What Is Diabetes Insipidus?

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Diabetes insipidus (DI) is a rare disorder in which the body can't regulate fluids properly. People with DI generally have intense thirst and pass a lot more urine than normal, which which can lead to severe dehydration.

All four types of diabetes insipidus share the fact that they are due to a hormonal abnormality, although the causes of that vary.

Read on to learn about the symptoms of diabetes insipidus, possible causes, and how it's diagnosed and treated.

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What's Happening in the Body

When your body's fluid-regulation system is working properly, the kidneys filter your blood and pull out wastes and extra fluids, which composes your urine. Typically, you produce somewhere between one and two quarts of urine in a day.

From the kidneys, the urine travels down small tubes called ureters to the bladder, where it's stored until the bladder becomes full and you need to urinate.

A hormone called vasopressin (a.k.a. antidiuretic hormone, or ADH) is key to these processes.

Vasopressin is produced by the hypothalamus, a small gland at the base of your brain. It's then stored in the pituitary gland, which is near the hypothalamus, and released into your bloodstream when your body's fluid level is low.

Vasopressin helps you body absorb less fluid from the bloodstream, meaning less urine is produced. The pituitary releases less vasopressin, or even none at all, when you have higher fluid levels. At those times, you'll produce more urine.

Diabetes insipidus involves a lack of vasopressin, which causes this system to malfunction and unhealthy amounts of fluid to be lost.

In spite of the similar names, DI is not related to the more-common diabetes mellitus in which the body is unable to regulate glucose (blood sugar).

Diabetes Insipidus Symptoms

Symptoms of diabetes insipidus include:

  • Extreme thirst
  • Extremely high output of urine that has little-to-no color or odor
  • Needing to get up at night to urinate
  • Bedwetting

A healthy adult typically passes less than three quarts a day, whereas someone with DI may produce as much as five to ten times that amount.

This varies depending on the individual and type of DI they have.

In Children

In babies and young children, DI symptoms can be hard to spot because a child isn't able to communicate about their thirst.

Along with thirst and excessive urine, they may have the following symptoms:

  • Trouble sleeping
  • Unexplained fussiness
  • Fever
  • Vomiting
  • Diarrhea
  • Delayed growth
  • Weight loss

If your child has any of these symptoms, be sure to talk to your pediatrician.

Complications

Untreated DI can lead to dehydration, so it's important to watch for symptoms of this potentially dangerous level of body fluid loss as well.

They include:

  • Thirst
  • Fatigue
  • Dry skin
  • Nausea
  • Sluggishness
  • Dizziness
  • Confusion

Sluggishness, dizziness, and confusion can be signs of severe dehydration, which requires immediate medical care. Without proper treatment, it can lead to seizures, brain damage, and even death.

Get immediate medical care for your child if they exhibit any symptoms of dehydration.

DI can also cause an imbalance of electrolytes in your blood. Electrolytes are minerals that are important for maintaining the right balance of fluids in your body.

Symptoms of electrolyte imbalance include:

  • Lethargy or fatigue
  • Nausea
  • Loss of appetite
  • Muscle cramps
  • Confusion

Types and Causes

Fewer than 20,000 people are diagnosed with diabetes insipidus in the United States each year. People of any age can have it, but the risk is significantly higher after age 40.

The cause of vasopressin dysregulation defines each of the four types of DI:

  • Central diabetes insipidus
  • Nephrogenic diabetes insipidus
  • Dipsogenic diabetes insipidus, also called primary polydipsia
  • Gestational diabetes insipidus

Central Diabetes Insipidus

Central DI is the result of damage to the hypothalamus or pituitary glands. Because those glands both play a role in the production, storage, and release of the hormone, damage can disrupt the system.

That causes the kidneys to filter too much fluid out of the blood, which leads to excess urination.

The glands can become damaged by:

  • Head injury
  • Surgery
  • Infection
  • Inflammation
  • Brain tumors

In some cases, however, central DI is caused by a genetic defect that results in problems with vasopressin production.

It's also possible to have central DI without an identifiable cause.

Nephrogenic Diabetes Insipidus

In nephrogenic DI, the problem is not with the brain, but with the kidneys themselves. For any of several reasons, they do not respond like they should to vasopressin and, therefore, always remove high amounts of fluid from your blood.

The kidneys may behave this way due to any of several factors, including:

  • Genetic makeup
  • Genetic mutation
  • Chronic kidney disease
  • Kidney infection or cysts
  • Some cancers
  • Blockage of the urinary tract
  • High calcium levels in the blood
  • Low potassium levels in the blood
  • Certain medications, especially lithium
  • Other diseases, including amyloidosis, Sjögren's syndrome, and Bardet-Biedl syndrome

In some cases, healthcare providers aren't able to determine the cause of nephrogenic DI.

Dipsogenic Diabetes Insipidus

This form of DI occurs because of a defect in the thirst mechanism—your body's signal that you need to take in fluids—which resides in your hypothalamus. This defect makes you abnormally thirsty all the time.

When someone is excessively thirsty, they tend to drink a lot more than usual. Their high fluid intake causes the body to secrete less vasopressin, and that leads the kidneys to produce more urine.

As in central DI, the hypothalamus' thirst mechanism may be damaged by:

  • Head injury
  • Surgery
  • Infection
  • Inflammation
  • Brain tumors

People may also be predisposed to dipsogenic DI by certain medications or mental health problems.

Gestational Diabetes Insipius

Gestational DI occurs during pregnancy and can be caused by two different factors.

The placenta can produces an enzyme that breaks down vasopressin in the mother's body, leading to excessive urine because the kidneys draw too much fluid from the bloodstream.

In addition, the mother's body may produce high levels of a chemical called prostaglandin, which makes the kidneys less responsive to vasopressin.

In many cases of gestational DI, symptoms are mild and not very noticeable, especially since pregnancy itself leads many women to urinate frequently. However, dehydration during pregnancy can lead to complications, including:

  • Neural tube defects
  • Low amniotic fluid
  • Premature labor

If you suspect gestational DI, be sure to keep yourself hydrated and talk to your healthcare provider right away.

Because it's caused directly by pregnancy-related factors, gestational DI typically goes away once the baby is born. However, it is likely to come back in future pregnancies.

Diagnosis

When your healthcare provider suspects you have some form of DI, you can expect the diagnostic process to involve some combination of the following:

  • Physical examination to look for signs of dehydration
  • Review of your symptoms, personal medical history, and family medical history
  • Urine tests, to see if urine is dilute or concentrated
  • Blood tests, which may help determine the type of DI
  • Fluid deprivation test, to determine the amount of urine you're passing
  • Magnetic resonance imaging (MRI), to look for problems with the hypothalamus or pituitary glands

These evaluations can not only help your healthcare provider diagnose diabetes insipidus, but identify the type you have.

Treatment

DI is often treated by nephrologists, which are healthcare providers who specialize in kidney disorders, or endocrinologists, who specialize in conditions related to the hormone-producing glands (including the hypothalamus and pituitary).

The main treatment for DI is drinking enough liquid to prevent dehydration. However, beyond that, treatment and management strategies are tailored to the specific type of DI.

Central DI can be treated by a man-made hormone called desmopressin, which is similar to vasopressin. It's available as a pill, a nasal spray, or an injection.

Treatment for nephrogenic DI is aimed at the underlying cause of the condition, when possible. This could mean removing a urinary blockage, discontinuing a medication, or normalizing blood levels of calcium or potassium.

It may also be treated with medications that help lower urine volume, including aspirin, Advil (ibuprofen), and certain diuretics called thiazides. Thiazides typically increase urine production, but in people with nephrotic DI, they have the reverse effect.

Dipsogenic DI doesn't yet have effective treatments, so symptom management is key. Healthcare providers recommend sucking on ice chips or sour candies to keep plenty of saliva in the mouth, which may help reduce thirst.

Small doses of desmopressin at bedtime may help reduce the number of times people need to get up and urinate. Your healthcare provider may want to monitor the levels of sodium in your blood before prescribing this drug.

Desmopressin is often prescribed for cases of gestational DI as well. It can help even in the cases where the placental enzyme destroys vasopressin because the enzyme doesn't have the same effect on the synthetic hormone.

Coping

Because dehydration is a real and serious concern, it's important to get into the habit of drinking more. Carrying a water bottle or extra beverages with you when you're away from home may help.

It's also wise to avoid the heat so you don't lose fluids through sweat. Cooling products might be a good idea when you can't do this or when you exercise.

Let the people you spend a lot of time with know that you're prone to dehydration and make sure they're familiar with the symptoms so they can get prompt medical care for you if the need arises.

DI is often a chronic condition. Other than drinking extra fluids, researchers haven't found any dietary or nutritional ways to treat or prevent DI. However, with proper diagnosis and treatment, most people who have it are able to manage their symptoms and lead normal lives.

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  • NIH National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes Insipidus.