10 COMMON DISEASES

CAUSES OF 10
COMMON SYMPTOMS

DIABETES

 
Subject Contents

Diabetes

 
Definition
Diabetes is a life-long disease marked by elevated levels of sugar in the blood. It can be caused by too little insulin (a chemical produced by the pancreas to regulate blood sugar), resistance to insulin, or both.
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Alternative Names
Diabetes mellitus
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Causes, incidence, and risk factors
To understand diabetes, it is important to first understand the normal process of food metabolism. Several things happen when food is digested:
  • A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body.
  • An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.
  • People with diabetes have high blood glucose. This is because their pancreas does not make enough insulin or their muscle, fat, and liver cells do not respond to insulin normally, or both. There are three major types of diabetes:
  • Type 1 diabetes
  • is usually diagnosed in childhood. The body makes little or no insulin, and daily injections of insulin are required to sustain life. Without proper daily management, medical emergencies can arise.
  • Type 2 diabetes
  • is far more common than type 1 and makes up about 90% of all cases of diabetes. It usually occurs in adulthood. Here, the pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to the insulin. Many people with Type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to the growing number of older Americans, increasing obesity levels, and widespread failure to exercise.
  • Gestational diabetes
  • is high blood glucose that develops at any time during pregnancy in a person who does not have diabetes.
  • Diabetes affects more than 16 million Americans. There are many risk factors for diabetes, including:
  • Family history of diabetes (parent or sibling)
  • Obesity
  • Age greater than 45 years
  • Certain ethnic groups (particularly African-Americans and Hispanic Americans)
  • Gestational diabetes
  • or delivering a baby weighing more than 9 pounds
  • High blood pressure
  • High blood levels of triglycerides (a type of fat molecule)
  • High blood cholesterol level
  • The American Diabetes Association recommends that all adults be screened for diabetes at least every three years. A person at high risk should be screened more often.
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    Symptoms
    High blood levels of glucose can cause several problems, including frequent urination, excessive thirst, hunger, fatigue, Weight loss and blurry vision. However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all. About 40% of type 2 diabetics have no symptoms of the condition. Symptoms of type 1 diabetes:
  • Increased thirst
  • Increased urination
  • Weight loss
  • in spite of
  • increased appetite
  • Fatigue
  • Nausea
  • Vomiting
  • Symptoms of type 2 diabetes:
  • Increased thirst
  • Increased urination
  • Increased appetite
  • Fatigue
  • Blurred vision
  • Slow-healing infections
  • Impotence in men
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    Signs and tests
  • Analysis of urine (urinalysis) showing glucose and ketones (products of the breakdown of fat)
  • Blood glucose level
  • Glucose tolerance test
  • (blood glucose is measured after drinking 75 grams of glucose)
  • Hemoglobin A1c (HbA1c) level
  • Patients with type 1 diabetes usually develop symptoms over a short period of time, and the condition is often diagnosed in an emergency setting. In addition to having high glucose levels, acutely ill type 1 diabetics have high levels of ketones. Ketones are produced by the breakdown of fat and muscle, and they are toxic at high levels. Ketones in the blood cause a condition called "acidosis" (low blood pH). Urine testing detects both glucose and ketones in the urine. Blood glucose levels are also high. Type 2 diabetes is diagnosed when:
  • A
  • fasting glucose level is higher than 126 mg/dL on two occasions
  • A
  • random glucose level is higher than 200 mg/dL and is accompanied by the classic symptoms of increased thirst, urination, and fatigue
  • A glucose level higher than 200 mg/dL is recorded 2 hours after drinking a standardized carbohydrate beverage (glucose tolerance test)
  • The hemoglobin A1c (HbA1c) level is a measure of average blood glucose during the previous two to three months. It is used to monitor a patient's response to diabetes treatment.
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    Treatment
    There is no cure for diabetes. The immediate goals of treatment are to stabilize the blood sugar and eliminate the symptoms of high blood sugar. The long-term goals of treatment are to prolong life, improve quality of life, relieve symptoms, and prevent long-term complications such as heart disease and kidney failure. The American Diabetes Association recommends that premeal blood sugar levels fall in the range of 80 to 120 mg/dL, bedtime blood levels fall in the range of 100 to 140 mg/dL, and HbA1c levels are at or below 7%. Education, diet, exercise, weight control , medication, blood glucose self-testing, and foot care are vital for good control of diabetes and prevention of its complications. EDUCATION: Diabetes education is an important part of a treatment plan. Appropriate education helps you incorporate diabetes management principles into daily life and reduce the need for emergency care. Basic principles of diabetes education include the following:
  • How to recognize and treat low (hypoglycemia) and high blood sugar (hyperglycemia)
  • What to eat and when
  • How to take insulin or oral medication
  • How to test and record blood glucose
  • How to test urine for ketones (type 1 diabetes only)
  • How to adjust insulin and/or food intake when changing EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE and eating habits
  • How to handle sick days
  • Where to buy diabetes supplies and how to store them
  • After patients learn the basics of diabetes care, it is important for them to learn about how the disease can cause long-term health problems and what the best ways to prevent these are. People with diabetes need to review and update their knowledge, because new research and improved ways to treat diabetes are constantly being developed. DIET: The American Diabetes Association (ADA) currently recommends that 50-60% of a person's diet should come from carbohydrates (starches and sugars), 10-20% from protein, and less than 30% from fats. Specific meal plans are based on an individual's usual food intake. People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugars from becoming extremely high or low. Type 2 diabetics should follow a well-balanced and low-fat diet. A registered dietician can be very helpful in planning dietary needs. Weight management and a well-balanced diet are important to achieving control of diabetes. Some people with type 2 diabetes can discontinue medications after intentional weight loss , although the diabetes is still present. EXERCISE '>EXERCISE : Regular EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE is especially important for the person with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. The Nurses' Health Study has shown that diabetics who EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE are less likely to experience a heart attack or stroke than diabetics who do not EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE regularly. A diabetic should be evaluated by his or her physician before starting an EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE program. Here are some EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE considerations:
  • Choose an enjoyable physical activity that is appropriate for your current fitness level.
  • Exercise every day, and at the same time of day, if possible.
  • Monitor
  • blood glucose levels before and after exercise.
  • Carry food that contains a fast-acting carbohydrate in case you become
  • hypoglycemic during or after exercise.
  • Carry a diabetes identification card and a mobile phone or change for a payphone in case of emergency.
  • Drink extra fluids that do not contain sugar before, during, and after exercise.
  • Changes in EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE intensity or duration may require changes in diet or medication dose to keep blood sugar levels from going too high or low. MEDICATION: Medications to treat diabetes include insulin and glucose-lowering pills, called oral hypoglycemic agents. The bodies of people with type 1 diabetes cannot make their own insulin, so daily insulin injections are required. The bodies of people with type 2 diabetes make insulin but cannot use it effectively. Insulin is not available in oral form. It is delivered by injections that are generally required one to four times per day. Some people use an insulin pump, which is worn at all times and delivers a steady flow of insulin throughout the day. Insulin preparations differ in how quickly they start to work and how long they remain active. Sometimes different types of insulin are mixed together in a single injection. The types of insulin to use, the doses required, and the number of daily injections are chosen by a health care professional trained to provide diabetes care. People who need insulin are taught to give themselves injections by their health care providers or diabetes educators. Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and/or oral medications. There are several oral hypoglycemic agents that lower blood glucose in type 2 diabetes. They fall into one of three groups:
  • Medications that increase insulin production by the pancreas. These include Amaryl, Glucotrol, and Glucotrol XL, Micronase, Diabeta, Glynase, Prandin, and Starlix.
  • Medications that increase sensitivity to insulin. These include Glucophage, Avandia, and Actos.
  • Medications that delay absorption of glucose from the gut. These include Precose and Glyset.
  • Most type 2 diabetics will require more than one medication for good blood sugar control within three years of starting their first medication. Different groups of oral medications may be combined, or insulin and oral medications may be used together. Some people with type 2 diabetes find they no longer need medication if they lose weight and increase activity, because when their ideal weight is reached, their own insulin and a careful diet can control their blood glucose levels. Oral hypoglycemic agents are not known to be safe for use in pregnancy '>pregnancy ; women who have type 2 diabetes and take these medications may be switched to insulin during pregnancy '>pregnancy and while breast-feeding. Gestational diabetes is treated with diet and insulin. SELF-TESTING: Self-monitoring of blood glucose is done by checking the glucose content of a drop of blood. Regular testing tells you how well diet, medication, and EXERCISE '>EXERCISE '>EXERCISE '>EXERCISE are working together to control your diabetes. The results of the test can be used to adjust meals, activity, or medications to keep blood sugar levels in an appropriate range. Testing provides valuable information for the health care provider and identifies high and low blood sugar levels before serious problems develop. Ketone testing is another test that is used in type 1 diabetes. Ketones build up in the blood when there is not enough insulin in people with type 1diabetes, eventually "spilling over" into the urine. The ketone test is done on a urine sample. High levels of blood ketones may result in a serious condition called ketoacidosis . Ketone testing is usually done at the following times:
  • When the blood sugar is higher than 240 mg/dL
  • During acute illness (for example, pneumonia, heart attack, or stroke)
  • When
  • nausea or vomiting occur
  • During
  • pregnancy '>pregnancy FOOT CARE: People with diabetes are prone to foot problems because of the likelihood of damage to blood vessels and nerves and a decreased ability to fight infection. Problems with blood flow and damage to nerves may cause an injury to the foot to go unnoticed until infection develops. Death of skin and other tissue can occur. If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations. To prevent injury to the feet, people with diabetes should adopt a daily routine of checking and caring for the feet as follows:
  • Check your feet every day, and report sores or changes and signs of infection
  •  
    Support Groups
    The stress of illness can often be helped by joining a support group where members share common experiences and problems. See diabetes - resources .
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    Expectations (prognosis)
    For many years, physicians thought the long-term complications of diabetes were inevitable. It is now known that this does not have to be true for most people. The Diabetes Control and Complications Trial (DCCT) studied the effects of tight blood sugar control on complications in type 1 diabetes. Patients treated for tight blood glucose control had an average HbA1c of approximately 7%, while patients treated less aggressively had an average HbA1c of about 9%. At the end of the study, the tight blood glucose group had dramatically fewer cases of kidney disease, eye disease, and nervous system disease than the less-aggressively treated patients. In the United Kingdom Prospective Diabetes Study (UKPDS), researchers followed nearly 4,000 people with type 2 diabetes for 10 years. The study monitored how tight control of blood glucose (HbA1c of 7% or less) and blood pressure (less than 144 over less than 82) could protect a person from the long-term complications of diabetes. This study found dramatically lower rates of kidney, eye, and nervous system complications in patients with tight control of blood glucose. In addition, there was a significant drop in all diabetes-related deaths, including lower risks of heart attack and stroke. Tight control of blood pressure was also found to lower the risks of heart disease and stroke. The results of the DCCT and the UKPDS dramatically demonstrate that good blood glucose and blood pressure control, many cof the omplications of diabetes can be prevented.
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    Complications
    Emergency complications include nonketotic hyperosmolar coma (see diabetic hyperglycemic hyperosmolar coma ). Long-term complications include:
  • Diabetic retinopathy
  • Diabetic nephropathy
  • Diabetic neuropathy
  • Peripheral vascular disease
  • Hyperlipidemia
  • ,
  • hypertension , atherosclerosis , and coronary artery disease
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    Calling your health care provider
    Go to the emergency room or call the local emergency number (such as 911) if symptoms of ketoacidosis occur:
  • Increased thirst
  • and
  • urination
  • Nausea
  • Deep and
  • rapid breathing
  • Abdominal pain
  • Sweet-smelling breath
  • Loss of consciousness
  • Go to the emergency room or call the local emergency number if symptoms of extremely low blood sugar (hypoglycemic
  • coma or severe insulin reaction) occur:
  • Weakness
  • Drowsiness
  • Headache
  • Confusion
  • Dizziness
  • Double vision
  • Lack of coordination
  • Convulsions
  • or
  • unconsciousness
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    Prevention
    Maintaining an ideal body weight and an active lifestyle may prevent the onset of type 2 diabetes. Currently there is no way to prevent type 1 diabetes.
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    Diabetes insipidus

     
    Definition
    A condition caused by the inability of the kidneys to conserve water that leads to frequent urination and pronounced thirst.
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    Alternative Names

     
    Causes, incidence, and risk factors
    Diabetes insipidus (DI) is an uncommon condition that occurs when the kidneys are unable to conserve water as they perform their function of filtering blood. The amount of water conserved is controlled by antidiuretic hormone (ADH, also called vasopressin). It is a hormone produced in a region of the brain called the hypothalamus. ADH is then stored and released from the pituitary gland, a small gland at the base of the brain. DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus. The major symptoms of diabetes insipidus are excessive urination and extreme thirst. The sensation of thirst stimulates patients to drink large amounts of water to compensate for water lost in the urine. Central diabetes insipidus is caused by damage to the hypothalamus or pituitary gland as a result of surgery, infection, tumor , or head injury . Although rare, this is the most common form of DI. Nephrogenic diabetes insipidus involves a defect in the parts of the kidneys that reabsorb water back into the blood stream. It occurs less often than central DI. Nephrogenic DI may occur as an inherited disorder in which male children receive the abnormal gene that causes the disease on the X-chromosome from their mothers. Nephrogenic DI may also be caused by diseases of the kidney (for example, polycystic kidney disease) and the effects of certain drugs (lithium, amphotericin B, demeclocycline). If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on body fluid or salt balance. If inadequate fluids are consumed, the large amount of water lost in the urine may cause dehydration and high blood sodium.
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    Symptoms
  • excessive thirst
  • may be intense or uncontrollable
  • craving for ice water may be present
  • excessive urine volume
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    Signs and tests
  • urine output greater than 3 liters a day
  • low specific gravity on urinalysis
  • Water deprivation test:
  • high urine output
  • central DI – urine output suppressed by a dose of ADH
  • nephrogenic DI – urine output not suppressed by a dose of ADH
  • MRI of the head
  • , revealing an abnormality in or near the hypothalamus or pituitary gland
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    Treatment
    The cause of the underlying condition should be treated when possible. Central diabetes insipidus may be controlled with vasopressin (desmopressin, DDAVP). Vasopressin is administered as either a nasal spray or tablets. Vasopressin is ineffective for patients with nephrogenic diabetes insipidus. If nephrogenic DI is caused by medication (for example, lithium), stopping the medication leads to recovery of normal kidney function in most cases. Hereditary nephrogenic DI is treated with fluid intake to match urine output and drugs that lower urine output. Drugs used to treat nephrogenic DI includes the anti-inflammatory medication indomethacin and the diuretics hydrochlorothiazide (HCTZ) and amiloride.
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    Support Groups

     
    Expectations (prognosis)
    The outcome is dictated by the underlying disorder. If treated, diabetes insipidus does not cause severe problems or reduce life expectancy.
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    Complications
    Inadequate fluid consumption can result in:
  • dehydration
  • dry skin
  • dry mucous membranes
  • sunken appearance to eyes
  • sunken fontanelles (soft spot) in infants
  • fever
  • rapid heart rate
  • weight loss
  • electrolyte
  • imbalance
  • fatigue
  • ,
  • lethargy
  • headache
  • irritability
  • muscle pains
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    Calling your health care provider
  • Call your health care provider if symptoms indicate diabetes insipidus may be present.
  • If you have diabetes insipidus, contact your health care provider if frequent urination or extreme thirst return.
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    Prevention

    Diabetes insipidus - central

     
    Definition
    A condition marked by extreme thirst and excessive urine output caused by a deficiency of a hormone ( vasopressin ) that normally would limit the amount of urine made. See also diabetes insipidus - nephrogenic .
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    Alternative Names
    Central diabetes insipidus
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    Causes, incidence, and risk factors
    Central diabetes insipidus is a rare condition caused by damage to the hypothalamus or pituitary gland in the brain. Damage may be related to surgery, infection, inflammation, tumor , or injury to the head . Sometimes the cause remains unknown. Very rarely, diabetes insipidus can be caused by a genetic defect. Normally, the hypothalamus in the brain makes vasopressin , a hormone that causes the kidneys to conserve water by making concentrated urine. In diabetes insipidus , there is a lack of vasopressin. Without vasopressin, the kidneys fail to reabsorb excess filtered water. This results in a rapid loss of water from the body in the form of dilute urine. A person with diabetes insipidus drinks large quantities of water, driven by extreme thirst , to compensate for the water loss.
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    Symptoms
  • Increased urine volume
  • Excessive thirst
  • Confusion and changes in consciousness if the patient is unable to drink
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    Signs and tests
  • Urinalysis
  • Low urine salt concentration
  • Urine output greater than 3 liters a day
  • Water restriction test: while the patient is hospitalized, urine volume and ability of the kidney to concentrate urine is evaluated every hour; plasma sodium concentration is evaluated every two hours
  • MRI of the head
  • , revealing an abnormality in or near the pituitary gland
  • Blood serum sodium/salt concentration may be high if the condition is untreated
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    Treatment
    The cause of the underlying condition should be treated. Vasopressin (desmopressin) will be administered either as a nasal spray, oral tablets, or injections under the skin. This controls the urine output and fluid balance, and prevents dehydration . In mild cases, increased water intake may be all that is needed. If the thirst mechanism is not working (for example, if a part of the brain called the hypothalamus is damaged), a presciption for a certain amount of water intake may also be needed (usually 2-2.5 L per day) to ensure proper hydration.
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    Support Groups

     
    Expectations (prognosis)
    The outcome is dictated by the underlying disorder. If treated, diabetes insipidus does not cause severe problems or reduce life expectancy.
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    Complications
  • Dehydration
  • Electrolyte
  • imbalance
  • Confusion and changes in mental status can develop if the condition is not treated. All patients with diabetes insipidus should wear a medic alert bracelet or necklace to alert care givers to this condition in an emergency situation
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    Calling your health care provider
    Call your health care provider if symptoms indicate diabetes insipidus may be present.
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    Prevention
    Many of the cases may not be preventable. Prompt treatment of infections, tumors and injuries may reduce risk.
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    Diabetes insipidus - nephrogenic

     
    Definition
    Nephrogenic diabetes insipidus is a disorder characterized by the passage of large volumes of urine due to a defect of the kidney tubules. See also diabetes insipidus-central .
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    Alternative Names
    Nephrogenic diabetes insipidus; Acquired nephrogenic diabetes insipidus;
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    Causes, incidence, and risk factors
    Antidiuretic hormone ( ADH '>ADH ; vasopressin ) is a hormone produced in the hypothalamus of the brain. It concentrates the urine by triggering the kidneys to reabsorb water into the blood stream rather than excreting water into the urine. Nephrogenic diabetes insipidus involves a defect in the kidney tubules (the portion of the kidneys that causes water to be excreted or reabsorbed). The specific kidney defect is usually a partial or complete failure of special receptors located on or within the kidney tubules to respond to ADH, the hormone that transmits the instruction to concentrate the urine to the inside of the cells. Excessive amounts of water are excreted with the urine, producing a large quantity of very dilute urine. There is little or no response to vasopressin, even though the blood level of this hormone is higher than normal. If thirst mechanisms are normal and adequate fluids are consumed, there are no significant effects on the fluid and/or electrolyte balance of the body. If inadequate fluids are consumed, the high urine output may cause dehydration and high blood sodium. Nephrogenic DI is a rare disorder. It may be present at birth as a result of a sex-linked defect (congenital nephrogenic DI) that usually affects men, although women can pass the gene on to their children. Most commonly, nephrogenic diabetes insipidus is an acquired disorder. Precipitating factors include drugs (lithium, demeclocycline, amphotericin B), electrolyte disorders (high calcium or low potassium levels), and urinary obstruction.
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    Symptoms
  • Excessive thirst
  • May be intense or uncontrollable
  • Craving for ice water may be present
  • Excessive urine volume
  • May exceed 3 to 15 liters per day
  • Inadequate fluid consumption can result in:
  • Dehydration
  • Dry skin
  • Dry mucous membranes
  • Sunken appearance to eyes
  • Sunken fontanelles (soft spot) in infants
  • Fatigue
  • ,
  • lethargy
  • Headache
  • Irritability
  • Low body temperature
  • Muscle pains
  • Rapid heart rate
  • Weight loss
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    Signs and tests
  • Examination may indicate
  • dehydration and/or shock if fluid intake is inadequate. The pulse rate may be rapid, with a low blood pressure present. The most significant indication of diabetes insipidus is persistent high urine output regardless of fluid intake. Signs associated with high urine output are:
  • High serum
  • osmolality
  • Low
  • urine osmolality
  • Normal or high
  • ADH '>ADH levels
  • The kidneys not making a more concentrated urine when the person is given ADH '>ADH
  • This disease may also alter the results of the following tests:
  • Urine specific gravity
  • Urine concentration test
  • Urine 24h volume
  • Serum sodium
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    Treatment
  • The goal of treatment is to regulate fluid levels in the body.
  • All cases should be treated with consistently high fluid intake. The volume of fluids consumed should approximately equal the volume of urine produced. Reduction or discontinuation of medications that may cause nephrogenic DI '>DI may improve symptoms. Hydrochlorothiazide may improve symptoms. This may be used alone or in combination with other medications, including indomethacin. Although this medication is a diuretic (these medications are usually used to increase urine output), hydrochlorothiazide can actually reduce the urine output for people with nephrogenic DI. This medication works by causing sodium and water to be excreted in the early part of the renal tubules (the proximal tubules). This leaves less fluid available for the late portion of the kidney to excrete ( distal tubule) -- this is the portion affected by nephrogenic DI '>DI -- and thus it limits the total volume of urine that can be excreted.
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    Support Groups

     
    Expectations (prognosis)
    Congenital nephrogenic DI '>DI is a chronic condition requiring lifelong treatment. Acquired nephrogenic DI '>DI may be short-term or long-term.
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    Complications
  • Severe
  • dehydration , shock (if inadequate fluid intake)
  • Hypernatremia
  • (high blood sodium)
  • Dilation of the ureters and bladder
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    Calling your health care provider
    Call your health care provider if symptoms indicate diabetes insipidus may be present.
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    Prevention
    There is no known prevention for congenital nephrogenic diabetes insipidus . Treatment of causative disorders may prevent some cases of acquired nephrogenic DI . Medications should only be used under the supervision of the health care provider.
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    Diabetes - diet

     
    Definition
    The Diabetes '>Diabetes diet consists of specific dietary guidelines developed by the American Diabetes Association and the American Dietetic Association for Diabetes '>Diabetes management. The overall principles are to reduce the amount of fat , simple sugar, and salt and increase the amount of complex carbohydrates and foods high in fiber .
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    Alternative Names
    Nutrition recommendations for people with diabetes; Diet - diabetes
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    Function
    There are two primary types of diabetes , and the nutritional goals for each are different. With type 1 diabetes , the main focus of diet planning is balance and consistency. Meals should be eaten at approximately the same time every day. Meals and snacks should be planned in conjunction with the insulin dose and the person's planned level of physical activity . The amount and type of food, and the carbohydrate, protein , and fat content of meals and snacks, should be consistent from day to day. This helps with the delicate balance of carbohydrate intake, insulin, and physical activity that is necessary for optimal blood levels of a sugar called glucose. If these components are not in balance, there can be wide variations, from too high to too low, in blood glucose levels. For children with type 1 diabetes, weight and growth patterns are a useful way of determining if the child's intake has been adequate. Witholding food or giving food when the child is not hungry should be discouraged. With type 2 diabetes , the main focus is on weight management and weight control , because 80% to 90% of people with this disease are overweight . A calorie-controlled meal plan is recommended, along with appropriate physical activity. In many cases, weight control and a planned diet alone control diabetes. Some people with type 2 diabetes must also take oral medications. Children with type 2 diabetes present special challenges. Meal plans should be recalculated often to account for the child's change in caloric requirements as he or she grows. Physical activity may be more difficult to plan for and may be much more erratic than in an adult. Children are more likely to require several snacks in their meal plan because they may not be able to meet their caloric needs in three meals. Concentrated sweets may be difficult to restrict at times, and parents may require additional help in planning for special occasions, such as birthdays and Halloween, when sweet foods abound.
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    Food Sources

     
    Side Effects

     
    Recommendations
    Reduce the amount of dietary fat . Current American Diabetes Association guidelines advise that less than 30% of total daily calories should come from fat sources. Protein choices with less fat are recommended, such as skinless poultry, fish, and lean meats. The recommended daily allowance is approximately two three-ounce servings of protein a day. A three-ounce portion of meat is approximately the size of a deck of playing cards. No more than 10% to 20% of the day's total calories should come from protein. Approximately 50% to 60% of the day's total calories should come from complex carbohydrates such as starches and whole-grain breads, with an emphasis on the high- fiber choices. Foods that are high in carbohydrates provide energy, minerals, and vitamins . Food sources of complex carbohydrates and fiber are fruits and vegetables, whole-grain breads and cereals, dried beans and peas, and lentils and legumes. Use sources of simple (concentrated) carbohydrates, such as table sugar, honey, soda, juice, or syrup, in moderation. Concentrated sources of carbohydrates cause the blood sugar levels to rise quickly. Exercise caution when eating simple carbohydrates. A registered dietitian can help you best decide how to include simple carbohydrates into your diet plan.
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    Diabetes risk factors

     
    Definition

     
    Alternative Names
    Risk factors for diabetes
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    Information
    Question: What type of people are at high risk for diabetes ? Answer:
  • Family history of diabetes
  • Obesity
  • Age greater than 45 years
  • Certain ethnic groups (African-Americans, Hispanic-Americans)
  • diabetes during pregnancy or baby weighing more than 9 pounds
  • High blood pressure
  • High blood levels of triglycerides (a type of fat molecule)
  • High blood cholesterol level
  • The American diabetes Association recommends that all adults be screened for diabetes at least every three years. A person at high risk should be screened more often. See diabetes .
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    Diabetes - resources

     
    Definition

     
    Alternative Names
    Resources - diabetes
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    Information
    The following are good sources of diabetes information: American Diabetes Association National Service Center 1660 Duke Street Alexandria, VA 22314 (800) 232-3472 www.diabetes.org Juvenile Diabetes Research Foundation 120 Wall Street New York, NY 10005-4001 Phone (212) 785-9500 www.jdrf.org The National Diabetes Information Clearinghouse One Information Way Bethesda, MD 23560 (301) 654-3327 National Institute of Diabetes and Digestive and Kidney Diseases www.niddk.nih.gov National Guideline Clearinghouse www.guideline.gov Additional resources can be found through local libraries, your healthcare provider and the yellow pages under "social service organizations".
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