There are four types of diabetes insipidus. Each type occurs due to a different mechanism and has a variety of potential causes. The type of diabetes insipidus determines its treatment.

Diabetes insipidus (DI) is a condition in which the body makes too much urine. While most people make 1 to 3 quarts of urine each day, people with DI can make up to 20 quarts of urine each day.

People with DI also often feel very thirsty. This leads to an increased intake of fluids throughout the day.

Since 2022, the condition is better known among medical professionals as arginine vasopressin disorder. This name change was primarily made to avoid confusion with diabetes mellitus, commonly shortened to diabetes.

There are four types of DI. Below, we explore each type and what causes it in more detail.

Most of the time, DI happens due to issues with a hormone called vasopressin. You may also see vasopressin called antidiuretic hormone.

Vasopressin is made in a part of the brain called the hypothalamus. It’s stored in the pituitary gland until it’s needed. Its role is to tell your kidneys to conserve fluids when fluid levels in your body fall too low.

There are four types of DI:

  • central
  • nephrogenic
  • dipsogenic
  • gestational

Each DI type has a different cause. We explore these in more detail below.

In central DI, or cranial DI, your hypothalamus doesn’t make enough vasopressin. When there’s not enough vasopressin, your kidneys cannot pull fluid back into the bloodstream. Instead, fluid is flushed out in the urine.

Central DI can develop from damage to your hypothalamus or pituitary gland. This can happen due to:

Some inherited genetic mutations can also cause central DI. One example is the mutations that lead to Wolfram syndrome.

In nephrogenic DI, your hypothalamus makes typical levels of vasopressin. However, your kidneys don’t respond well to it.

This means that even if your pituitary gland releases vasopressin in response to low fluid levels, your kidneys won’t adjust to retain more fluid. Instead, fluid continues to be eliminated through your urine.

The potential causes of nephrogenic DI include:

Dipsogenic DI, also known as primary polydipsia, is a rarer type of DI. It’s also a type that doesn’t occur due to issues related to vasopressin.

Instead, in dipsogenic DI, there’s a problem with your hypothalamus that makes you feel very thirsty. Being extremely thirsty leads to a higher intake of fluids and results in increased urination.

Dipsogenic DI can happen due to damage to your hypothalamus. As with central DI, this can occur from an injury, brain surgery complications, an infection, or inflammation.

Some people with certain mental health conditions, such as schizophrenia, may also develop dipsogenic DI.

Gestational DI is also a less common type of DI. It typically happens during the third trimester of pregnancy.

In gestational DI, the placenta makes too much of an enzyme that breaks down vasopressin. When this enzyme breaks down vasopressin, there’s less available to help your kidneys balance your body’s fluid levels.

Pregnant people with liver disease may be at a higher risk of this type of DI. This is because the liver is responsible for managing levels of the enzyme breaking down the vasopressin.

If you have DI, it’s important to make sure you get enough fluids. Doing so helps prevent dehydration, a potential complication.

A doctor may also recommend that you make some dietary changes that reduce the amount of urine your kidneys make. This typically includes lowering your intake of salt and protein.

The specific treatment for DI that you receive can depend on the type you have.

Central diabetes insipidus treatment

Desmopressin can treat central DI. It’s a synthetic hormone used to replace the missing vasopressin. It’s typically given as a nasal spray or oral pill.

Nephrogenic diabetes insipidus treatment

It’s possible that nephrogenic DI may go away when its underlying cause is treated. This can include:

  • correcting high calcium levels
  • addressing low potassium levels
  • stopping a medication that’s causing nephrogenic DI

Another treatment is thiazide diuretics with nonsteroidal anti-inflammatory drugs (NSAIDs). This combination treatment can lower the filtering rate of your kidneys, meaning less urine is made.

Dipsogenic diabetes insipidus treatment

So far, researchers haven’t found an effective way to treat dipsogenic DI. Treatment typically involves coaching to reduce fluid intake.

It may also be beneficial to take steps to reduce thirst. This can include avoiding medications that cause dry mouth or sucking on ice chips to keep the mouth moist.

Gestational diabetes insipidus treatment

As with central DI, desmopressin is used to help replace missing vasopressin in gestational DI. Desmopressin is resistant to the enzymes that break down naturally produced vasopressin.

Gestational DI typically goes away 4 to 6 weeks after delivery.

Talk with a doctor if you develop symptoms of DI. The two main symptoms are:

While your symptoms may not be due to DI, they may be from another health condition that needs to be addressed. One example is diabetes mellitus, which can also cause increased urination and extreme thirst.

After getting your medical history and doing a physical exam, a doctor can use several tests to help diagnose the type of DI you may have.

Diagnostic tests can include:

  • Urinalysis: A urinalysis can see whether your urine is very diluted. It can also look for increased glucose in your urine, a potential sign of diabetes mellitus.
  • Blood tests: Blood tests can check your vasopressin levels as well as your calcium and potassium levels. Blood tests can also measure blood sugar levels to help rule out diabetes mellitus.
  • Water deprivation test: During a water deprivation test, you don’t drink water for several hours. During this time, a healthcare professional checks the quantity and properties of the urine you pass. People with DI continue to pass lots of diluted urine.
  • Stimulation test: In this test, you’re given an injection of desmopressin. If your body responds by making less urine that’s more concentrated, you may have central DI. If your body still continues to make lots of diluted urine, you could have nephrogenic DI.
  • MRI scan: A doctor can use an MRI scan to check for damage to your hypothalamus or pituitary gland. This can help them diagnose central or dipsogenic DI.

Below, we cover the answers to some additional frequently asked questions about DI.

What is the most common type of diabetes insipidus?

Central DI is the most common type.

What’s the difference between diabetes insipidus and diabetes mellitus?

In diabetes mellitus, your body cannot make or use insulin well, leading to high blood sugar that can cause increased urination and thirst.

People with DI have blood sugar levels in a standard range. However, due to issues with the hormone vasopressin, their kidneys cannot concentrate urine well. This leads to a boost in urine production and thirst levels.

Is diabetes insipidus type 1 or type 2?

There’s no type 1 or type 2 of DI. These terms refer to diabetes mellitus, which is an unrelated health condition that can cause similar symptoms.

DI causes increased urination and extreme thirst. Problems with the hormone vasopressin often cause it. There are four types of DI. Each type has its own specific mechanism and potential causes.

Talk with a doctor if you have symptoms of DI. They can order several tests to confirm a diagnosis of DI and determine what type you have. The type of DI determines the treatment you receive.