The Accuracy Of Polyuria, Polydipsia, Polyphagia, And Indian Diabetes Risk Score In Adults Screened For Diabetes Mellitus Type-ii
Context: The World Health Organization report suggests that over 19% of the world's diabetic population currently resides in India. Unfortunately, >50% of the diabetics in India are unaware about their diabetic status. In the poor income country like India, it is essential to use cost-effective methods for screening for diabetes, and traditionally using three classical symptoms and Indian Diabetes Risk Score (IDRS) tool is helpful but, data regarding their diagnostic accuracy is very less. Objective: (1) To assess the diagnostic accuracy of polyuria, polydipsia, polyphagia, and IDRS for detecting diabetes. Settings and Design: Six hundred and seventy-seven adult individuals >20 years of age were screened for diabetes and assessed polyuria, polydipsia, polyphagia, and IDRS score. All were subjected for postprandial blood glucose level. Subjects and Methods: For diagnostic accuracy sensitivity, specificity, positive and negative predictive values, likelihood ratios (LRs, for positive and negative tests), and accuracy was calculated for each symptom. Similarly, by receiver operative curve (ROC) curve analysis, we carried out sensitivity and specificity of IDRS. Results: There was statistically significant association between these three classical symptoms and diabetes status of individuals. When present, all these three symptoms carried 7.34% sensitivity and 98.42% specificity with positive predictive value 47.06% and NPV 84.70%, LR+4.36, LR−0.94 with accuracy of 85%. The optimum cutoff value of IDRS score was >50, which carried sensitivity 73%, specificity 58.7%, and area under curve for ROC was 68% (P < 0.001). Conclusions: This study has shown highest specificity for these three classical symptoms in diagnosing diabetes, but these symptoms were insensitive to detect a Continue reading >>
Diabetes Symptoms: When Diabetes Symptoms Are A Concern
Diabetes symptoms are often subtle. Here's what to look for — and when to consult your doctor. Early symptoms of diabetes, especially type 2 diabetes, can be subtle or seemingly harmless — that is, if you even have symptoms at all. Over time, however, you may develop diabetes complications, even if you haven't had diabetes symptoms. In the United States alone, more than 8 million people have undiagnosed diabetes, according to the American Diabetes Association. But you don't need to become a statistic. Understanding possible diabetes symptoms can lead to early diagnosis and treatment — and a lifetime of better health. If you're experiencing any of the following diabetes signs and symptoms, see your doctor. Excessive thirst and increased urination Excessive thirst (also called polydipsia) and increased urination (also known as polyuria) are classic diabetes symptoms. When you have diabetes, excess sugar (glucose) builds up in your blood. Your kidneys are forced to work overtime to filter and absorb the excess sugar. If your kidneys can't keep up, the excess sugar is excreted into your urine, dragging along fluids from your tissues. This triggers more frequent urination, which may leave you dehydrated. As you drink more fluids to quench your thirst, you'll urinate even more. Fatigue You may feel fatigued. Many factors can contribute to this. They include dehydration from increased urination and your body's inability to function properly, since it's less able to use sugar for energy needs. Weight loss Weight fluctuations also fall under the umbrella of possible diabetes signs and symptoms. When you lose sugar through frequent urination, you also lose calories. At the same time, diabetes may keep the sugar from your food from reaching your cells — leading to constant Continue reading >>
Why Does Diabetes Make You So Thirsty?
Excessive thirst, or polydipsia, can be triggered by different factors such as eating too much salt or taking medications that cause dry mouth. Thirst is also a symptom of diabetes. For people with diabetes, thirst can be a sign of hyperglycemia, or high blood sugar. The kidneys play a vital role in regulating levels of blood sugar by filtering the blood and absorbing excess glucose. When very high levels of sugar build up in the blood, the kidneys can’t keep up and they produce more urine than normal — a condition known as polyuria. As a result, you can become dehydrated. “People who have well-controlled diabetes should be at no increased risk for excessive thirst compared with somebody who doesn’t have diabetes,” says Noah Bloomgarden, MD, assistant professor of medicine-endocrinology at the Albert Einstein College of Medicine and clinical endocrinologist in the division of endocrinology, diabetes, and metabolism at the Montefiore Health System in the Bronx, New York. “It’s really poor control of one’s blood sugar and an increase in urination and excretion of water that makes people [with diabetes] feel very thirsty and increases their need to maintain water balance.” As Dr. Bloomgarden points out, even people who are doing a good job of controlling their diabetes can develop very high blood sugar. A cold, infection, or even a very stressful situation can cause blood sugar to rise, and excessive thirst may be the first sign that something is wrong. “If you’re experiencing excessive thirst, you should contact your doctor immediately, because it may indicate severe hyperglycemia,” says Bloomgarden. If you have diabetes and you’re not sure whether you’re unusually thirsty, Bloomgarden suggests that you check your blood sugar. If your blood sug Continue reading >>
Polydipsia – Symptom Of Diabetes
Polydipsia is the term for excessive thirst. Polydipsia can happen as a result of high sugar levels and is therefore one of the symptoms of diabetes. If you have diabetes and recurrent thirst, it could be a sign that your sugar levels are running too high. Causes of polydipsia Strong thirst, polydipsia, may be caused by factors such as: Hyperglycemia (high blood sugar levels) as a result of diabetes mellitus Vomiting Diarrhea Diabetes insipidus Kidney disease Medications including diuretics When to see your doctor If you have recurrent thirst that comes back despite drinking water, it is important to see your doctor as it could indicate a health problem. Polydipsia in people with diabetes If you have type 1 diabetes, it’s important to test your sugar levels and, if your sugar levels are above 15 mmol/l, to test for ketones as well. Contact your health team if you have high ketone levels or you struggle to get your sugar levels back to normal. If you have type 2 diabetes and have a blood glucose testing kit, it can help to test your sugar levels to see whether your sugar levels are regularly going too high. If you are struggling to keep your sugar levels under control or have regular thirst, it’s important to let your doctor know. How diabetes can lead to polydipsia When blood glucose levels are high, the body will try to pass glucose out of the blood through the urine and this will mean passing out more urine than normal. One consequence of this is that the body will need to take in more water to replace the water it’s passing out as urine and therefore we feel the signs of thirst. Type 2 diabetes is a metabolic disorder that is characterized by high levels of glucose in the bloodstream which leads to hyperglycemia if untreated. It is strongly linked to obesity an Continue reading >>
Practice Essentials Diabetes insipidus (DI) is defined as the passage of large volumes (>3 L/24 hr) of dilute urine (< 300 mOsm/kg). It has the following 2 major forms: Two other forms are gestational DI and primary polydipsia (dipsogenic DI); both are caused by deficiencies in AVP, but the deficiencies do not result from a defect in the neurohypophysis or kidneys. Signs and symptoms The predominant manifestations of DI are as follows: The most common form is central DI after trauma or surgery to the region of the pituitary and hypothalamus, which may exhibit 1 of the following 3 patterns: In infants with DI, the most apparent signs may be the following: In children, the following manifestations typically predominate: If the condition that caused DI also damaged the anterior pituitary or hypothalamic centers that produce releasing factors, patients may present with the following: Physical findings vary with the severity and chronicity of DI; they may be entirely normal or may include the following: See Clinical Presentation for more detail. If the clinical presentation suggests DI, laboratory tests must be performed to confirm the diagnosis, as follows: Additional studies that may be indicated include the following: See Workup for more detail. Management Most patients with DI can drink enough fluid to replace their urine losses. When oral intake is inadequate and hypernatremia is present, provide fluid replacement as follows: Give dextrose and water or an intravenous fluid that is hypo-osmolar with respect to the patient’s serum; do not administer sterile water without dextrose IV Administer fluids at a rate no greater than 500-750 mL/hr; aim at reducing serum sodium by approximately 0.5 mmol/L (0.5 mEq/L) every hour Pharmacologic therapeutic options include the follo Continue reading >>
For the term formerly used in reference to compulsive drinking of alcohol, see Dipsomania. Polydipsia is excessive thirst or excess drinking. The word derives from the Greek πολυδίψιος (poludípsios) "very thirsty", which is derived from πολύς (polús, "much, many") + δίψα (dípsa, "thirst"). Polydipsia is a nonspecific symptom in various medical disorders. It also occurs as an abnormal behaviour in some non-human animals, such as in birds. Causes This symptom is characteristically found in diabetics, often as one of the initial symptoms, and in those who fail to take their anti-diabetic medications or whose condition is poorly controlled. It can also be caused by a change in the osmolality of the extracellular fluids of the body, hypokalemia, decreased blood volume (as occurs during major hemorrhage), and other conditions that create a water deficit. This is usually a result of osmotic diuresis. Diabetes insipidus ("tasteless" diabetes, as opposed to diabetes mellitus) can also cause polydipsia. Polydipsia is also a symptom of anticholinergic poisoning. Zinc is also known to reduce symptoms of polydipsia by causing the body to absorb fluids more efficiently (reduction of diarrhea, induces constipation) and it causes the body to retain more sodium; thus a zinc deficiency can be a possible cause. The combination of polydipsia and (nocturnal) polyuria is also seen in (primary) hyperaldosteronism (which often goes with hypokalemia). Antipsychotics can have side effects such as dry mouth that may make the patient feel thirsty. Psychogenic and non-psychogenic primary polydipsia Main article: Primary polydipsia Primary polydipsia describes excessive thirst and water intake caused in the absence of physiological stimuli to drink. T Continue reading >>
Diabetes Mellitus And Polyuria
Diabetes comes from the Greek word which means “siphon”. There are two distinct disorders that share the first name diabetes: diabetes mellitus and diabetes insipidus. This is because both disorders cause polyuria, or excessive urine output. Diabetes insipidus is a disorder of urine concentration which we will discuss in spring quarter. Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is hyperglycemia, or high levels of glucose in the plasma. How does hyperglycemia cause excessive urine production? To answer this, we need to understand a little bit about how the kidney works. Each kidney contains about a million functional units called nephrons (blue structure in the figure). The first step in the production of urine is a process called filtration (green arrow). In filtration, there is bulk flow of water and small molecules from the plasma into Bowman’s capsule (the first part of the nephron). Because of the nonspecific nature of filtration, useful small molecules such as glucose, amino acids, and certain ions end up in the forming urine, which flows into the kidney tubules. To prevent the loss of these useful substances from the body, the cells lining the kidney tubules use epithelial transport to transfer these substances out of the forming urine and back into the extracellular fluid. This process is known as reabsorption (purple arrows). Under normal circumstances, 100% of the glucose that is filtered is Continue reading >>
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What Are The 3 P's Of Diabetes?
The 3 classic symptoms of diabetes mellitus are polyuria, polydipsia and polyphagia -- also known as the 3 P's. Polyuria, polydipsia and polyphagia are defined as an increase in urination, thirst and hunger, respectively. The presence of the 3 P’s is a good indication that your blood sugar may be too high. With type 1 diabetes (T1DM), these symptoms typically develop relatively quickly and are more obvious, often leading to diagnosis of the condition. With type 2 diabetes (T2DM), the 3 P's are often more subtle and develop more gradually. As a result, people with type 2 diabetes may overlook these symptoms, leading to a delay in diagnosis. Video of the Day The 3 P’s of diabetes are typically among the first symptoms to occur in T1DM, but they can occur with other conditions. Polyuria, or excessive urine production, can be identified by needing to urinate during the night, frequent bathroom trips or accidents in potty-trained children. Polydipsia, a consequence of polyuria, is characterized by excessive thirst. An increase in fluid intake due to polydipsia can also contribute to increased urination. Polyphagia is the term for excessive or increased hunger. It occurs with diabetes because blood sugar is fails to enter body tissues normally, leaving them short of fuel to produce energy. To compensate, fat and muscle are broken down and used for energy resulting in weight loss, lack of energy and fatigue, which are most often seen with T1DM. Signs of long-term high blood sugar, such as blurred vision and tingling or numbness in hands and feet, are more common at diagnosis with T2DM. High Blood Sugar and the 3 P's The 3 P's of diabetes all stem from high blood sugar levels. Blood sugar is normally filtered by the kidneys but then reabsorbed into the blood. When blood sug Continue reading >>
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Mammillary Polydipsia And Diabetes Insipidus: A Study Of The Rhythmicity Of Water Intake.
Abstract Rats with polydipsia induced by electrolytic mammillary lesions show a normal daily rhythmicity of water intake compared with sham lesioned animals, when kept in a 12:12 hours light-dark cycle of illumination. Water is mainly consumed during the dark phase (approximately 80-90% of the total amount). On the other hand, rats with centrally induced diabetes insipidus by means of electrolytic lesions in the median eminence show a clear-cut alteration in this rhythmicity, drinking only 67% of the total amount during the dark phase. This effect could be due to the continuous necessity of these animals to drink water in order to maintain fluid homeostasis, and is not related to food rhythmicity alterations. Taken together, and on the basis of the daily rhythmicity of water intake, these results suggest that mammillary polydipsia may be different from that observed when diabetes insipidus is present. Continue reading >>
Diagnostic Accuracy Of Copeptin In The Differential Diagnosis Of The Polyuria-polydipsia Syndrome: A Prospective Multicenter Study.
Abstract CONTEXT: The polyuria-polydipsia syndrome comprises primary polydipsia (PP) and central and nephrogenic diabetes insipidus (DI). Correctly discriminating these entities is mandatory, given that inadequate treatment causes serious complications. The diagnostic "gold standard" is the water deprivation test with assessment of arginine vasopressin (AVP) activity. However, test interpretation and AVP measurement are challenging. OBJECTIVE: The objective was to evaluate the accuracy of copeptin, a stable peptide stoichiometrically cosecreted with AVP, in the differential diagnosis of polyuria-polydipsia syndrome. DESIGN, SETTING, AND PATIENTS: This was a prospective multicenter observational cohort study from four Swiss or German tertiary referral centers of adults >18 years old with the history of polyuria and polydipsia. MEASUREMENTS: A standardized combined water deprivation/3% saline infusion test was performed and terminated when serum sodium exceeded 147 mmol/L. Circulating copeptin and AVP levels were measured regularly throughout the test. Final diagnosis was based on the water deprivation/saline infusion test results, clinical information, and the treatment response. RESULTS: Fifty-five patients were enrolled (11 with complete central DI, 16 with partial central DI, 18 with PP, and 10 with nephrogenic DI). Without prior thirsting, a single baseline copeptin level >21.4 pmol/L differentiated nephrogenic DI from other etiologies with a 100% sensitivity and specificity, rendering a water deprivation testing unnecessary in such cases. A stimulated copeptin >4.9 pmol/L (at sodium levels >147 mmol/L) differentiated between patients with PP and patients with partial central DI with a 94.0% specificity and a 94.4% sensitivity. A stimulated AVP >1.8 pg/mL differentia Continue reading >>
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Excessive thirst (medical term polydipsia [pah-lee-DIP-see-uh]; abreviated as PD) is a symptom of diabetes. Diabetic animals often drink incessantly because they are dehydrated from the cell-dehydrating effects of hyperglycemia, plus the effects of their bodies casting off the excess glucose through excessive urination, taking hydration with it. Diabetes mellitus is not the only condition or disease for which excess drinking is a symptom. The "other" diabetes, diabetes insipidus, gets its nickname, "the thirsty disease", from the excessive drinking of its sufferers. Urinary tract infections can cause polydipsia and polyuria. Polydipsia is a sign or symptom indicating, due to lack of sufficient insulin, the body is unable to properly metabolize carbohydrates. With the addition of proper treatment, the symptom resolves, as the system now has enough insulin to accomplish this process properly. NEVER restrict water for a diabetic pet! When there is poor or no blood glucose control, this is the only way it can be lowered--by literally flushing as much as possible out of the system. Regulation with the proper dose(s) of insulin will mean your pet no longer needs to drink abnormally because there is no excess of glucose to cause this. Caregivers should provide adequate clean drinking water for their diabetic pets at all times. An animal's water consumption will diminish as it becomes more regulated and, if a switch is made from a dry-food diet to a wet-food diet, the animal will obtain more of its hydration from the wet food, which is often 70% or more moisture. Polydipsia results in polyuria, or excessive urination. Together, the three "polys"--polydipsia, polyuria and polyphagia, excessive hunger, are vicious circles of uncontrolled or poorly controll Continue reading >>
What is polydipsia? Polydipsia is the medical term for excessive thirst. It's common to feel thirsty at times but long-term thirst and having to drink a lot more water than usual could be a warning sign of health conditions, including diabetes. Most experts suggest drinking around 6-8 glasses of fluid a day for good health. If you are feeling so thirsty that you regularly drink far more than that - seek medical advice. While not drinking enough water or fluids can be bad for the body - too much can also cause problems. Excessive thirst is a separate symptom to experiencing a dry mouth. Causes of polydipsia Feeling more thirsty can be due to everyday things, including: Hot weather Sweating a lot Having salty or spicy food Vomiting (being sick) Heavy loss of blood Some medication Health conditions that can cause excessive thirst and drinking a lot of fluids as a symptom include: Diabetes insipidus – which affects the kidneys and is not actually a form of diabetes Burns Infections Sickle cell anaemia Accidents, brain injury Organ problems affecting the heart, kidneys or liver Mental health conditions involving excessive drinking, including schizophrenia - called psychogenic polydipsia Complications of polydipsia Drinking too many fluids can reduce sodium levels in the bloodstream and put too much water into cells - called hyponatraemia. Symptoms of hyponatraemia include headache, nausea, and feeling confused. In severe cases it can result in falling into a coma or death. Polydipsia diagnosis A doctor will diagnose polydipsia based on a person's symptoms, medical history and a physical examination. Tests may be arranged, including urine tests and blood tests. A doctor will want to know how much urine (pee) is passed a day - more than 5 litres is a warning sign of polydips Continue reading >>
Polyuria, Polydipsia—not Always Diabetes
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Diabetes Insipidus: Causes, Symptoms And Treatment
Diabetes insipidus is a condition where the body loses too much fluid through urination, causing a significant risk of dangerous dehydration as well as a range of illnesses and conditions. There are two forms of the disease: nephrogenic diabetes insipidus and central diabetes insipidus (also known as neurogenic diabetes insipidus). A number of factors have been linked to the development of diabetes insipidus, which may also occur in pregnancy or with the use of certain medications. Establishing the cause of the problem can help determine the most appropriate treatment to support the regulation of water balance in the body. Diabetes insipidus is a condition that can be managed successfully. Contents of this article: What is diabetes insipidus? An uncommon condition, diabetes insipidus is a disorder affecting the regulation of body fluid levels. Two key symptoms resemble those of the more common forms of diabetes that affect blood sugar levels (diabetes mellitus types 1 and 2).1-5 People with diabetes insipidus produce excessive amounts of urine (polyuria), resulting in frequent urination and, in turn, thirst (polydipsia). However, the underlying cause of these two symptoms is quite different from the causes in types 1 and 2 diabetes. In diabetes mellitus, elevated blood sugar prompts the production of large volumes of urine to help remove the excess sugar from the body. In diabetes insipidus, it is the body's water balance system itself that is not working properly. Here are some key points about diabetes insipidus. More detail and supporting information is in the body of this article. Diabetes insipidus is a condition where the body fails to properly control water balance, resulting in excessive urination. Diabetes insipidus can be caused by low or absent secretion of t Continue reading >>
Diabetes insipidus is characterised by extreme thirst and the passing of large amounts of urine. It is caused by the lack of sufficient vasopressin, a hormone produced by the brain that instructs the kidneys to retain water. Treatment options include vasopressin replacement. On this page: Diabetes insipidus is characterised by extreme thirst and the passing of vast amounts of urine. It is caused by insufficient vasopressin, a hormone produced by the brain that instructs the kidneys to retain water. Without enough vasopressin, too much water is lost from the body in urine, which prompts the affected person to drink large amounts of fluids in an attempt to maintain their fluid levels. In severe cases, a person may pass up to 30 litres of urine per day. Without treatment, diabetes insipidus can cause dehydration and, eventually, coma due to concentration of salts in the blood, particularly sodium. The name of this condition is a little misleading, since diabetes insipidus has nothing to do with diabetes mellitus (a condition characterised by high blood sugar levels), apart from the symptoms of thirst and passing large volumes of urine. The word diabetes means 'to go through' - describing the excessive urination. Insipidus means the urine is tasteless, whereas mellitus suggests it is sweet from its sugar content. This terminology dates back to a time when physicians literally dipped a finger in the patient's urine and tested its taste. Not a diagnostic method much in use today! Symptoms The symptoms of diabetes insipidus include: Extreme thirst that can't be quenched (polydipsia) Excessive amounts of urine (polyuria) Colourless urine instead of pale yellow Waking frequently through the night to urinate Dry skin Constipation Weak muscles Bedwetting. Too much water is lost in Continue reading >>