Diabetes insipidus (DI) is a rare condition that occurs when your kidneys are unable to conserve water. It results in extreme thirst and frequent urination of insipid, or dilute and odorless, urine.
A healthy adult will typically urinate
There are several types of diabetes insipidus, and they can often be treated successfully. Keep reading to learn more about this condition.
Diabetes insipidus vs. mellitus
Diabetes insipidus is not related to diabetes mellitus (often referred to simply as diabetes), and it does not affect your blood sugar levels.
This means you can have diabetes insipidus without having diabetes. In fact, diabetes insipidus can occur in anyone.
The word “insipid” means flavorless, and a primary symptom of diabetes insipidus is urine that’s clear and odorless. On the other hand, the word “mellitus” means sweet. Diabetes mellitus gets its name from the fact that a primary symptom of diabetes is sweet-smelling urine.
The main symptoms of diabetes insipidus are:
- excessive thirst (polydipsia), which can cause an uncontrollable craving for water
- excessive urine volume, which can cause you to wet the bed or to get up during the night to urinate frequently
Possible symptoms in infants and young children include:
- excessive thirst
- unusually wet diapers, bedwetting, or excessive urine output
- fussiness and irritability
- high fever
- dry skin
- delayed growth
Adults can experience some of the above symptoms, plus:
Diabetes insipidus can also cause severe dehydration, which can lead to seizures, brain damage, and even death if left untreated.
Contact a doctor immediately if you or your child are experiencing these symptoms.
Diabetes insipidus can occur when any part of the system that regulates fluid in your body breaks down. It’s closely associated with low levels of antidiuretic hormone (ADH), also known as vasopressin. ADH levels affect how well your kidneys conserve water.
To understand diabetes insipidus, it helps to understand how your body normally uses and regulates fluids.
Fluids make up around 50 to 60 percent of an adult’s overall body mass and around 75 percent of an infant’s, according to StatPearls.
Maintaining the proper amount of fluid in your body is key to your overall health. Consuming water and food throughout the day helps provide fluid to your body. Urinating, breathing, and sweating help eliminate fluid from your body.
Your body uses a system of organs and hormone signals to regulate body fluids. It makes less urine when you need to replace fluid lost to sweating and makes more urine when there’s too much fluid in your body.
- The kidneys play an important role in fluid regulation by removing extra fluid from your bloodstream.
- The bladder stores the fluid waste until you urinate it out.
- The brain produces ADH, which is stored in the pituitary gland after production.
- The hypothalamus is the specific area of the brain where ADH is made. The hypothalamus regulates thirst.
- When your body needs to retain water, the pituitary gland will release ADH into the bloodstream.
- When you need to get rid of water, ADH is either released in smaller amounts or not released at all, and you’ll urinate more often.
There are four types of diabetes insipidus:
- central diabetes insipidus
- nephrogenic diabetes insipidus
- dipsogenic diabetes insipidus
- gestational diabetes insipidus
Central diabetes insipidus
Central diabetes insipidus is the most common type of diabetes insipidus. It’s caused by damage to the pituitary gland or hypothalamus. This damage means ADH cannot be produced, stored, or released normally. Without ADH, large amounts of fluid are released into the urine.
Central diabetes insipidus is often the result of:
- head trauma
- conditions that cause brain swelling
- brain tumors
- surgery affecting the pituitary gland or hypothalamus
- loss of blood supply to the pituitary gland
- rare genetic conditions
Nephrogenic diabetes insipidus
Nephrogenic diabetes insipidus can be genetic or acquired.
Certain genetic mutations can damage the kidneys, leaving them unable to respond to ADH.
Other possible causes of the kidney damage — and nephrogenic diabetes insipidus — include:
- medications, such as lithium or tetracycline (achromycin V)
- blockage of the urinary tract, which includes obstruction of the ureters (which carry urine from the kidney to the bladder)
- electrolyte imbalances, such as too much calcium or not enough potassium
- chronic kidney disease, on rare occasions
Did you know?
The kidneys are made up of small structures called nephrons.
Dipsogenic diabetes insipidus
Dipsogenic diabetes insipidus is caused by dysfunction of the thirst mechanism in the hypothalamus. This dysfunction can cause you to feel excessively thirsty and drink too much liquid.
Dipsogenic diabetes insipidus has also been associated with certain medications and conditions, including mental health conditions.
Gestational diabetes insipidus
Gestational diabetes insipidus only occurs during pregnancy.
It can take place when an enzyme made by the placenta destroys a person’s ADH. The placenta plays an important role in the exchange of nutrients and waste products between the fetus and the parent.
Gestational diabetes insipidus can also occur when increased levels of prostaglandin, a hormone-like chemical, makes the kidneys less sensitive to ADH.
The condition should resolve after pregnancy.
A doctor will talk with you about your symptoms and determine which tests are necessary. They may use several tests for diagnosis.
Urine gravity test
Your doctor will take a sample of your urine to test for salt and other waste concentrations. This is known as a urine specific gravity test. If you have diabetes insipidus, your urine sample will have a high concentration of water and a low concentration of other waste. Your urine specific gravity results wlll be low.
Water deprivation test
You’ll be asked to stop drinking water for a specified period of time before the water deprivation test. You’ll then give blood and urine samples, and your doctor will measure changes in:
- blood sodium levels
- blood osmolality levels, which indicate whether dissolved particles (such as minerals and chemicals) are present
- blood levels of ADH
- urine output
- urine composition
- body weight
In addition to measuring your ADH levels, your doctor may give you synthetic ADH during the test to see if your kidneys respond as expected to ADH.
The water deprivation test is performed under close supervision, and certain people may require hospitalization to ensure it’s performed safely.
During an MRI, a machine takes an image of your brain tissue using magnets and radio waves. Your doctor will then look at these images to see if there’s any brain tissue damage that’s causing your symptoms.
Your doctor will also look closely at images of your hypothalamus or pituitary gland for any damage or abnormalities.
Genetic screening may be performed to look for an inherited form of diabetes insipidus based on your family history.
Treatment will depend on the type of diabetes insipidus you’re diagnosed with and the severity of your condition.
In mild cases, your doctor may simply recommend that you increase your water intake.
Central diabetes insipidus treatment
Desmopressin (DDAVP, Nocturna) is an artificial hormone that’s often used to treat central diabetes insipidus.
It’s a synthetic form of ADH. It’s available as a pill, a nasal spray, or an injection. While taking this medication, it’s important to regulate your water intake and drink only when you’re thirsty.
If your diabetes insipidus is caused by another condition such as a tumor or an issue with the pituitary gland, your doctor will treat that condition first and then determine if the diabetes insipidus still needs to be treated.
Nephrogenic diabetes insipidus treatment
In nephrogenic diabetes insipidus, addressing the underlying cause may cure the problem.
Other treatments include:
- high doses of desmopressin
- diuretics, which can be taken along with either aspirin or ibuprofen (Advil, Motrin)
- other nonsteroidal anti-inflammatory drugs (NSAIDs), such as indomethacin
When taking these medications, it’s important to drink water only when you’re thirsty.
If your diabetes insipidus is the result of medications you’re taking, your doctor will work with you to replace or stop taking these medications. Do not stop taking any medication without talking with your doctor first.
Dipsogenic diabetes insipidus treatment
There’s no specific treatment for dipsogenic diabetes insipidus, but treating symptoms or primary mental health conditions may bring relief.
Gestational diabetes insipidus treatment
Gestational diabetes insipidus does not typically require treatment. Desmopressin may be prescribed for severe gestational diabetes insipidus.
Lifestyle changes are vital to the treatment of diabetes insipidus.
The most important action is avoiding dehydration. You can do this by bringing water with you wherever you go or offering water every few hours to your child if they have diabetes insipidus. Your doctor will help you determine how much fluid you should be drinking each day.
Carry a medical alert card in your wallet or wear a medical bracelet so that others know about your diabetes insipidus in case of an emergency. Dehydration can happen quickly, so those around you should know of your condition.
Your outlook depends on the underlying cause of your diabetes insipidus. When diabetes insipidus is treated properly, the condition does not typically cause any severe or long-term complications.