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 dehydra- tion when fluid intake is altered. Rapid weight loss will  follow  the  rapid  dehydration. TREATMENT—In  almost  all  cases,  vaso- pressin   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  defini- tive  evaluation. Hypothyroidism Myxedema is a condition in which decreased thyroid  secretions  produce  characteristic  re- actions.   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  defini- tive 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