What-Is-Diabetes-Insipidus

When we think about diabetes, our knowledge is often limited to two types only. Namely, type 1 and type 2 diabetes. These are the variants of one type of diabetes, i.e,  diabetes mellitus. So, what is diabetes insipidus and how common is it in the world?

According to reports from the NHS, around 1 in 25,000 people suffer from Diabetes Insipidus (DI). Although not as common as diabetes mellitus, DI is a rare medical condition that affects the kidney’s ability to conserve water. What this does is contribute to a cycle of frequent urination and excessive thirst in the patient.

While a healthy person typically urinates between 1-3 quarts of urine, a patient with DI can urinate as much as 20 quarts of urine per day, often leading to dehydration and electrolyte imbalance in the body.

However, the good news is that an early diagnosis of diabetes insipidus is treatable and manageable with proper medical intervention. This article will explore everything there is to know about DI, its symptoms, causes, diagnosis, and treatment.

What is Diabetes Insipidus?

Diabetes Insipidus (DI) is a rare medical condition that alters the kidney’s normal ability to retain water, leading to frequent urination and loss of fluids from the body.

Thankfully, it is a treatable condition, helping most DI patients lead a comfortable lifestyle without affecting their quality of life. Just minor changes in their lifestyle can help them lead a normal life.

Additionally, DI can either be chronic, meaning that the patient has experienced it for the majority of their life since their birth or it can be acute or temporary as a consequence of an underlying medical concern.

The condition often leads to an imbalance of fluids in the body, forcing the kidneys to work at an overdrive to expel the excess fluid out of the body through urination. Although there is no proper cure for DI yet, the symptoms can be managed with proper medical treatments.

What are the Symptoms of Diabetes Insipidus?

The diabetes insipidus symptoms typically comprise of two major ones:

  • Excessive thirst
  • Frequent urination

However, besides these primary symptoms, there are a few additional ones that affect children and adults separately.

Accessory Symptoms of Diabetes Insipidus (DI)
ChildrenAdults
-Unusually wet diapers-Bedwetting-Fussiness-Irritability-Dehydration-High fever-Dry skin-Delayed growth-Confusion-Dizziness-Sluggishness-Severe dehydration-Brain fog-Nausea-Fainting-Brain damage (in severe cases)-Seizures (in severe cases)

Keep in mind that the primary symptoms of DI can also present themselves due to another underlying condition. So, if you are experiencing excessive thirst or frequent urination, it doesn’t necessarily mean you have DI. It could also be indicative of other undiagnosed complications.

Hence, getting a doctor’s appointment, and getting the prescribed testing is crucial if you want to get a confirmed diagnosis and then get on the relevant treatment regime for the same.

What Causes Diabetes Insipidus?

Moving on from the symptoms, the next thing worth considering is the causes. As we mentioned, the main factor that contributes to DI is the kidney’s ability to retain fluid.

But, how is that triggered?

The onset of DI is often associated with low levels of the body’s antidiuretic hormone (ADH), otherwise known as vasopressin. The unstable availability of ADH in the bloodstream also affects renal function in the body. The exact cause behind DI is still unknown.

The ADH or vasopressin is produced in the hypothalamus, which is the body’s thirst-regulating center. Sometimes, issues with hypothalamic functions could also contribute to the incidence of DI in the patient.

Causes of Different Types of DI
Central diabetes insipidus-Damage to the hypothalamus or pituitary gland-Inflammation-Tumors-Autoimmune reaction-Gene mutation in chromosome 20
Nephrogenic diabetes insipidus-Side effects of certain medicines-Low potassium levels-High calcium levels-Blockage in the urinary tract-Inherited gene mutation-Chronic kidney disease
Dipsogenic diabetes insipidus-Surgical complications leading to damage in the hypothalamus or pituitary gland-Mental health conditions like schizophrenia, OCD, etc.
Gestational diabetes insipidus-Enzymatic breakdown of ADH

What are the Different Types of Diabetes Insipidus?

Much like Diabetes Mellitus, which is of two types, there are four different types of Diabetes Insipidus:

Central diabetes insipidus

This happens when the body doesn’t have enough availability of ADH in the bloodstream. If the feedback loop between the hypothalamus and the pituitary gland is damaged, it can lead to central DI. Also, any form of injury or damage to these parts of the body can lead to central DI as well.

Nephrogenic diabetes insipidus

This type of DI isn’t a result of the complications from the higher centers. The hypothalamus produces enough ADH and the pituitary gland releases it when needed. However, the released ADH isn’t picked up by the kidneys, leading to fluid imbalance.

Dipsogenic diabetes insipidus

This is another rare type of DI, where there is an issue with the hypothalamus that’s unrelated to ADH production. This leads to excessive thirst in the patient, leading to fluid imbalance and frequent urination.

Gestational diabetes insipidus

Like gestational diabetes, gestational DI is a temporary and acute medical condition that happens during pregnancy, making a woman experience frequent urination. The primary trigger behind this condition is the high levels of an enzyme that break down the ADH in the bloodstream. It could also be a consequence of placental issues in the expecting mother.

Diabetes Insipidus can affect anyone, irrespective of age and gender. However, paying attention to the symptoms is crucial. If you witness such symptoms out of the blue, it is ideal to consult a doctor about it instead of taking things for granted.

How is Diabetes Insipidus Different from Diabetes Mellitus?

Although both these types of diabetes cause primary symptoms of excessive thirst and frequent urination, the conditions, in theory, are entirely different.

Diabetes mellitus deals with unregulated blood glucose levels in the body. It happens when either the pancreas isn’t producing enough insulin (type-1) or the secreted insulin isn’t being used by the cells to produce energy (type-2). This leads to consistently high levels of blood glucose levels, which are often managed with oral medications or insulin injections.

Diabetes insipidus, as we have been talking about, is a rare condition that affects the body’s fluid balance and the kidney’s ability to reserve water. This leads to frequent urination, in turn triggering the thirst in the patient, creating a vicious loop in the patient.

When it comes to looking into the prevalence of these conditions, Diabetes Mellitus is a lot more common compared to Diabetes Insipidus.

If you are noticing a sudden onset of the symptoms, pay close attention to them and seek immediate medical intervention. Earlier testing is also crucial to confirm the diagnosis and then get on a needed treatment regime.


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How is Diabetes Insipidus Diagnosed?

Diabetes insipidus is due to the unregulated levels of ADH or vasopressin in the bloodstream. This means that your first line of diagnosis starts with taking notes of the symptoms.

If you notice a sudden increase in your frequency of urination and thirst, pay attention to the symptoms. Sometimes, the issues could be due to the heat and peak of the summer months.

However, if you notice the symptoms not getting any better, it could be a direct consequence of an undiagnosed case of DI.

In that case, your next step is to book a doctor’s appointment. You can reach out to your primary healthcare provider, following which they might refer you to a specialist if something more severe is happening with your body.

That aside, some of the diagnostic tests that indicate a possibility of DI are:

Water deprivation test – the test involves fluid restriction in the patient while they are being closely monitored by the doctor. As the patient is deprived of water, the doctor monitors potential changes in the body, including changes in body weight, urine output, urine and blood concentration, etc. Your doctor might also monitor the body’s ADH levels during that period. Any kind of abnormalities in any of these standard elements can confirm a diagnosis of DI.

MRI – if your doctor suspects that there could be damage to the hypothalamus or the pituitary gland, they will prescribe an MRI to get a closer look into the structure. The MRI looks for the presence of inflammation, anatomical anomalies, or possible tumor growth.

Genetic screening – since gene mutations in chromosome 20 and a few other associated genetic complications are often responsible for DI, comprehensive genetic screening can help with a diagnosis too.

Urine gravity test – this involves the collection of a urine sample to analyze the presence of salts and other waste elements in the urine. Patients with DI have urine with high water concentration and low waste concentration.

How is Diabetes Insipidus Treated?

Following a diagnosis, your doctor will then look into determining which type of DI you have. Depending on that, the treatment starts.

The treatment options for DI vary on the type, so let us break them down in detail:

Central diabetes insipidus

  • For central DI, patients with mild symptoms are often asked to increase their water intake.
  • In patients with abnormalities in the hypothalamus and pituitary gland, the issue is first treated before further treatments are administered to manage the symptoms of DI.
  • Patients are also prescribed a synthetic hormone termed desmopressin, which has antagonistic functions to ADH, thereby reducing urination.

Nephrogenic diabetes insipidus

  • The patients with nephrogenic DI are first advised to switch to a low-salt diet to reduce the urine formation in the kidneys.
  • Also, the patients have to increase their water intake to reduce potential risks of dehydration.
  • Treatment with hydrochlorothiazide, a type of anti-diuretic also helps in managing the symptoms of nephrogenic DI.
  • In case the symptoms of nephrogenic DI are due to the side effects of certain medications, your doctor will either stop or switch the medicines.

Gestational diabetes insipidus

  • Like central DI, even treatment for gestational DI is done with a medication called desmopressin.
  • Sometimes, the treatment often starts with lifestyle changes, including a low-salt diet, drinking more water, eating a healthy and balanced diet, etc. Following that, your doctor will put you on the relevant treatment based on the patient’s needs.

What are some of the best Lifestyle Changes for Diabetes Insipidus?

Besides medication and hormone therapy, lifestyle changes are crucial to managing DI. Since the condition contributes to elevated risks of DI, maintaining a proper lifestyle is essential.

The most common lifestyle change starts with the person’s diet. It will involve switching to a low-salt diet or drinking more water every day. However, the ideal amount of water per day depends on your doctor’s recommendations.

Since dehydration can often lead to risks of fainting, it is ideal to carry a medical alert card as a safety measure.

FAQs

Are diabetes mellitus and diabetes insipidus the same thing?

Diabetes mellitus (DM) and diabetes insipidus (DI) are two completely different conditions. DM leads to unregulated blood glucose levels while DI leads to the kidney’s inability to retain fluids. DM is a consequence of unregulated insulin levels while DI is due to unregulated levels of ADH in the body.

How do you prevent diabetes insipidus?

DI isn’t a preventable condition since it’s a consequence of unregulated ADH levels in the body. Most patients with DI can’t prevent the onset of this condition.

What are the initial signs of diabetes insipidus?

Diabetes insipidus typically starts with a sudden onset of excessive thirst and frequent urination. Since the symptoms are very similar to diabetes mellitus, the symptoms are often confused with each other. An extensive diagnosis is thus very crucial.

Conclusion

Diabetes insipidus is a rare but quite severe medical condition. Getting an earlier diagnosis and aligned treatment can not the manage the condition but regulate the symptoms as well.

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Ms. Srujana is Managing Editor of Cogito137, one of India’s leading student-run science communication magazines. I have been working in scientific and medical writing and editing since 2018. I am also associated with the quality assurance team of scientific journal editing. I am majoring in Chemistry with a minor in Biology at IISER Kolkata.

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