Diabetes Insipidus is a rare condition where the kidneys are unable to store water in your body. The body produces excessive urine that is insipidus – odorless and dilute – and as a result, feels extra thirsty. Unlike a healthy body that passes 1-2 quarts of urine every day, people with this condition can pass 3-20 quarts of urine a day.
Although the condition has ‘diabetes’ in it, it is nowhere related to diabetes mellitus- a condition where the blood sugar levels are above 140 mg/dL. The only factor common amongst both is that both lead to frequent urination and constant thirst. While people with diabetes mellitus carry the risk of heart diseases and high blood pressure, people with diabetes insipidus can have normal sugar levels.
Types of Diabetes Insipidus
There are mainly four types of diabetes insipidus:
1) Central Diabetes
Under this type, damage to the hypothalamus or pituitary gland causes disruption in the production, storage, and release of vasopressin – a hormone that tells your kidneys how much to conserve water. As a result, the kidneys remove excess amounts of fluids – causing an increase in urination.
This condition occurs when the kidneys are unable to respond to vasopressin and remove too much fluid from the bloodstream.
When there is damage to the thirst mechanism situated in an individual’s hypothalamus. This results in constant thirst and frequent liquid intake, which suppresses vasopressin secretion.
This condition occurs only during the time of pregnancy. In certain cases, the placenta produces an enzyme that breaks down the vasopressin inside the mother’s body. In other cases, mothers produce prostaglandin – a chemical that reduces the sensitivity of the kidneys to vasopressin.
Diabetes Insipidus Symptoms
The most common signs you might notice would be:
- Frequent urination or symptoms of polyuria
- Excessive thirst or polydipsia
The need for frequent urination can result in dehydration. Some people might also notice weakness, muscular pain, lethargy, and irritability. In the case of children, they may experience vomiting and diarrhea, delayed growth, and fever.
Diabetes Insipidus Causes
Since there are different types of this condition, each type has a different cause. However, one thing common amongst all four types is that the body is unable to conserve fluids due to disruptions in vasopressin.
Central and dipsogenic diabetes insipidus are caused as a result of:
- Head injury
Whereas, the causes of nephrogenic diabetes insipidus are:
- Medication, specifically lithium
- Low levels of potassium
- Blockage in the urinary tract
- High levels of calcium
- Chronic kidney disease
Please note that in certain cases, the causes of diabetes insipidus are unknown.
Diabetes Insipidus vs. Mellitus
Just because diabetes insipidus and diabetes mellitus have the term ‘diabetes’ in it, both should not be related. Diabetes mellitus is a condition where blood sugar levels are above the normal range. While mellitus is more common and can be diagnosed with the help of a glucometer in seconds, diabetes insipidus can be diagnosed with a series of blood and urine tests that can take hours.
Under both conditions, the body experiences frequent urination and constant thirst, also known as polyuria and polydipsia. While diabetes management requires lifestyle modifications in diet and exercise, diabetes insipidus can be managed only with the help of fluid intake and medications.
Diabetes Insipidus Diagnosis
If you experience the symptoms of diabetes insipidus, your doctor might suggest you visit a nephrologist or endocrinologist and run a series of blood and urine tests. During that time, you would be asked to limit your fluid intake, and thereafter, the doctor measures the sodium level in the urine.
It can be diagnosed on any of the following basis:
- Family History
If you have a history of this condition, the healthcare provider will be able to diagnose the cause of the condition. To understand more, he/she might ask you questions about your medical history.
- Physical Exam
In this form of diagnosis, a doctor looks out for signs of dehydration of the patient’s skin and appearance.
In this form of diagnosis, the urine sample is collected and checked to see if the urine is dilute or concentrated. Moreover, this test can rule out the possibility of diabetes mellitus by monitoring glucose levels.
- Blood Tests
The blood test is conducted to check the sodium level in the bloodstream. This can help in identifying if you are suffering from diabetes insipidus and in certain cases, determine the type.
- Fluid Deprivation Test
A fluid deprivation test measures the changes in body weight and urine concentration after limiting fluid intake. There are two ways to conduct the test:
Short form of deprivation test – The patient is asked to restrict his/her fluid intake for a period of time, usually during and after dinner. The urine samples are then collected the next morning.
Formal fluid deprivation test – In order to conduct this test, the health care provider checks for signs of dehydration. This is conducted every 1-2 hours until the patient’s blood pressure drops, has a rapid heartbeat, he/she loses 5% or more of the initial weight, or urine concentration increases.
- Magnetic Resonance Imaging
MRI is a form of a test under which the pictures of the body’s soft tissues and internal organs are taken without the help of x-rays. This helps in understanding if the patient is having problems with his/her hypothalamus or pituitary glands.
Diabetes Insipidus Treatment
Please note there is no cure for diabetes insipidus. The easiest form of managing the condition involves sufficient fluid intake in order to prevent dehydration. Please note the treatment depends and varies on the type of diabetes insipidus:
Central diabetes insipidus – A synthetic hormone known as desmopressin helps in treating central diabetes insipidus. This is available in the form of a nasal spray, pill, or injection. The hormone replaces the vasopressin produced by the body.
Nephrogenic diabetes insipidus – It is essential to treat the cause to cure nephrogenic diabetes insipidus. In some instances, changing the balance of calcium and potassium levels in the body can work. The medications generally include diuretics combined with ibuprofen or aspirin.
Dipsogenic diabetes insipidus – There is no treatment known for dipsogenic diabetes insipidus. It is often recommended to suck sour candies or ice chips as it helps in moistening the mouth. For people who experience difficulty in sleeping due to frequent urges to urinate, doses of desmopressin can help.
Gestational diabetes insipidus – Since gestational diabetes insipidus does not require treatment after the delivery, the medication is for a short period. The treatment involves the prescription of desmopressin; it does not get destroyed by the placenta.
Although diabetes insipidus is not a life-threatening condition unless chronic, it is possible to live a healthy life if recommendations are followed and the signs are kept under control.
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