Diabetes Insipidus: Types, Symptoms, Causes, Risk Factors, Diagnosis, Complications, Treatments, Outlook

Medically Reviewed by Dr. K on 20 May 2022

Table of Contents

 

  1. What Is Diabetes Insipidus?
  2. Diabetes Insipidus vs. Diabetes Mellitus
  3. Symptoms of Diabetes Insipidus
  4. Symptoms in Infants and Children
  5. Diabetes Insipidus Causes
  6. Diabetes Insipidus Risk Factors
  7. Types of Diabetes Insipidus
  8. Diabetes Insipidus Diagnosis
  9. Complications of Diabetes Insipidus
  10. Diabetes Insipidus Treatment
  11. Diabetes Insipidus Outlook

 

What Is Diabetes Insipidus?

Diabetes insipidus is an unusual disorder in which the body produces excessive amounts of “insipid" urine, which is colourless and odourless. The average person pees between 1 and 2 quarts a day. Individuals with diabetes insipidus will transfer between three and twenty quarts of urine each day.

Diabetes Insipidus vs. Diabetes Mellitus

Diabetes insipidus is not to be confused with diabetes mellitus. Their names are almost identical, but they have just one thing in common: they make you thirsty and make you urinate a lot.

If you have diabetes insipidus, the hormones that help the body maintain a healthy fluid balance are ineffective. This disease affects just one in every 25,000 individuals.

Diabetes mellitus (often abbreviated to “diabetes") is a condition in which the body is unable to use nutritional resources properly. It is becoming more prevalent, affecting nearly 500 million people globally. 

Symptoms of Diabetes Insipidus

Symptoms comprise the following:

  • Severe thirst
  • Frequent urination – polyuria
  • Getting up often throughout the night to urinate.
  • Preference for cold beverages.
  • Dehydration
  • Weakness
  • Muscle pains
  • Irritability
  • Fatigue
  • Feeling sluggish
  • Dizziness
  • Confusion
  • Nausea

Symptoms in Infants and Children

The symptoms are similar in children and young adults. Keep an eye out for the following symptoms in infants:

  • Crankiness
  • Slow growth
  • Poor feeding

Among the symptoms observed in children are the following:

  • Drinking a lot of water
  • Urinating frequently, sometimes every hour
  • New bedwetting 
  • Waking during the night to urinate
  • Dehydration

Diabetes Insipidus Causes

In a region of the brain called the hypothalamus, the body produces a hormone called vasopressin. Your pituitary gland stores this hormone. Vasopressin instructs the kidneys to retain water, which results in more concentrated urine. Antidiuretic hormone, or ADH, is another name for vasopressin.

When you are dehydrated or thirsty, the vasopressin levels rise. Your kidneys can absorb an increased amount of water and produce concentrated urine. When you consume sufficient amounts of liquid, vasopressin levels decrease, and urine that is produced is transparent and diluted.

Central diabetes insipidus occurs because the body does not produce sufficient vasopressin. If you produce enough insulin but your kidneys do not function properly, you have nephrogenic diabetes insipidus.

In any case, the outcome is the same. Since your kidneys are unable to retain water, they can produce a large amount of light urine even though you are dehydrated.

Diabetes Insipidus Risk Factors

Genetic defects inherited from your parents will increase the risk of developing diabetes insipidus. This occurs in about 1% to 2% of instances.

Types of Diabetes Insipidus

Central diabetes insipidus

This occurs when injury to the hypothalamus or pituitary gland impairs the way the body produces or releases vasopressin. Your kidneys drain an excessive amount of urine from your bloodstream, causing you to urinate more often. This injury can be caused by: 

  • A tumour
  • Head injury
  • A clogged or bulging artery (aneurysm)
  • Langerhans cell histiocytosis is one of these diseases
  • Infection 
  • Inflammation
  • Surgery

Nephrogenic diabetes insipidus

This occurs when your kidneys do not respond to vasopressin and remove an excessive amount of fluid from your bloodstream. It is unclear what the underlying cause for this is, although some possible reasons include the following:

  • Blocked urinary tract
  • Chronic kidney disease
  • Calcium deficiency 
  • Potassium deficiency 
  • Certain medications, such as lithium

Dipsogenic diabetes insipidus

This condition, sometimes called main polydipsia, occurs anytime the body has difficulty regulating your thirst. When you drink, the liquid reduces the amount of vasopressin generated by your body thus increasing your urination. Damage to the hypothalamus or pituitary glands can occur for a variety of reasons, including the following:

  • A tumour
  • Head injury 
  • Infection
  • inflammation
  • Surgery

Certain prescriptions or mental health conditions can increase your risk of developing dipsogenic diabetes insipidus.

Insipid gestational diabetes

This form is only present during pregnancy. Occasionally, a woman's placenta, the organ that supplies oxygen and nutrition to her baby, produces an enzyme that inhibits vasopressin breakdown. Other pregnant people produce more prostaglandin, a hormone-like substance that reduces the sensitivity of their kidneys to vasopressin. The majority of instances of gestational diabetes insipidus are moderate and do not manifest clearly. The disorder normally resolves after birth, although it can recur during a subsequent pregnancy.

Diabetes Insipidus Diagnosis

Your doctor will do a medical examination. They'll inquire about your medical records, and that of your relatives. You will be subjected to a series of examinations, which may involve the following:

  • Urinalysis: You'll get a sample of your urine, which your doctor can submit to a laboratory to determine its concentration. Additionally, they will search for glucose levels, and can assist them in determining if you have diabetes insipidus or diabetes mellitus. You will need to collect the urine for a 24-hour duration to determine how much is being generated.
  • Blood test: This test can determine the electrolytes and glucose levels in your blood. This informs the doctor whether you have type 2 diabetes mellitus or type 1 diabetes insipidus. This can assist them in determining the type.
  • Fluid deprivation test: This test determines the differences in the body weight, blood sodium level, and urine concentration following a period of inactivity. There are two distinct types:
    • Short-form fluid deprivation test: You abstain from alcohol for a brief while. You extract a sample and return it to your doctor, who takes it to a laboratory.
    • Formal fluid deprivation test. This procedure will be performed in a hospital to ensure that you do not get dehydrated. Per hour or two, you will be measured and given a sample until:
      • When you stand, the blood pressure falls too low or you have a fast pulse.
      • You lose at least 5% of the initial body weight.
      • Over the course of two to three measurements, your urine content increases somewhat.
  • MRI: This procedure produces high-resolution images of the internal organs and soft tissues. It is used by the specialist to determine if there is an issue with the hypothalamus or pituitary gland.
  • Genetic screening: Your doctor may recommend this test if any members of your family have had problems with excessive urine production.

Complications of Diabetes Insipidus

Uncontrolled diabetes insipidus will increase the risk of developing complications such as:

  • Dehydration: Diabetes insipidus impairs the body's ability to retain fluids. It's very easy to get dehydrated. Prolonged dehydration can lead to dangerous effects in your body like seizures, headaches, kidney injury, confusions.
  • Electrolyte imbalance: Electrolytes are minerals found in the body that have a small amount of electricity. When you lose an excessive amount of water, your electrolyte levels will rise. This may result in the following:
    • Headaches 
    • Constantly exhausted (fatigue).
    • Irritability 
    • Muscle pain
  • Less sleep: Nocturia, a medical term for waking up during the night to urinate, may occur as a result of diabetes insipidus. As a consequence, you'll have a less restful sleep.

Diabetes Insipidus Treatment

To begin, your physician will advise you to drink lots of fluids. This would compensate for the continuous loss of water. Your treatment will vary according to the type you have:

  • Central diabetes insipidus: You would be prescribed desmopressin (DDAVP) or vasopressin (Pitressin). Typically, it appears in the form of a nasal spray. Additionally, there are treatments that enhance the effectiveness of these medications.
  • Nephrogenic diabetes insipidus: Nephrogenic diabetes insipidus may be more difficult to handle. If the condition is triggered by a prescription, discontinuing the medication can help. Other medications can help alleviate symptoms. Indomethacin (Indocin) and diuretics such as amiloride (Moduretic 5-50) or hydrochlorothiazide are examples of these (Microzide). Although diuretics normally cause increased urination, in this situation, they help you produce fewer urine. Occasionally, once the underlying trigger is addressed, this situation resolves.
  • Dipsogenic diabetes insipidus: This disease is incurable. However, a few methods can help alleviate symptoms. Suck on ice chips or sour candy to help moisten your lips, increase saliva flow, and alleviate your thirst. If you awaken many times during the night to urinate, a small dose of desmopressin at bedtime can help.
  • Gestational diabetes insipidus: Desmopressin is safe to use during pregnancy. Your issues should resolve themselves until you have the baby.

Diabetes Insipidus Outlook

Diabetes insipidus is not associated with kidney dysfunction or dialysis. Your kidneys will continue to perform their primary function of filtering your blood.

However, you would be more susceptible to dehydration. Often keep something to drink nearby, particularly when it's hot or you're exercising.

Sources

Referenced on  15/4/2021

  1. eMedicine: “Diabetes Insipidus."
  2. MedicineNet: “Diabetes Insipidus."
  3. Nephrogenic Diabetes Insipidus Foundation: “NDI Facts and Statistics."
  4. Diabetes Insipidus Foundation: “What Is Diabetes Insipidus?"
  5. The National Institute of Diabetes and Digestive and Kidney Diseases: “Diabetes Insipidus,” “Diabetes Statistics.”
  6. National Health Service: “Diabetes insipidus.”
  7. DiabetesInsipidus.org: “Diabetes Insipidus Statistics.”
  8. Cleveland Clinic: “Diabetes Mellitus: An Overview,” “Nocturia.”
  9. Mayo Clinic: “Diabetes insipidus.”
  10. Medscape: “Diabetes Insipidus Workup.”
  11. You and Your Hormones: “Diabetes insipidus.”
  12. Children’s Hospital of Philadelphia: “Diabetes Insipidus in Children.”
  13. Merck Manual Consumer Version: “Central Diabetes Insipidus.”
  14. https://www.webmd.com/diabetes/guide/what-is-diabetes-insipidus

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