What type of diabetes do you have?

What type of diabetes do you have?

People today use diabetes to discuss a “sugar” issue. Although this is true, it is not the only factor that describes diabetes. There are actually four types of diabetes, only two of which 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.

Type 1 diabetes mellitus is an autoimmune disease in which pancreatic alpha cells no longer produce insulin. Insulin's function in our body is to push sugar (glucose) from the bloodstream into our body organs (liver, muscles and fatty tissue) for later storage for energy use. Type 1 patients present to doctors as thin adolescents with an increase in thirst and urination. Medications used to treat this are different types of insulin (Lispro, NPH, Glargine, etc.) depending on its short- or long-lasting effects.

Type 2 diabetes mellitus is a metabolic disorder in which the pancreatic alpha cells reduce insulin production. This can allow more sugar to remain in the bloodstream and damage various organs in the body if not detected early or controlled through 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 habits such as poor diet. Medications used to treat this disease include metformin, sulfonylureas, and alpha-glucosidase inhibitors.

Central diabetes insipidus is a neurogenic disorder in which the hypothalamus in the brain fails to produce antidiuretic drug (ADH), also known as vasopressin. This hormone is stored in the posterior pituitary gland of the brain until it is used in the kidneys to reabsorb water. ADH controls the concentration of urine excreted from the body. However, if it is not made, our bodies cannot reabsorb water, so we 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. The treatment is to replace the hormone with artificial desmopressin.

Nephrogenic diabetes insipidus is a pathological disorder in which the receptors on the collecting tubules in the kidneys do not respond to ADH. This problem prevents the kidneys from concentrating urine, releasing very dilute urine. Patients with excessive thirst and urination cause severe dehydration. Causes of this acquired disease may include lithium consumption or electrolyte imbalances. This condition can be treated with a low-sodium, low-protein diet as well as diuretics such as hydrochlorothiazide and amiloride.

Next time you see a person here who claims they are diabetic, ask them, “What type of diabetes do you have?” Then you will know what is wrong with them and how to treat them.

Inspired by Dr. Adrienne Hicks