Diabetes Insipidus

Diabetes Insipidus

Diabetes Insipidus

Recently, @EMHighAK (Alex Koyfman) asked about any “teaching points” with respect to Pediatric DKA and Cerebral Edema. In addition to referencing an oldie, but a goodie morsel on Cerebral Edema, I also mentioned that we should all be careful not to attribute all ketonuria in vomiting kids to “starvation ketosis.” That got me to thinking about other potential diabetes related urine pitfalls. What about the child with polyuria but no glucosuria? Is that reassuring and do I quickly assume that the child is just super-hydrated? Let us take a minute to recall that there is another diabetes to consider: Diabetes Insipidus.
“Diabetes,” etymologically, has origins in words that mean “to pass through” and was used to describe excessive passage of urine (polyuria).
“Mellitus” has origins from words that mean honey and/or sweetness.
“Insipidus” stems from words that meant lacking flavor or taste.
So to differentiate between the two, all we have to do is taste the urine. Simple.
This was how physicians of antiquity would evaluate the urine. (Delicious!)
Ok… I don’t advise this… and I’m pretty sure there are some hospital regulations that make that practice a reason to terminate your employment.
I am glad we have replaced human tongues with urine dipsticks for this!
Diabetes Insipidus = the inability to concentrate urine
Can be due to:
Central CNS process – vasopressin deficiency
Any process that impairs production and release of vasopressin can lead to diabetes insipidus. [Dabrowski, 2016]
Central Diabetes Insipidus (DI) is more common than Nephrogenic Continue reading

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Stress of divorce can 'triple risk' of children getting diabetes

Stress of divorce can 'triple risk' of children getting diabetes

Stressful life events in childhood such as death or illness in the family, divorce or separation can triple the risk of developing type 1 diabetes, research has suggested.
A study carried out in Sweden analysed more than 10,000 families with children aged between two and 14 who did not already have the condition and also looked at factors including whether there was any family conflict, change of family structure, interventions from social services or unemployment.
Parents were given questionnaires asking them to assess such serious life events, parental stress, worries and the parent's social support and 58 children were subsequently diagnosed with type 1 diabetes.
Diabetes: the facts and figures
Cure for Type 1 diabetes imminent after stem-cell breakthrough
Researchers said that, as it is unlikely such stressful events can be avoided, families need support to cope if such problems occur.
The study said that while the causes of type 1 diabetes are unknown, it is usually preceded by the body's own immune system attacking and killing beta cells in the pancreas, which produce insulin.
Environmental factors such as viral infection, dietary habits, birth weight and early weight gain, as well as chronic stress, have all been proposed as risk factors, and the new research aimed to examine whether psychological stress during a child's first 14 years of life might increase the risk.
They said that since rates among young children are increasing in most countries, environmental factors are being examined even more seriously.
You need to have the Adobe Flash Player to view this conte Continue reading

The anti-diabetes diet: a 2,000 calorie-a-day food planner

The anti-diabetes diet: a 2,000 calorie-a-day food planner

Have we forgotten what a healthy amount of food looks like? GP Ann Robinson thinks so. Writing in the Guardian, she responded to the warning by the charity Diabetes UK, that the rise in cases of the disease is threatening to bankrupt the NHS.
Robinson pointed out that because the rise in cases seems to be due to the increase in the number of people living with Type 2 diabetes – which can be linked to obesity – tackling it will require a “massive change in the way we lead our lives”. With the UK becoming a “nation of grazers”, it was time schools taught pupils what 2,000 calories a day “looks and feels like”, said Robinson.
So we asked Kelly McCabe of the British Dietetic Association to produce a working week’s approximate 2k-a-day plan. We hope you like lentils:
Breakfast: Yoghurt with berries, nuts and seeds (100g Total 0% yoghurt, handful mixed berries, 1 tbsp mixed seeds, 2 sliced brazil nuts).
Lunch: Smoked salmon, low-fat cream cheese and spinach sandwich on soya and linseed bread, with a handful of cherry tomatoes.
Dinner: Sweet potato, spinach and lentil dhal (made with 100g red lentils, and a large sweet potato: makes enough for lunch tomorrow).
Breakfast: Banana porridge (3 tbsp whole rolled porridge oats, semiskimmed milk, ½ sliced banana, 2 sliced brazil nuts).
Lunch: Sweet potato, spinach and lentil dhal (leftovers).
Dinner: Parma-ham-wrapped salmon (one small fillet, 2 slices ham) with asparagus and 4 tbsp pesto sauce, 80ml creme fraiche, handful new potatoes.
Breakfast: Scrambled eggs with smoked salmon and avocado o Continue reading

Deaths among people with diabetes in Australia 2009–2014

Deaths among people with diabetes in Australia 2009–2014

The Australian Institute of Health and Welfare (AIHW) has released this report which highlights that death rates for people with diabetes are almost double those of other Australians and that people with diabetes are more likely to die prematurely. Between 2009 and 2014, death rates fell by 20 per cent for people with type 1 diabetes but rose by 10 per cent for those with type 2 diabetes.
Diabetes and its complications are major causes of illness, disability and death in Australia. People with diabetes are more likely to die prematurely than people without diabetes.
This report examines the 156,000 deaths that occurred between 2009 and 2014 among 1.3 million Australians with diagnosed type 1 and type 2 diabetes.
Specifically, data from the National Diabetes Services Scheme and the National Death Index were combined to look at causes of death and death rates for people with diabetes compared with the general population.
Creating a comprehensive picture of diabetes-related deaths is important for population-based prevention strategies and could help to improve care for all people with diabetes.
Death rates for people with diabetes almost double that of other Australians
Compared with the Australian population, death rates for people with diabetes were nearly twice as high for those with type 1 diabetes in 2012-2014, and 1.6 times as high for those with type 2 diabetes in 2014.
This higher mortality was apparent across sex, age, socioeconomic status and remoteness (for type 2 diabetes only) groups.
The disparity in death rates between people with diabetes and the general popul Continue reading

Caring for A Dog With Diabetes

Caring for A Dog With Diabetes

I adopted my first dog, a scruffy 10-pound terrier mix named Frankie, when I was an adult and fairly clueless about all things canine. I wasn’t really prepared to care for the cute but alien creature that had entered my home, and I definitely wasn’t anticipating that, a few years down the road, I would be meeting the needs of a dog with diabetes. By then, however, I was completely besotted with him.
I’d liked dogs – or at least the idea of them – since I was a kid, but had never had much interaction with them. I grew up in a small Brooklyn apartment with a mother who feared all creatures great and small. None of my childhood friends had dogs either. Our urban Flatbush neighborhood was a far cry from Lassie country.
It wasn’t until I moved from New York and settled into a house with a large yard in Tucson that I gave in to my vague hankerings for canine companionship- not to mention to the nudgings of a dog rescuer friend, who emailed me a picture of a cute, disheveled pup who had been found wandering in the streets. The local humane society estimated he was about five years old. He had the sweetest, furry face, large intelligent eyes. I fell harder for him than I’d ever done for a guy on a dating site.
I would like to report that Frankie and I bonded immediately when my rescuer friend left him with me, that as soon as his trusting little face looked into mine, I knew I’d made the right decision. I would like to, but that would be a lie. Frankie’s little face wasn’t trusting; it was terrified.
Pride and obstinacy have their rewards. Slowly, slowly, I won Continue reading

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