What is diabetes insipidus?
Diabetes insipidus is a rare condition in which the kidneys are unable to retain water. This leads to excessive urination and an increased risk of dehydration, a loss of body fluids and electrolytes, which can be life threatening when severe and untreated. Diabetes insipidus occurs when the body improperly uses antidiuretic hormone, or vasopressin, which is made in the hypothalamus of the brain. Vasopressin acts on the kidneys to regulate urine concentration. When the normal production or function of vasopressin is disrupted in some way, diabetes insipidus can result.
There are four major types of diabetes insipidus. Central diabetes insipidus is caused by problems with the pituitary gland. Nephrogenic diabetes insipidus can develop when the kidneys do not respond properly to vasopressin. In dipsogenic diabetes insipidus, the body’s system for regulating the sense of thirst is damaged. Finally, gestational diabetes insipidus occurs in pregnant women when the placenta destroys the mother’s vasopressin.
Treatment for diabetes insipidus depends highly on the type of diabetes insipidus. In mild cases, simply drinking extra fluids may be sufficient to prevent complications. For most cases of central and gestational diabetes insipidus, a drug called desmopressin, which is a synthetic version of vasopressin, is an effective treatment. Nephrogenic diabetes insipidus is generally treated with other drugs, such as hydrochlorothiazide. There is no treatment for dipsogenic diabetes insipidus.
Diabetes insipidus can lead to several complications, including dehydration or overhydration. In untreated cases, complications can be severe, even life threatening. Receiving the appropriate medical treatment for diabetes insipidus is especially important as the symptoms can be similar to those of the more common diabetes mellitus, though the two diseases are unrelated. Modern medicine is very effective at treating most cases of diabetes insipidus.
While severe complications from diabetes insipidus are rare, the condition can lead to dangerous dehydration. Seek immediate medical care (call 911) for serious symptoms of dehydration, such as fever or sunken appearance of the eyes.
Seek prompt medical care if persistent symptoms of diabetes insipidus occur, such as excessive thirst.
What are the symptoms of diabetes insipidus?
Symptoms of diabetes insipidus are related to poor water retention and include excessive urination and excessive thirst. Symptoms are generally not life threatening, but can lead to severe dehydration if proper medical treatment is not obtained.
Common symptoms of diabetes insipidus
You may experience diabetes insipidus symptoms daily or just once in a while. At times any of these symptoms can be severe:
- Craving for ice water
- Frequent urination
- High urine volume
- Low urine concentration (pale urine)
Symptoms that might indicate a serious condition
In some cases, diabetes insipidus can lead to serious dehydration that should be evaluated immediately in an emergency setting. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious dehydration symptoms including:
- Dry lips
- High fever (higher than 101 degrees Fahrenheit)
- Sunken appearance of the eyes
What causes diabetes insipidus?
Diabetes insipidus arises from damage to the body’s systems, which are in charge of regulating water balance. This includes damage to the adrenal glands, the kidneys, or glands in the central nervous system. The specific cause of diabetes insipidus depends on the type of diabetes insipidus.
Causes of central diabetes insipidus
Central diabetes insipidus is the most common type of diabetes insipidus. It occurs because of damage to the pituitary gland and poor regulation of vasopressin. Damage to the pituitary can result from:
Causes of nephrogenic diabetes insipidus
In nephrogenic diabetes insipidus, the kidneys cannot properly process vasopressin. Damage to the kidney’s vasopressin response mechanism can result from:
Hypercalcemia (too much calcium in the blood)
Kidney failure or certain kidney diseases
Medication side effects, such as side effects from lithium
Other causes not currently known
Causes of dipsogenic diabetes insipidus
Dipsogenic diabetes insipidus happens when there is damage to the body’s sense of thirst. The sense of thirst is located in a part of the brain called the hypothalamus. Damage to the hypothalamus can occur due to:
Causes of gestational diabetes insipidus
Gestational diabetes insipidus arises in pregnant women when the placenta manufactures an enzyme that attacks the mother’s vasopressin, leading to poor fluid regulation.
A number of factors increase the risk of developing diabetes insipidus. Not all people with risk factors will get diabetes insipidus. Risk factors for diabetes insipidus include:
How is diabetes insipidus treated?
Mild cases of diabetes insipidus may not require medical treatment, or they may require that you drink extra water during the day. In more serious cases of diabetes insipidus, the treatment depends on the type of diabetes insipidus.
Treatment of central and gestational diabetes insipidus
Gestational diabetes insipidus only occurs during pregnancy and will resolve after birth. During pregnancy, artificial vasopressin can be taken. Central diabetes insipidus is also generally treated with medications designed to mimic vasopressin, such as:
Desmopressin injection (DDAVP)
Desmopressin nasal spray (Stimate, Minirin)
Desmopressin pill (DDAVP)
Treatment of nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus cannot be treated with artificial vasopressin. Instead, treatments for nephrogenic diabetes insipidus include:
Anti-inflammatory drugs, such as indomethacin (Indocid, Indocin)
Diuretics, such as hydrochlorothiazide mixed with amiloride (Moduretic)
Increasing fluid intake
Treatment of dipsogenic diabetes insipidus
Effective treatments for dipsogenic diabetes insipidus are not known. However, careful fluid regulation is important to prevent dehydration.
What you can do to improve your diabetes insipidus
Diabetes insipidus prevents your body’s fluid regulation mechanisms from working properly. If you have diabetes insipidus, regulating or increasing your fluid intake may help with symptoms. Fluid intake should only be modified on the advice of a health care professional, as some medications may interfere with fluid regulation.
In most cases of diabetes insipidus, there are no complications. If enough fluids are consumed, diabetes insipidus is not severe or life threatening. However, losing too much fluid can have serious consequences. Complications of untreated or poorly controlled diabetes insipidus can be serious, especially if dehydration results. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of diabetes insipidus include:
Dehydration (loss of body fluids and electrolytes, which can be life threatening when severe and untreated)