Learn more about this unusual disorder that disrupts the body's fluid balance, causing excessive urination and possibly leading to dehydration.
Diabetes insipidus (die-uh-BEE-teze in-SIP-uh-dus) is an uncommon disorder that causes an imbalance of fluids in the body. This imbalance leads you to produce large amounts of urine. It also makes you very thirsty even if you have something to drink.
While the terms "diabetes insipidus" and "diabetes mellitus" sound similar, they're not related. Diabetes mellitus — which involves high blood sugar levels and can occur as type 1 or type 2 — is common and often referred to simply as diabetes.
There's no cure for diabetes insipidus. But treatments can relieve your thirst and decrease your urine output and prevent dehydration.
Signs and symptoms of diabetes insipidus include:
If your condition is serious and you drink a lot of fluids, you can produce as much as 20 quarts (about 19 liters) of urine a day. A healthy adult typically urinates an average of 1 to 2 quarts (about 1 to 2 liters) a day.
An infant or young child with diabetes insipidus may have the following signs and symptoms:
See your doctor immediately if you notice excessive urination and extreme thirst.
Diabetes insipidus occurs when your body can't properly balance the body's fluid levels.
Your kidneys filter the fluid portion of your blood to remove waste products. The majority of the fluid is returned to the bloodstream while the waste and a smaller amount of fluid make up urine. Urine is excreted from your body after being temporarily stored in your bladder.
A hormone called anti-diuretic hormone (ADH), or vasopressin, is needed for the fluid that's filtered by the kidneys to go back into the bloodstream. ADH is made in a part of the brain called the hypothalamus and stored in the pituitary gland, a small gland found in the base of the brain. Conditions that cause a deficiency of ADH or block the effect of ADH result in production of excess urine.
If you have diabetes insipidus, your body can't properly balance fluid levels. The cause depends on the type of diabetes insipidus you have. Types include:
Nephrogenic diabetes insipidus. Nephrogenic diabetes insipidus occurs when there's a defect in the structures in your kidneys that makes your kidneys unable to properly respond to ADH.
The defect may be due to an inherited (genetic) disorder or a chronic kidney disorder. Certain drugs, such as lithium or antiviral medications such as foscarnet (Foscavir), also can cause nephrogenic diabetes insipidus.
Primary polydipsia. Also known as dipsogenic diabetes insipidus, this condition can cause production of large amounts of diluted urine from drinking excessive amounts of fluids.
Primary polydipsia can be caused by damage to the thirst-regulating mechanism in the hypothalamus. The condition has also been linked to mental illness, such as schizophrenia.
Sometimes, there's no obvious cause of diabetes insipidus. However, in some people, the disorder may be the result of an autoimmune reaction that causes the immune system to damage the cells that make vasopressin.
Nephrogenic diabetes insipidus that's present at or shortly after birth usually has an inherited (genetic) cause that permanently changes the kidneys' ability to concentrate urine. Nephrogenic diabetes insipidus usually affects males, though women can pass the gene on to their children.
Diabetes insipidus may lead to dehydration. Dehydration can cause:
Diabetes insipidus can cause an imbalance in minerals in your blood, such as sodium and potassium (electrolytes), that maintain the fluid balance in your body. Symptoms of an electrolyte imbalance may include:
Tests used to diagnose diabetes insipidus include:
Water deprivation test. While being monitored by a doctor and health care team, you'll be asked to stop drinking fluids for several hours. To prevent dehydration while fluids are restricted, ADH allows your kidneys to decrease the amount of fluid lost in the urine.
While fluids are being withheld, your doctor will measure changes in your body weight, urine output, and the concentration of your urine and blood. Your doctor may also measure blood levels of ADH or give you synthetic ADH during this test. This will determine if your body is producing enough ADH and if your kidneys can respond as expected to ADH.
Treatment options depend on the type of diabetes insipidus you have.
Central diabetes insipidus. If you have mild diabetes insipidus, you may need only to increase your water intake. If the condition is caused by an abnormality in the pituitary gland or hypothalamus (such as a tumor), your doctor will first treat the abnormality.
Typically, this form is treated with a synthetic hormone called desmopressin (DDAVP, Nocdurna). This medication replaces the missing anti-diuretic hormone (ADH) and decreases urination. You can take desmopressin in a tablet, as a nasal spray or by injection.
Most people still make some ADH, though the amount can vary day to day. So, the amount of desmopressin you need also may vary. Taking more desmopressin than you need can cause water retention and potentially serious low-sodium levels in the blood.
Other medications might also be prescribed, such as chlorpropamide. This can make ADH more available in the body.
Nephrogenic diabetes insipidus. Since the kidneys don't properly respond to ADH in this form of diabetes insipidus, desmopressin won't help. Instead, your doctor may prescribe a low-salt diet to reduce the amount of urine your kidneys make. You'll also need to drink enough water to avoid dehydration.
Treatment with the drug hydrochlorothiazide (Microzide) may improve your symptoms. Although hydrochlorothiazide is a type of drug that usually increases urine output (diuretic), it can reduce urine output for some people with nephrogenic diabetes insipidus.
If your symptoms are due to medications you're taking, stopping these medicines may help. However, don't stop taking any medication without first talking to your doctor.
If you have diabetes insipidus:
You're likely to first see your primary care doctor. However, in some cases when you call to set up an appointment you may be referred to a specialist called an endocrinologist.
Here's some information to help you get ready for your appointment.
For diabetes insipidus, some basic questions to ask your doctor include:
Your doctor is likely to ask you several questions, including:
While you're waiting for your appointment, drink until your thirst is relieved, as often as necessary. Avoid activities that might cause dehydration, such as physical exertion or spending time in the heat.
May 4th, 2021