Pituitary Gland and Diabetes Insipidus

Diabetes Insipidus

When the Pituitary Gland is involved there are three types of diabetes insipidus: 

Central Diabetes Insipidus a deficiency of the hormone ADH (Anti-Diuretic Hormone) in the Posterior Pituitary Gland. The urine is very dilute but without the sugar taste of the urine associated with diabetes mellitus.

Neurogenic Diabetes Insipidus is an insensitivity of the kidneys to ADH that controls excretion of body fluid. The urine is very diluted sense the inability of the hormone ADH to restrict water loss. Again, like in Central Diabetes Insipidus, no glucose is present in the urine.

Iatrogenic Diabetes Insipidus - an artifact of medical drug use that causes the kidneys to excrete large amounts of urine. There is no glucose in the urine.

Diabetes Insipidus is characterized by excessive thirst and the excretion of large amounts of severely diluted urine, that, with a reduction of fluid intake, that has no effect on the concentration of the urine. This means the patient needs to continually take fluids into their body to prevent dehydration from the fluid loss excreted from the body. You need reserve water if you are exposed to conditions where excess water is lost normally.

Diabetes Mellitus and Diabetes Insipidus are two entirely separate conditions with unrelated mechanisms. Both cause the production of large amounts of urine (Polyuria). Diabetes Mellitus causes polyuria by a process called osmotic diuresis due to high blood sugar leaking into the urine and  carrying excess water with it. 

Osmosis is the process where water moves through a selectively permeable membrane from an area of low solute concentration to an area of high solute concentration. When leakage of blood glucose from the blood capillaries into the tubular ducts takes place it increases the solute concentration in the tube above that in the blood capillaries. Water, therefore, flows into the tubule by osmosis. Since this causes diuresis excretion from the kidneys along with the sugar the taste of urine in diabetes mellitus is sweet to the taste.

Diabetic Retinopathy

Diabetic Retinopathy

It is damage to the retina coat of the eye caused by complications from diabetes. It can lead to blindness. It affects approximately 80% of diabetics with a history of diabetes for at least ten years.

The necessity for an early eye examination schedule by an ophthalmologist is essential. The earlier the detection, in a diabetic patient, the possibility to reduce the effects of diabetic retinopathy increases.

The detection of diabetic retinopathy is difficult. A diabetic experiences no early warning signs. The presence of blood capillaries in the eye are especially sensitive to poor blood glucose control. High blood  glucose damages the capillaries in the retina of the eye. This is the beginning of the non-proliferative  diabetic retinopathy. Detection of this stage of the disease is one reason for the very early schedule of visits to an ophthalmologist. You can't detect the early changes. Early changes, that are reversible, and do not threaten central vision is called background retinopathy.

If you didn't see an ophthalmologist and schedule a series of  examinations to detect the early start of the disease you may detect vision changes. Blurring vision makes driving and reading difficult. Blurred vision is minor the first time you experience it. The blood capillaries, in the retina, begin to leak. This is called ocular hemorrhage and blurs vision. Proliferative diabetic retinopathy is the proliferation of new blood capillaries at the back of the eye that leak. A second, more severe leaking of blood from the capillaries, begins soon after. The onset may occur in several days to several weeks later.

Your eye has the ability to reabsorb the few red blood cells that leak the first time from the capillaries. The next phase a much greater amount of blood leaks. The reabsorption of the blood may take  from only a few days to as much as years to clear. These hemorrhages usually take place at night during sleep. The blurring of the vision deepens. Your activities that require clear vision decline.

The elevation of blood glucose that causes the blood capillaries to leak also cause a swelling of the crystalline lens of your eyes. Edema, or swelling, is the result of sugar alcohol accumulating in the lens. You experience the thickening of the lens as blurred distance  vision. Your near vision is not affected or the changes are slight.

Hyperglycemia causes the death and thickening of the basement membranes of the capillary cells. The capillary begins to leak. Holes begin to open that allow the contents of the capillary spill into the chamber of the eye that contains the retina. Some diabetics develop macular edema. When fluid from the capillary moves into the macula your vision blurs even more. The macular portion of the retina is responsible for the detailed portion of our vision.

As the proliferative diabetic retinopathy progresses severe non-proliferative diabetic retinopathy enters an advanced, or proliferative stage when blood vessels grow. Without treatment these new capillaries can bleed, cloud vision and destroy the retina.

Glaucoma can result as the capillaries grow and prevent the proper reabsorption of the fluid in the eye. The build up of pressure can damage the optic nerve. The blindness is now permanent.

Islets of Langerhans Transplantation

Goal of Transplantation

When you agree to have a transplantation, from a donor of their Islets of Langerhans from the Pancreas, the goal is to infuse enough islets to control your blood glucose level thus removing the need for insulin injections.

A successful transplant can slow or prevent the progression of complications like nerve, blood vessel and eye changes associated with diabetes. It should help with good control of blood glucose levels.

Unless you are receiving a transplant from an identical twin that contains cells with exactly the same DNA your immune system will think the transplanted cells are foreign bodies and produce anti-bodies to kill them.

This requires the administration of drugs that supress your immune system. You must continue to use some of the drugs for the rest of your life.

For different diabetes events these mugs are great participant gifts.

Procedure

Transplanted islets come from the pancreas of a deceased donor. The  pancreas is subjected to a mixture of purified enzymes called collagenases that isolate islets from the other pancreatic tissue. The researchers inject the enzyme solution into the pancreatic duct that runs the length of the pancreas. This causes the pancreas to swell. The donor pancreas is then cut up into little chunks, transferred to a Ricordi's Chamber where digestion takes place until the islets are separated out from the exocrine gland tissue. 

The pancreas has both endocrine products and exocrine products. 

For our sake, we are interested in the endocrine products,  insulin and glucagon. They are hormones that are secreted into the blood circulatory system directly when called upon to control blood glucose levels. They are found in the islets.

The products that digest our food in the small intestine are enzymes. They enter the small intestine through ducts. When tissue does that the products are referred to as exocrine. (Pass into a duct system - not the circulatory system)

The islets are separated from the exocrine debris in a purification process. During the transplant procedure a catheter (tube) is carefully guided through the upper portion of your abdomen and into the hepatic portal vein of the liver. This provides the way the islets are placed into the body where they can begin to function.

It takes a little time for the islets to attach to the new blood capillaries and to produce insulin. As the new islets ramp up for production of insulin the physician may order many tests to check blood glucose levels after the transplant. You may need to continue injections of insulin to help you bridge the gap until the new cells take over.

Immune System Depression

Like everything else there is no free lunch. If you have to suppress the immune system, to prevent the immune system from destroying the islet cell from an unrelated donor, you leave your  body more susceptible to other diseases that may enter you body. Your physician can inform you of those possibilities.

Three drugs currently used to suppress the immune system are Daclizumab (Zenapax), Sirolimus (Rapamune) and Tacrolimus (Prograf). Two of the drugs, Sirolimus and Tacrolimus, you must take for life. In conclusion, immune system suppressant drugs are not a cure. They provide a comfort level to allow a transplant to do its thing. The alternative is the destruction of the transplanted cells.

Mis--diagnosis of Type II Diabetes

Type II Diagnosis and Type I Diagnosis - Cause for Concern?

The population in the U.S. is bordering on obesity. Obesity and lack of exercise are contributing factors in the onset of Adult Onset Type II diabetes.

Physicians routinely see patients with high blood glucose that are obese and inactive. They make a diagnosis of Type II diabetes that results in a program of treatment that doesn't make the patient feel better.

The reason the patients don't feel better is, in many cases, because they suffer from Type I diabetes. The protocol for treating Type I diabetes is different from Type II diabetes.

When the correct diagnosis is finally made the patient begins to feel much better.

Here is a link to an excellent article, published in todays Wall Street Journal, that is well written that addresses the problem that exists today.