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Diabetes Insipidus – What It Is, How to Spot It, and How to Deal with It

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When you heard about diabetes insipidus, you probably think that it is similar to diabetes mellitus. It is a pretty understandable condition – because of the word diabetes, right? Both conditions share some of the most common symptoms, such as constant thirst and frequent urination (more than the usual). However, both conditions are completely separated and different. Whereas diabetes mellitus are pretty common and general (especially among those who don’t really take care of their health well), diabetes insipidus is actually a rare condition.

Understanding Diabetes Insipidus

So, what is diabetes insipidus? As it was mentioned before, it is a rare and uncommon disorder concerning fluids imbalance within the body. This condition will always make you super thirsty, even after you have taken a lot of drink. You will also urinate quite a lot. Unfortunately, this condition doesn’t have any cure. But proper treatment should be able to decrease the urine’s output as well as relieving your constant thirst.

This is a disorder where your kidneys pass excessive (and quite abnormal) a lot of volume of the urine within insipid state, which means that it is odorless and it is dilute. People in general normally urinate to 1 to 2 quarts of urine each day. People with diabetes insipidus, however, can urinate up to 3 quarts – even 20 quarts per day. They will constantly be thirsty and they drink tons of liquids.

Diabetes Insipidus vs Diabetes Mellitus

Diabetes mellitus includes the type 1 and 2 of diabetes. It leads to the body having high blood sugar level (also known as blood glucose) because it isn’t able to convert the blood glucose to energy. In normal condition, the body should be able to convert the blood sugar to energy so it can be burned off and you have the energy to do your everyday activities. People with diabetes mellitus, however, will need help to convert their blood glucose to energy. They also need help to maintain the normal blood glucose level.

Diabetes insipidus is the condition where the kidneys aren’t able to balance the body’s fluids. People with this condition have normal level for blood glucose, but there is something wrong with their kidneys – which lead to the situation where they urinate excessively and suffer from on-going thirst.

Kidneys and Their Functions

Your kidneys may be small, but it has one of the most important roles in regulating the correct system of your body. If your kidneys are damaged, your system will be affected too. Kidneys look like beans in a size of your fist. Everyone has a pair of it, located on each side of the body, left and right. Your kidneys are located right below your rib cage. Each is located on the side of your spine.

The function of the kidneys is mainly to filter out the blood. They are responsible for filtering around 120 quarts to 150 quarts of blood in order to produce 1 to 2 quarts of the urine, which consists mostly of extra fluid and waste. The kidneys are related to your bladder through the ureters. Ureters are basically the tubes where urine flows from your kidneys to your bladder, where the urine will be stored for a while before it is released. During urination, urine flows out from the bladder through the urethra, another tube that is situated at the bottom side of the bladder.

You see, the body regulates the amount of fluid by balancing the intake and removing the extra excess. Your thirst is the one controlling your body’s rate of liquid intake. On the other hand, urination is the one removing the extra fluid. People lose fluid through breathing, sweating, diarrhea, and sweating.

All of these processes are controlled by a certain hormone. Your hypothalamus (which is the small gland right on the base of your brain) is responsible for producing such a hormone, known as Vasopressin. Also known as antidiuretic hormone, Vasopressin would control the rate of fluid removal (through urination). Vasopressin is kept and stored within a nearby pituitary gland. When your body has reached a low level of liquid, Vasopressin would be released to your bloodstream, so it can signal the kidneys to slow down the liquid absorption (from the bloodstream) which results in less urine. When your body has a lot of fluid, the pituitary gland will only release a smaller amount of Vasopressin (sometimes even none) so your kidneys can take more fluid from your bloodstream – resulting in higher level urine.

Different Types of Diabetes Insipidus

According to Leann Olansky, MD, an endocrinologist at Cleveland Clinic’s Department of Endocrinology, it is likely that two main defects leading to diabetes insipidus. One is the body’s inability to make Vasopressin (likely lead to Central Diabetes Insipidus). Another one is the kidneys’ inability to respond to Vasopression, leading to Nephrogenic Diabetes Insipidus.

In general, diabetes inspidius causes depend on the different type of the disorder. In general, there are 4 major types of diabetes insipidus.

Central

Diabetes insipidus happens when there’s a damage either within the pituitary gland or hypothalamus – it leads to disruptions in the (supposed to be) normal storage, production, and release of the Vasopressin. Because of the disruption, the kidneys take too much fluid from your body, increasing the rate of urination. The damage to the gland or the hypothalamus may result from:

It is also possible that inherited gene defect may be responsible for the disruption in Vasopressin release, storage, and production. But this cause would be so rare. In some of the cases, the exact cause remains unknown.

Nephrogenic

In this type of diabetes insipidus, it is the kidneys that are being problematic and not normally function properly. The kidneys don’t normally respond to the hormone (Vasopressin) so it removes too much fluid from the bloodstream continuously. This type usually results from inherited gene mutations or changes, which prevent your kidneys from responding properly to Vasopressin.

Other causes include:

In some cases, it is possible that the exact causes would be unknown too

Dipsogenic

This type results from the defect in your thirst mechanism – which is located in your hypothalamus. Because of the defect, there is an abnormal increase in the liquid intake and thirst sensation. The condition would suppress the secretion of Vasopressin and increase the output of urine. The same conditions that damage the pituitary or hypothalamus (such as head injury, tumor, inflammation, infection, or surgery) may also damage your thirst mechanism. Mental health issues or some medication may lead to dipsogenic diabetes insipidus.

Gestational

This is a situation that only happens during pregnancy. During this stage, many of the hormones and enzymes are in chaotic state. In some cases, the placenta (the temporary organ connecting the baby and mom) produces an enzyme that somewhat breaks down mom’s Vasopressin. It is also possible that pregnant moms produce more prostaglandin. This is hormone-like chemical reducing kidneys’ sensitivity to Vasopressin.

In this type of diabetes insipidus, most of the moms have mild case – without any noticeable or significant symptoms. In most cases, this condition will disappear after the delivery. But the mom is pregnant again, the condition may return again.

The Common Symptoms

The symptoms to diabetes insipidus may include:

In extreme cases, the urination level can reach 20 quarts (around 19 liters) a day which is pretty abnormal. It is also possible that kids or infant may also have this disorder. The symptoms may include:

Everyone should know that there is something with them if they urinate too much. If the frequency of urination is too high and it is accompanied by extreme and on-going thirst, you need to see your doctor right away.

Complications

If the issue isn’t treated, it may lead to:

Diabetes Insipidus Treatments

Since you will be losing quite a lot of liquid because of your condition, the primary solution is to have a lot of water. It will prevent dehydration and keep you stay hydrated. It is also possible that your doctor refer you to a nephrologist or an endocrinologist. A Nephrologist is a physician specializing in treating kidney issues. An Endocrinologist is a physician specializing in treating hormone-producing glands disorders.

Of course, for further developments, the diabetes insipidus treatment depends on the diabetes insipidus type.

Central

This treatment includes Desmopressin being used to treat the problem. Desmopressin is a man-made or synthetic hormone that is made available in a form of a pill, a nasal spray, or an injection. The idea is to replace the natural Vasopressin in the body with the medication. According to WebMD Medical References, this medication can manage the symptoms but it can’t cure the issue.

Nephrogenic

It is possible that this disorder goes away after the exact cause is being treated. For instance, if you can balance the potassium or calcium level in the body or you may switch medication, the issue can go away on its own.

Basically, the medication for this type includes diuretics that can be combined with ibuprofen or aspirin. It is also possible to administer the diuretics alone. Doctors generally prescribe diuretics so patients can remove the fluid from their body. There is a class of diurethics (named Thiazides) that will help the kidneys’ urine concentration as well as reducing the urine production. Ibuprofen or aspirin can also help to reduce the volume of urine.

Dispogenic

Unfortunately, researchers haven’t found a completely effective way to treat this condition. Patients can try sucking on sour candies or ice chips so their mouths will remain moist. Such a way can also increase the flow of saliva – reducing the want to drink. If you constantly have to wake up at night to pee because of this condition, you can consider taking Desmopressin (just a small dose) during bedtime. It should help reducing the urge to pee. But this should be done with your healthcare providers’ monitoring and observation. They will monitor your blood sodium level so you won’t suffer from hyponatremia or low sodium level within the blood.

Gestational

In most cases, pregnant moms don’t need any treatment at all. However, it is possible that doctors may prescribe you Desmopressin – but only if the condition is too disturbing or annoying. In most cases, pregnant moms don’t need more treatments after they deliver the baby.

Important Points to Understand and Remember

Diagnosing Diabetes Insipidus

Doctors will have to ask you questions concerning your health history, your family’s health history, and physical exams.

There is also the so-called fluid deprivation test that will measure the changes within your blood sodium, body weight, and also urine concentration after you stop drinking anything within a short period of time. There are 2 types of tests for this one:

Follow your doctor’s direction, take the medicine prescribed, and make sure to have enough drink are some of your best efforts to deal with diabetes insipidus.