Diabetes insipidus
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Diabetes Insipidus (DI) is a medical disorder characterized by a huge increase in urine output and abnormal intake of high amounts of fluid or frequent feelings of thirst. The common problem indicated by the condition is abnormal or dysfunctional kidneys unable to concentrate urine properly. There are other symptoms associated with the disease because the body cannot produce and store the hormone responsible for the kidneys to absorb water. Antidiuretic hormone (ADH) or vasopressin deficiency or insensitivity of the kidneys to it results to very diluted urine with low osmolality.

Diabetes Insipidus is not the same as Diabetes Mellitus although they both have the same common symptoms of excessive urination and thirst. Other aspects like causes, treatment and prevention methods are very different. Diabetes Insipidus is called “water diabetes” while Diabetes Mellitus is called “sugar diabetes”. Loss of water during excessive urination triggers feelings of thirst to re-supply the body and maintain normal fluid levels. The problem can occur in both children and adults and treatment approach will depend on the severity of the disease.


The two most common signs and symptoms of the disorder are excessive urination and extreme thirst. Excessive urination would be described as letting out over 50mL/kg of bodyweight every 2 hours among adults. An adult taking in over 1 gallon of water a day would be considered as excessive drinking. Compared to Diabetes Mellitus, urine of Diabetes Insipidus patients does not contain glucose although dehydration signs may be present despite pale-colored urine. Patients will most likely urinate every 2 hours or so depending on water intake including at night causing them to wake up. Affected individuals may not manifest any other symptom aside from the two for several years as long as adequate water is ingested to make up for excessive urination. They are however, constantly at risk for dehydration.

Children may present other symptoms due to fluid loss such as loss of appetite, weight loss or gain, altered eating habits and growth hindrances. Infants may also manifest symptoms like unexplained fussiness or crying outbursts, frequently wet diapers, dry skin with cool extremities, fever, diarrhea and vomiting. Adults may also manifest dry mouth, hypotension or low blood pressure, rapid heart rate, weight loss, fever, headache, sunken eyes and electrolyte imbalance. Excessive fluid intake or constant feelings of thirst is also referred to as polydipsia while excessive urination is called polyuria. Dipsogenic Diabetes Insipidus does not predispose individuals to dehydration but they may be at risk for water intoxication or overhydration if other medications are taken or there are other underlying conditions.
diabetes insipidus
Image: Diabetes Insipidus


There are categorically 4 types of Diabetes Insipidus wherein each has a unique cause requiring various treatment approaches. Central or Neurogenic Diabetes Insipidus is the first type which is the most common. It is caused by inadequate vasopressin which is a hormone responsible for acting on the kidney to concentrate urine to control and reduce overall urine output. The posterior part of the pituitary gland may be damaged due to tumors, injury, infection, etc. causing inadequate production of the hormone. Onset may be during childhood usually through hereditary means. Gestational Diabetes Insipidus is the second type which develops during pregnancy. The condition is mainly caused by the placenta destroying the hormone early on. Signs and symptoms are temporary however and usually disappear 4 to 6 weeks post-partum. The third type is Nephrogenic Diabetes Insipidus which is caused by drugs that may damage the kidneys or inherited genetic defects. Drug causes are treatable but genetic causes are permanent. The fourth and final type is Dipsogenic Diabetes Insipidus caused by excessive fluid intake. There may be some damage in the hypothalamus region of the brain causing thirst mechanism problems.


Treatment of Diabetes Insipidus usually depends on the type present as well as the signs and symptoms presented. Mild Central Diabetes Insipidus may be alleviated by simply increasing water consumption to about 2.5 liters or more everyday. Central Diabetes Insipidus is treated by taking the synthetic hormone desmopressin via nasal spray, injection or oral tablets in order to improve antidiuretic actions in the body. The hormone is considered very safe and effective by reducing total urine output. If there are underlying conditions affecting the pituitary gland directly like a disease or tumor, this has to be treated first with medications or surgery before focusing on Diabetes Insipidus.

Nephrogenic Diabetes Insipidus may be treated with low-salt diet to minimize total urine output. The patient is also advised to increase fluid intake. Some medications may initially be used for others to increase urine output but in the case of DI patients, these act differently and reduce urine output instead. A good example would be indomethacin and hydrochlorothiazide. If drugs are suspected to be causing kidney problems, these may be discontinued under doctor’s advice and supervision.

Gestational Diabetes Insipidus may be treated with demopressin as well. In some cases wherein the thirst mechanism is altered, the hormone may not work well. Desmopressin is also not indicated for Dipsogenic DI because although it can reduce urine output, thirst and fluid intake is not alleviated. Patient management may be the best option in order to make sure that he or she will not become water intoxicated or dehydrated. For all cases, adequate hydration is vital to offset excessive urine output.


Congenital causes of Diabetes Insipidus such as the nephrogenic type cannot be prevented. If the condition is caused by underlying factors like disease, tumor or organ damage, these may be treated first with the intent to reduce or eliminate symptoms of DI. Pregnant women are advised to eat healthy and exercise regularly. People should be vigilant enough to detect the condition as soon as it arises to learn about coping skills and have emergency support ready. Just like any other disease or disorder, all individuals should try as much to stay healthy by eating and drinking right, sleeping well and getting different forms of activity and leisure.
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