glucose in the blood
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Week 9 Discussion
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Week Nine Discussion
Pathophysiology of DM and DI
Diabetes mellitus (DM) and diabetes insipidus (DI) are two conditions that are associated with hormonal dysregulation. DM is hyperglycemia either from lack of insulin secretion, action, or both (Huether & McCance, 2017). The most common types of DM are type 1 and type 2. Type 1 is characterized by beta-cell destruction and is most often autoimmune. Hyperglycemia ensues, when about 80% of beta cells are destroyed (Huether & McCance, 2017). With a loss of insulin and amylin, glucagon secretion increases. With DM type 1, there is more glucose in the blood, along with increased metabolism of fats and protein, resulting in large amounts of ketones (Huether & McCance, 2017). DM type 2 is considered a disease of insulin resistance. Insulin resistance is when insulin-sensitive tissues have a poor response to insulin (Hammer & McPhee, 2019; Huether & McCance, 2017). The primary factor associated with insulin resistance is obesity. Beta cells respond to insulin resistance by producing more insulin, but eventually, the number of beta cells decrease (Huether & McCance, 2017). As with type 1, glucagon and serum glucose increase, and amylin decreases.
DI is caused by insufficient amounts or lack of antidiuretic hormone (ADH) so that the body is unable to concentrate urine. DI results from either central nervous cause (central DI), or kidney disease (nephrogenic DI) (Hammer & McPhee, 2019). Lack of ADH generates large amounts of urine – up to 20L/day (Hammer & McPhee, 2019). Patients present with polyuria, thirst, dehydration, and hypernatremia. DM and DI share common symptoms of polyuria and thirst and are dysfunctional in hormonal control. However, the illnesses themselves are very different. DM is a lack or insensitivity of insulin, whereas DI is a lack or insensitivity to ADH.
Patient Behavior and Age
Behavior influences one’s risk of DM type 2. Obesity is a significant risk factor for DM type 2 (National Institutes of Health, 2016). Obesity plays a large role in insulin resistance in the development of DM (Huether & McCance, 2017). Those who are overweight and have insulin resistance or DM type 2 should be encouraged to exercise and lose weight (National Institutes of Health, 2016). DI can either be hereditary or acquired. Acquired causes can include surgery, brain injury, trauma, cancer, infection, autoimmune, drug-induced, and snake venom (Kalra et al., 2016). No risk factor or cause seems to be purely behavior-related.
DM type 1 can develop at any age, but it is more likely when someone is a child or young adult (Centers for Disease Control and Prevention (CDC), 2019). Those over the age of 45 are more at risk for DM type 2 (CDC, 2019). However, the incidence of type 2 is increasing in children as young as ten years old (CDC, 2017). Over 1/3 of children and youth in America are overweight, and those who are overweight are at risk for insulin resistance and the development of DM type 2 (CDC, 2017). Children most often present with inherited DI, and adults usually present with acquired DI. Gestational DI occurs in 1/30,000 pregnancies (Kalra et al., 2016).
References
CDC. (2019). Who’s at risk? Retrieved from https://www.cdc.gov/diabetes/basics/risk-
factors.html
CDC. (2017). Prevent type 2 diabetes in kids. Retrieved from
https://www.cdc.gov/features/prevent-diabetes-kids/index.html
Hammer, G.D., & McPhee, S.J. (2019). Pathophysiology of disease: An introduction to clinical
clinical medicine (6th ed.). New York: NY: McGraw-Hill Education.
Huether, S.E., & McCance, K.L. (2017). Understanding pathophysiology (6th ed.). St. Louis,
MO: Mosby.
Kalra, S., Zargar, A.H., Jain, S.M., Sethi, B., Chowdhury, S., Singh, A.K., … Malve, H. (2016).
Diabetes insipidus: The other diabetes. Indian Journal of Endocrinology and Metabolism,
20(1), 9-21. doi: 10.4103/2230-8210.172273
National Institutes of Health. (2016). Risk factors for type 2 diabetes. Retrieved from
https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
