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Diabetes Insipidus - Causes, Types, Symptoms, and Treatment

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Diabetes insipidus is a condition characterized by water and fluid imbalance in the body due to vasopressin deficiency. Read further to know more.

Written by

Dr. Asna Fatma

Medically reviewed by

Dr. Basuki Nath Bhagat

Published At January 27, 2023
Reviewed AtJuly 12, 2023

Introduction:

Diabetes insipidus is characterized by excessive thirst, excessive urination, large amounts of diluted urine, and increased levels of sodium in the body. The condition occurs due to a deficiency of the antidiuretic hormone vasopressin. Diabetes insipidus is often confused with diabetes mellitus, a more common metabolic disorder characterized by increased blood sugar levels and occurs due to a deficiency of pancreatic hormone (insulin). Whereas, in the case of diabetes insipidus, the blood sugar levels are within the normal range, and there is no lack of insulin in the body. Diabetes insipidus is a rare condition, and the common age of onset of the disease is between ten to 20 years.

What Is Diabetes Insipidus?

Diabetes insipidus is a disorder that is rare and presents with characteristic symptoms of excessive urination (polyuria) and excessive thirst (polydipsia). In an individual affected by diabetes insipidus, the kidneys cannot retain water, which causes an imbalance of water (fluids) and an imbalance of electrolytes, and salts in the body. This occurs due to a deficiency of a specific hormone called vasopressin, the antidiuretic hormone. Vasopressin is vital for the kidneys to regulate the water balance in the body. An average person produces about one to three quarts of urine per day (0.95 to 2.84 liters approx). But in the case of an individual with diabetes insipidus, this value may increase up to 20 quarts of urine (18.9 liters) per day.

What Causes Diabetes Insipidus?

Diabetes insipidus can occur due to any condition that affects the production, transportation, and release of the hormone vasopressin because disturbance in these activities will lead to vasopressin deficiency in the body, which is the primary cause of diabetes insipidus. The kidneys use vasopressin to regulate and balance the amount of water and fluids in the body. In some cases, there could be a problem in the part of the brain that controls thirst, which leads to an excessive amount of water intake, eventually causing diabetes insipidus.

What Are the Different Types of Diabetes Insipidus?

Based on the cause of the condition, diabetes insipidus can be of four types:

  1. Central Diabetes Insipidus: Vasopressin is produced in the hypothalamus and stored in the posterior part of the pituitary gland. When the amount of fluids in the body is reduced, the pituitary gland releases vasopressin, which signals the kidneys to conserve fluids by pulling them from the urine and returning it to the blood circulation. However, in the case of central diabetes insipidus, there is a deficiency of vasopressin, and the kidneys fail to conserve fluids leading to an imbalance of fluids in the body. Therefore, central diabetes insipidus occurs when the body can not make an adequate amount of vasopressin. This may occur due to: any damage to the pituitary gland or the hypothalamus, tumors of the pituitary gland, head injury, autoimmune conditions (a condition in which the body’s immune system attacks healthy cells), or inflammation and infections.

  2. Nephrogenic Diabetes Insipidus: In the case of nephrogenic diabetes insipidus, there is enough vasopressin production in the body, but the kidneys fail to respond to the hormone. There is a defect in the structure of the kidneys, which causes its ability to respond to vasopressin. This defect in the kidneys can occur due to, certain drugs, low serum potassium levels, low serum calcium levels, blockage in the urinary tract, and chronic kidney diseases.

  3. Dipsogenic Diabetes Insipidus: This type of diabetes insipidus is also known as primary polydipsia. The hypothalamus is responsible for controlling the thirst-regulation mechanism in the body; there is an occurrence of dipsogenic diabetes insipidus. The problem with the hypothalamus causes a constant feeling of thirst, which leads to excessive drinking of water and, subsequently, excessive urination. Damage to the hypothalamus due to trauma or surgery, tumors, infections, certain drugs, etc., can lead to dipsogenic diabetes insipidus.

  4. Gestational Diabetes Insipidus: This temporary condition develops during pregnancy. It is a rare condition, and it occurs when the mother’s placenta overproduces an enzyme that breaks down vasopressin. Women who are bearing twins and triplets in their wombs are more likely to develop gestational diabetes insipidus because they have more placental tissue.

What Are the Symptoms of Diabetes Insipidus?

The common signs and symptoms of diabetes insipidus include:

  • Polydipsia (excessive thirst) even after drinking liquids often.

  • Polyuria (excessive urination).

  • Excessive urination at night (nocturia).

  • Urine is dilated and increased in volume.

  • If there is an unavailability of water, dehydration can occur.

  • Sudden decrease of blood pressure on standing or sitting (orthostatic hypotension).

Young children and infants show symptoms like:

  • Irritability.

  • Lethargy.

  • Nausea and vomiting.

  • Constipation.

  • Fever.

  • Frequent bedwetting.

  • Heavily wet diapers.

  • Delayed growth.

  • Physical and mental retardation in advanced and untreated cases.

Is Diabetes Insipidus a Common Disease?

Diabetes insipidus is a rare condition, and the rate of occurrence is about one in 25,000 people globally. Both males and females are affected equally.

How Is Diabetes Insipidus Diagnosed?

Diabetes insipidus is diagnosed by studying the physical signs and symptoms of the patient, medical and family history, along with the presence of characteristic polyuria and polydipsia. A variety of blood and urine examinations are also done to evaluate the concentration of salt, electrolytes, and sugars. The following tests are done to confirm the diagnosis:

  • Urinalysis: A test of urine to detect a wide range of disorders. In the case of diabetes insipidus, the urinalysis will show over-dilution of the urine and the absence of sugar in the urine, which will mean the patient is not affected by diabetes mellitus.

  • Blood Examinations: The amount of sodium and calcium in the blood is evaluated.

  • Fluid or Water Deprivation Test: It is the definitive diagnostic test for diabetes insipidus, which determines the cause of the condition. During this test, the patient is asked not to drink water or any other fluid for several hours (four to eight hours approx), and then the amount of urine the patient passes is measured. The doctor will also monitor the weight and urine composition. Blood levels of vasopressin are also measured during this test. If there is no change in the water loss despite fluid deprivation, a synthetic form of vasopressin (Desmopressin) is given to the patient to distinguish between central diabetes insipidus and nephrogenic diabetes insipidus.

  • Imaging Test: MRI (magnetic resonance imaging) or CT scan (computed tomography) may be done to evaluate any damage to the hypothalamus or the pituitary gland or to check for the presence of any tumors in the brain.

  • Stimulation Test: During this test, the body is stimulated to produce vasopressin with the help of certain intravenous solutions. This is followed by measuring the blood levels of copeptin, a peptide that increases with an increase in the level of vasopressin.

How Is Diabetes Insipidus Treated?

In order to treat diabetes insipidus, it is important to ensure adequate fluid intake and reduction of urine output. The treatment varies depending on the cause of the condition and the severity of vasopressin deficiency in the body.

  • Central Diabetes Insipidus: In the case of partial central diabetes insipidus, with residual vasopressin activity, certain drugs like Hydrochlorothiazide may be useful in curing the condition. However, in the case of severe central diabetes insipidus with no vasopressin activity, a synthetic form of vasopressin known as Desmopressin is used as replacement therapy. Desmopressin may be injectable, taken orally, or in the form of a nasal spray.

  • Nephrogenic Diabetes Insipidus: In most cases, nephrogenic diabetes insipidus subsides when the underlying cause of the condition is treated. For example, drugs that may be causing the condition can be stopped or changed; chronic renal diseases should be treated; calcium and sodium levels should be balanced and the use of diuretic drugs to reduce urine output.

  • Gestational Diabetes Insipidus: The condition usually subsides after the child's birth; however, during pregnancy, the doctor may prescribe Desmopressin as it is safe for the mother and the child.

  • Dipsogenic Diabetes Insipidus: There is no definitive treatment for the condition. However, sucking on ice and candies may increase the salivary flow and reduce the feeling of thirst. The doctor may advise Desmopressin in small doses to be taken at bedtime to reduce urination frequency at night.

  • Treatment for Children: Children affected by diabetes insipidus are given Hydrochlorothiazide along with water and formula milk. However, the use of Hydrochlorothiazide or Desmopressin should be done very cautiously because infants and children require a certain amount of water and fluid intake for their proper growth and development.

What Are the Complications of Diabetes Insipidus?

Diabetes insipidus can lead to the following complications if it is left untreated or if it is not treated properly. Common complications include:

  • Dehydration occurs because the body loses a lot of fluids and electrolytes.

  • Dehydration can lead to fainting, weakness, dizziness, dry mouth, and altered mental alertness.

  • Cardiovascular symptoms like an irregular heartbeat (arrhythmia).

  • Dry skin and dry mucous membranes.

  • Confusions, seizures, and changes in consciousness.

  • In very few cases, it can lead to comatose or coma (prolonged period of unconsciousness).

  • Sudden drop of blood pressure on standing or changing positions.

What Is the Difference Between Diabetes Insipidus and Diabetes Mellitus?

Diabetes insipidus is often mistaken to be similar to diabetes mellitus, a more common disorder, because of the similarity in the names of both conditions. Along with similar names, the two conditions have polyuria and polydipsia as their characteristic symptoms. However, the mechanism and cause of both disorders are entirely different. The difference between diabetes mellitus and diabetes insipidus are:

Diabetes Insipidus vs. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)?

Diabetes Insipidus vs. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)

Conclusion:

Diabetes insipidus is a rare condition occurring due to a deficiency of the pituitary hormone vasopressin (antidiuretic hormone). Any condition that affects the production of vasopressin or blocks the action of vasopressin can lead to excessive urine production. The diagnosis and treatment of the condition require synthetic vasopressin (Desmopressin). The different types of diabetes insipidus require different types of treatment modalities. However, the condition is not severe or life-threatening and can be managed easily with proper treatment and precautions.

Frequently Asked Questions

1.

How Does Lithium Cause or Affect Diabetes Insipidus?

Diabetes insipidus occurs when there is a deficiency or resistance to ADH (antidiuretic hormone), leading to an inability of the kidneys to concentrate urine and retain water. In some individuals taking lithium, the drug can interfere with ADH function, resulting in a similar effect as diabetes insipidus. The exact mechanism behind this effect is not fully understood, but it is believed to involve the interference with the response of the kidneys to the antidiuretic hormone.

2.

Why Is Hypotonic Solution Given in Diabetes Insipidus?

Hypotonic solutions, like 0.45 % saline, are given to people with diabetes insipidus to replace the water lost from urinating too much. These solutions also help to bring back the right balance of fluids in the body. Diabetes insipidus is a condition where the kidneys cannot make urine concentrated. When this happens, drinking a solution with more water than electrolytes can prevent dehydration and keep sodium levels balanced.

3.

What Causes the Low Urine Osmolality in Diabetes Insipidus?

In diabetes insipidus, urine concentration is low because there is not enough antidiuretic hormone or the body does not respond properly to it. Normally, ADH helps the kidneys reabsorb water, making the urine more concentrated. Insufficient ADH hampers the kidneys' ability to produce concentrated urine, producing larger quantities of diluted, watery urine with low osmolality.

4.

What Causes High Serum Osmolality in Diabetes Insipidus?

Water retention in the kidneys is disrupted due to the malfunction of the antidiuretic hormone that typically assists in this process. This leads to less water being absorbed by the kidneys. As a result, the body loses more water through urine, causing dehydration and an increase in the concentration of solutes in the bloodstream, which leads to higher serum osmolality.

5.

What Are the Symptoms Common to Both Diabetes Mellitus and Diabetes Insipidus?

Both diabetes mellitus and diabetes insipidus have similar symptoms, which are increased thirst (polydipsia) and increased urination (polyuria). Both of these conditions can make a person very thirsty and make them urinate a lot of diluted urine. But, the reasons why these symptoms happen and how they happen are very different for each condition.

6.

Which Hormone Is Responsible for Causing Diabetes Insipidus?

Diabetes insipidus happens when there is not enough or a weak response to a hormone called antidiuretic hormone or vasopressin. ADH is made in a part of the brain called the hypothalamus and is kept in a small organ called the pituitary gland. When ADH is sent through the bloodstream, it works on the kidneys to control the amount of water that is absorbed back into the body. This helps make urine more concentrated and keeps water in the body.

7.

Can Lithium Cause Nephrogenic Diabetes Insipidus?

Lithium can cause nephrogenic diabetes insipidus by interfering with the kidney's response to antidiuretic hormone. In some individuals, long-term use of lithium can impair the kidneys' ability to respond to ADH, leading to reduced water reabsorption, excessive urination, and the characteristic symptoms of nephrogenic diabetes insipidus.

8.

Why Are Diuretics Given in the Cases of Nephrogenic Diabetes Insipidus?

By using diuretics, such as thiazide diuretics, the excretion of sodium and water is increased, which can help counteract the kidneys' reduced response to ADH and result in a decrease in urine output.

9.

Why Is Hydrochlorothiazide Used in Treating Diabetes Insipidus?

Hydrochlorothiazide is a thiazide diuretic sometimes used in the treatment of nephrogenic diabetes insipidus to help reduce excessive urine production. Hydrochlorothiazide is not effective for central diabetes insipidus, as it acts on the kidneys rather than addressing the underlying hormonal cause.

10.

How Does Amiloride Help in Treating Diabetes Insipidus?

Amiloride helps with lithium-induced nephrogenic diabetes insipidus by blocking sodium channels in the kidneys, which reduces the excessive excretion of sodium and water caused by lithium. This leads to decreased water loss and lower urine output, alleviating the symptoms of nephrogenic diabetes insipidus induced by lithium. But, Amiloride is not a cure for the condition and is used in combination with other medications.

11.

What Are the Defining Features of Diabetes Insipidus?

Diabetes insipidus is known by the following features:


- Excessive urination.


- Increased thirst.


- Diluted urine.


- No hyperglycemia.


- Potential dehydration.


- Possible nocturia (urinating frequently at night).


- Electrolyte imbalance.

12.

Why Does Diabetes Insipidus Cause Low Specific Gravity of Urine?

Diabetes insipidus causes low specific gravity in urine because the condition leads to reduced water reabsorption, resulting in the production of large volumes of diluted urine with low specific gravity. Specific gravity is the measure of urine concentration, and when the urine is diluted, it has a lower specific gravity value.

13.

Why Are Kidneys Active at Night With Diabetes Insipidus?

In diabetes insipidus, the kidneys remain active even at night because, the lack of ADH or the kidneys' inability to respond to it results in reduced water reabsorption, leading to increased urine production even during sleep, causing nocturia.

Dr. Basuki Nath Bhagat
Dr. Basuki Nath Bhagat

Family Physician

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diabetes insipidus
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