Polyuria with the Concurrent manifestation of Central Diabetes Insipidus (CDI) & Type 2 Diabetes Mellitus (DM)

Coexistence of type 2 diabetes mellitus, arginine vasopressin deficiency, and Marfan syndrome: A case report

Diabetes mellitus (DM) and arginine vasopressin deficiency (AVP-D) are characterized by polyuria. Marfan syndrome is an autosomal dominant disorder caused by pathogenetic variants in FBN1. Here, we report a patient with type 2 diabetes mellitus, AVP-D, and Marfan syndrome. Although the coexistence of type 2 diabetes mellitus and AVP-D is rare, for those patients with type 2 diabetes mellitus, the existence of AVP-D should be considered when polyuria is not in accordance with the blood glucose levels, especially for those with a low urine specific gravity. Specific symptoms or signs help to identify Marfan syndrome early, and genetic testing of the FBN1 pathogenetic variant helps to make a definitive diagnosis.

Early-induced diabetic obese rat MACAPOS 2

BACKGROUND

Diabetes mellitus is a metabolic disease characterized by an abnormally high blood glucose level. Glucose intolerance and insulin resistance are two characteristics that promote the onset and development of type 2 diabetes. The aim of this study was to create a diabetic rat model from obese rat MACAPOS 2.

METHODS

A group of rats was subjected to a high-fat diet (HFD) compared to a control group (NC) which received a normal diet. After 16 weeks of HFD, Lee index was calculated, obese rats were subjected to an oral glucose tolerance test (OGTT) and insulin tolerance test (ITT). One group of HFD rats (HFDZ) received streptozotocin 22.5 mg/kg (iv). One week later, weight gain, water and food intakes, urine volume and fasting blood glucose levels were evaluated. Animals were also subjected to glucose tolerance and insulin tolerance tests.

RESULTS

After 16 weeks of HFD, rats became obese, glucose intolerant and resistant to insulin. The body weight of rats was significantly high (+ 26.23%) compared to normal rats, glycemia remained significantly high (+ 45.46%, P < 0.01) two hours after administration of glucose in high-fat diet rats, water intake and urine volume were comparable to those of NC. In HFD, the streptozotocin injected after one week (HFDZ), amplified glucose intolerance. During ITT, glycemia remained significantly (P < 0.01) high from 15 min; and did not vary during the 60 min of ITT. The fasting glycemia one week after streptozotocin injection was significantly high (288 mg/dL) compared to HFD (114 mg/dL), associated whit a significant (P < 0.01) increase in water intake and 24 h urine volume.

CONCLUSION

These results showed that MACAPOS 2 associated with a low dose of streptozotocin (22.5 mg/dL) early leads to the diabetes in obese albinos Wistar rats and could be a real model to study the type 2 diabetes mellitus.

A 75-Year-Old Woman with a 5-Year History of Controlled Type 2 Diabetes Mellitus Presenting with Polydipsia and Polyuria and a Diagnosis of Central Diabetes Insipidus

BACKGROUND Central diabetes insipidus (CDI) is a rare disorder characterized by large volumes of dilute urine because of a lack of antidiuretic hormone. Co-existing CDI and diabetes mellitus without inherited disorders such as Wolfram syndrome are rare. It is both important and challenging to diagnose this combination because the 2 conditions present with thirst, polydipsia, and polyuria. A few cases of CDI developing in patients with type 2 diabetes mellitus (T2D) have been reported. We report an unusual case of CDI that developed in an older patient with T2D. The aims of this report are to share the clinical course and discuss clues to the early diagnosis of CDI in T2D. CASE REPORT A 70-year-old Japanese woman developed T2D with hyperglycemia symptoms, including thirst, polydipsia, and polyuria. After starting medical treatment, the hyperglycemia and its symptoms improved. The glycated hemoglobin level decreased from 9% to 6%. However, 5 years later (at 75 years of age), she re-exhibited thirst, polydipsia, and polyuria despite stable glycemic control. Her urine volume was large (6.3 L/day). A urine glucose test was negative. The plasma osmolality was high (321 mOsm/kg), while the urinary osmolality was low (125 mOsm/kg). A significant increase in urinary osmolality following vasopressin administration indicated a diagnosis of CDI. Desmopressin therapy effectively relieved the symptoms. CONCLUSIONS This case highlights the need to consider CDI as a rare but important comorbid disorder in patients with diabetes mellitus, including T2D, particularly those presenting with thirst, polydipsia, and polyuria despite well-controlled glycemia.

V. In vitro antidiabetic, antioxidant activities and chemical composition of Ajuga parviflora Benth. shoot

Introduction: Ajuga parviflora Benth. (Lamiaceae) is an herbaceous plant that possesses ethnomedicinal values and is well known for its folkloric management of diabetes. This study was aimed to provide an experimental justification for its traditional antidiabetic use. Methods: Hydroalcoholic extract of A. parviflora shoot was quantified for its total phenolic content (TPC), total flavonoid content (TFC), and total tannin content (TTC). Gas chromatography-mass spectrometry (GC-MS) and Fourier transform infrared spectrophotometer (FTIR) spectroscopy were also used for their chemical nature. Additionally, the extract was evaluated for its inhibitory potential against key enzymes linked with hyperglycemia by in vitro means. Subsequently, for estimation of the antioxidant capacities 2,2-diphenyl-2-picrylhydrazyl radical (DPPH), 2,2’-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) radical (ABTS), and hydrogen peroxide (H2O2) scavenging activities were determined.Results: GC-MS analysis revealed numerous biologically active phytoconstituents including brassicasterol, phytol, and palmitic acid. The presence of different active functional groups such as alcohol, nitrile, amine, alkyl halide, alkene, and alkane was confirmed by FTIR analysis. The extract showed a significant (P≤ 0.05) dose-dependent inhibition for α-amylase enzyme (132.38±1.18 μg/mL), α-glucosidase enzyme (22.66±0.11 μg/mL), DPPH radical (103.03±1.59 μg/mL), ABTS radical (140.10±3.40 μg/mL) and H2O2 radical (298.26±4.37 μg/mL). TPC, TFC, and TTC were found 64.06±0.35 mg/g of the gallic acid equivalent (GAE), 45.27±0.58 mg/g of the rutin equivalent (RE), and 127.42±1.82 mg/g of the tannic acid equivalent (TAE), respectively. Conclusion: A. parviflora extract showed significant antioxidant and antidiabetic potentials. Thus, this plant might be served as a novel approach for discovering new and effective drug molecules against hyperglycemia.

Euglycemic Diabetic Ketoacidosis with Persistent Diuresis Treated with Canagliflozin

Diabetic ketoacidosis is characterized by hyperglycemia, anion-gap acidosis, and increased plasma ketones. After the resolution of hyperglycemia, persistent diuresis is rare. We herein report the case of a 27-year-old Asian woman with type 2 diabetes who was treated with a sodium-glucose cotransporter 2 (SGLT2) inhibitor (canagliflozin) who developed euglycemic diabetic ketoacidosis and persistent diuresis in the absence of hyperglycemia. Physicians should consider euglycemic diabetic ketoacidosis in the differential diagnosis of patients treated with SGLT2 inhibitors.

Diabetic ketoacidosis in a patient with acromegaly and central diabetes insipidus treated with octreotide long-acting release

A 43-year-old man was diagnosed with acromegaly due to pituitary GH-secreting macroadenoma, and underwent craniotomy surgery. After surgery, he was given octreotide long-acting release (LAR) to treat the residual tumor. Eighteen months later, he presented polydipsia and polyuria due to diabetic ketoacidosis (DKA) and central diabetes insipidus (CDI). His casual plasma glucose level was 570 mg/dL, his HbA1c was 14.9%, and his urine was strongly positive for ketone bodies. We discuss a causal relationship among DKA, CDI, and treatment with LAR in this case with residual GH-secreting tumor from the perspective of insulin secretion and resistance.

Diabetes insipidus: The other diabetes

Diabetes insipidus (DI) is a hereditary or acquired condition which disrupts normal life of persons with the condition; disruption is due to increased thirst and passing of large volumes of urine, even at night. A systematic search of literature for DI was carried out using the PubMed database for the purpose of this review. Central DI due to impaired secretion of arginine vasopressin (AVP) could result from traumatic brain injury, surgery, or tumors whereas nephrogenic DI due to failure of the kidney to respond to AVP is usually inherited. The earliest treatment was posterior pituitary extracts containing vasopressin and oxytocin. The synthetic analog of vasopressin, desmopressin has several benefits over vasopressin. Desmopressin was initially available as intranasal preparation, but now the oral tablet and melt formulations have gained significance, with benefits such as ease of administration and stability at room temperature. Other molecules used for treatment include chlorpropamide, carbamazepine, thiazide diuretics, indapamide, clofibrate, indomethacin, and amiloride. However, desmopressin remains the most widely used drug for the treatment of DI. This review covers the physiology of water balance, causes of DI and various treatment modalities available, with a special focus on desmopressin.