What is Diabetes Insipidus?
Highlights
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Diabetes insipidus is a rare and treatable condition that develops when the body produces too much urine.
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The different types of diabetes insipidus are caused by factors having to do with the hypothalamus, the pituitary gland, and/or the kidneys.
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Typical symptoms of all of the types of diabetes insipidus include excessive thirst, dry mouth, and frequent urination.
Diabetes is a common condition that affects how the body turns food into energy. While most people have likely heard of type 1 and type 2 diabetes, there are actually several more types of diabetes that are caused by different factors.
These forms of the condition typically develop as a result of hormonal imbalances, weight gain, or even genetics.
In the case of diabetes insipidus – a rare and treatable condition – the body produces too much urine. It is completely unrelated to diabetes mellitus (type 1 and type 2 diabetes).
What Causes Diabetes Insipidus?
Diabetes insipidus is mostly caused by an issue with how your body makes and uses antidiuretic hormone (ADH, or vasopressin). This hormone is produced by the hypothalamus – the part of the brain that links the nervous system and the endocrine system.
After it produces ADH, the hypothalamus sends the hormone to the pituitary gland for storage. This gland is the part of the endocrine system that makes, stores, and releases important hormones like ADH.
ADH helps control the amount of water your kidneys reabsorb during their filtration process. When you’re dehydrated or losing blood pressure, your body produces and releases more ADH so that the kidneys know to hold onto more water instead of releasing it in your urine.
In the case of someone with diabetes insipidus, the hypothalamus may not be making enough ADH, the pituitary gland may not be releasing enough of it, or the kidneys may not be using the hormone properly.
This causes frequent and excessive water loss through urine.
In simpler terms, the body can usually control how much water you lose when you pee so that you don’t become dehydrated. Those with diabetes insipidus run a higher risk of dehydration.
Are There Different Types of Diabetes Insipidus?
As previously discussed, the cause of diabetes insipidus can come as a result of a problem with the hypothalamus, the pituitary gland, or the kidneys. There are four different types of this condition, all developing for different reasons regarding the function of these components of the endocrine system.
Central diabetes insipidus
The most common type of this condition, central diabetes insipidus (CDI) develops when the body doesn’t have enough ADH. This typically means that there may be damage to the hypothalamus or pituitary gland.
This damage may be the result of infection, inflammation, or an issue caused by surgery. While it’s possible that the cause may be genetic, it’s very rare.
Nephrogenic diabetes insipidus
This form of diabetes insipidus can be either acquired or hereditary. Nephrogenic diabetes insipidus occurs when the pituitary gland releases enough ADH, but the kidneys cannot properly retain water.
This issue with kidney function can be due to a genetic mutation, chronic kidney disease, a response to certain medications, low levels of potassium or high levels of calcium in the blood, or an obstruction in the urinary tract.
Gestational diabetes insipidus
Gestational diabetes insipidus (GDI) occurs during pregnancy. It’s a temporary condition that occurs if the placenta makes too much of an enzyme that breaks down ADH.
The placenta is a temporary organ that provides nourishment to the baby. While rare for all pregnancies, GDI is more common in mothers carrying more than one baby because they have more placental tissue.
Gestational diabetes insipidus typically goes away shortly after the pregnancy is over.
Dipsogenic diabetes insipidus
This condition is slightly different from the other types of diabetes insipidus. It’s typically caused by excessive fluid intake (polydipsia) due to an issue with the thirst-regulating mechanism in the hypothalamus.
Drinking too much fluid can decrease the release of ADH hormone and lead to increased urination.
Key Point: What is Psychogenic Polydipsia?
Some psychiatric and mental health disorders – such as schizophrenia – can result in compulsive water-drinking.
Experts have a few leading theories to explain this behavior.
One theory is that those with schizophrenia may have lower sensitivity to the signal in the brain that indicates thirst.
Other beliefs lie in polydipsia being a method to purge or self-treat.
The last possibility is that excessive water-drinking is an unexplained compulsion that unfortunately can result in dipsogenic diabetes insipidus.
What are the Symptoms of Diabetes Insipidus?
Symptoms include increased urination (polyuria) – including frequent urination at night (nocturia) – and excessive thirst (polydipsia).
On average, adults release approximately one to three liters of urine per day. However, those with diabetes insipidus who are consuming excessive fluids may produce as much as 19 liters of urine daily.
Infants may present with vomiting, retching, unexplained fevers, lethargy, and irritability.
If you notice any of these symptoms in yourself or your child, be sure to contact your healthcare provider immediately.
Are there any potential complications?
As a result of polyuria, those with any type of diabetes insipidus may experience dehydration. This can cause the following symptoms:
- Thirst
- Dry mouth
- Fatigue
- Dizziness
- Lightheadedness
- Fainting
- Nausea
Diabetes insipidus can also affect mineral levels in the blood that maintain the body’s balance of fluids. These minerals – or electrolytes – include sodium and potassium. Symptoms of an electrolyte imbalance may include:
- Confusion
- Nausea
- Vomiting
- Weakness
- Loss of appetite
What are the Risk Factors of Diabetes Insipidus?
While anyone can get diabetes insipidus, there are some people who are at higher risk. These include:
- Those with a family history of the disorder.
- Those who take certain medications – such as diuretics that can lead to kidney problems
- Those who have high levels of calcium
- Those who have low levels of potassium
- Those who have had brain surgery or a serious brain injury
When Should You Seek Medical Advice?
It’s advised to see a licensed medical professional if you constantly feel thirsty (especially craving cold water) and are peeing more than usual.
Typically, adults urinate four to seven times a day, while children tend to urinate more as they have smaller bladders. Be sure to see your healthcare provider if your child is peeing 10 or more times a day.
If you feel the urge to pee all of a sudden or you pee small amounts at frequent intervals, it may also be an indicator of diabetes insipidus.
Your healthcare provider will likely carry out a series of tests to determine the cause of you or your child’s thirst and frequent urination.
LifeMD can help you determine if you have diabetes insipidus or another underlying condition that is causing these symptoms. Make an appointment with a licensed medical professional if you have more questions about this condition or your symptoms.
Is Diabetes Insipidus Treatable?
Not all types of diabetes insipidus are curable, but they are manageable with medications. Treatment is dependent on the type you have.
A common treatment option for central diabetes insipidus and gestational diabetes insipidus is desmopressin. This is a medication that works like ADH to increase water absorption and reduce urine production.
Desmopressin comes as an injection, a pill, or in a nasal spray. This medication is generally very safe, but it may have some potential side effects including:
- Headache
- Abdominal pain
- Nausea
- Stuffy or runny nose
- Nosebleeds
Treatment for nephrogenic diabetes insipidus is typically more complicated. Healthcare providers have been known to treat NDI with thiazide diuretics – a class of medications that reduce the amount of urine produced by the kidneys.
Other options may include nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin or ibuprofen. These medications also help to further reduce urine volume – especially when used in conjunction with thiazide diuretics.
If your medication has been determined as the cause of your nephrogenic diabetes insipidus diagnosis, talk to your healthcare provider about switching your medication.
Dipsogenic diabetes insipidus tends to be the most challenging to treat, as health experts are still exploring possible causes of this condition.
This being said, if an underlying condition has been identified as a possible cause of dipsogenic diabetes (such as a mental health condition), treatment may be directed at that cause.
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