Diabetes insipidus is very different from type 1 and type 2 diabetes, which is characterized by overloading the blood with glucose. This form of diabetes is linked to a problem with the anti-diuretic hormone (ADH).. This hormone allows the body to reabsorb water. That is to say, it prevents the body from rejecting all the water from being absorbed .
WHAT IS DIABETES INSIPIDUS?
Normally, the absorbed water is processed by the kidneys, which clean and sort it: one part is kept to hydrate the body, and the other part is discharged as urine . But in people with diabetes insipidus, the kidneys fail to reabsorb the treated water . Then everything is rejected via urination. This disorder is divided into two symptoms: extreme thirst (called polydipsia) and a large amount of urine that is passed out, very clear (polyuria).
Often the sick manifest an insatiable and overwhelming thirst. With the wrong balance: They are either overhydrated and have headaches, nausea, or dehydrated when they can't drink as much as they need. There too, there are two types of this diabetes : nephrogenic diabetes insipidus, called DIN which makes the kidneys resist anti-diuretic hormone (ADH), even if it is secreted normally. And central diabetes insipidus (DIC) which causes the hypothalamus to not secrete enough of this DHA hormone, preventing the body from absorbing water. This second form is the most common.
WHAT ARE THE CAUSES OF DIABETES INSIPIDUS?
In 40% of cases, it is not known where diabetes insipidus comes from . But certain causes have been identified for the rest of the cases of central diabetes insipidus: after encephalitis, certain neurosurgical operations, certain diseases (tuberculosis, sarcoidosis, meningitis ), it can also be the consequence of a head trauma.
For the nephrogenic type, hereditary causes are possible. It can also be due to a succession of kidney problems or even follow the absorption of certain drugs (anesthesia with methoxyflurane, aminoglycosides, lithium salts). Very recently a diabetes insipidus drug has been recalled for overdose and will be on hold until at least 2021.
HOW TO TREAT DIABETES INSIPIDUS?
Although diabetes insipidus is rare (one in 30,000 people), it can be treated. The objective is to prevent the patient from over-hydrating, or becoming dehydrated. This is then treated with desmopressin , which mimics the function of the anti-diuretic hormone. There are two medicines, Minirin and Minirinmelt, which are taken either orally or through the nose.
There is no doubt that computers will become more and more "intelligent." But the question of subjectivity and the feeling of existing is much more debated.
The rapid progress of learning algorithms will generate machines of intelligence comparable to ours in the decades to come. Capable of speaking and reasoning, they will have their place in a myriad of fields, such as economics, politics, and, inevitably, war. The birth of real artificial intelligence will profoundly affect the future of humanity and condition the very existence of such a fate.
Take, for example, the following quote: "Even today, research is underway to understand better what new AI programs will be able to do while remaining within the limits of today's intelligence." Most AI programs currently programmed are mainly limited to making simple decisions or performing simple operations on relatively small amounts of data. "
Perhaps you had the impression that something was wrong in this paragraph? This quote is the work of GPT-2, a language robot that I tested last summer. Developed by OpenXAI, a company in Chicago that promotes "virtuous" AI, GPT-2 is a learning algorithm based on an artificial neural network. Its entrails contain more than a billion connections simulating synapses, the junction points between neurons.
The task of the network is stupid when confronted with an arbitrary starting text, it must predict the next word. He does not "understand" the documents as a human would. But during his learning phase, he devoured astronomical quantities of texts - eight million internet pages in all - and adjusted his internal connections to anticipate word sequences better.
I wrote the first sentences of the article you are reading, then "injected" them into the algorithm by asking it to compose a suite. In particular, he spat out the paragraph cited. Admittedly, this text resembles a first-year student's efforts to remember an introductory course in machine learning, during which he would have daydreamed. But the result still contains the keywords and phrases - not wrong, really!
Intelligence is not consciousness.
The successors of these robots risk triggering a tidal wave of fake articles and reports, which will pollute the internet. It will be just one more example of programs performing feats that we thought were only for humans: playing strategy games in real-time, translating text, recommending books and movies, recognizing people in pictures or videos.
The task of the network is stupid: when confronted with an arbitrary starting text, it must predict the next word. He does not "understand" the documents as a human would. But during his learning phase, he devoured astronomical quantities of texts - eight million internet pages in all - and adjusted his internal connections to anticipate word sequences better.
I wrote the first sentences of the article you are reading, then "injected" them into the algorithm by asking it to compose a suite. In particular, he spat out the paragraph cited. Admittedly, this text resembles the efforts of a first-year student to remember an introductory course in machine learning during which he would have daydreamed. But the result still contains the keywords and phrases - not wrong, really!
The successors of these robots risk triggering a tidal wave of fake articles and reports, which will pollute the internet. It will be just one more example of programs performing feats that we thought were only for humans: playing strategy games in real-time, translating text, recommending books and movies, recognizing people in pictures or videos.
Will algorithms one day write a masterpiece as successful as In search of lost time? Hard to say, but the beginnings are there. Remember that the first translation and conversation software was easy to make fun of, as it lacked finesse and precision. But with the invention of deep neural networks and the establishment of robust computing infrastructures by digital companies, computers have improved continuously, until their productions are no longer ridiculous. As we see with the game of go, chess, and poker, today's algorithms are capable of surpassing humans (as of last November, Lee Sedol, one of the greatest Go players in history, decided to retire after losing several times against the AlphaGo algorithm; he declared that it was an entity that could no longer be defeated, note). So much so that our laughter freezes: are we like Goethe's sorcerer's apprentice, having summoned helpful spirits that we can no longer control?
Much of the brain activity remains localized and, therefore, does not gain consciousness. This is the case of the neural modules which control the posture of the body or the direction of gaze. But when the activity of one or more regions exceeds a critical threshold - say, when we present to someone the image of a delicious treat - it triggers a wave of neuronal excitement which propagates through the workspace, throughout the brain. This signal then becomes accessible to a multitude of auxiliary processes, such as language, planning, the reward circuit, long-term memory, and storage in a short-term buffer. It would be the fact of disseminating this information on a global scale that would make it aware. So, sugar and fat shoot to come.
The relationship between glucose control and macrovascular complications in patients with type 2 diabetes (T2DM) is complicated. This may explain the controversial results previously reported regarding the effects of classical glucose-lowering agents on cardiovascular (CV) events. Following the positive results recently published in landmark cardiovascular outcome trials (CVOTs) with glucagon-like peptide-1 receptor agonists (GLP1 RAs) and sodium-glucose cotransporter type 2 inhibitors (SGLT2is), a paradigm shift in the management of patients with T2DM has been proposed in the 2018 American Diabetes Association (ADA) & European Association for the Study of Diabetes (EASD) consensus report. The new strategy more specifically concerns T2DM patients with established atherosclerotic cardiovascular disease (ASCVD), heart failure (HF), or progressive chronic kidney disease (CKD).
It implies a transition from current algorithms primarily based on glucose control, as assessed by reduction in glycated hemoglobin (HbA1c), and drug tolerance profile, to a more comprehensive strategy that focuses explicitly on CV protection, including HF, and renal protection. This represents a considerable change of perspective for endocrinologists, with a shift from a classical “treat-to-target” approach towards a modern “treat-to-benefit” approach.
Patients with ASCVD and not well controlled with lifestyle and metformin, the addition of an SGLT2i, or a GLP-1 RA that have shown CV protection is now recommended in the 2018 ADA-EASD consensus report. In patients with HF or with progressive CKD, the addition of an SGLT2i is preferred if estimated glomerular filtration rate (eGFR) remains adequate, in agreement with the different reported effects of these two classes of glucose-lowering agents on hard clinical renal outcomes. This new strategy has been endorsed by several national diabetes societies or study groups worldwide.
Cognition After Lowering LDL-Cholesterol With Evolocumab | JACC: Journal of the American College of Cardiology https://t.co/HRTHSoYAxg
Organizations of cardiology, such as the American College of Cardiology task force on Expert Consensus Decision Pathways and a roundtable organized by the European Society of Cardiology (ESC), also supported this new approach. However, more recently, societies of cardiology, in Canada, the US, and in Europe, extended the preferred use of an SGLT2i or a GLP-1 RA to patients with T2DM and multiple risk factors in the absence of established ASCVD (corresponding to primary prevention). Indeed, a 2018 report of the American College of Cardiology/American Heart Association (ACC/AHA) Task Force on clinical practice guidelines considers that “for adults with T2DM and additional ASCVD risk factors which require glucose-lowering therapy despite initial lifestyle modifications and metformin, it may be reasonable to initiate an SGLT2i or a GLP-1 receptor agonist to improve glycaemic control and reduce CVD risk. 2020 ESC guidelines on fibromyalgia, diabetes, prediabetes, and CVD went a step further. Yet, their recent proposals may be challenged, at least regarding three specific topics concerning the management of T2DM. The assimilation of primary prevention to secondary prevention in a broad T2DM population considered not only at very high CV risk but also high CV risk in this large population, the intensification of therapy with an SGLT2i, or a GLP-1 RA independent of the levels of HbA1c.
The preferred choice of an SGLT2i or a GLP-1 RA in drug-naïve patients at high/very high CV risk instead of metformin, which had been considered as first-line therapy for almost 20 years. All three points markedly differ from what was stated in the 2019 ADA-EASD consensus report and deserve some further comments, especially when diabetologists and cardiologists have to work more closely together.
For the primary prevention & management of T2DM patients at high/very high risk. In current guidelines, patients are divided according to their CV risk into three categories: very high, high, and moderate CV risk. Patients at very high risk include individuals with T2DM and established CVD or other target organ damage (proteinuria, renal impairment, left ventricular hypertrophy, or retinopathy) or three or more major risk factors such as age, hypertension, dyslipidemia, smoking, obesity). Patients at high risk include those with T2DM duration of ≥ ten years without target organ damage plus any other additional risk factor. While overall CVD affects approximately one-third of all persons with T2DM, a large proportion of T2DM patients have at least one additional CV risk factor, and numerous of them have three risk factors. Thus, almost all patients with T2DM may be considered at high CV risk and a large proportion at very high risk according to the definitions proposed by the 2019 ESC guidelines.
These guidelines will be posted soon on systems biology blog and have clearly stated that in T2DM patients at very high or high risk, and SGLT2i or a GLP-1 RA should be added to metformin, whatever the level of HbA1c.
