Diabetes mellitus: Symptoms, Causes and Treatment

Diabetes mellitus: Symptoms, Causes and Treatment

 

If a person is very thirsty and wants to drink a lot of fluids, and this is not just due to heat or heavy exercise, it may indicate the development of diabetes and it is advisable to consult a doctor - even if tests show that sugar levels are normal. Because diabetes takes many forms, in addition to the widespread and well-known diabetes, it is possible to develop so-called diabetes mellitus, the most important signs of which are increased thirst and increased urine output - up to five to six liters or more per day.

 

The name diabetes mellitus covers a number of diseases characterized by the inability of the renal tubules to regulate the reabsorption of water in the body from so-called primary urine, which is formed by the kidneys filtering blood. These diseases are caused by a disorder in the production of antidiuretic hormone, or ADH, or by a lack of action of this hormone. As already mentioned, these disorders are manifested by strong thirst and unusually large amounts of un-concentrated urine.

 

Depending on the cause, diabetes mellitus is divided into four different types, which may be due to disorders of antidiuretic hormone synthesis or release, renal insensitivity to this hormone, although it develops fully; These disorders can also be caused by the use of certain medications, head trauma, a tumor in the head, surgery that affects the brain, hormonal changes during pregnancy, and other causes. The patient may also have primary polydipsia, a type of diabetes mellitus based on a lowered thirst threshold due to damage to the center of the brain or an obsessive desire to drink and an increase in the amount of blood circulating in the body. In such patients, increased fluid intake also results in an increased need to urinate to reduce excess fluid in the body.

 

Regardless of the cause of the diabetes, it is characterized by increased thirst and an increased need to urinate. The patient with these symptoms should consult an endocrinologist, because only a specialist will be able to distinguish which form of diabetes mellitus the patient has and determine what treatment it needs.

 

A person constantly loses fluid through the kidneys, skin and lungs. If we do not take in enough fluid as a compensator, the amount of dissolved salts in the liquid part of the blood - plasma - increases the osmolality of the blood. Thanks to a system that balances the amount of fluid ingested and excreted, a healthy person has a very limited osmolality range - 285-295 mOsm / kg, which depends on the body's current requirements.

 

The basic element of this system is the cells located in the hormone control center in the brain. The cells respond to increased osmolality in the blood by stimulating the thirst center or releasing the antidiuretic hormone or vasopressin. It is a key hormone that contributes to the balance of the body's internal environment. Vasopressin performs several functions: it narrows blood vessels (mainly the liver, kidneys, heart and endocrine organs), acts on the blood clotting system and many other functions. However, its main function is to regulate the excretion of water through the kidneys by acting on the renal tubules and increasing fluid reabsorption.

 

The release of vasopressin is stimulated by a number of factors, including pain, stress, sleep, exercise, nausea, and chemicals such as anesthetics, nicotine, and others. One of the most important factors that reduces the release of this hormone is the use of alcohol.

 

 

How can diabetes mellitus occur?

Central diabetes mellitus develops when the lesion affects most of the cells in the part of the brain that produce the aforementioned hormone vasopressin, the hormone control center in the hypothalamus. It is a fairly rare disease that affects one in 2,500 people. It is equally common in both men and women. More often, it is a secondary disease associated with damage to the hypothalamus and pituitary glands in the brain caused by a tumor, malignant tumor metastasis or brain injury. It should be noted that benign pituitary tumors very rarely lead to the development of diabetes mellitus.

 

Central diabetes mellitus can also occur with inherited diseases or genetic syndromes. This can be a consequence of autoimmune diseases. In many cases, it is also impossible to identify a specific cause.

 

Symptoms of diabetes mellitus

Irrespective of the cause and form of the disease, the manifestations of diabetes mellitus are identical. The main symptoms are regular increased thirst and increased need to get rid of fluid in the body - excessive urination or polyuria.

 

Polyuria can develop gradually, but most often begins suddenly. The amount of urine excreted varies from three to up to 20 liters per day. Thirst develops due to dehydration, and the amount of fluid you drink usually matches the amount you pass in your urine. Patients complain of sleep disorders because they have to go to the toilet at night, the first sign of diabetes in children may be wetting in bed. Polyuria, which lasts for several years, can lead to dilation of the urinary system, accumulation of water in the kidneys, while excessive water intake can cause gastric enlargement, and dehydration can reduce the secretion of various enzymes in the gastrointestinal tract. Loss of water causes constipation, dryness of the skin and mucous membranes, which means reduced salivation and sweating, patients become easily irritated, unbalanced, and the body weakens.

 

In the case of dehydration, when the amount of fluid lost through drinking cannot be restored in sufficient quantities or there is no opportunity to drink, young children and the elderly are at risk of developing very severe neurological symptoms, seizures or even prolonged loss of consciousness - coma.

 

In the diagnosis of endocrine diseases, the determination of hormone levels or metabolites of hormone metabolites in the blood or urine is most commonly used. In the case of diabetes mellitus, the level of vasopressin is not determined because it is difficult to determine in the laboratory and the methods are very expensive. Therefore, the action of vasopressin is assessed by measuring the osmotic concentration or osmolality of blood and urine.

 

Patients with polyuria should be evaluated to determine the type of diabetes they are suffering from. This is done by measuring the amount of fluid ingested and excreted over 24 hours, and it is recommended that this test be performed twice. Urinating agents should be discontinued two days before this fluid measurement, but fluid intake should not be limited. The diagnosis is confirmed if more than 2.5 to three liters of urine are excreted per day (more than 40 milliliters per kilogram of body weight per day) and it is at a low concentration - it is light, almost colorless.

 

Initially, your doctor may also prescribe biochemical tests to rule out other causes of polyuria, such as high blood sugar, increased or decreased urinary calcium or acute renal failure, daily circulating urine tests every three hours and a functional non-fluid test. under the supervision of a doctor.

 

Significant fluctuations in urine output per portion (50 milliliters to 250 milliliters) and the predominance of urine excreted during the day over that excreted overnight, as well as peak urine density, indicate that urinary concentration and dilution are maintained.

 

If the tests confirm a central form of diabetes mellitus, vasopressin development and release disorders, a magnetic resonance imaging of the brain will be performed to confirm the diagnosis, as diabetes mellitus may be the first sign of a pituitary tumor or another tumor localized to the area.

 

Treatment of diabetes mellitus

Treatment is based on the replacement of insufficient hormone with a synthetic analogue of the antidiuretic hormone - desmopressin. This synthetic hormone replacement narrows blood vessels less and lasts longer than vasopressin (12 to 24 hours), which is individual for each person.

Therapy is started with an overnight dose - finding the minimum effective dose at which there is no longer a need to urinate at night, then the duration of action is assessed. When polyuria appears, it means a daily dose (morning and lunch). This medicine should usually be taken two to three times a day.

 However, medication is not always necessary - if the amount of fluid released is up to four liters per day, sometimes it is enough to take just the right amount of fluid.

Occasionally, patients with severe thirst may be referred for psychiatric counseling, as they may also be a sign of mental illness.