by the pancreatic beta cells. It may also be caused by destruction of the pancreas from disease or tumors.
SYMPTOMS—In children and young adults, diabetes is normally characterized by a sudden onset of symptoms. The onset is more insidious in older patients. The classic symptoms of polyuria, polydipsia (excessive thirst), hunger, weight loss, itching, blurred vision, and fatigue will normally be the first signs of diabetes. There are many complications that arise from this disease. In many instances, diabetes may not be detected until the rise of these complications that include ketosis, acidosis, and coma (often the result of inadequate insulin, although coma may also be induced by hypoglycemia); vascular complications (i.e., slow healing injuries, ulcers, and decreased blood supply to feet); diabetic neuropathy (e.g., tingling, paresthesia, decreased or absent sweating); and skin infections.
TREATMENT—The treatment for diabetes is centered around restoring the patient’s metabolism and maintaining the general health and nutritional state. The diabetic diet is a normal diet with the exception that caloric and carbohydrate intake is restricted. Oral hypoglycemia agents are well tolerated as a rule. A physician will prescribe insulin therapy for patients whose hypoglycemia cannot be controlled by alternate methods. When diabetes is suspected, refer the patient for definitive diagnosis.
Diabetes Insipidis
This is a chronic disorder of the pituitary gland or hypothalamus that is the result of a deficiency of vasopressin (also called the antidiuretic hormone or ADH). Inadequate ADH secretion reduces water resorption and is more frequently found in males. Trauma or tumors may also cause this condition.
SYMPTOMS—The onset is normally slow with increasing polydipsia and polyuria. If preceded by trauma, infectious disease, or emotional shock, the onset may be abrupt. The patient will exhibit thirst, drinking up to 40 liters per day. The patient experiences rapid dehydration when fluid intake is altered. Rapid weight loss will follow the rapid dehydration.
TREATMENT—In almost all cases, vasopressin tannate in oil given IM (never IV) normally controls the symptoms. Diuretics, such as hydrochlorothiazide, will normally reduce urinary output.
Hyperthyroidism
This disease is characterized by excessive secretion of the thyroid hormones, increased metabolic rate, and exophthalmos (protrusion of the eyeball).
SYMPTOMS—These include weakness, nervousness, sensitivity to heat, restlessness, weight loss, increased appetite, eyelid sag, headaches, nausea, abdominal pain, diarrhea, and an enlarged thyroid. Normally there is a history of hyperthyroidism in the family.
TREATMENT—Refer the patient for definitive evaluation.
Hypothyroidism
Myxedema is a condition in which decreased thyroid secretions produce characteristic reactions. This condition may be the result of radioiodine therapy, surgical excision, or atrophy of the pituitary gland.
SYMPTOMS—There is a gradual personality change with the patient becoming more and more apathetic. Characteristic myxedematous features such as an enlarged tongue; slow deep-toned speech; dry, thickened, edematous skin; and puffiness of the eyelids, hands, and face are common. Alopecia (loss of hair) of the scalp and eyebrows is common. The patient will complain of drowsiness, increased sensitivity to cold, and constipation, and the deep tendon reflexes will be delayed.
TREATMENT—Refer the patient for definitive evaluation and treatment.
Addison’s Disease This disease is an insufficiency of the adrenocortical hormones. It is an insidious, progressive disease that is characterized by increasing weakness, fatigability, increased pigmentation of the skin and mucous membranes, weight loss, hypotension, dehydration, anorexia, nausea, vomiting, and occasional hypoglycemia. The cause of this condition is normally due to adrenocortical atrophy of unknown etiology. 2-32
