Diabetes Insipidus (DI): Types, Causes, Symptoms And Treatment- All You Need to Know

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body.

Diabetes insipidus is a rare disorder that causes the body to make too much urine. While most people make 1 to 3 quarts of urine a day, people with diabetes insipidus can make up to 20 quarts of urine a day. People with this disorder need to urinate frequently, called polyuria. They may also feel thirsty all the time and drink lots of liquids, a condition called polydipsia.

Causes And Symptoms

People of all ages can develop diabetes insipidus. You are more likely to develop the condition if

• You have a family history of diabetes insipidus,
• You had brain surgery or a major head injury
• You take medicines that can cause kidney problems, including some bipolar disorder medicines and diuretics.

Diabetes insipidus is usually caused by problems with a hormone called vasopressin that helps your kidneys balance the amount of fluid in your body. Problems with a part of your brain that controls thirst can also cause diabetes insipidus.

Types

Specific causes vary among the four types of diabetes insipidus: central, nephrogenic, dipsogenic, and gestational.

1. Central diabetes insipidus: In central diabetes insipidus, your body doesn’t make enough vasopressin, also called “antidiuretic hormone.” Vasopressin is produced in your hypothalamus, a small area of your brain near the pituitary gland. When the amount of fluids in your body falls too low, the pituitary gland releases vasopressin into your bloodstream. The hormone signals your kidneys to conserve fluids by pulling fluids from your urine and returning fluid to your bloodstream. But if your body can’t make enough vasopressin, the fluid may get flushed out in your urine instead. Causes of central diabetes insipidus include damage to your hypothalamus or your pituitary gland from surgery, infection, inflammation, a tumor, or a head injury an autoimmune disorder an inherited gene mutation
2. Nephrogenic diabetes insipidus: In nephrogenic diabetes insipidus, your body makes enough vasopressin but your kidneys don’t respond to the hormone as they should. As a result, too much fluid gets flushed out in your urine. Causes include some medicines, especially those used to treat bipolar disorder low levels of potassium in your blood high levels of calcium in your blood blocked urinary tract an inherited gene mutation chronic kidney disease, though rarely
3. Dipsogenic diabetes insipidus: In this type of diabetes insipidus, a problem with your hypothalamus causes you to feel thirsty and drink more liquids. As a result, you may need to urinate often. Causes include damage to your hypothalamus from surgery, infection, inflammation, a tumor, or a head injury some medicines or mental health problems
4. Gestational diabetes insipidus: Gestational diabetes insipidus is a rare, temporary condition that can develop during pregnancy. This type of diabetes insipidus occurs when the mother’s placenta makes too much of an enzyme that breaks down her vasopressin. Women who are pregnant with more than one baby are more likely to develop the condition because they have more placental tissue. Because the liver plays a role in curbing the enzyme that breaks down vasopressin, diseases, and conditions that affect liver function also increase risk. Examples include preeclampsia and HELLP syndrome.

Treatment

1. Drink enough liquids to prevent dehydration. But doing so can disrupt your regular lifestyle, including your sleep.
2. Health care professionals most often treat central diabetes insipidus with a man-made hormone called desmopressin which replaces the vasopressin your body is not making. You can take this medicine as a nasal spray, a pill, or a shot.
3.  In some cases, nephrogenic diabetes insipidus may go away after treating its cause. For example, switching medicines or taking steps to balance the amount of calcium or potassium in your body may be enough to resolve the problem. Diuretic medicines called thiazides help reduce the amount of urine your kidneys make. Other treatments can include nonsteroidal anti-inflammatory drugs or other types of diuretics.
4. Researchers haven’t found an effective way to treat dipsogenic diabetes insipidus. Sucking on ice chips or sugar-free candies to moisten your mouth and increase saliva flow may help reduce your thirst. If you wake up many times at night to urinate, your health care professional may suggest you take a small dose of desmopressin at bedtime.

(With inputs from By Dr. Ravivir Singh Bhalla, Director, Internal Medicine, Fortis Escorts Hospital Faridabad)