the synthetic hormone, which happens quickly they usually follow-up with an MRI of the brain to look for underlying issues.

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Nephrogenic Diabetes:

When Diabetes Insipidus is first suspected they will usually rule out Central Diabetes first because it is easier to diagnose than Nephrogenic. The symptoms of excess diluted urine, and very high sodium levels are the same. However, the biggest difference between the two is that those with NDI will show normal to high levels of ADH in the blood stream because the pituitary gland secretes the hormone normally, however the kidney’s do not have the receptors that receive and respond to the hormone. This disease is caused most of the time by a genetic mutation in the “X” chromosome, therefore it can affect entire families. This condition is typically  but not always diagnosed during infancy or within the few months of life due to level of extreme dehydration resulting from this. Treatment for this type of diabetes is very different than CDI. Blood work has to be taken regularly for a couple reasons. To check if a person is hydrated, the blood work will show how much sodium is in the blood. The safe range is 135-145. Anything above 145 means a person is dehydrated. Anything below the safe range means you are too hydrated and it is very dangerous to be outside of this safe range in either direction. Blood work is also drawn to check kidney function and other electrolytes such as potassium and vitamin d. Some medications used to treat NDI such as Indomethacin have been known to cause renal failure and kidney injury. Constant extreme fluctuations in hydration levels, along with constant dehydration is strenuous for the kidney’s. Unfortunately, most people with NDI are denied transplants due to the nature of what causes the failure. Most people are treated using diuretics, however the system in which they are treated varies from doctor to doctor. Amiliroid, Diuril (or chlorothiazide if Diuril is not available), hydrochlorothiazide and Indomethacin are typical medications used for treatment. These medications help reduce polyuria (or excess urination) and retain water however they are by no means a “cure” as the urine still does not concentrate and extreme volumes of water are necessary to remain within the safe zone.

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Gestational Diabetes Insipidus:

Just as with Gestational Diabetes Mellitus, this type of Diabetes Insipidus happens during pregnancy. It is the only form of DI that can be cured because it caused by hormones that are caused by pregnancy, and once these hormones are no longer it will go away once the pregnancy is over.

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Dipsogenic Diabetes:

This type of Diabetes Insipidus takes everything we just learned about DI and reverses it. Rather than the problem being that there is not enough water in the body and too high of a sodium level, there is too much water in the body and not enough sodium. There is a “safe range” that a persons sodium level needs to reside for well-being and this level is the same for everyone (135-145). When you are outside of this range whether dehydrated or too hydrated it is extremely dangerous. When you are too hydrated it is called hyponatremia, also known as “water intoxication.” When the water in your body increases, your cells swell. Sudden decreases in sodium can also lead to rapid brain swelling which can result in coma or death.

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Diabetes Mellitus

Type 1 Diabetes:

Those with this form are known to be “insulin-dependent.” This form of diabetes often begins in childhood because it is an autoimmune condition. The antibodies in the pancreas attack themselves and the damage incurred causes the pancreas to stop making insulin. Only 5% of the people that have Diabetes, have type 1.

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Type 2 Diabetes:

Those with this form of diabetes are known to be “non-insulin dependent” and it is primarily caused by living an unhealthy life-style. The pancreas produces some insulin, but the cells in the body either become resistant to it or not enough is produced. This typically affects adults, but due to the rise in obese children and unhealthy eating habits, it is becoming more common for this type to affect those in their adolescent years. There are an estimated 21 Million people diagnosed with Diabetes Mellitus in the United States, and 20 million of these people have type 2 diabetes. It is also estimated that roughly 86 million ages 20 and up in the United States are pre-diabetic. (diabetes.org)

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Gestational Diabetes:

This form of diabetes affects women who are pregnant. Sometimes the hormones that occur during pregnancy prevent the pancreas from producing enough insulin, or the body becomes insulin resistant. This is a temporary condition and generally clears up after the pregnancy is over, but does put the mother at risk to develop Type 2 later in life.

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