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Diabetes Inspidus

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  3. Diabetes Inspidus

Overview of Diabetes Inspidus

Diabetes Insipidus (DI) (ذیابیطس شکری) is a type of diabetes that is related to your kidney’s malfunctioning. In this condition, your kidney becomes unable to conserve water and your urge to drink water and urinate is increased. A patient with DI urinates frequently and passes between 3 and 20 quarts a day. 

You can’t confuse Diabetes Insipidus (DI) with diabetes mellitus, which is simply diabetes and occurs more often. It is a rare disorder that disturbed the hormones regulating water balance in your body. Although there is no specific cure for DI through treatment symptoms can subside.

Signs and Symptoms of Diabetes Inspidus

Some common signs and symptoms of DI are:

  • Severe thirst
  • Urinate a lot (your doctor might call this polyuria)
  • Getting up to go a lot at night
  • Preference for cold drinks
  • Dehydration
  • Weakness
  • Muscle pains
  • Irritability
  • Fatigue
  • Feeling sluggish
  • Dizziness
  • Confusion
  • Nausea

Types of Diabetes Inspidus

Causes of Diabetes Inspidus

Causes of DI vary with the type:

Central Diabetes Insipidus: This type of DI is due to vasopressin disturbance. This is the peptide hormone produced by your hypothalamus or pituitary gland. It regulates the body’s ability to retain water. It is also known as Antidiuretic Hormone (ADH). 

ADH balance is disturbed when the hypothalamus or pituitary gland is damaged. It results in the loss of too much liquid from the body in the form of urine. This damage occurs due to the following reasons:

  • Tumour
  • Head injury
  • Blocked or bulging artery (aneurysm)
  • Diseases such as Langerhans cell histiocytosis
  • Infection
  • Inflammation
  • Surgery
  • Nephrogenic Diabetes Insipidus: If your Kidney becomes unable to respond to ADH and remove a large amount of water from the blood it results in “Nephrogenic diabetes insipidus”. 

Doctors are unable to know the exact reason but some include:

  • A blocked urinary tract
  • Chronic kidney disease
  • High levels of calcium in your blood
  • Low levels of potassium in your blood
  • Some medications, like lithium
  • Dipsogenic Diabetes Insipidus: It is also called “primary polydipsia”. This occurs when you can’t control your thirst. When you drink a lot of water, it results in a decrease in the ADH level and you frequently urinate. It can be due to damage to the hypothalamus and pituitary gland by:
  • Tumour
  • Head injury
  • Infection
  • Inflammation
  • Surgery
  • Gestational diabetes insipidus: Gestational diabetes insipidus is a rare condition. It affects pregnant women. During pregnancy, an enzyme released by the placenta destroys the vasopressin hormone in the mother.
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Risk Factors of Diabetes Inspidus

Some common risk factors associated with the occurrence of diabetes insipidus are:

Health-Related Complications of Diabetes Insipidus

Diabetes insipidus can lead to 

  • Dry mouth due to dehydration
  • Changes in skin elasticity
  • Thirst
  • Fatigue
  • Electrolyte imbalance (sodium and potassium)

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Prevention

In most cases, diabetes insipidus is a permanent condition. You likely will not be able to prevent it. Most of the time, this is associated with some other disease or health issue. However, effective measures for the primary prevention of diabetes insipidus include:

  • Reduction of salt intake 
  • Avoidance of lithium and other drugs that can affect kidneys in any way. 
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Diagnosis

After an initial consultation, your doctor may suggest you undergo some diagnostic tests such as:

Urinalysis: The level of salts and waste will be estimated in your urine sample during urinalysis. If you have DI the concentration of water in your urine will be high while the concentration of other wastes will be below. 

Water Deprivation Test: Your doctor will ask you to stop drinking liquid for a certain period before this test. After which the following changes will be measured:

  • Blood sodium and osmolality levels
  • Bodyweight
  • Urine output
  • Urine composition
  • ADH blood levels

Magnetic Resonance Imaging (MRI): MRI test is performed to locate any damage in the hypothalamus or pituitary gland by using radio waves or magnets. This test is important because any damage and injury to the hypothalamus can affect the release of hormones that regulate water balance in your body.

Genetic Screening: It is performed to check if you have a family history in DI. 

Treatment of Diabetes Inspidus | When to Consult a Doctor

Treatment usually depends on the type and severity of DI. In mild cases, the doctor will suggest you regulate your water intake in a day.

  • Drugs and Medication: In nephrogenic DI, treatment of the cause cures the problem. Other treatment methods include the intake of high doses of desmopressin, in combination with drugs like aspirin or ibuprofen. When taking these, it’s necessary to drink water only when you feel thirsty.

  • Hormone Treatment: Desmopressin is used for the treatment of all types of DI. It is an artificial hormone that is synthetically prepared by using vasopressin as a reference. It can be taken by pills, nasal sprays, or injections. 

During desmopressin intake, you must regulate your water intake and drink only when feeling thirsty. It is used to treat central DI and severe gestational DI.

In case of any concerning signs and symptoms, you need to visit a certified diabetologist or endocrinologist. 

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