Diabetes Mellitus, commonly known as sugar, is a syndrome (group of diseases) associated with elevated blood sugar level due to disturbance in Carbohydrate, Amino Acid and Fat metabolism. Diabetes results from defects in insulin production from pancreas or insulin action.  There are two types of diabetes i.e. Primary and Secondary Diabetes. Primary Diabetes includes Insulin Dependent Diabetes Mellitus and Non-insulin Dependent Diabetes Mellitus. Secondary type includes pancreatic disease (infection and inflammation of pancreas), Endocrine diseases (increased or decreased hormone production), caused by drugs (steroids, diuretics) and diabetes of pregnancy called Gestational Diabetes.

A similar term we might hear sometimes is Diabetes Insipidus, what is it? Is it same as Diabetes Mellitus? While we might get a lot of questions about this third problem also called diabetes we might not commonly hear about it. Let’s discuss the details below for improving your understanding about the three above mentioned queries.

Type 1 diabetes

Type 1 diabetes results from disturbance in immune function of the body which damages its own pancreas with absolute loss of insulin production. It usually occurs at the age of puberty i.e. 10-13 years but it can present at any age. Risk factors of Type 1 diabetes include hereditary susceptibility, viral infections, pancreatic disturbances and immune system malfunction. Clinical picture includes increased thirst, increased urine output, weight loss and increased appetite, hazy vision and itching. Diabetes may be diagnosed on the basis of symptoms, on investigations or because of complications. Complications may include infections, disturbance in vision, decreased muscle mass, foot ulcers and heart attack.

Type 2 diabetes

Type 2 diabetes results from blend of opposition of insulin action and insulin secretion. This type manifests itself generally after 30 years of age.  MODY (Maturity Onset Diabetes of Young) is a modified form of Type 2 Diabetes. The disease is suspected in young persons who present with diabetic features along with family history of diabetes. Its risk factors include genetics, environmental issues like deskbound life style and pancreatic malfunction. Patient with Type 2 diabetes shows signs of increased urination and thirst but most of the patients do not show any symptom at all. They present with belated injury healing, low energy, visual disturbances and infections. Diagnostic tests include Fasting Blood Sugar level, Random blood sugar, Glucose Tolerance Test and Urine analysis for sugar, proteins and infections.

Diabetes Insipidus

It results from impaired water reabsorption. It may be due to two underlying causes,

  • Impaired ADH secretion. The secretion of the hormone is reduced.
  • The kidney’s ADH receptors have impaired response to the hormone.

Both of the above mentioned causes result is passage of large amounts of urine.

Type 1 Diabetes Vs Type 2 Diabetes Vs Diabetes Insipidus.

Precipitating factors:

Type 1 factors are unknown till now.

Type 2 factors are age, obesity and previous history of diabetes in pregnancy.

Diabetes Insipidus: More than 50% of the cases are idiopathic. Rest 50% maybe congenital, inherited, tumour, trauma, infections like meningoencephalitis.

Insulin secretion:

In Type 1 Diabetes, insulin is very low or absent.

In type 2 Diabetes, insulin is present but the large amount required for Carbohydrate digestion after meals, is not released.

Diabetes Insipidus, Insulin mechanism is not disturbed.

Insulin resistance:

In Type 1, insulin resistance occurs only with increased blood sugar level.

In Type 2, resistance is mostly present.

Diabetes Insipidus, no effect on Insulin.

Expanded fasting:

In Type 1, long fasting causes increased blood sugar level and increased level of ketone bodies in blood.

In Type 2, sugar level improves.

Diabetes Insipidus, may cause dehydration

Withdrawal of insulin:

In Type 1, ketoacidosis occurs.

In Type 2, ketoacidosis does not occur.

Diabetes Insipidus, no effect.

C- peptide:

Type 1 diabetic patient does not have C-peptide.

Type 2 diabetic patients show C-peptide.

Diabetes Insipidus, no C peptide.

Treatment:

In Type 1 diabetes, Insulin is given.

In Type 2, oral drugs are given to reduce blood sugar level.

Diabetes Insipidus, treatment of the underlying cause.

Conclusion

While Diabetes Mellitus is a disorder of insulin production and resistance which is multi factorial disease in source. Its treatment includes dietary modifications, insulin and oral anti-diabetic drugs. Not giving proper attention towards treatment may result in manifold complications. Diabetes Insipidus is a disorder of ADH and its receptors with prime effect on the kidneys. Not known to many people, the disorder leads to severe dehydration and unsatisfying thirst. It may also result in an emergency. What is your opinion?

Sources:

Oxford handbook of Clinical Medicine

Wikipedia

Davidson’s textbook of Medicine