Diabetes Insipidus causes & diagnosis (DI)
Tags: Medical, Diabetes Insipidus, Treatment, Diabetes

Diabetes Insipidus (DI) is a rare disorder with a reported prevalence of 1 in 25,000 people in the general population. In this disorder, there is an imbalance of fluids in the body and the kidneys pass an abnormally large volume of urine which is colourless and odourless.

In this article, we are going to discuss in detail diabetes insipidus causes & diagnosis.

Did you know that Insipidus comes from the word ‘insipid’, meaning weak or tasteless?

In most people, the kidneys pass about 1–2 litres of urine a day but in people with DI, the kidney can pass about 3 to 19 litres of urine a day in severe cases. As a result, the person may feel extreme thirst even if he/she has something to drink.

Adults have a higher chance of developing the condition but it can occur at any age. In rare cases, diabetes insipidus diagnosis can occur during pregnancy also, known as gestational diabetes insipidus.

Now, you must keep reading the blog to know more about the condition, its diagnosis, causes, treatment and how it differs from Diabetes Mellitus. In order to understand Diabetes Insipidus, first, let us learn about the role of kidneys and normal fluid regulation in your body.

Role of kidneys and normal fluid regulation

The kidneys play a very important role in fluid balance.

Kidneys are bean-shaped organs about the size of a fist located just below the rib cage, one on each side of the spine. To produce 1–2 litres of urine, the kidneys normally filter about 120 to 150 quarts of blood composed of waste and extra liquids.

In overall body mass, fluids can make up as much as 60% and maintaining the proper amount of fluids in the body is key for overall health management. While urination removes most of the fluid from the body, breathing and sweating also help to remove fluid from your body.

A system of organs and hormone signals are used by your body to normally regulate the fluids. The kidneys play a very important role in fluid balance and regulation by removing extra fluid from the bloodstream.

The fluid levels are regulated in the body either by producing less urine when there is a need to replace fluid lost to sweating or making more urine when there is too much fluid in your body. Your brain (hypothalamus) regulates the feeling of thirst and the need to drink water.

What is Diabetes Insipidus (DI) and how is it different from Diabetes Mellitus (DM)?

Diabetes insipidus diagnosis happens when either the secretion or response to the pituitary hormone ‘vasopressin”, also known as antidiuretic hormone (ADH) is impaired. It results in the production of very large amounts of dilute urine which is colourless and odourless often leading to dehydration and increased thirst.

In most cases of DI, there isn’t enough antidiuretic hormone (ADH) production or the kidneys are not responding properly to ADH. Excessive production of urine can result in dangerous dehydration if a person does not increase the water intake.

Another question that might come to your mind: Are Diabetes Insipidus and Diabetes Mellitus related?

The answer is Diabetes Insipidus and Diabetes Mellitus (both type 1 and type 2) are unrelated, although both conditions might have similar symptoms like frequent urination and constant thirst. Here is the difference:

In Diabetes Mellitus, high sugar levels lead to the production of large volumes of urine to help remove excess sugar from the body.

In Diabetes Insipidus, increased urination is due to disturbance in the water balance system of the body.

Of the two conditions, diabetes mellitus is more harmful and harder to manage. Let us now take a look at the different types of Diabetes Insipidus.

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What are Diabetes Insipidus causes and types?

The brain produces an antidiuretic hormone (ADH), also known as vasopressin which is stored in the pituitary gland after production. When the body needs to retain water, the pituitary gland releases vasopressin into the bloodstream.

But what causes DI? When there is a need to remove water from the body, the hormone is either released in very small amounts or not released at all, leading to urination more often.

Diabetes Insipidus causes include a disruption in hormone production or when any part of the regulation system breaks down. If a person has diabetes insipidus, the body can’t properly balance fluid levels.

There are 4 types of diabetes insipidus and each type of Diabetes Insipidus causes are unique. Types include:

1. Central Diabetes Insipidus

When there is some damage to a person’s hypothalamus or pituitary gland, it causes disruption in the normal production, storage and release of vasopressin leading to central diabetes insipidus. This causes the kidney to remove large amounts of fluid from the body which leads to increased urination.

There can be various reasons which can result in damage to the hypothalamus or pituitary gland:

Surgery in the area of the pituitary gland or hypothalamus

Infection

Any inflammation

A tumour in or near the pituitary gland

Head injury

Loss of blood supply to the pituitary gland

An inherited defect in the gene that produces vasopressin

In some cases, the cause might be unknown.

Damage to the hypothalamus or pituitary gland can cause Central Diabetes Insipidus.

2. Nephrogenic Diabetes Insipidus

In Nephrogenic Diabetes Insipidus, the response of the kidneys to vasopressin is affected. The kidneys are unable to properly respond to vasopressin due to a defect in the structures of the kidneys. Like central DI, nephrogenic DI is very rare.

The defect may be due to:

In inherited (genetic) nephrogenic DI, the condition results in the kidneys either completely or partially not responding to vasopressin.

In the acquired form of nephrogenic DI, the kidney’s ability to concentrate urine when water needs to be conserved is also reduced.

Acquired/secondary nephrogenic DI can have various causes, including:

Kidney cysts that may develop due to other conditions such as polycystic kidney disease

Kidney infection

High levels of calcium in the bloodstream

Some cancers

Certain medications, especially lithium or tetracycline

Low potassium levels in the body

Blockage in the urinary tract

3. Dipsogenic Diabetes Insipidus

Dipsogenic diabetes insipidus cause is a defect in the thirst mechanism and is not related to ADH (vasopressin). It occurs when the mechanism that makes you feel thirsty is damaged and you might feel thirsty even when fluid isn’t needed.

It can be caused by damage to the hypothalamus. The same reasons which might lead to central DI can lead to dipsogenic diabetes insipidus.

It can also be caused due to:

Certain medication

Mental illnesses or mental health problems

4. Gestational Diabetes Insipidus

Gestational Diabetes Insipidus occurs only during the pregnancy period and most pregnant women who develop Gestational DI have a mild case that does not lead to noticeable symptoms. It usually goes away once the mother delivers the baby, however, it can occur again if the mother becomes pregnant again.

In a few cases, it occurs due to an enzyme released by the placenta that degrades vasopressin while in other cases, pregnant women produce more prostaglandin, a hormone-like chemical that reduces the kidney sensitivity to vasopressin.

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Now let us take a look at how your healthcare provider will help in Diabetes Insipidus diagnosis.

Diabetes Insipidus Diagnosis

How do you know if you have diabetes insipidus? Your healthcare provider can diagnose it based on the following:

1. Medical and family history

Your healthcare provider can diagnose diabetes insipidus by taking medical and family history, asking to review the symptoms and whether any member in the family has a history of diabetes insipidus or its symptoms.

2. Physical examination

By physical examination, the healthcare provider can diagnose diabetes insipidus by examining the skin, appearance and checking for the signs of dehydration.

3. Urinalysis

A urinalysis test is done to see whether the urine is dilute or concentrated. It also helps in distinguishing between diabetes insipidus and diabetes mellitus if there is the presence of glucose in urine.

The doctor may also ask you to collect urine in a special container over a period of 24 hours to measure the total amount of urine produced by the kidneys for diagnosis.

4. Blood test

A blood test is done to determine the sodium levels in the body which can help diagnose diabetes insipidus and in certain cases help understand the type of DI also.

5. Water deprivation test

Water or fluid deprivation test is a reliable test to help in diabetes insipidus diagnosis. The test has to be performed by a specialist under proper supervision. Your healthcare provider may perform two types of water deprivation tests -

a. Short form of deprivation test

In this test, the patient is instructed to stop drinking all liquids or fluids for a specific period of time, usually during dinner. The next morning, the patient is asked to collect the urine sample at home. A urine sample is given to the lab to measure the concentration of the urine.

b. Formal water deprivation test

This test is performed at the hospital to continuously monitor the patient to check for the signs of dehydration. It involves allowing the patient to become increasingly dehydrated while taking blood and urine samples.

Samples taken during the test are analysed to determine the concentration of urine and blood and measure the levels of electrolytes, especially sodium in the body. Close supervision is done to rule out psychogenic polydipsia, a condition that causes a person to drink large volumes of water habitually.

Under normal conditions, dehydration triggers the secretion of vasopressin leading the kidneys to conserve water and concentrate the urine while in diabetes insipidus, either insufficient vasopressin is released or the kidneys are resistant to the hormone. Testing these dysfunctions will help diagnose and define the type of diabetes insipidus.

6. Magnetic resonance imaging (MRI)

MRIs cannot diagnose diabetes insipidus but will help in checking if there is any problem in the hypothalamus or pituitary gland of the patient. It will also help the health care provider to determine if diabetes insipidus is the possible cause of the patient’s symptoms.

Symptoms of Diabetes Insipidus

Your body’s primary responses to dehydration are thirst to increase the water intake and decrease urine output for conserving water loss in the body. This will lead urine to become concentrated and dark yellow in colour.

In adults, symptoms of Diabetes Insipidus include:

Severe thirst

Passing more than 3 litres of urine a day (polyuria)

Waking up a lot during the night to go for urination

Peeing during sleep (bed-wetting)

Pale, colourless urine with a low measured concentration of urine

Weakness

Muscle pains

Crankiness and dehydration

Bed-wetting is one of the symptoms of Diabetes Insipidus.

In infants and children, symptoms of Diabetes Insipidus include:

In infants, you need to watch out for:

Crankiness

Slow growth

Poor feeding

Weight loss

Fever

Vomiting

Infants with hereditary nephrogenic DI may not eat properly and fail to gain weight with slow growth. They may also be irritable experiencing fever, diarrhoea and vomiting causing recurrent episodes of dehydration which leads to slow growth and delayed development in infants.

Diabetes Insipidus diagnosis must be done on time and should be well-managed, as over time it can damage the bladder and kidneys leading to pain, infections and kidney failure. With proper treatment, it can be managed with very few complications and lead to a normal lifespan.

In children, signs include:

Drinking a lot of water

Peeing often, sometimes every hour

New bed-wetting or starting to wake up during the night frequently to pee

Dehydration

Low energy

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Diabetes Insipidus complications

If Diabetes Insipidus isn’t under control or managed properly, it can make you more likely to have these Diabetes Insipidus complications:

1. Dehydration

The major complication of Diabetes Insipidus is dehydration i.e. if water loss is more than the intake. As the level of water loss increases, more symptoms of dehydration can become visible.

You might notice the below symptoms with dehydration:

Extreme thirst

Fatigue

Dizziness

Confusion

Nausea

Loss of consciousness

Dry skin

Sluggishness

Did you know? Severe dehydration can lead to seizures, permanent brain damage and even death. Seek immediate care if there are any symptoms of severe dehydration such as confusion, dizziness or sluggishness. You can prevent dehydration by increasing your water intake throughout the day.

2. Electrolyte imbalance

Electrolytes are minerals in the body with an electric charge. They are present in blood, urine, tissues and other body fluids. When the amount of water changes in your body, the level of electrolytes can become too low or too high.

In Diabetes Insipidus when you lose too much water, your electrolyte levels can go up or low which might cause:

A headache

Feeling tired all the time or fatigue

Irritability

Muscle pain

3. Disturbed sleep

Diabetes Insipidus can lead to nocturia, a condition in which you wake up at night due to frequent urination resulting in a disturbed sleep or a less restful night.

Without medical treatment, other possible complications of Diabetes Insipidus may include:

Low body temperature

Accelerated heart rate

Weight loss and frequent headaches

Low blood pressure (hypotension)

Kidney or brain damage

Diabetes Insipidus treatment

The Diabetes Insipidus treatment primarily is to prevent dehydration by drinking enough fluids. Your health care provider may refer you to a nephrologist for treating kidney problems or an endocrinologist for treating disorders of the hormones.

As Diabetes Insipidus types have different causes, similarly treatment for extreme thirst or frequent urination depends on the type of Diabetes Insipidus.

1. Central Diabetes Insipidus

To treat central DI, a synthetic or man-made hormone called desmopressin in form of injection, nasal spray or pill is given which works by replacing the vasopressin that the body naturally produces and decreases urination.

It helps in managing the symptoms of central DI, however, it does not cure the disease.

2. Nephrogenic Diabetes Insipidus

In nephrogenic DI, since kidneys don’t respond to ADH properly, giving desmopressin won’t help in managing the symptoms. Instead, your doctor may advise a low-salt diet to decrease urine production by the kidneys and increase water intake to prevent dehydration.

Medications for nephrogenic DI include a class of diuretics called thiazides, either given alone or in combination with aspirin or ibuprofen.

Diuretics are commonly prescribed to help patients’ kidneys remove fluid from the body. Instead in nephrogenic DI, diuretics are given to reduce urine production and concentrate urine.

3. Dipsogenic Diabetes Insipidus

No effective dipsogenic Diabetes Insipidus treatment guidelines is yet found by the researchers.

It is advised to try sucking on ice chips or sour candies to keep the mouth moistened and increase the saliva flow, which may help in reducing the desire to drink water.

Taking a small dose of desmopressin at bedtime may help the patients who wake frequently at night to urinate. Your healthcare provider initially may monitor the blood sodium levels to prevent low sodium levels (hyponatremia) in the body.

4. Gestational Diabetes Insipidus

The doctors prescribe desmopressin for pregnant women with gestational diabetes insipidus as the placenta does not destroy desmopressin, unlike vasopressin. After delivery, most of the women will not need any treatment.

Most people with Diabetes Insipidus can prevent serious complications and live a normal life by following the doctor’s advice and recommendations to keep their symptoms under control.

After delivery, most of the women will not need any treatment for Gestational Diabetes Insipidus.

Lifestyle modifications and dietary changes

Lifestyle modifications play an important role in managing the symptoms of Diabetes Insipidus. The most important part is to prevent dehydration. You can carry a water bottle wherever you go or offer your child to drink water every few hours if they have DI. Your doctor will help you determine your daily fluid intake.

You can carry a medical alert card in your wallet so that others can know about your condition in case of emergency as dehydration can happen quickly and at any time.

Your doctor may advise you to have a low-salt diet and refer to a nutritionist for making a customized diet plan. Reducing caffeine and avoiding processed foods from the diet as these are high in salt can be effective steps to control water retention and consume foods with high water content such as melons.

Diabetes Insipidus is often difficult or impossible to cure as it results either from genetic problems or due to other conditions. However, symptoms can be managed effectively if Diabetes Insipidus diagnosis and treatment is done properly. While it is a lifelong condition, with ongoing treatment, the outlook can be good.

Remember to always have something to drink close by as you will be more prone to dehydration especially if the weather is too hot or when you exercise. Carry your medication with you and avoid situations where you can’t get water.

To manage your symptoms, get support from a strong healthcare team at Zyla. We work 24x7 to answer your every query in real-time with a team of experts which includes endocrinologists and nutritionists, physiotherapists and psychologists.

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