Difference between Diabetes Mellitus and Diabetes Insipidus Sample

Questions: 1.Why is the Disease given the name Diabetes Mellitus? How does Diabetes Mellitus differ from Diabetes Insipidus? 2.Individuals with the Diabetes Mellitus are Classified into two Main groups. What are they and what is the basis of the cCassification System used? 3.How are Patients Diagnosed as Diabetics? What treatment Options are most used to Manage this Condition? 4.What Changes in the Metabolism of glucose and fat (triglycerides) are observed in this disease? What Symptoms might a Diabetic show as a result of these Metabolic Changes and why do these Occur?5.Determine the Concentration of Glucose in each Patient serum Sample and plot Glucose Concentration against the time over which the Samples were Obtained. 6.What Potential Long term Problems would a Pharmacist need to be aware of when advising a Diabetic Client? Answers: 1.The word diabetes is the short version for diabetes mellitus (DM). It is adapted from the words of Greek and Latin language- diabetes and mellitus which means siphon (passing through) and honeyed/sweet respectively. This word was firstly used in English medical literature language around1425, as diabetes and in 1675, Thomas Williams used the wordmellituswith diabetes to signifies the sweet taste of urine (Lakhtakia, 2013). Classical symptoms of DM include high blood sugar levels, elevated hunger, thirst and too much urination while that of diabetes insipidus include elevated thirst, and large amount of dilute urine.DM is of auto-immune, genetic or lifestyle in origin while diabetes insipidus is generally caused due to deficiency of anti-diuretic hormone or gene defect. The treatment of DM involves insulin injection and some lifestyle changes while that of insipidus involves use of desmopressin or diuretics (Smith Vermaak, 2009). 2. Majority of DM cases are of two broad pathogenic categories on basis of their pathophysiology. First one is the type I DM which is due to insulin deficiency or its secretion from the -cells of the pancreas, while second one is type II DM which is more prevalent than type I. Type II DM is either caused due to development of insulin resistance or due to insufficient insulin secretion. Hyperglycemia is also observed in the latter case which may cause pathological changes in the body tissues, even before diabetes is being detected (American Diabetes Association, 2014a). Type I DM is also called juvenile onset DM, which is mainly characterized with complete deficiency of insulin in blood. It usually occurs before the age of 20 years. On the other hand, type II DM characterized by either deficiency of insulin or its inability to activate gluco-receptors. Type II DM is age related and usually occurs after the age of 60 years (American Diabetes Association, 2009b). 3.DM involves elevated blood sugar levels, which is diagnosed by estimating plasma glucose level at different time of the day. According to the World Health Organization (WHO), a person with fasting blood glucose levels ranging from 6.1 - 6.9 mmol/litreor 110 - 125 mg/dlitre are presumed to be suffering from impaired fasting blood glucose while person with a blood glucose level of 7.8 mmol/litreor 140 mg/dlitre, but less than 11.1 mmol/litre or 200 mg/dlitre, two hours prior to a 75 g of oral glucose loading have an impaired glucose tolerance. Individuals should also be checked for glycated hemoglobin levels, which if at or above 48 mmol/mol indicates DM (Selvin et al., 2010; Consultation, W.H.O., 1999; Definition, W.H.O., 2006). DM is an incurable metabolic disorder but it can be managed by controlling blood glucose levels. Changes in lifestyle like diet controls and appropriate exercises help the anti-hyperglycaemic drugs to manage the glucose levels. Following are the drugs which are clinically used in management of DM. Sulfonyl ureas: Glimepride, Gliclazide etc Biguanides: Metformin etc Thiazolidenediones: Pioglitazone etc. DPP IV inhibitors: Vildagliptin etc. Alpha glucosidase inhibitors: Acarbose Meglitinides: Nateglinide etc. Combinations of some above mentioned drugs A routine estimation of glycated haemoglobin (Hb1AC) is very important for managinf the DM (Zarowitz et al, 2015). Along with the pharmacological changes, dietary modifications and lifestyle changes are immensely helpful in management of DM. 4.DM is characterized by absolute or relative deficiency of insulin in blood. Deficiency of insulin causes abnormalities in the metabolism of carbohydrate, protein and fat. The main functions of insulin are: Increases glucose uptake Increases glucose use and storage Increases protein synthesis Increases fat storage In diabetic patients the above mentioned function of insulin got disturbed. In diabetes mellitus (deficiency of insulin) causes following changes in carbohydrate metabolism. Diminished uptake of glucose by insulin sensitive tissue like adipose tissue and muscles. Promote the processes that increase the blood glucose and inhibit the process that removes the glucose form blood. Increased glycogenolysis Decreased glycogen synthesis Retarded glycolysis Promote gluconeogenesis The deficiency of insulin causes following changes in lipid metabolosim. Increased lipolysis Diminished lipogenesis Decreased removal of ketones and increased production of ketone bodies. The metabolic alteration in metabolism of carbohydrates and lipids leads to various biochemical and physical changes in patient. Some of them are listed below (Do et al., 2012). Symptoms due to impaired carbohydrate metabolism Symptoms due to impaired lipid metabolism Polyuria, Polydypsia and Polyphagia Ketone body formation causes ketourea Glycosuria Acidosis Weight loss Low pH stimulates the respiratory centre and causes rapid, deep breathing Muscle wasting due to negative nitrogen balance Acidosis may lead to coma High cholesterol level which leads to atherosclerosis Table 1: Symptoms arises due to altered metabolism in diabetic patients 5.Comment on the results for the two patients The standard plot of glucose concentration was drawn using the serial dilutions. A straight line curve has obtained with equation Y = 0.068X + 0.016. Putting different absorbance from blood samples of patient A and B were calculated and illustrated through a line chart (Figure 2). Figure 1: Standard plot, Absorbance vs Glucose concentration Figure 2: Comparison between glucose concentrations of patient A and patient B Comment: The normal fasting value of plasma glucose concentrations are 6.1 mMol/L. However, while doing postprandial glucose test, the blood glucose concentration after 2 hours should be 7.8 mMol/L. Figure 2 shows the result of postprandial blood glucose test of two different patients. Patient A has higher blood glucose values and remains above then the permissible limits till the completion of test. On the contrary, patient B has controlled blood glucose levels (Martin et al., 2012). This result shows that patient A has lower levels of blood insulin which is unable to metabolize the available glucose. The result also signifies the Patient A is suffering from DM. It can be confirmed by repeating the test (American Diabetes association, 2014b) 6.DM is a chronic disease which affects the patients at a variety of levels. Therefore the pharmacist must counsel the patient about the nature of disease and its associated complications. Pharmacist must also advice the patients about the lifestyle changes and therapeutic treatment involved. The patients should be told that DM is lifelong and progressive disorder which needs basic modifications in the lifestyle. Pharmacist must also emphasize upon the significance of medication therapy, and advise them to strictly follow the prescribed medication therapy. The pharmacist must also notify the patients about the change the quality of life if the disease is not controlled (McCord, 2006). The pharmacist must stress upon the crucial areas of lifestyle changes like healthy diet, physical activity, and cessation of smoking, alcohol intake while advising the patients. Diet: A controlled diet is the basis of treatment in DM. So, pharmacist must carefully advocate the importance of dietary intake of protein, carbohydrate and fat. Carbohydrates directly affect the blood glucose levels in the body. So, the daily intake of carbohydrate should be kept constant should be according to the daily physical activity. It is practical to advise the patients of DM to restrict the use of saturated fatty acids as it increase the risk of cardiac diseases and obesity. Increased fiber intake in the daily diet also needs to be recommended as it serves the purpose of fullness of belly and increases satiety. It also delays the absorption of fats and carbohydrates thus diminishing the chances of hyperglycemia (Katz, 2014). Physical activity: Physical exercise can aid in promoting body weight management in the DM patients along with appropriate caloric uptake. But the pharmacist must take great care in advising the patients about physical exercise to avoid exhaustion or hypoglycemia (Balk et al, 2015). Smoking and alcohol intake: Smoking increases the chances of hypertension and cardiac diseases; so the pharmacist must warn the patients that continuous smoking might increase the risk of these cardiac complications in the DM patients. The pharmacist must also inform the DM patients that alcohol intake significantly affect the blood glucose levels even if their blood glucose levels are fairly controlled (Smith, 2009). References American Diabetes Association, 2014. Diagnosis and classification of diabetes mellitus.Diabetes care,37(Supplement 1), pp.S81-S90. American Diabetes Association, 2014. Standards of medical care in diabetes2014.Diabetes care,37(Supplement 1), pp.S14-S80. Balk, E.M., Earley, A., Raman, G., Avendano, E.A., Pittas, A.G. and Remington, P.L., 2015. Combined diet and physical activity promotion programs to prevent type 2 diabetes among persons at increased risk: a systematic review for the Community Preventive Services Task Force.Annals of internal medicine,163(6), pp.437-451. Do, G.M., Jung, U.J., Park, H.J., Kwon, E.Y., Jeon, S.M., McGregor, R.A. and Choi, M.S., 2012. Resveratrol ameliorates diabetes?related metabolic changes via activation of AMP?activated protein kinase and its downstream targets in db/db mice.Molecular nutrition food research,56(8), pp.1282-1291. Katz, D.L., 2014. Diet and diabetes: lines and dots.The Journal of nutrition,144(4), pp.567S-570S. Lakhtakia, R., 2013. The history of diabetes mellitus.Sultan Qaboos University Medical Journal,13(3), p.368. Martin, R.J., Ratan, R.R., Reding, M.J. and Olsen, T.S., 2012. Higher Blood Glucose within the Normal Range Is Associated with More Severe Strokes.Stroke research and treatment,2012. McCord, A.D., 2006. Clinical Impact of a Pharmacist?Managed Diabetes Mellitus Drug Therapy Management Service.Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy,26(2), pp.248-253. Selvin, E., Steffes, M.W., Zhu, H., Matsushita, K., Wagenknecht, L., Pankow, J., Coresh, J. and Brancati, F.L., 2010. Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.New England Journal of Medicine,362(9), pp.800-811. Smith, M.D. and Vermaak, J.S., 2009. Diabetes Mellitus and Diabetes Insipidus. InGeneral Surgery(pp. 319-328). Springer London. Smith, M.D. and Vermaak, J.S., 2009. Diabetes Mellitus and Diabetes Insipidus. InGeneral Surgery(pp. 319-328). Springer London. Zarowitz, B., Allen, C., OShea, T., Dalal, M.R., Haumschild, M. and DiGenio, A., 2015. Type 2 diabetes mellitus treatment patterns in US nursing home residents.Postgraduate medicine,127(5), pp.429-437.