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Diabetes insipidus is a condition that affects the body’s fluid balance, resulting in excessive urine production and increased thirst even after drinking fluids.
It is important to note that diabetes insipidus and diabetes mellitus, which are commonly referred to as “diabetes,” are two distinct conditions. Diabetes mellitus is a more prevalent condition that can manifest as either type 1 or type 2 and involves high blood sugar levels.
Antidiuretic Hormone (ADH), also known as vasopressin, is primarily to blame for diabetes insipidus; either your body doesn’t produce enough of it or your kidneys don’t utilize it properly.
While diabetes insipidus cannot be cured, there are available treatments that can effectively manage its symptoms. These treatments aim to alleviate excessive thirst, reduce urinary output, and prevent dehydration.
Symptoms
Diabetes insipidus symptoms and signs include:
- Frequent drinking water and urination at night
- Generating a lot of urine that is pale in color
- Extreme thirst
- Craving for cold drinks
You may create up to 20 quarts (or 19 liters) of pee every day if your condition is severe and you consume a lot of fluids. An adult who is in good health normally urinates between 1 and 3 quarts (or 1 and 3 liters) each day.
- Children with diabetes insipidus may exhibit some of the following signs and symptoms:
- Generating a lot of urine that is pale in color
- Getting soaking wet diapers or wetting the bed
- Extreme thirst
- Craving for cold drinks
- Growth delay
- Losing weight
- Fever
- Vomiting
- Constipation
- Sleeping problems
- Visual problems
- Headache
If you experience excessive urine and intense thirst, consult a doctor right away.
Causes
When the body’s fluid levels are not adequately balanced, diabetes insipidus develops.
The fluid component of your blood is filtered by your kidneys to remove waste. While the majority of the fluid is returned to the bloodstream, urine is made up of waste and a small quantity of fluid. After being momentarily stored in your bladder, urine is expelled from your body.
Body needs anti-diuretic hormone (ADH), also known as vasopressin, to keep appropriate water balance. This hormone helps the fluid that is filtered by the kidneys back into the bloodstream again. ADH is produced in the hypothalamus, a region of the brain, and is then kept in the pituitary gland, a little gland situated at the base of the brain. Excess urine is produced when there is a deficiency in ADH or when it is blocked from working.
If you have diabetes insipidus, your body struggles to maintain correct fluid balance. Depending on the type of diabetes insipidus you have, the cause may vary. Types consist of:
- Central diabetes insipidus. By interfering with the normal production, storage, and release of ADH, damage to the pituitary gland or hypothalamus from surgery, a tumor, a head accident, or disease can result in central diabetes insipidus. Another possible reason of this issue is an inherited genetic disorder. In some cases, the disorder may be attributed to an autoimmune response wherein the body’s immune system attacks the cells responsible for producing ADH.
- Nephrogenic diabetes insipidus. When your kidney is compromised, they are unable to respond to ADH as they should, resulting in nephrogenic diabetes insipidus. A chronic kidney condition or an inherited (genetic) issue could be to blame for the impairment. Nephrogenic diabetes insipidus can also be brought on by a number of pharmaceuticals, including lithium and antiviral treatments like foscarnet. Blocked urinary tract or a urinary tract infection can also cause the disease.
- Gestational diabetes insipidus. Pregnancy-related diabetic insipidus is uncommon. ADH in the mother is destroyed by an enzyme produced by the placenta only during pregnancy.
- Primary polydipsia. This disorder, also called as dipsogenic diabetes insipidus, can lead to the production of huge volumes of diluted urine as a result of consuming an excessive amount of fluids.
Damage to the hypothalamic system that controls thirst might result in primary polydipsia. Additionally, schizophrenia and other mental illnesses have been linked to the condition.
While the cause of diabetes insipidus can be challenging to diagnose, testing can help identify an underlying cause over time.
Risk factors
Although anyone can develop diabetes insipidus, certain individuals may be at a higher risk. This includes people who:
- Have a member of the family with a history of the disorder.
- Take specific medications, such as diuretics, which can lead to kidney problems.
- Have elevated levels of calcium or decreased levels of potassium in their bloodstream.
- Have had a severe head injury or undergone brain surgery.
Diagnosis
The following tests are used to identify diabetic insipidus:
- Water deprivation test. You’ll be instructed to refrain from drinking fluids for a number of hours while being observed by a doctor and medical staff. Your doctor will monitor changes in your body weight, urine production, and the concentration of your urine and blood as fluids are withheld from you. Your doctor will also check your blood levels of ADH. During this test, your doctor might provide artificial ADH. This will reveal whether your body is making enough ADH and whether your kidneys are able to react to ADH as expected.
- Urine test. Testing urine to determine if it contains a high amount of water can be beneficial in diagnosing diabetes insipidus.
- Blood test. Examining the levels of specific substances in the blood, such as sodium, potassium, and calcium, can assist in diagnosing diabetes insipidus and may aid in determining the type of the condition.
- Magnetic Resonance Imaging (MRI). An MRI can be used to check for anomalies in the pituitary gland or hypothalamus. This examination is non-invasive. It creates precise images of the brain’s tissues using radio waves and a strong magnetic field.
- Genetic screening. Your doctor could advise genetic testing if other members of your family have experienced issues with excessive urinating.
Treatment
The types of diabetes insipidus that you have will determine your treatment options.
You might simply need to drink more water if you have mild diabetic insipidus.
- Central diabetes insipidus. Your doctor will first address the abnormality if the condition is brought on by one, such as a tumor, in the pituitary gland or hypothalamus. Desmopressin (DDAVP, Nocdurna), a synthetic hormone, is typically used to treat this type. Anti-diuretic hormone (ADH) is replaced by this medicine, which also lessens urination. Desmopressin comes in tablet, nasal spray, and injection forms. The majority of people with central diabetes insipidus still produce some ADH, even though the amount can change daily. Therefore, the dosage of desmopressin you require may also change. Desmopressin overdose can result in water retention and potentially dangerously low blood salt levels.
- Nephrogenic diabetes insipidus. Desmopressin won’t help because the kidneys don’t react to ADH effectively in this type of diabetes insipidus. Instead, to lessen the volume of urine your kidneys produce, your doctor could advise a low-salt diet. Additionally, you must consume enough water to stay hydrated.
Your symptoms might get better with treatment with the medication hydrochlorothiazide. Although the diuretic drug hydrochlorothiazide typically causes an increase in urine production, it can also cause a decrease in urine production in some individuals with nephrogenic diabetes insipidus.
Stopping the meds you’re taking could help if your symptoms are brought on by them. Nevertheless, consult your doctor before stopping any medication.
- Gestational diabetes insipidus. The synthetic hormone desmopressin is the most common form of treatment for those who have pregnancy diabetes insipidus.
- Primary polydipsia. Other than reducing fluid intake, there is no specific treatment for this type of diabetes insipidus. If a mental disease is connected to the condition, treating the mental illness may help with the symptoms of diabetes insipidus.
